bluuebunny/crossref_metadata_2025 huggingface dataset:
1650 HOW DO PATIENTS AGED 65+, PHARMACISTS AND PHYSICIANS ENVISAGE THE IMPLEMENTATION OF PHARMACOGENOMIC-GUIDED CARE IN HOSPITAL?
Authors: David V , Tomlinson J , Cheong V-Lin , Sagoo G S , Smith H , Rattray M , Bryant E , Fylan B
Published: July 2023

Introduction

Pharmacogenomics is using a patient’s genetic information to predict their likely response to a medicine. There is evidence that patients who receive pharmacogenomic-guided care benefit from a reduction in clinically significant adverse drug reactions. Therefore, pharmacogenomic testing can be used as a medicines optimisation tool to prevent adverse drug reactions in older people and reduce associated hospital admissions. This qualitative study aimed to identify the facilitators and barriers to implementing pharmacogenomic-guided prescribing in acute care for older patients by examining the views of patients, pharmacists and physicians.

Method

Following consent, patients (aged 65+), pharmacists and physicians across two hospital sites, participated in a semi-structured interview. The interviews were transcribed and analysed using the Framework approach to identify themes describing barriers or facilitators to implementing pharmacogenomic-guided care. Patient interviews were analysed separately from the healthcare professional interviews and supporting quotes were selected to illustrate each theme.

Results

Nine patients, six pharmacists and five physicians participated in the study. Framework analysis of the patient interview transcripts identified three themes: (1) Information delivery (2) Standard of care (3) Participation in pharmacogenomic-guided care. Framework analysis of the professional interviews produced the themes: (1) Level of interest (2) Workforce pressures (3) Support required for the workforce. Professionals do not have enough knowledge of pharmacogenomic-guided care to confidently apply it to their clinical practice. Patients want to be involved in pharmacogenomic-guided prescribing decisions so pharmacogenomics does not feel imposed on them.

Conclusion(s)

Older patients view pharmacogenomic-guided care as therapeutically beneficial and would like to be involved in pharmacogenomic-guided prescribing decisions, with information about pharmacogenomic-guided care tailored to their information-seeking preferences. Professionals envisage pharmacogenomic-guided care as potentially useful in improving their prescribing and medicines reviews but are concerned that operational pressures could make its implementation impractical.
1591 BARRIERS AND FACILITATORS FOR THE PROVISION OF CONTINENCE CARE FOR CARE HOME RESIDENTS: A QUALITATIVE EVIDENCE SYNTHESIS
Authors: Wheeldon J , de Viggiani N , Cotterill N
Published: July 2023

Introduction

Incontinence affects a significant proportion of older adults who reside in care homes. Incontinence symptoms have been linked to comorbidities, an increased risk of infection and reduced quality of life and mental wellbeing of residents. However, continence care provision can often be poor for residents, further compromising the health and wellbeing of this vulnerable population.

Method

A systematic qualitative evidence synthesis and thematic analysis established the current evidence-base of barriers and facilitators for the provision of continence care in care homes.

Results

The evidence synthesis revealed complex barriers and facilitators at three influencing levels: macro (structural, societal and external influences), meso (organisational and institutional influences) and micro (day-to-day actions of individuals impacting care provision). Macro-level barriers included negative stigmas relating to incontinence, aging and working in the older adult social care sector, restriction of continence care resources such as containment products (i.e. pads), short staffing in care facilities, shortfalls in the professional education and training of care home staff and the complex health and social care needs of older adult residents. Meso-level barriers included task-centred organisational cultures, ageist institutional perspectives regarding old age and incontinence, inadequate care home management and poor communication and teamwork among care staff. Micro-level barriers included both staff and residents’ poor knowledge of continence care and negative attitudes towards incontinence symptoms, management and treatment.

Conclusions

These findings help to outline the complexities of continence care provision in older adult care homes. Macro, meso and micro level influences demonstrate problematic and interrelated barriers across international contexts, indicating that improving continence care in this setting is extremely challenging due to the multiple levels at which care provision, services and individuals are impacted. Older adult social care policy-makers, researchers and service-providers must recognise this complexity in any intervention that aims to improve continence care in care homes.
1645 A SMALL VESSEL DISEASE SYNDROME? SYMPTOMS ASSOCIATED WITH CEREBRAL SVD PROGRESSION AND INCIDENT INFARCTS AFTER MINOR STROKE
Authors: Clancy U , Arteaga C , Garcia D J , Hewins W , Penman R , Valdés-Hernández M C , Wiseman S , Stringer M , Thrippleton M J , Kampaite A , Hamilton O K L , Chappell F M , Rudilosso S , Jochems A C C , Liu D , Zhang J , Brown R , Bastin M E , Muñoz Maniega S , Hamilton I , Job D , Doubal F N , Wardlaw J M
Published: July 2023

Introduction

Small vessel disease (SVD) lesions may cause symptoms apart from stroke. We aimed to determine whether white matter hyperintensity (WMH) progression and incident infarcts associate with gait, mood, and cognitive symptoms.

Method

We recruited patients with non-disabling stroke (modified Rankin Scale <3), performed diagnostic MRI, and questioned participants/informants about gait, mood, cognitive, Center Epidemiologic Studies-Depression Scale (CES-D), Neuropsychiatric Inventory-Questionnaire (NPI-Q) symptoms and Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). The baseline visit occurred < 3months post-stroke. We repeated MRI and symptoms assessments every 3-6 months for 12 months, assessing WMH change and incident infarcts (i.e. new since previous scan) on DWI or FLAIR. We analysed WMH using cubed root normalised for intracranial volume. We used linear mixed-effects models, adjusting for age, gait speed, modified Rankin Scale, and time for gait symptoms; age, anxiety, MoCA, stroke subtype, and time for cognitive/neuropsychiatric symptoms.

Results

We recruited 230 participants (mean age=65.8 [SD=11.2] years; 34% female; 56.5% lacunar); median baseline WMH volumes = 8.26mL (IQR 3.65-19.0); one-year = 8.24mL (IQR = 4.15-20.1). Incident infarcts (n=110, 82/110 (74.5%) small subcortical subtype) occurred in 53/230 (23%) of patients. WMH progression over one year was associated with falls (OR=4.13 [95% CI=1.6-10.1]); self-reported brain fog (OR=3.13 [95% CI=1.11-8.82]); and increasing NPI-Q scores (est=2.12 [95% CI=0.46-3.77] p=0.012). Baseline and one-year WMH volumes were cross-sectionally associated with apathy (baseline OR=8.78 [95% CI=2.56-31.88]; one-year OR=4.83 [95% CI=1.43-17.26]). Higher CES-D depression scores were associated with incident infarcts (mean 15.2 [12.9] with vs 11.9 [SD10.6] without; est=2.26 (95% CI=0.12-4.4), p=0.038). WMH progression and infarcts were not associated with fatigue, anxiety, subjective memory complaints, confusion, dizziness, or IQCODE scores.

Conclusions

SVD progression following minor stroke co-associates with specific gait/cognitive/mood symptoms. WMH progression and incident infarcts may cause non-focal, non-stroke symptoms which characterise a potential ‘SVD syndrome’.
1519 WELLBEING OF UNPAID CARERS OVER FIFTY: AN ANALYSIS OF DATA FROM ENGLISH LONGITUDINAL STUDY OF AGEING
Authors: Brack C , Makin S , Kynn M , Murchie P
Published: July 2023

Introduction

There is relatively little known about physical health of older people who are unpaid carers. The English Longitudinal Study of Ageing (ELSA) Wave 9 (2019) was used to examine the relationship between unpaid caring and health. This study contains information on frailty, caring, comorbidities and Instrumental Activities of Daily Living (IADL) from 8,736 participants 50 years and over.

Methods

We included participants who received a nurse visit in Wave 9 (n=3,047), 21 were excluded due to missing data. Frailty was calculated using the ELSA-Frailty Index (FI). Carers were those in receipt of Carers Allowance or self-reported unpaid caring.

Results

351 carers and 2675 non-carers were included. Carers were younger (64.5 (10.2) vs 66.7 (10.5), p<0.001) and more likely to be married (78.1% vs 62.8%, p<0.001). Carers had a lower median FI score (0.07 (0.04-0.14) vs 0.15 (0.12-0.21), p=0.000) however, 45/536(8%) of moderately and severely frail participants were carers. Of 966 non-frail (FI <0.12) participants: 9/246(2.6%) carers experienced difficulties with IADLs, compared to 5/720(0.69%) non-carers; 79/246(31%) of carers had impaired mobility, compared to 39/720(5%) of non-carer; and 51/246(20%) had 2+ comorbidities, compared to 17/720(2.4%) non-carers. Of 1524 mildly frail (FI>0.12-0.24) participants: 16/60(26.7%) carers experienced difficulties with IADLs, compared to 116/1464(0.69%) non-carers; 58/60(97%) of carers had impaired mobility, compared to 807/1464(55%) non-carers; and 42/60(70%) had 2+ comorbidities, compared to 607/1464(41.4%) non-carers. On frailty-adjusted multivariable analysis there was a strong association between carer status and comorbidities with Odds Ratio (OR)3.01 (95%CI 2.21-4.10); impaired mobility, OR 11.08 (95%CI7.52-16.32); and impaired IADLs, OR 5.44(95%CI3.48-8.48)

Conclusions

Carers are less likely to be frail but more likely to struggle with at least one IADL, experience comorbidity or mobility impairment than equivalently frail peers. This suggests that, in the over 50s, either caring contributes to impairment or the burden of care falls on the more impaired.
1651 VIDEO-RECORDING PATIENTS FOR DIRECT CARE PURPOSES: A SYSTEMATIC REVIEW WITH SPECIFIC FOCUS ON THE OLDER PATIENT
Authors: Ellis S , Lear R , Ollivierre-Harris T , Long S , Mayer E
Published: July 2023

Introduction

Video-recordings of patients may offer advantages over text-based documentation to supplement assessment and decision-making – particularly for older patients with complex needs. Our systematic review aimed to evaluate the application, acceptability, and impact of video-based records; here we highlight current evidence on using video-recordings to support direct care delivery for older patients.

Methods

Five electronic databases (Medline/Embase/PsycInfo/Cochrane/HMIC) were searched from 2012-2022. Studies involving videorecording patients aged ≥ 18 years for diagnosis, care, or treatment were identified. Study quality was assessed using published appraisal tools. Acceptability was evaluated through i) recruitment/retention rates, and ii) synthesis of patients’ and professionals’ perspectives and experiences. Sekhon’s Theoretical Framework of Acceptability (TFA), consisting of seven constructs (affective attitude/burden/ethicality/intervention coherence/opportunity costs/self-efficacy), underpinned the synthesis.

Results

Of 14,221 citations, 27 studies (mainly low-quality) met inclusion criteria. 10/27 studies recruited older patients including those with Parkinson’s Disease (PD), dementia, stroke, end-of-life care, average age was 69. Video-recording was used in diagnosis, management/monitoring, and rehabilitation of older patients. Mean recruitment rate was 58.8% (34.2%-73.7%): mean retention rate was 81.3% (73.4%-100%). Reasons for non-participation/withdrawal related to the video-recording intervention itself (privacy concerns/poor video quality) and other factors (patients lost to follow-up). Framework synthesis generated 17 sub-themes linked to the seven TFA constructs. Attitudes to video-based records were largely positive. Video-recordings were perceived to be helpful in facilitating diagnosis/treatment/care for patients with movement disorders (PD; high-risk fallers), including in dementia populations. Digital literacy, illness severity and cognitive impairment influenced patients’ capacity to consent to video-recording. Healthcare professionals were concerned about technical challenges but burden was minimised through using portable devices (e.g. iPad) for video capture.

Conclusion

Video-based records may be acceptable to older patients and professionals, providing valid consent is obtained and the potential benefits are recognised. Further research is needed to evaluate the acceptability, feasibility, and effectiveness.
1530 MEDIATION EFFECT OF CHILDHOOD HEALTH STATUS, LIFE ADVERSITIES, FINANCIAL CONDITION, AND NETWORK SATISFACTION ON SUICIDAL IDEATION
Authors: Ho-Ling Liu R , Chi-Pun Liu B
Published: July 2023

Introduction

The study is to explore how childhood health status (X), early life adversities (M1), financial condition (M2), and satisfaction with social networks (M3) are associated with the development of suicidal ideation (Y) over time among older adults in 13 European countries. Respondents were drawn from the Survey of Health, Ageing, Retirement, in Europe (SHARE) conducted in 2013 (Wave 5), 2015 (Wave 6), 2016 (Wave 7), and 2020 (Wave 8). 56.8% (n=10043) of respondents were female, and 43.2% (n=7642) were male. The mean age at Wave 8 was 72.35 (range 60-103).

Method

The conditional process analysis using the PROCESS macro (model 6), which can perform the same functions as structural equation modelling, was applied (Hayes, Montoya & Rockwood, 2017).

Results

A poor childhood health status (X) (coeff=.1222, p<.001) was found to have a direct impact on suicidal ideation (Wave 8), but its effect was decreased after considering the mediation effect of the three mediators (coeff of M1=.1511, p<.001, coeff of M2=.1931, p<.001, and coeff of M3=-.1640, p<.001) (Coeff of X to Y via M1, M2 and M3=.0428, p=.1913, Full competitive mediation).

Conclusion

Findings show that poor childhood health status contributed significantly to developing suicidal ideation over time. The cumulative risk of early life adversities and a worse financial situation than expected earlier in life positively mediated the impact of adverse childhood health status on developing suicidal ideation. However, a satisfied social network can eliminate the cumulated risk of adverse childhood health status, early life adversities, and a worse financial situation in the development of suicidal ideation. A higher level of satisfaction with social networks, especially since the outbreak of the COVID-19 pandemic, is a protective risk for suicidal ideation among older adults.
1565 PREVALENCE OF FRAILTY IN A TIA CLINIC AND ASSOCIATIONS WITH MORTALITY
Authors: Elliott A , Beishon L , Minhas J , Mistri A , Eveson D , Jones W , Quinn T , Robinson T
Published: July 2023

Background and aims

Frailty is a clinical syndrome of increased vulnerability to stressors, associated with adverse outcomes after stroke, but its impact on outcomes after transient ischaemic attack (TIA) remain unclear.

Methods

Retrospective analysis of 1185 patients referred by the emergency department (ED) who attended TIA clinic with a Clinical Frailty Scale (CFS) within two weeks. Records were combined from two routinely collected databases, and prevalence of frailty was determined. Frailty was classified as CFS score >/=4. Data were collected on date of death, and hazard ratios (HR) were determined through cox proportional hazard regression, adjusted for prognostic factors.

Results

7945 patients were referred through the ED between 01/01/2016 and 12/03/2022. 1185 patients were included. 53.5% (n=634) had frailty. Patients with frailty tended to be older (median age 81 vs 74, p<0.001) and female (53.9% vs 39.9% p<0.001). TIA was diagnosed in 28.3% (n=335), 61.2% (n=205) of whom were frail. Stroke was diagnosed in 23.1% (n=274). 46.7% of these had frailty (n=128). In TIA patients and the whole cohort (WC), frailty (TIA: HR 2.69 [95%CI 1.23-5.87, p=0.013], WC: 2.58 [95%CI 1.64-4.08, p<0.001]; and increasing age [HR 1.07 95% CI 1.04-1.12], were predictive of mortality. In stroke patients, only increasing age was predictive of death, (HR 1.11 [95%CI 1.04-1.19, p=0.003]).

Conclusions

Frailty is common in TIA and is predictive of mortality. Studies are required to investigate the effects of frailty on other outcomes after TIA, including: quality of life; progression to stroke; and how frailty impacts rehabilitation.
1664 ASSESSING FRAILTY AND ANTICHOLINERGIC BURDEN IN STROKE PATIENTS: A PROSPECTIVE, OBSERVATIONAL STUDY
Authors: Prescott D F , Drenan M , Quinn T
Published: July 2023

Introduction

Frailty assessment in stroke is not commonly integrated into clinical practice, despite current clinical recommendations. Pre-stroke frailty is associated with longer-term mortality, length of admission, and disability. Similarly, anticholinergic burden (ACB) is not routinely reviewed, even though it is associated with cognitive and physical impairment, increased hospital admissions, and higher mortality in older people. Healthcare Improvement Scotland-Frailty (HIS-Frailty) is a novel tool for the evaluation of frailty in older people. Our aim was to compare and correlate the identification and severity of frailty with HIS-Frailty to the Rockwood Clinical Frailty Scale (CFS) in stroke. We also used the ACB Score to determine if there was a difference in ACB between hospital admission and discharge in these patients.

Methods

We conducted a prospective, observational, single-centre study in a stroke unit. Patients with a cerebrovascular diagnosis were included. We compared frailty assessment through linear correlation and ACB through mean difference in scores.

Results

were considered statistically significant if p-value < 0.05 and highly statistically significant if p-value < 0.005. SPSS® 26.0 was used to perform data analysis. We included 145 patients. 110 (76%) were older than 60 years and 75 (52%) were male. Most admissions were due to ischemic stroke (67%), closely followed by TIA (14%). Forty-eight (32%) were classified as frail. There was a strong positive correlation between HIS-Frailty and the CFS (r = 0.95; p <0.00001; R2 = 0.91). Seventy-nine (55%) patients had significant ACB. There was no significant difference between ACB at admission and discharge (MD = 0.010, CI 95% -0.52 to 0.54; p = 0.97).

Conclusion

HIS-Frailty may prove to be a consistent and easy tool for the systematic identification of frailty in stroke patients, in accordance with best clinical practice guidelines. We should identify and standardise measures to reduce ACB after admission for stroke.
Discovery of new functions of food proteins and their structural development for multifunctional applications
Authors: Ochiai Akihito
Published: July 2023

Proteins and peptides derived from various food sources are used in a variety of applications, including functional foods, pharmaceuticals, and cosmetics. The three-dimensional structure of proteins provides useful insights into their functions and essential information for the creation of proteins with new functions. In this review, a series of functional conversion technologies based on protein structural information derived from foods traditionally consumed in Japan, such as natto (fermented soybeans) and rice, are introduced. For natto, we first identified 2 types of Bacillus subtilis-derived endolytic and exolytic enzymes with different modes of action on soybean cell wall polysaccharides and then focused on the technology used to create an endolytic enzyme from an exolytic enzyme. By applying this technology, a method for creating novel bioactive peptides from rice seed proteins was established. The modified peptides created could provide diverse options for the production of substances such as pharmaceuticals and cosmetic materials.
HNSPPI: a hybrid computational model combing network and sequence information for predicting protein–protein interaction
Authors: Xie Shijie , Xie Xiaojun , Zhao Xin , Liu Fei , Wang Yiming , Ping Jihui , Ji Zhiwei
Published: July 2023

Most life activities in organisms are regulated through protein complexes, which are mainly controlled via Protein–Protein Interactions (PPIs). Discovering new interactions between proteins and revealing their biological functions are of great significance for understanding the molecular mechanisms of biological processes and identifying the potential targets in drug discovery. Current experimental methods only capture stable protein interactions, which lead to limited coverage. In addition, expensive cost and time consuming are also the obvious shortcomings. In recent years, various computational methods have been successfully developed for predicting PPIs based only on protein homology, primary sequences of protein or gene ontology information. Computational efficiency and data complexity are still the main bottlenecks for the algorithm generalization. In this study, we proposed a novel computational framework, HNSPPI, to predict PPIs. As a hybrid supervised learning model, HNSPPI comprehensively characterizes the intrinsic relationship between two proteins by integrating amino acid sequence information and connection properties of PPI network. The experimental results show that HNSPPI works very well on six benchmark datasets. Moreover, the comparison analysis proved that our model significantly outperforms other five existing algorithms. Finally, we used the HNSPPI model to explore the SARS-CoV-2-Human interaction system and found several potential regulations. In summary, HNSPPI is a promising model for predicting new protein interactions from known PPI data.
Hand, foot and mouth disease: is it time for an update?
Authors: Griffin Laoise , Rafferty Siobhan , Ahmad Kashif
Published: July 2023

Hand, foot and mouth disease (HFMD) is a viral illness caused most commonly in the past by coxsackievirus A16 and enterovirus 71. The disease mainly affects paediatric populations younger than 5 years of age and is characterized by lesions of the oral mucosa, palms and soles, lasting for 7–10 days. In recent years, coxsackievirus 6 has become a major cause of HFMD outbreaks in Ireland and worldwide. This strain causes more severe disease with unique findings compared with typical viral strains. We review the increasing presentation of patients with atypical cases in our institution and the implications.
Gambling Disorder, Financial Loss and Suicide—A Journey to the ‘Outer Reaches’ of the Common Law
Authors: O’Sullivan Janet
Published: July 2023

Almost as soon as Briggs J opined in Calvert v William Hill Credit Ltd (2008) that ‘recognition of a common law duty to protect a problem gambler from self-inflicted gambling losses involves a journey to the outermost reaches of the tort of negligence, to the realm of the truly exceptional’, the legal and technological context of his dictum utterly transformed. The liberalising regime of the Gambling Act 2005 was not in force when the facts of Calvert occurred, and the legislation was itself out of date by the time it was implemented, with the arrival of highly addictive online gambling platforms, smartphones, sophisticated targeted marketing and ubiquitous advertising. Today, gambling disorder is a growing, devastating psychiatric disorder and a major public health problem, with far too many sufferers taking their own lives as a result, while gambling operators commit egregious breaches of licensing conditions and codes of practice intended to protect vulnerable customers. This article considers how the common law should respond, concluding that gambling disorder should no longer languish at the ‘outermost reaches’ of the tort of negligence.
The role of artificial intelligence in the endoscopic diagnosis of esophageal cancer: a systematic review and meta-analysis
Authors: Guidozzi Nadia , Menon Nainika , Chidambaram Swathikan , Markar Sheraz Rehan
Published: July 2023

Early detection of esophageal cancer is limited by accurate endoscopic diagnosis of subtle macroscopic lesions. Endoscopic interpretation is subject to expertise, diagnostic skill, and thus human error. Artificial intelligence (AI) in endoscopy is increasingly bridging this gap. This systematic review and meta-analysis consolidate the evidence on the use of AI in the endoscopic diagnosis of esophageal cancer. The systematic review was carried out using Pubmed, MEDLINE and Ovid EMBASE databases and articles on the role of AI in the endoscopic diagnosis of esophageal cancer management were included. A meta-analysis was also performed. Fourteen studies (1590 patients) assessed the use of AI in endoscopic diagnosis of esophageal squamous cell carcinoma—the pooled sensitivity and specificity were 91.2% (84.3–95.2%) and 80% (64.3–89.9%). Nine studies (478 patients) assessed AI capabilities of diagnosing esophageal adenocarcinoma with the pooled sensitivity and specificity of 93.1% (86.8–96.4) and 86.9% (81.7–90.7). The remaining studies formed the qualitative summary. AI technology, as an adjunct to endoscopy, can assist in accurate, early detection of esophageal malignancy. It has shown superior results to endoscopists alone in identifying early cancer and assessing depth of tumor invasion, with the added benefit of not requiring a specialized skill set. Despite promising results, the application in real-time endoscopy is limited, and further multicenter trials are required to accurately assess its use in routine practice.
Extracorporeal cardiopulmonary resuscitation for refractory OHCA: lessons from three randomized controlled trials—the trialists’ view
Authors: Ubben Johannes F H , Heuts Samuel , Delnoij Thijs S R , Suverein Martje M , van de Koolwijk Anina F , van der Horst Iwan C C , Maessen Jos G , Bartos Jason , Kavalkova Petra , Rob Daniel , Yannopoulos Demetris , Bělohlávek Jan , Lorusso Roberto , van de Poll Marcel C G
Published: July 2023

Extracorporeal cardiopulmonary resuscitation is a promising treatment for refractory out-of-hospital cardiac arrest. Three recent randomized trials (ARREST trial, Prague OHCA study, and INCEPTION trial) that addressed the clinical benefit of extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest yielded seemingly diverging results. The evidence for extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest, derived from three recent randomized controlled trials, is not contradictory but rather complementary. Excellent results can be achieved with a very high level of dedication, provided that strict selection criteria are applied. However, pragmatic implementation of extracorporeal cardiopulmonary resuscitation does not necessarily lead to improved outcome of refractory out-of-hospital cardiac arrest. Centres that are performing extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest or aspire to do so should critically evaluate whether they are able to meet the pre-requisites that are needed to conduct an effective extracorporeal cardiopulmonary resuscitation programme.
A rare case of cardiac myxoma with light bulb–like cystic morphology: a case report
Authors: Futami Shutaro , Hieda Michinari , Fukata Mitsuhiro , Shiose Akira
Published: July 2023

Background

Cystic myxomas are quite rare. Moreover, few reports have evaluated the causes that constituted them.

Case summary

A 73-year-old Asian man presented for pre-operative examination of osteoarthritis, and transthoracic echocardiography (TTE) revealed an incidental intracardiac mass. Therefore, he was referred to our department for further evaluation. He had no specific symptoms or family history related to tumours and heart failure. The TTE showed a 32 × 24 mm spherical mass adherent to the left atrial septum. The upper part of the mass was cystic in formation and hypoechoic inside and resembled a light bulb. Transoesophageal echocardiography showed the feeding arteries flowing from the bottom into the cystic part. In addition, two jet strips drained from the cystic part in the direction of the mitral valve. Coronary angiography revealed the feeding arteries, which consisted mainly of the right coronary artery conus branch and the left circumflex branch, and the blood flowed into the saccular area from the feeding arteries and excreted towards the mitral valve. Surgical resection was performed due to the mobility, and the histopathology confirmed a cystic myxoma.

Discussion

We described the unique anatomical formation of a cystic myxoma, which consisted of an exquisite balance between the tumour-feeding arteries and the draining outlet vessels.
Entirely zero-contrast diagnosis and revascularization for bilateral stenotic iliac disease with advanced chronic kidney disease: a case report
Authors: Wakabayashi Kohei , Suzuki Toshiaki , Sato Chisato , Nishikura Tenjin
Published: July 2023

Background

Peripheral artery disease (PAD) is usually diagnosed with non-invasive arterial testing methods such as Doppler ultrasound or computed tomography angiography and treated with revascularization using contrast media, which increases the risk of contrast nephropathy and the need for subsequent renal replacement therapy, especially in patients with advanced chronic kidney disease (CKD). Therefore, it is important to identify a worthy alternative strategy for use in high-risk patients.

Case summary

We present the case of a 79-year-old man with bilateral claudication and advanced CKD. The patient had a high risk of sustained reduction in renal function and requirement of renal replacement therapy in the event that contrast media was used. Therefore, we planned a zero-contrast strategy for diagnosis and treatment. The case was diagnosed as bilateral stenotic iliac disease with non-contrast magnetic resonance angiography. Zero-contrast intervention was conducted successfully under magnetic resonance angiography and intra-vascular ultrasound guidance, resulting in an excellent clinical outcome and avoidance of worsening renal function.

Discussion

This zero-contrast strategy appears to be a viable alternative to angiography using contrast for diagnosis and treatment in patients with PAD and advanced CKD where contrast use is relatively contraindicated.
Characterizing atrial fibrillation symptom improvement following de novo catheter ablation
Authors: Reading Turchioe Meghan , Volodarskiy Alexander , Guo Winston , Taylor Brittany , Hobensack Mollie , Pathak Jyotishman , Slotwiner David
Published: July 2023

Aims

Atrial fibrillation (AF) symptom relief is a primary indication for catheter ablation, but AF symptom resolution is not well characterized. The study objective was to describe AF symptom documentation in electronic health records (EHRs) pre- and post-ablation and identify correlates of post-ablation symptoms.

Methods and results

We conducted a retrospective cohort study using EHRs of patients with AF (n = 1293), undergoing ablation in a large, urban health system from 2010 to 2020. We extracted symptom data from clinical notes using a natural language processing algorithm (F score: 0.81). We used Cochran’s Q tests with post-hoc McNemar’s tests to determine differences in symptom prevalence pre- and post-ablation. We used logistic regression models to estimate the adjusted odds of symptom resolution by personal or clinical characteristics at 6 and 12 months post-ablation. In fully adjusted models, at 12 months post-ablation patients, patients with heart failure had significantly lower odds of dyspnoea resolution [odds ratio (OR) 0.38, 95% confidence interval (CI) 0.25–0.57], oedema resolution (OR 0.37, 95% CI 0.25–0.56), and fatigue resolution (OR 0.54, 95% CI 0.34–0.85), but higher odds of palpitations resolution (OR 1.90, 95% CI 1.25–2.89) compared with those without heart failure. Age 65 and older, female sex, Black or African American race, smoking history, and antiarrhythmic use were also associated with lower odds of resolution of specific symptoms at 6 and 12 months.

Conclusion

The post-ablation symptom patterns are heterogeneous. Findings warrant confirmation with larger, more representative data sets, which may be informative for patients whose primary goal for undergoing an ablation is symptom relief.
Dissipation of pesticides by stream biofilms is influenced by hydrological histories
Authors: Bertrans-Tubau Lluís , Menard Yoann , Batisson Isabelle , Creusot Nicolas , Mazzella Nicolas , Millan-Navarro Debora , Moreira Aurélie , Morin Soizic , Ponsá Sergio , Abril Meritxell , Proia Lorenzo , Romaní Anna M , Artigas Joan
Published: July 2023

To evaluate the effects of hydrological variability on pesticide dissipation capacity by stream biofilms, we conducted a microcosm study. We exposed biofilms to short and frequent droughts (daily frequency), long and less frequent droughts (weekly frequency) and permanently immersed controls, prior to test their capacities to dissipate a cocktail of pesticides composed of tebuconazole, terbuthylazine, imidacloprid, glyphosate and its metabolite aminomethylphosphonic acid. A range of structural and functional descriptors of biofilms (algal and bacterial biomass, extracellular polymeric matrix (EPS) concentration, microbial respiration, phosphorus uptake and community-level physiological profiles) were measured to assess drought effects. In addition, various parameters were measured to characterise the dynamics of pesticide dissipation by biofilms in the different hydrological treatments (% dissipation, peak asymmetry, bioconcentration factor, among others). Results showed higher pesticide dissipation rates in biofilms exposed to short and frequent droughts, despite of their lower biomass and EPS concentration, compared to biofilms in immersed controls or exposed to long and less frequent droughts. High accumulation of hydrophobic pesticides (tebuconazole and terbuthylazine) was measured in biofilms despite the short exposure time (few minutes) in our open-flow microcosm approach. This research demonstrated the stream biofilms capacity to adsorb hydrophobic pesticides even in stressed drought environments.
Life-Space Mobility: Normative Values From a National Cohort of U.S. Older Adults
Authors: Lo Alexander X , Wadley Virginia G , Brown Cynthia J , Long D Leann , Crowe Michael , Howard Virginia J , Kennedy Richard E
Published: July 2023

Background

Life-space mobility, which measures the distance, frequency, and independence achieved as individuals move through their community, is one of the most important contributors to healthy aging. The University of Alabama at Birmingham Life-Space Assessment (LSA) is the most commonly used measure of life-space mobility in older adults, yet U.S. national norms for LSA have not previously been reported. This study reports such norms based on age and sex among community-dwelling older adults.

Methods

A cross-sectional analysis using data from the national REasons for Geographic and Racial Disparities in Stroke cohort study. LSA data were available for 10 118 Black and White participants over age 50, which were grouped by age (in 5-year increments) and sex, weighted for the U.S. national population. Correlations were calculated between LSA and measures of functional and cognitive impairment and physical performance.

Results

The weighted mean LSA ranged from 102.9 for 50–54-year-old males to 69.5 for males aged 85 and older, and from 102.1 for 50–54-year-old females to 60.1 for females aged 85 and older. LSA was strongly correlated with measures of timed walking, activities of daily living, cognition, depressive symptoms, and quality of life (all p < .001).

Conclusions

We report U.S. national norms for LSA among community-dwelling Black and White older adults. These norms can serve as a reference tool for determining if clinical and research samples have greater or lesser life-space mobility than typical older adults in the United States for their age and sex.
Effects of Fe and Al distributions on the Pv–PPv phase transition pressure of MgSiO3
Authors: Xia Wenming , Niu Caoping , Zhao Jing , Wang Xianlong
Published: July 2023

Based on the first-principles method combined with Special Quasi-random Structures package, we investigated the effects of impurities distributions on the perovskite (Pv)–post-perovskite (PPv) phase transition pressures of Fe- and Al-bearing MgSiO3. 61 different distribution configurations were calculated. The results show that the distribution has marginal effect on the Pv–PPv phase transition pressure of Fe2+-bearing MgSiO3. However, the separate of Al3+Al3+ ions can significantly increase the Pv–PPv phase transition pressure to that higher than the core–mantle boundary (CMB) pressure. In the most disordered structures of Al3+Al3+-bearing case constructed by SQS, the Pv–PPv phase transition pressure is higher than 400 GPa. Based on our previous result, we proposed that only Fe2+-bearing MgSiO3 can induce the discontinuous increase in shear wave velocity at the CMB, while Al3+Al3+-, Fe3+Al3+- and Fe3+Fe3+-bearing MgSiO3 cannot.
Rates of nursing home closures were relatively stable over the past decade, but warrant continuous monitoring
Authors: Hughes Kelly , Feng Zhanlian , Li Qinghua , Segelman Micah , Oliveira Iara , Dey Judith Goldberg
Published: July 2023

For years, nursing home closures have been a concern for the industry, policymakers, consumer advocates, and other stakeholders. We analyzed data from 2011 through 2021 and did not find persistent increases in the closure rates. Closures were relatively stable from 2011 to 2017, averaging 118 facilities (0.79%) per year and increasing to 143 (0.96%) in 2018 and 200 (1.34%) in 2019. Closures decreased during the COVID-19 pandemic, averaging 133 facilities in 2020 and 2021 (0.90%). Medicaid-only nursing facilities had higher closure rates than Medicare-only skilled-nursing facilities and dually certified nursing homes. The Census regions (divisions) of the South (West South Central) and Northeast (New England) had the highest closure rates, while the South (South Atlantic and East South Central) had the lowest rates. Facility characteristics associated with increased closure risk included smaller size, lower occupancy rate, urban location, no ownership changes, lower inspection survey ratings, higher staffing ratings, higher percentages of non-White residents and Medicaid residents, lower percentages of Medicare residents and residents with severe acuity, and location in states with more nursing home alternatives. Additional research should examine the impact of closures on resident outcomes and access to care.
Development of a composite healthy ageing score: evidence from middle-to-older aged Australians
Authors: John Eme Eseme , Astell-Burt Thomas , Yu Ping , Brennan-Horley Chris , Feng Xiaoqi
Published: July 2023

We developed and validated a composite healthy ageing score (HAS) to address the absence of a definitive composite score comprising multiple health domains that measure healthy ageing in epidemiology. The HAS is developed from 13 health domains reported to influence healthy ageing. Data to measure these domains was extracted from the 45 and Up Study baseline. We applied best practices for scale validation and development. Physical functioning, cognitive function, mental health, sleep, quality of life, balance, social connections and overall health were retained. Functional capacity and resilience were uncovered as underlying latent structures. The HAS ranges from 0 to 16 with higher scores indicating a better health profile. This research contributes a comprehensive measuring tool, HAS, It enables examination and comparison of individual or collective health profiles and the investigation of the factors that influence their chances of living healthy for longer.
Neonatal emollient therapy and massage practices in Africa: a scoping review
Authors: Blanks Keona J H , Musaba Milton W , Ren Lily , Burgoine Kathy , Mukunya David , Clarke Andrew , Williams Sarah , Gebremichael Tewodros , Waiswa Peter , Darmstadt Gary L
Published: July 2023

There have been few reports from Africa on the use and health effects of emollient therapy for newborn infants. We aimed to describe neonatal skin care practices in Africa, and to illuminate opportunities to introduce evidence-based interventions to improve these practices. We conducted a scoping review of the quantitative and qualitative published peer-reviewed and grey literature in English on emollient use in Africa. Outcomes of interest included neonatal skin care practices, with a focus on the application of oils and other products to infant skin, including in association with bathing and massage. We screened 5257 articles and summarised findings from 23 studies—13 qualitative, nine quantitative and one mixed methods—that met our study criteria. Seven studies reported the use of emollients for perceived benefits, including thermal care, treatment for illness, promotion of growth and development, infection reduction, skin condition improvement, spirituality and lubrication to aid massage. Four studies reported the quantitative health impact of skin care product applications, including improvements in skin condition, neurodevelopment and bone growth, as well as a reduction in nosocomial infections. This review highlights opportunities for skin care intervention and future research on neonatal skin care practices in Africa.
Impact of antimicrobial use on abundance of antimicrobial resistance genes in chicken flocks in Vietnam
Authors: Nhung Nguyen Thi , Dutta Avijit , Higginson Ellen , Kermack Leanne , Yen Nguyen Thi Phuong , Phu Doan Hoang , Kiet Bach Tuan , Choisy Marc , Geskus Ronald B , Baker Stephen , Carrique-Mas Juan
Published: July 2023

Objectives

We investigated longitudinally Vietnamese small-scale chicken flocks in order to characterize changes in antimicrobial resistance gene (ARG) content over their life cycle, and the impact of antimicrobial use (AMU) on an intervention consisting of veterinary advice provision.

Methods

AMU data and faecal samples were collected from 83 flocks (25 farms) at day-old, mid- and late-production (∼4 month cycle). Using high-throughput real-time PCR, samples were investigated for 94 ARGs. ARG copies were related to 16S rRNA and ng of DNA (ngDNA). Impact of AMU and ARGs in day-olds was investigated by mixed-effects models.

Results

Flocks received a mean (standard error, SE) animal daily dose (ADD) of 736.7 (83.0) and 52.1 (9.9) kg in early and late production, respectively. Overall, ARGs/16S rRNA increased from day-old (mean 1.47; SE 0.10) to mid-production (1.61; SE 0.16), further decreasing in end-production (1.60; SE 0.1) (all P > 0.05). In mid-production, ARGs/16S rRNA increased for aminoglycosides, phenicols, sulphonamides and tetracyclines, decreasing for polymyxins β-lactams and genes that confer resistance to mutiple classes (multi-drug resistance) (MDR). At end-production, aminoglycoside resistance decreased and polymyxin and quinolone resistance increased (all P < 0.05). Results in relation to ngDNA gave contradictory results. Neither AMU nor ARGs in day-olds had an impact on subsequent ARG abundance. The intervention resulted in 74.2% AMU reduction; its impact on ARGs depended on whether ARGs/ngDNA (+14.8%) or ARGs/16S rRNA metrics (−10.7%) (P > 0.05) were computed.

Conclusions

The flocks’ environment (contaminated water, feed and residual contamination) is likely to play a more important role in transmission of ARGs to flocks than previously thought. Results highlight intriguing differences in the quantification of ARGs depending on the metric chosen.
On the incentives to exacerbate polarization
Authors: Montagnes Pablo , Van Weelden Richard
Published: July 2023

An organizer seeks to extract rents from competing interests in a polarized environment. We model these interests as three potential bidders, a neutral bidder, and two bidders who are “polarized” in that they prefer the neutral bidder to win rather than the other polarized bidder. The organizer cannot commit to an optimal mechanism, but can decide which bidders to allow to participate. While greater competition is generally thought to benefit the organizer, we identify conditions under which she increases expected revenue by preventing the neutral bidder from participating, thereby increasing the willingness to pay for polarized bidders. Thus, rather than seeking to bring about compromise, organizers have an incentive to exacerbate conflict. Excluding the neutral bidder always makes the auction less efficient, but the incentive to exclude her is greatest precisely when it lowers efficiency the most. We discuss applications in economics and politics (JEL D44, D62, D72).
ST773 Pseudomonas aeruginosa wound infection as a result of medical tourism to Turkey
Authors: Berger Ori , Lurie-Weinberger Mor N , Tsyba Evgenia , Talisman Ran
Published: July 2023

Medical tourism for cheaper aesthetic surgeries in countries like Turkey may result in infections like carbapenem-resistant Pseudomonas aeruginosa. Bioinformatics analysis of a reported case in Israel revealed a highly virulent and antibiotic-resistant strain, emphasizing the need for infection control and appropriate antibiotic use in medical tourism.
Bioeconomy and New Materials: Challenges and Opportunities for Sustainable Agriculture
Authors: Rangel Vázquez Lexlie I
Published: July 2023

Agriculture is essential for the subsistence and food security of the planet, it is part of the essential industries in most countries, triggering entrepreneurship, employment and social development, which is why the world's governments see agriculture and agroindustry as the path that allows increase the productivity and efficiency of crops production, however in a context of limited natural resources and growing environmental challenges, this goal is complicated. Sustainable agriculture refers to meets the requirements of adequately supplying food and preserving the potential of natural resources without compromising the present and future potential of the soil resource.
Synthetic Multi-walled Carbon Nanotubes Affect Arabidopsis thaliana Growth through Blocking the TOR Signaling Pathway
Authors: Cisneros Gladys Juárez , Ochoa-Barragán Rogelio , Kumar-Tiwari Dhirendra , Sánchez-Yáñez Juan Manuel , Villegas-Moreno Javier
Published: July 2023

The phytotoxicity of synthetic multi-walled carbon nanotubes (MWCNTs) on plant growth has been documented. However, the physiological mechanisms associated with it are not clear. The activity of TOR signaling pathway and phytoregulators balance play key roles in plant growth regulation and their stress response.
Effect of Multi-walled Carbon Nanotubes and Manganese and Zinc Doped Ferrites on the Development of Capsicum annuum
Authors: Cisneros Gladys Juárez , Sánchez-Yáñez Juan Manuel , Villegas-Moreno Javier , Kumar-Tiwari Dhirendra
Published: July 2023

Nanotechnology applied to agriculture (nanoagriculture) represents a watershed in the study and development of novel alternatives that could strongly influence agricultural practices. In this research, we documented the comparative study with multi-walled carbon nanotube (MWCNT) and ferrites doped with zinc-manganese in C. annuum development, due to the nanoparticles study in plant crops has been showing beneficial effects.