bluuebunny/crossref_metadata_2025_split huggingface dataset:
501 DISCHARGE AFTER HIP FRACTURE SURGERY IN RELATION TO MOBILISATION TIMING BY PATIENT CHARACTERISTICS: A NATIONAL DATABASE STUDY
Authors: Sheehan K J , Goubar A , Martin F C , Potter C , Jones G D , Sackley C , Ayis S 
Published: June 2021

Abstract

Introduction
Early mobilisation leads to a two-fold increase in the odds of discharge by 30-days compared to late mobilisation. Whether this association varies by identified reasons for delayed mobilisation is unknown.

Methods
Audit data linked to hospitalisation records for patients 60 years or older surgically treated for hip fracture in England/Wales 2014–2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed for early compared with late mobilisation across subgroups defined by dementia, delirium, hypotension, prefracture ambulation and residence, accounting for competing risk of death.

Results
Overall, 34,253 patients presented with dementia, 9,818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 10%, 8%, 8%, 12%, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or from residential care mobilised early compared to those without dementia, delirium, hypotension, with outdoor ambulation prefracture, or from home. Adjusted odds ratios of discharge by 30-days for early compared with late mobilisation were 1.71 (95% CI 1.62–1.81) for those with dementia, 2.06 (95% CI 1.98–2.15) without dementia, 1.56 (95% CI 1.41–1.73) with delirium, 2.00 (95% CI 1.93–2.07) without delirium, 1.83 (95% CI, 1.66–2.02) with hypotension, 1.95 (95% CI, 1.89–2.02) without hypotension, 2.00 (95% CI 1.92–2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.70–1.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19–2.41) from home, and 1.64 (95% CI 1.51–1.77) from residential care.

Conclusion
Irrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of discharge by 30-days. Fewer patients with these conditions, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation.
509 POTENTIALLY INAPPROPRIATE MEDICATION USE AND MORTALITY IN PATIENTS WITH COGNITIVE IMPAIRMENT
Authors: Buckley E , Jonsson A , Flood Z , Lavelle M , O’Sullivan N , Nurdin N , Dowling P , Duggan E , McCreevey C , Duggan J , Kyne L , McCabe J J 
Published: June 2021

Abstract

Introduction
Potentially inappropriate medications (PIMsare associated with falls, hospitalisation, and cognitive decline. Few studies have investigated the association between PIMsrelated to cognitive impairment (PIMCog) and mortality in dementia or mild cognitive impairment (MCI).

Methods
This was a retrospective observational study. Patients diagnosed with MCI or dementia (DSM-IV criteria) presenting to a tertiary-referral memory clinic from 2013–2019 were eligible. The primary outcome was all-cause death. Secondary outcomes were vascular death and non-vascular death defined according to formal certification. The primary exposure variable of interest was PIMCog, defined as any medication in the Beers 2015 or STOPP criteria, classified as potentially inappropriate for patients with cognitive impairment. Anticholinergic burden was measured using the anticholinergic cognitive burden (ACB) scale. Polypharmacy was defined as ≥5 medications. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results
There were 418 patients included (n = 261 dementia, n = 157 MCI). The median age was 79 (interquartile range {IQR} 74–82) and median follow-up was 809 days (IQR 552–1,571). One or more PIMCog was prescribed in 141 patients (33.4%). PIMCog use was associated with all-cause mortality after adjustment for age, sex, dementia severity, Charlson Co-morbidity Index, chronic obstructive pulmonary disease, congestive cardiac failure, and peripheral vascular disease. (HR 1.96, 95% CI 1.24–3.09). PIMCog use was associated with vascular death (HR 3.28, 95% CI 1.51–7.11) but not with non-vascular death (HR 1.40 95% CI: 0.78–2.52). Neither an ACB ≥3 (HR 0.87, 95% CI: 0.46–1.64) or polypharmacy (HR 1.87, 95% CI: 0.67–5.24) were associated with death.

Conclusion
The burden of PIMCog use in patients with cognitive impairment is high. PIMCog use is independently associated with all-cause mortality and vascular death. This is a potential modifiable risk factor for death in patients with neurocognitive disorders. Further research is required to independently validate this finding.
436 POSTOPERATIVE SYSTOLIC HYPOTENSION IN FRACTURED NECK OF FEMUR PATIENTS
Authors: Jones R , Cook J , Cannon A 
Published: June 2021

Abstract

Introduction
Secondary analysis of outcomes after 11,085 hip fracture operations from the prospective UK Anaesthesia Sprint Audit of Practice (ASAP 2) found an association between reduced intraoperative systolic arterial pressure (SAP) and postoperative mortality at five and 30 days. We sought to determine the incidence of hypotension in the postoperative period, rather than just intraoperatively, in a small sample of patients with fractured neck of femur.

Method
We performed a retrospective review of the notes, electronic vital signs and electronic general practice records from 40 patients with fractured neck of femur. We identified the latest SAP performed at their general practice (if done within one year before admission). We noted the pre-operative baseline SAP reading from the ward as well as the lowest SAP during several time periods: the pre-operative period; the fracture surgery; the recovery room; and during each 24-h period postoperatively until the fifth postoperative day.

Results
A SAP recording from general practice within the previous year was only accessible in 21 (53%) of patients, but where it was accessible, it was within 20% of the immediate preoperative SAP in 14 (66%) of patients. The incidence of relative hypotension (&lt; 80% preoperative SAP) was 54% in the operating theatre, 41% in the recovery room, 65% on the ward during the remainder of the first postoperative 24 h, 55% during postoperative day 2, 53% during day 3, 33% during day 4 and 41% during day 5.

Conclusions
Postoperative hypotension was common in our sample. In our analysis, the highest incidence was on the ward during the first 24 hours postoperatively. However, 41% of patients still had hypotension 5 days postoperatively.
450 EDUCATIONAL PROGRAMMES FOR FRAIL OLDER PEOPLE, THEIR FAMILIES, CARERS, AND HEALTH-CARE PROFESSIONALS: A SYSTEMATIC REVIEW
Authors: Viggars R J , Finney A , Panayiotou B 
Published: June 2021

Abstract

Introduction
With an ever-increasing, ageing population, there is inevitable increase in people living with frailty with a growing demand on the NHS in the UK. Healthcare policy emphasises holistic care and a multimorbid approach to meet these needs. Frailty is seen as a measurable, complex, fluid and variable state affected by a balance of resilience versus vulnerability across domains which impact on quality of life. The FCCF positions frailty as a LTC and suggests that a holistic and person-centred approach to education is required for people living with frailty, their families, carers and health care professionals. This is a systematic review of research studies providing educational programmes or initiatives to these groups and addresses whether the content and application will compliment and support the facilitation of the FCCF.

Methods
Following standardised methods and guidelines, electronic databases were searched. Two reviewers were involved in the research collection process, applying the inclusion and exclusion criteria. Quality appraisal tools were used to ensure robust quality assessment and then the findings were narratively synthesised.

Results
There was real heterogeneity of study design with variable quality according to the tools used. There was a paucity of high-quality evidence; (2 = high quality, 3 = low quality, 5 = medium quality). There were four thematic domains prominent from the synthesis: 1) Health Promotion (namely exercise and nutrition), 2) Empowerment, 3) Self-care, 4) Online platform delivery.

Conclusion
It is evident that educational programmes and initiatives are vital for the prevention and management of frailty. To be truly effective, such programmes must include a combination of health promotion, empowerment and self-care and be accessible to all target populations. Further work is needed to look at effective, accessible, sustainable delivery systems, including that of online digital platforms.
457 NUTRITION, SARCOPENIA AND FRAILTY
Authors: Du W 
Published: June 2021

Abstract

Many older people admitted to hospital are malnourished/at risk of malnourishment (30%), have swallowing problems (55%), are frail (25%), have sarcopenia (50%) or a combination of these. On admission to hospital frail older people are at significant risk of worsening nutritional status and prolonged hospital stay. Nutritional status should be identified, documented, food intake monitored and where appropriate they should be referred to the dietitian.
The question remains, do staff recognise that frail older people may not eat their food increasing their risk of poor nutrition and outcome.

Methods
Older people admitted to a ‘Frailty’ Ward were directly observed during lunchtime by WD. The Minimal Eating Observation Form –Version II (MEOF-II) was used to document how much they ate. Frailty status (CFS), presence of Sarcopenia (Sarc-F) and whether a referral to dietetics or speech and language therapy (SLT) was completed.

Results
39 patients were observed. Mean age was 82.38 years; median CFS 6 (3–8); median Sarc-F 4(0–9). Median MEOF II was 0 (0–5). Two patients were referred to dietetics and 4 to SLT. 7/40 (17,5%) were at high risk for undernutrition, a further 8/40(20%) were at moderate risk. 82% were severely frail, the remaining were mildly frail. 94% (16/17) exhibited sarcopenia. There was significant correlation between MEOF II and CFS (r = 0.4887, p = 0.00162); MEOFII and Sarc-F (r = 0.4395, p = 0.00512). There was correlation between CFS and Sarc-F (r = 0.80296, p &lt; 0.00001). Only one (6%) was referred to the dietitian.

Conclusion
Frail older adults are often undernourished on admission to hospital. Nutritional intake is often poor with acute illness. Screening, observation and monitoring of nutritional intake should highlight concerns and needs for intervention. These study high lights that a significant number of older people are frail, fail to complete meals, are at significant risk of under nutrition, yet proactive intervention does not occur.
537 AGE, FRAILTY AND COMORBIDITY IN COVID-19 INPATIENTS 65 AND OLDER
Authors: Obiechina N , Michael A , Khan R R A , Ali M , Zainudin M , Mekala T , Doyle C-M , Nandi A 
Published: June 2021

Abstract

Introduction
Higher incidence of COVID-19 and poorer outcomes have been shown to be associated with age, frailty and comorbidity. Older people have more risk of severe COVID 19; hospitalization, ITU admission, ventilation and mortality.

Aim
To assess the correlation between age, frailty and comorbidity in COVID-19 inpatients 65 years and older.

Methods
A retrospective, cross-sectional analysis was carried out on COVID 19 inpatients 65 and older in a UK district general hospital. Patients with no microbiological evidence of COVID-19 and patients with incomplete data were excluded from the study. Demographic data, frailty score and comorbidity index were extracted from the electronic records of patients. SPSS 27 statistical software was used to perform descriptive analysis and linear regression coefficient.

Results
357 COVID-19 patients 65 and over were assessed; 207 males and 150 females. Mean age was 81.9 +/− 9.31. Frailty scores were measured using the Rockwood Clinical Frailty Scale (CFS) and comorbidity was calculated using the Charlson Comorbidity Index (CCI). There was positive correlation between age and Clinical Frailty Scale (r=. 436; p&lt;. 001), between age and Charlson Comorbidity Index (r=. 448; p&lt;. 001, and between frailty and comorbidity (r=. 429; p&lt;. 001).

Conclusion
In COVID-19 inpatients 65 and older, there was positive correlation between age and Clinical Frailty Scale, between age and Charlson Comorbidity Index and between frailty and comorbidity. More studies are needed to explore the interaction between age, frailty and comorbidity and COVID 19 morbidity and mortality.
Double PIK3CA Alterations and Parallel Evolution in Colorectal Cancers
Authors: Lin Ming-Tseh , Zheng Gang , Rodriguez Erika , Tseng Li-Hui , Parini Vamsi , Xian Rena , Zou Ying , Gocke Christopher D , Eshleman James R 
Published: June 2021

Abstract

Objectives
To demonstrate clinicopathologic features and evaluate the clonality of double PIK3CA alterations in colorectal cancers (CRCs).

Methods
Clonality was examined in 13 CRCs with double PIK3CA alterations (1.7% of CRCs or 9.6% of PIK3CA-mutated CRCs). Multiregional analyses were performed to confirm subclonal PIK3CA alterations.

Results
PIK3CA alterations were detected within exon 9 (51%), exon 20 (23%), exon 1 (15%), and exon 7 (6.0%). CRCs with exon 7 alterations showed a significantly higher incidence of double PIK3CA alterations. Most double PIK3CA alterations consisted of a hotpsot alteration and an uncommon alteration; they were often clonal and present within a single tumor population. Multiregional analyses of CRCs with predicted subclonal double-alterations revealed multiclonal CRCs with divergent PIK3CA variant status originating from a common APC- and KRAS-mutated founder lineage of adenoma.

Conclusions
The findings supported multiclonal CRCs resulting from parallel evolution during the progression from adenoma to adenocarcinoma within the mitogen-activated protein kinase pathway, as previously demonstrated, or the mammalian target of rapamycin pathway. Further studies are warranted to elucidate clinical significance and potential targeted therapy for CRC patients with double PIK3CA alterations and impacts on clinical decision-making in patients with multiclonal CRCs harboring divergent PIK3CA mutational status.
PuffAligner: a fast, efficient and accurate aligner based on the Pufferfish index
Authors: Almodaresi Fatemeh , Zakeri Mohsen , Patro Rob 
Published: June 2021

Abstract

Motivation
Sequence alignment is one of the first steps in many modern genomic analyses, such as variant detection, transcript abundance estimation and metagenomic profiling. Unfortunately, it is often a computationally expensive procedure. As the quantity of data and wealth of different assays and applications continue to grow, the need for accurate and fast alignment tools that scale to large collections of reference sequences persists.

Results
In this article, we introduce PuffAligner, a fast, accurate and versatile aligner built on top of the Pufferfish index. PuffAligner is able to produce highly sensitive alignments, similar to those of Bowtie2, but much more quickly. While exhibiting similar speed to the ultrafast STAR aligner, PuffAligner requires considerably less memory to construct its index and align reads. PuffAligner strikes a desirable balance with respect to the time, space and accuracy tradeoffs made by different alignment tools and provides a promising foundation on which to test new alignment ideas over large collections of sequences.

Availability and implementation
All the data used for preparing the results of this paper can be found with 10.5281/zenodo.4902332. PuffAligner is a free and open-source software. It is implemented in C++14 and can be obtained from https://github.com/COMBINE-lab/pufferfish/tree/cigar-strings.

Supplementary information
Supplementary data are available at Bioinformatics online.
Induced pluripotent stem cell-derived motor neurons of CMT type 2 patients reveal progressive mitochondrial dysfunction
Authors: Van Lent Jonas , Verstraelen Peter , Asselbergh Bob , Adriaenssens Elias , Mateiu Ligia , Verbist Christophe , De Winter Vicky , Eggermont Kristel , Van Den Bosch Ludo , De Vos Winnok H , Timmerman Vincent 
Published: June 2021

AbstractAxonal Charcot-Marie-Tooth neuropathies (CMT type 2) are caused by inherited mutations in various genes functioning in different pathways. The types of genes and multiplicity of mutations reflect the clinical and genetic heterogeneity in CMT2 disease, which complicates its diagnosis and has inhibited the development of therapies. Here, we used CMT2 patient-derived pluripotent stem cells (iPSCs) to identify common hallmarks of axonal degeneration shared by different CMT2 subtypes. We compared the cellular phenotypes of neurons differentiated from CMT2 patient iPSCs with those from healthy controls and a CRISPR/Cas9-corrected isogenic line. Our results demonstrated neurite network alterations along with extracellular electrophysiological abnormalities in the differentiated motor neurons. Progressive deficits in mitochondrial and lysosomal trafficking, as well as in mitochondrial morphology, were observed in all CMT2 patient lines. Differentiation of the same CMT2 iPSC lines into peripheral sensory neurons only gave rise to cellular phenotypes in subtypes with sensory involvement, supporting the notion that some gene mutations predominantly affect motor neurons. We revealed a common mitochondrial dysfunction in CMT2-derived motor neurons, supported by alterations in the expression pattern and oxidative phosphorylation, which could be recapitulated in the sciatic nerve tissue of a symptomatic mouse model. Inhibition of a dual leucine zipper kinase could partially ameliorate the mitochondrial disease phenotypes in CMT2 subtypes. Altogether, our data reveal shared cellular phenotypes across different CMT2 subtypes and suggests that targeting such common pathomechanisms could allow the development of a uniform treatment for CMT2.
Subcortical Contribution of Corticospinal Transmission during Visually Guided Switching Movements of the Arm
Authors: Suzuki Shinya , Nakajima Tsuyoshi , Irie Shun , Ariyasu Ryohei , Ohtsuka Hiroyuki , Komiyama Tomoyoshi , Ohki Yukari 
Published: June 2021

Abstract
In animal experiments, the indirect corticospinal tract (CST) system via cervical interneurons has been shown to mediate motor commands for online adjustment of visuomotor behaviors, such as target-reaching. However, it is still unclear whether the similar CST system functions to perform similar motor behaviors in humans. To clarify this, we investigated changes in motor-evoked potentials (MEPs) in the elbow muscles following transcranial magnetic stimulation, transcranial electrical stimulation, or cervicomedullary stimulation while participants executed target-reaching and switching movements. We found that the MEP, whether elicited cortically or subcortically, was modulated depending on the direction of the switching movements. MEP facilitation began around the onset of the switching activities in an agonist muscle. Furthermore, ulnar nerve-induced MEP facilitation, which could be mediated by presumed cervical interneuronal systems, also increased at the onset of MEP facilitation. In a patient with cortical hemianopsia who showed switching movements in the scotoma, the MEPs were facilitated just before the switching activities. Our findings suggested that CST excitation was flexibly tuned with the switching movement initiation, which could partly take place in the subcortical networks, including the presumed cervical interneuronal systems.
Evolution of a novel technology for gastroesophageal reflux disease: a safety perspective of magnetic sphincter augmentation
Authors: DeMarchi Janet , Schwiers Michael , Soberman Mark , Tokarski Allison 
Published: June 2021

Summary
Magnetic sphincter augmentation using the LINX® device is a minimally invasive surgical option for patients with gastroesophageal reflux disease. An estimated 30,000 devices have been implanted worldwide. Device removals and erosion are identified risks. The objective of this analysis is to explore the procedure evolution with an emphasis on the removals and associated characteristics that may guide future clinical practice. The Manufacturer and User Facility Device Experience and Ethicon’s complaint databases were queried for all surgical device explants since January 2013. Device unit sales were used to determine the rates. The endpoint was based upon the time from implant to explant. Explant and erosion rates were calculated at yearly intervals and the Kaplan-Meier estimator was used to measure the time to explant. Chi-square analyses were used to investigate the risk of explant associated with the size, geography and implant year. Overall, 7-year cumulative risk of removal was 4.81% (95% Confidence Interval (CI) CI: 4.31–5.36%). The likelihood of removal was significantly related to the device size (P &lt; 0.0001), with smaller sizes being more likely to be explanted. The primary reasons for device removal and relative percentages were dysphagia/odynophagia (47.9%), persistent gastroesophageal reflux disease (20.5%) and unknown/other (11.2%). Overall, the 7-year cumulative risk of erosion was 0.28% (95% CI: 0.17–0.46%). The average device size increased from 14.2 beads ± 1.0 in 2013 to 15.3 beads ± 1.2 in 2019 (P &lt; 0.001). Surgical technique and perioperative management play an important role in the outcomes. Clinical practice changes since magnetic sphincter augmentation has been incorporated into clinical use are associated with improved outcomes and should be further characterized. Smaller device size is associated with increased removal and erosion rates.
Spatial Patterns of Canopy Disturbance and Shortleaf Pine in a Mixedwood Forest
Authors: Goode J Davis , Hart Justin L , Dey Daniel C , Torreano Scott J , Clark Stacy L 
Published: June 2021

Abstract
The spatial structure of forest ecosystems is dominated by the horizontal and vertical distribution of trees and their attributes across space. Canopy disturbance is a primary regulator of forest spatial structure. Although the importance of tree spatial pattern is widely acknowledged as it affects important ecosystem processes such as regeneration and recruitment into the overstory, quantitative reference spatial conditions to inform silvicultural systems are lacking. This is especially true for mixedwood forests, defined as those that contain hardwoods and softwoods in the canopy. We used data from a preexisting network of plots in a complex-stage mixedwood stand to investigate the influence of canopy disturbance on stand and neighborhood-scale spatial patterns. We reconstructed canopy disturbance history and linked detected stand-wide and gap-scale disturbance events to establishment and spatial patterns of shortleaf pine. The majority of shortleaf pine establishment coincided with stand-wide or gap-scale disturbance. Shortleaf pine was clustered at the stand scale but was randomly distributed at the neighborhood scale (i.e. five tree clusters), which was a legacy of the historical disturbance regime. These results may be used to improve natural disturbance-based silvicultural systems to restore and maintain mixedwood forests for enhanced resilience and provisioning of ecosystem goods and services.