bluuebunny/crossref_metadata_2025_split huggingface dataset:
112 A Critical Evaluation of the VIP Tool in Identifying Frailty in the Older Adult in a Kerry Hospital
Authors: Brolly Amanda , Bergin Liza , McQuinn Paudie , Buckley O’Sullivan Shinann , Naughton Corina 
Published: September 2019

Abstract

Background
The Variable Indicative of Placement risk (VIP) is a tool that was developed in Belgium to identify older people at risk of adverse health outcomes at the time of hospital admission (Vandewoude et al 2008). VIP is a simple 3-item screening tool for the selection of hospitalized patients aged 70 and older who are at increased risk of problems at discharge. It asks three simple questions about frailty factors already existing before admission. This tool has been validated to select patients who would benefit from a geriatric assessment (Vandewoude et al 2008).
As part of the implementation process, it is important to critically review VIP as a frailty screening and selection tool for the Frailty Intervention Therapy Team (FITT) service compared to age criteria alone. There is a risk that patients screening negative on VIP could be inappropriately excluded from the FITT review.

Methods
All patients over 75 were screened using the VIP tool over a 6 week period by nursing staff in triage The “Think Frail” tool was also used to screen all patients reviewed by FITT- both positive & negative VIP Data was retrospectively gathered and VIP positive/negative patients reviewed by FITT were analysed

Results
55% were VIP positive 45% were VIP negative 16.5% of VIP negative patients were screened positive for frailty using the “Think Frail” tool We found VIP under-recognised patients presenting with reduced mobility (5.5%, n=20), acute confusion (2.7%, n=10) and polypharmacy (8.1%, n=29), all potentially modifiable frailty

Conclusion
The VIP tool is not sensitive to identifying the presence of pre-frailty markers including falls, polypharmacy and acute confusion. Further research is needed into the use of the VIP tool in Ireland. It is recommended that this tool is not used independently to identify frailty in the ED.
146 The Lived Experience of Carer Resilience Told by Carer Advocates
Authors: Reid Laura , Harmon Aisling 
Published: September 2019

Abstract

Background
Established in 2013 this network of volunteer family carers is a national advocacy group that presents a vital opportunity for carers to use their voice to raise awareness of issues affecting families living with dementia in Ireland. The network is facilitated by a dementia specific service provider.
These carer advocates wish to present on a piece of qualitative research they have recently conducted on the topic of carer resilience at the advanced stages of caring for a loved one with dementia.

Methods
There are 43 family carer advocates on the network, all of whom were invited to participate in this research.
The piece of qualitative research conducted by the network with its members took the form of a questionnaire.
The research sought to ascertain how informed and supported carers felt as their loved ones transitioned to long term residential care and the stage thereafter.
This research did not discuss the level of professional care given to their loved one but what supports and services were offered to the carer at that time and how this affected their resilience.
The aspect of caring for a loved one availing of hospice care naturally emerged during the research process and this topic was also explored in relation to carer resilience.
Completed questionnaires were analysed to show findings and draw conclusions.

Results
The research gives insight into the lived experience of carer resilience told by carer advocates. The results show that carer advocates feel ill-informed and badly supported as their loved one transitions to or resided in long term residential care.
The research also showed that carers feel more informed and supported if their loved one availed of hospice care rather than long term residential care.

Conclusion
Carers are not properly informed or supported when their loved one transitions to or resides in long term residential care and this negatively affects their resilience.
APOE genotype, hypertension severity and outcomes after intracerebral haemorrhage
Authors: Biffi Alessandro , Murphy Meredith P , Kubiszewski Patryk , Kourkoulis Christina , Schwab Kristin , Gurol Mahmut Edip , Greenberg Steven M , Viswanathan Anand , Anderson Christopher D , Rosand Jonathan 
Published: September 2019

Abstract
Intracerebral haemorrhage in the elderly is a severe manifestation of common forms of cerebral small vessel disease. Nearly 60% of intracerebral haemorrhage survivors will develop clinical manifestations of small vessel disease progression including recurrent haemorrhage, ischaemic stroke, dementia, late-life depression and gait impairment within 5 years. Blood pressure measurements following intracerebral haemorrhage are strongly associated with this risk. However, aggressive blood pressure lowering in the elderly carries substantial risks. In order to determine whether there might be an opportunity to select individuals at the highest risk for small vessel disease progression for aggressive blood pressure reduction, we investigated whether APOE gene variants ɛ2/ɛ4 modify the association between blood pressure and small vessel disease clinical progression after intracerebral haemorrhage. We conducted a single-centre longitudinal study at a tertiary care referral centre (Massachusetts General Hospital in Boston, MA, USA), analysing 716 consecutive survivors of acute intracerebral haemorrhage, enrolled from January 2006 to December 2016. We conducted research interviews at the time of enrolment and obtained APOE genotypes from peripheral venous blood samples. We followed patients longitudinally by means of validated phone-based research encounters, aimed at gathering measurements of systolic and diastolic blood pressure, as well as information on small vessel disease clinical outcomes (including recurrent haemorrhage, incident ischaemic stroke, incident dementia, incident depression and incident gait impairment). APOE ε4 and systolic blood pressure were associated with the risk of recurrent haemorrhage, ischaemic stroke and post-haemorrhage dementia, depression and gait impairment (all P &lt; 0.05). APOE ε4 and systolic blood pressure interacted to increase the risk of recurrent haemorrhage, ischaemic stroke, dementia and gait impairment (all interaction P &lt; 0.05). Among patients with elevated blood pressure following intracerebral haemorrhage (average systolic blood pressure 120–129 mmHg and diastolic blood pressure &lt;80 mmHg) only those with one or more APOE ε4 copies were at increased risk for one or more small vessel disease outcomes (hazard ratio = 1.97, 95% confidence interval 1.17–3.31). Among haemorrhage survivors with hypertension (stage 1 and beyond) APOE genotype also stratified risk for all small vessel disease outcomes. In conclusion, APOE genotype modifies the already strong association of hypertension with multiple small vessel disease clinical outcomes among intracerebral haemorrhage survivors. These data raise the possibility that genetic screening could inform blood pressure treatment goals in this patient population.
Evaluating stably expressed genes in single cells
Authors: Lin Yingxin , Ghazanfar Shila , Strbenac Dario , Wang Andy , Patrick Ellis , Lin David M , Speed Terence , Yang Jean Y H , Yang Pengyi 
Published: September 2019

Abstract

Background
Single-cell RNA-seq (scRNA-seq) profiling has revealed remarkable variation in transcription, suggesting that expression of many genes at the single-cell level is intrinsically stochastic and noisy. Yet, on the cell population level, a subset of genes traditionally referred to as housekeeping genes (HKGs) are found to be stably expressed in different cell and tissue types. It is therefore critical to question whether stably expressed genes (SEGs) can be identified on the single-cell level, and if so, how can their expression stability be assessed? We have previously proposed a computational framework for ranking expression stability of genes in single cells for scRNA-seq data normalization and integration. In this study, we perform detailed evaluation and characterization of SEGs derived from this framework.

Results
Here, we show that gene expression stability indices derived from the early human and mouse development scRNA-seq datasets and the "Mouse Atlas" dataset are reproducible and conserved across species. We demonstrate that SEGs identified from single cells based on their stability indices are considerably more stable than HKGs defined previously from cell populations across diverse biological systems. Our analyses indicate that SEGs are inherently more stable at the single-cell level and their characteristics reminiscent of HKGs, suggesting their potential role in sustaining essential functions in individual cells.

Conclusions
SEGs identified in this study have immediate utility both for understanding variation and stability of single-cell transcriptomes and for practical applications such as scRNA-seq data normalization. Our framework for calculating gene stability index, "scSEGIndex," is incorporated into the scMerge Bioconductor R package (https://sydneybiox.github.io/scMerge/reference/scSEGIndex.html) and can be used for identifying genes with stable expression in scRNA-seq datasets.
Toward a precision behavioral medicine approach to addressing high-risk sun exposure: a qualitative analysis
Authors: Stump Tammy K , Spring Bonnie , Marchese Sara Hoffman , Alshurafa Nabil , Robinson June K 
Published: September 2019

Abstract

Objectives
Precision behavioral medicine techniques integrating wearable ultraviolet radiation (UVR) sensors may help individuals avoid sun exposure that places them at-risk for skin cancer. As a preliminary step in our patient-centered process of developing a just-in-time adaptive intervention, this study evaluated reactions and preferences to UVR sensors among melanoma survivors.

Materials and Methods
Early stage adult melanoma survivors were recruited for a focus group (n = 11) or 10-day observational study, which included daily wearing a UVR sensor and sun exposure surveys (n = 39). Both the focus group moderator guide and observational study exit interviews included questions on UVR sensing as a potential intervention strategy. These responses were transcribed and coded using an inductive strategy.

Results
Most observational study participants (84.6%) said they would find information provided by UVR sensors to be useful to help them learn about how specific conditions (eg, clouds, location) impact sun exposure and provide in-the-moment alerts. Focus group participants expressed enthusiasm for UVR information and identified preferred qualities of a UVR sensor, such as small size and integration with other devices. Participants in both studies indicated concern that UVR feedback may be difficult to interpret and some expressed that a UVR sensor may not be convenient or desirable to wear in daily life.

Discussion
Melanoma survivors believe that personalized UVR exposure information could improve their sun protection and want this information delivered in a method that is meaningful and actionable.

Conclusion
UVR sensing is a promising component of a precision behavioral medicine strategy to reduce skin cancer risk.
Creative Destruction and Uncertainty
Authors: Sedláček Petr 
Published: September 2019

Abstract
Uncertainty rises in recessions. But does uncertainty cause downturns or vice versa? This paper argues that counter-cyclical uncertainty fluctuations are a by-product of technology growth. In a firm dynamics model with endogenous technology adoption, faster technology growth widens the dispersion of firm-level productivity shocks, a benchmark uncertainty measure. Moreover, faster technology growth spurs a creative destruction process, generates a temporary downturn, and renders uncertainty counter-cyclical. Estimates from structural vector autoregressions (VARs) on U.S. data confirm the model’s predictions. On average, 1/4 of the cyclical variation in uncertainty is driven by technology shocks. This fraction rises to 2/3 around the “dot-com” bubble.
Ramelteon for Prevention of Postoperative Delirium: A Randomized Controlled Trial in Patients Undergoing Elective Pulmonary Thromboendarterectomy*
Authors: Jaiswal Stuti J. , Vyas Anuja D. , Heisel Andrew J. , Ackula Haritha , Aggarwal Ashna , Kim Nick H. , Kerr Kim M. , Madani Michael , Pretorius Victor , Auger William R. , Fernandes Timothy M. , Malhotra Atul , Owens Robert L. 
Published: September 2019

Objectives:
To assess the efficacy of ramelteon in preventing delirium, an acute neuropsychiatric condition associated with increased morbidity and mortality, in the perioperative, ICU setting.

Design:
Parallel-arm, randomized, double-blinded, placebo-controlled trial.

Setting:
Academic medical center in La Jolla, California.

Patients:
Patients greater than or equal to 18 years undergoing elective pulmonary thromboendarterectomy.

Interventions:
Ramelteon 8 mg or matching placebo starting the night prior to surgery and for a maximum of six nights while in the ICU.

Measurements and Main Results:
Incident delirium was measured twice daily using the Confusion Assessment Method-ICU. The safety outcome was coma-free days assessed by the Richmond Agitation-Sedation Scale. One-hundred twenty participants were enrolled and analysis completed in 117. Delirium occurred in 22 of 58 patients allocated to placebo versus 19 of 59 allocated to ramelteon (relative risk, 0.8; 95% CI, 0.5–1.4; p = 0.516). Delirium duration, as assessed by the number of delirium-free days was also similar in both groups (placebo median 2 d [interquartile range, 2–3 d] vs ramelteon 3 d [2–5 d]; p = 0.181). Coma-free days was also similar between groups (placebo median 2 d [interquartile range, 1–3 d] vs ramelteon 3 d [2–4 d]; p = 0.210). We found no difference in ICU length of stay (median 4 d [interquartile range, 3–5 d] vs 4 d [3–6 d]; p = 0.349), or in-hospital mortality (four vs three deaths; relative risk ratio, 0.7; 95% CI, 0.2–3.2; p = 0.717), all placebo versus ramelteon, respectively.

Conclusions:
Ramelteon 8 mg did not prevent postoperative delirium in patients admitted for elective cardiac surgery.
Evidence map of ductal carcinoma in situ management options
Authors: Bouskill Kathryn , Hempel Susanne , Richardson Andrea , Ganz Patricia A. , Baxi Sangita , Zutshi Rushil , Larkin Jody , Motala Aneesa , Miles Jeremy N. V. , Crandall Carolyn J. 
Published: September 2019

Abstract

Objective:
Ductal carcinoma in situ (DCIS) has the potential to progress to invasive carcinoma. The optimal management of DCIS and methods for individualizing treatment of DCIS are still being determined. This evidence map depicts the robustness and topical span of research on DCIS management choice on patient-centered and clinical outcomes.

Methods:
We searched PubMed, EMBASE, PsycINFO, PubMed Health, PROSPERO, and clinical practice guideline sites to identify systematic reviews of DCIS management options and consulted with topic experts. A bubble plot visualizes the literature volume and research content for patient-centered outcomes. An online decision tree facilitates discussions with patients and guides through the available evidence.

Results:
In total, 40 systematic reviews met inclusion criteria. The research syntheses addressed DCIS management options, including the role of magnetic resonance imaging, axillary surgery/sentinel lymph node biopsy, and excisional biopsy. The map shows existing evidence for mutually exclusive treatment options including active surveillance, breast-conserving surgery, nipple sparing mastectomy, and simple mastectomy. Research findings for intraoperative radiation, adjuvant radiation therapy, adjuvant hormone therapy, hypofractionation radiotherapy, accelerated partial breast irradiation, radiation therapy plus boost, and combined radiation and hormone therapy, as well as for breast reconstruction after mastectomy and surveillance mammography postsurgery are also displayed. The evidence map highlights a scarcity of robust evidence on patient-centered outcomes.

Conclusions:
The evidence map provides an overview of DCIS research showing the range of management options and remaining decisional dilemmas that follow a diagnosis of DCIS. It maps the evidence in accessible tools to guide practice and future research.

Video Summary:

http://links.lww.com/MENO/A448.
Extraluminal Sigmoid Sinus Angioplasty: A Pertinent Reconstructive Surgical Method Targeting Dural Sinus Hemodynamics to Resolve Pulsatile Tinnitus
Authors: Hsieh Yue-Lin , Wang Wuqing 
Published: September 2019

Objectives:
1) To provide information on the treatment of pulsatile tinnitus (PT) with transtemporal extraluminal sigmoid sinus angioplasty (ESSA); and 2) to discuss the current clinical management of PT.

Study Design:
This was a retrospective study.

Settings:
Multi-institutional tertiary university medical centers.

Patients:
Fifty-four PT patients with transverse–sigmoid sinus enlargement and prominent transverse–sigmoid junction with or without sigmoid sinus wall anomalies or transverse sinus anomalies.

Intervention:
All patients underwent ESSA under local anesthesia.

Main Outcome Measures:
Intraoperative discoveries and surgical resolution of PT, morphology, and computational fluid dynamics.

Results:
Fifty-three of the 54 (98%) patients experienced a significant reduction in, or complete resolution of, PT after ESSA. No major surgical complications occurred, except for one case where we observed a full collapse of the sinus wall. On average, this surgery reduced the cross-sectional area at the transverse–sigmoid junction by 61.5%. Our intraoperative discoveries suggest that sigmoid sinus wall anomalies may not be a definitive cause of PT. The transverse–sigmoid sinus system was significantly larger (in term of both cross-sectional area and volume) on the ipsilesional side compared with the contralesional side. Following ESSA, the vascular wall pressure and vortex flow at the transverse–sigmoid junction decreased considerably, and the flow velocity and wall shear stress increased significantly.

Conclusion:
ESSA is a highly effective surgical technique for PT patients with transverse–sigmoid sinus enlargement and prominent transverse–sigmoid junction, regardless of whether they also have sigmoid sinus wall or transverse sinus anomalies. A large transverse–sigmoid system with prominent transverse–sigmoid junction is a predisposing factor for PT, and only by improving patients’ intrasinus hemodynamics could PT be resolved efficiently. In cases without complete obstruction of venous return, ESSA is safe. No postoperative complications related to neurological disorders were observed.
Understanding pretreatment loss to follow-up of tuberculosis patients: an explanatory qualitative study in Chennai, India
Authors: Thomas Beena E. , Suresh Chandra , Lavanya J. , Lindsley Mika M. , Galivanche Amith T. , Sellappan Senthil , Ovung Senthanro , Aravind Amritha , Lincy Savari , Raja Agnes Lawrence , Kokila S. , Javeed B. , Arumugam S. , Mayer Kenneth H. , Swaminathan Soumya , Subbaraman Ramnath 
Published: September 2019

AbstractIntroductionPretreatment loss to follow-up (PTLFU)—dropout of patients after diagnosis but before registration in treatment—is a major gap in TB care delivery in India and globally. Patient and healthcare worker (HCW) perspectives are critical for developing interventions to address this problem.MethodsWe prospectively tracked newly diagnosed smear-positive TB patients from 22 TB diagnostic centers in Chennai, one of India’s largest cities. Patients who did not start therapy within 14 days, or who died or were lost to follow-up before official registration in treatment, were classified as PTLFU cases. We conducted qualitative interviews with all trackable PTLFU patients, or family members of patients who had died. We conducted focus group discussions (FGDs) with three types of HCWs involved in TB care. Interview and FGD recordings were transcribed, coded, and analyzed with the support of Dedoose 8.0.35 software to identify key themes. We created categories into which these themes clustered, identified relationships among thematic categories, and assembled findings into a broader explanatory model for PTLFU.ResultsWe conducted six FGDs comprising 53 HCWs and 33 individual patient or family member interviews. Themes clustered into five categories. Examining relationships among these categories revealed two pathways leading to PTLFU as part of a broader explanatory model. In the first pathway, administrative and organizational health system barriers—including the complexity of navigating the system, healthcare worker absenteeism, and infrastructure failures—resulted in patients feeling frustration or resignation, leading to disengagement from care. Health system barriers experienced by patients were in turn shaped by constraints that made it difficult for HCWs to do their jobs effectively. In the second pathway, negative or judgmental HCW attitudes and behaviors towards patients contributed to patient distrust of the health system, resulting in refusal of further care.ConclusionHealth system barriers contribute substantially to PTLFU directly and by amplifying patient-related challenges to engaging in care. Interventions should focus on removing administrative hurdles patients face in the health system, improving the quality of the HCW-patient interaction, and alleviating constraints HCWs face in being able to provide optimal patient-centered care.
De novo EIF2AK1andEIF2AK2variants are associated with developmental delay, leukoencephalopathy, and neurologic decompensation
Authors: Mao Dongxue , Reuter Chloe M. , Ruzhnikov Maura R.Z. , Beck Anita E. , Farrow Emily G. , Emrick Lisa T. , Rosenfeld Jill A. , Mackenzie Katherine M. , Robak Laurie , Wheeler Matthew T. , Burrage Lindsay C. , Jain Mahim , Liu Pengfei , Calame Daniel , Küry Sebastien , Sillesen Martin , Schmitz-Abe Klaus , Tonduti Davide , Spaccini Luigina , Iascone Maria , Genetti Casie A. , Graf Madeline , Tran Alyssa , Alejandro Mercedes ,   Undiagnosed Diseases Network, Lee Brendan H. , Thiffault Isabelle , Agrawal Pankaj B. , Bernstein Jonathan A. , Bellen Hugo J. , Chao Hsiao-Tuan 
Published: September 2019

ABSTRACTEIF2AK1andEIF2AK2encode members of the Eukaryotic Translation Initiation Factor 2 Alpha Kinase (EIF2AK) family that inhibits protein synthesis in response to physiologic stress conditions. EIF2AK2 is also involved in innate immune response and the regulation of signal transduction, apoptosis, cell proliferation, and differentiation. Despite these findings, human disorders associated with deleterious variants inEIF2AK1andEIF2AK2have not been reported. Here, we describe the identification of eight unrelated individuals with heterozygousde novomissense variants inEIF2AK1(1/8) orEIF2AK2(7/8). Features seen in these eight individuals include white matter alterations (8/8), developmental delay (8/8), impaired language (8/8), cognitive impairment (7/8), ataxia (6/8), dysarthria in probands with verbal ability (6/6), hypotonia (6/8), hypertonia (5/8), and involuntary movements (3/8). Individuals withEIF2AK2variants also exhibit neurological regression in the setting of febrile illness or infection. We use mammalian cell lines and patient-derived fibroblasts to further confirm the pathogenicity of variants in these genes and found reduced kinase activity. EIF2AKs phosphorylate Eukaryotic Translation Initiation Factor 2 Subunit 1, (EIF2S1, also known as EIF2α), which then inhibits EIF2B activity. Deleterious variants in genes encoding EIF2B proteins cause childhood ataxia with central nervous system hypomyelination/vanishing white matter disease (CACH/VWM), a leukoencephalopathy characterized by neurologic regression in the setting of febrile illness and other stressors. Our findings indicate thatEIF2AK2missense variants cause a neurodevelopmental syndrome that may share phenotypic and pathogenic mechanisms with CACH/VWM.