bluuebunny/crossref_metadata_2025_split huggingface dataset:
2888 De-prescribing anti-Hyperglycemics in the elderly—a quality improvement project
Authors: Venkatraghavan P , Gilpin R 
Published: January 2025

Abstract

Introduction
There has been a recent shift in guidelines regarding HbA1c targets in the frail population. NICE (June 2022) advocate individualised HbA1c targets for frail patients with diabetes in circumstances where the long-term benefit is uncertain or when a tight glycaemic control would increase the risk of poor clinical outcomes. This is backed up by randomised control trials that have showed that Hba1c levels &lt;53 mmol/mol (7%) because of anti-hyperglycaemic therapy are associated with increased morbidity and mortality in frail patients with diabetes. This led us to explore the current standards with regards to HbA1c review and consequent anti-hyperglycaemic deprescribing in frail patients in Hereford County Hospital.

Methods
Two audit cycles have been completed from March–June 2024 with a total sample size of 28 patients. Inclusion criteria were patients aged over 65 with a history of diabetes and a Rockwood Frailty score of 5 or more.

Results
The results of the first cycle showed that only 20% of the study group had their HbA1c reviewed. Only one had evidence of de-prescribing considerations. After the first cycle, a poster was created highlighting the importance of considering deprescribing for frail patients. The results of the second cycle indicated improvements following the poster display with 22% of the study population having had their HbA1c reviewed with subsequent considerations to de-prescribe. Furthermore, the poster generated positive informal feedback and stimulated conversations with colleagues about deprescribing.

Discussion and conclusion
For frail diabetic patients presenting to the Emergency department, deprescribing their diabetic medications is often not considered. They may be on medications that could be potentially causing more harm than benefit. Staff education appears to have a positive benefit, but more work needs to be done to ensure that deprescribing is considered for these patients.
2632 Determining the feasibility of a TCD-NIRS protocol to measure cerebral haemodynamics in dementia, delirium, and depression
Authors: Edwards O , Ball J , Sensier Y , Panerai R , Beishon L 
Published: January 2025

Abstract

Introduction
Transcranial Doppler ultrasonography (TCD) and Near-Infrared spectroscopy (NIRS) are indirect measures of neurovascular coupling (NVC). NVC is the relationship between cerebral blood flow and neuronal activity to meet the metabolic demands of the brain. No studies have integrated TCD-NIRS to investigate the feasibility of measuring NVC in those with dementia, delirium, and depression.

Methods
32 participants (median [IQR] age 73.0 [70.0,78.5], 50% female, healthy (HC, n = 10), depression (n = 11), dementia (n = 6), delirium (n = 5)), underwent continuous cerebral blood velocity measurements in the middle (dominant MCAv) and posterior (non-dominant PCAv) cerebral arteries using TCD at rest and in response to four tasks. Heart rate (3-lead ECG), end-tidal CO (nasal capnography), blood pressure (Finometer), and prefrontal oxygenated (HbO2) and deoxygenated (HbR) haemoglobin (NIRS) were also measured. NVC was determined as absolute change in MCAv (cm/s) or concentration change for an attention task (serial subtraction), passive motor (arm movement) and passive sensory task (cotton wool), or PCAv for a visuospatial task (dot counting). We determined differences in NVC by a mixed two-way repeated measures analysis of variance, with post-hoc testing via Tukey.

Results
Resting CBv (cm/s) was significantly different between groups in MCAv (HC: 53.9 (SD = 8.09), depression: 41.9 (9.31), dementia: 42.5 (13.7), delirium: 32.6 (7.48), p = 0.002) and PCAv (p = 0.045), after correction for age and BP (p = 0.011). TCD: initial NVC responses increased for all three groups (delirium excluded) for all tasks (20–30s), (p = 0.026), but with no main effect of diagnosis. NIRS: There was a significant difference between tasks for the HbO2 and HbR responses (p = 0.046, p = 0.033). Diagnosis had a significant effect on the HbR response only (p = 0.034).

Conclusion
An integrated TCD-NIRS protocol was feasible in these patient groups to measure NVC, but less-so in delirium. Further work is needed to investigate NVC using integrated TCD-NIRS in larger sample sizes.
2661 Hospital At home—an opportune training environment for internal medicine trainees
Authors: Moore S , Furmedge D , Schiff R 
Published: January 2025

Abstract

Introduction
Hospital at home (HAH) is growing apace in the United Kingdom, offering hospital-delivered treatments at home. In parallel, increasingly structured alternative training pathways are being created to enable doctors to train outside of formal specialty training programmes. With a need to train doctors to work in community settings, a HAH rotation within a locally developed internal medicine training (IMT) programme at one large NHS Foundation Trust was evaluated.

Method
A questionnaire was designed to review the alignment of HAH rotation experience with the IMT curriculum and its acceptability as a clinical rotation within an IMT stage 1 equivalent programme. The questionnaire was distributed to all doctors who had previously undertaken a HAH rotation at junior clinical fellow level in the previous five years. Free-text responses were analysed with thematic analysis.

Results
23/27 responded (85%). 74% had pursued IMT following their non-traditional training year. 78% agreed that HAH would be a suitable placement for a 4-month IMT rotation, with 74% interested in a HAH role following completion of training. HAH offers core content in internal and geriatric medicine. Curriculum coverage within a HAH rotation included improved confidence in clinical decision making, leadership, risk management, multidisciplinary team working and increased exposure to advanced care planning and palliative medicine. Being part of contextual, personalised medicine with shared decision making central was also cited as beneficial over traditional hospital rotations. Disadvantages were a lack of exposure to core IMT procedural skills, resuscitation and fewer opportunities to attend outpatient clinic.

Conclusion
Whilst limited to one geographical service, results indicate that HAH is a prime learning environment for internal medicine training as part of a carefully balanced programme ensuring access to all curriculum competencies. Where sufficiently developed, HAH rotations can be included in IMT programmes delivering much needed generalist skills.
2858 A network analysis of morbidities associated with mental-physical multimorbidity among Brazilian elderly people (ELSI-Brazil)
Authors: Batista SRR , Wottrich VS , Pereira EM , Silva RR 
Published: January 2025

Abstract

Introduction
The coexistence of two or more morbidities, including at least one mental morbidity, is defined as mental-physical multimorbidity (MP-MM). It is linked to significant poor outcomes, such as a high burden of healthcare utilisation, particularly in the elderly.

Method
To evaluate the complex connections between the 16 physical and mental morbidities among Brazilian older people from the Brazilian Longitudinal Study of Ageing, we performed a network analysis (NA), a sophisticated multivariate statistical technique to estimate all relationships between morbidities represented by an undirected grafus. The objective was to estimate patterns in a complex set of multiple aleatory variables and display them in a network map within nodes and edges representing the variables and the interrelationships among them. In this study, we applied the NA to model interrelationships among chronic physical morbidities and depression. We utilised data from 6.104 participants of the second wave (2019–2020) of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil). The data were adjusted according to the Ising model with the IsingFit function by R Software. Centrality and stability measures were assessed by the bootstrap method through the bootnet library.

Findings
In this network, depression, low back pain, and hypertension were the morbidities that had the most effects on the network’s overall structure, according to an examination of the centrality metrics of the nodes (strength, proximity, and betweenness). Depression was the morbidity with the higher betweenness.

Conclusion
The model’s interpretation indicates that depression is the illness that has the highest influence on the model and would likely be the most beneficial area for intervention.
A survey of current trends in postgraduate year 2 pediatric pharmacy residencies and growth of pediatric ambulatory care pharmacy practice
Authors: Davis Margaret S , Autry Elizabeth , Bosley Tyler , Kuhn Robert 
Published: January 2025

Abstract

Purpose
This study sought to characterize current trends in the program structure of postgraduate year 2 (PGY2) pediatric pharmacy residencies and to describe the growth of pediatric ambulatory care as a practice specialty.

Methods
A 99-question survey was designed to collect information regarding the current structure of PGY2 pediatric pharmacy residency programs. The survey was distributed electronically to PGY2 residency program directors (RPDs) and was open for 6 weeks from September to November 2023.

Results
75 distinct programs were eligible for participation; 43 programs (response rate, 57.3%) were included in the final analysis. Of the 43 respondents, 14 (32.6%) indicated their program was at a stand-alone children’s hospital. The majority of programs (22 of 43, 51.2%) require residents to spend 7 to 9 months of their residency year on required rotations. Nineteen of 40 respondents (47.5%) indicated their residents staff in both clinical and operational areas. The most commonly reported frequency was every third weekend. Most respondents indicated requiring up to 15 presentations of varying types. A total of 41 respondents participated in the ambulatory care section of the survey; 75% of respondents (30 of 40) reported there has been growth in the number of pharmacists in pediatric ambulatory care at their institution in the last 5 years.

Conclusion
This study describes the current state of PGY2 pediatric pharmacy residency programs, including educational opportunities and trends in staffing and academic activity requirements. This study also adds to available literature on pediatric ambulatory care and potential opportunities for resident-led expansion.
Graph contrastive learning of subcellular-resolution spatial transcriptomics improves cell type annotation and reveals critical molecular pathways
Authors: Lu Qiaolin , Ding Jiayuan , Li Lingxiao , Chang Yi 
Published: January 2025

Abstract
Imaging-based spatial transcriptomics (iST), such as MERFISH, CosMx SMI, and Xenium, quantify gene expression level across cells in space, but more importantly, they directly reveal the subcellular distribution of RNA transcripts at the single-molecule resolution. The subcellular localization of RNA molecules plays a crucial role in the compartmentalization-dependent regulation of genes within individual cells. Understanding the intracellular spatial distribution of RNA for a particular cell type thus not only improves the characterization of cell identity but also is of paramount importance in elucidating unique subcellular regulatory mechanisms specific to the cell type. However, current cell type annotation approaches of iST primarily utilize gene expression information while neglecting the spatial distribution of RNAs within cells. In this work, we introduce a semi-supervised graph contrastive learning method called Focus, the first method, to the best of our knowledge, that explicitly models RNA’s subcellular distribution and community to improve cell type annotation. Focus demonstrates significant improvements over state-of-the-art algorithms across a range of spatial transcriptomics platforms, achieving improvements up to 27.8% in terms of accuracy and 51.9% in terms of F1-score for cell type annotation. Furthermore, Focus enjoys the advantages of intricate cell type-specific subcellular spatial gene patterns and providing interpretable subcellular gene analysis, such as defining the gene importance score. Importantly, with the importance score, Focus identifies genes harboring strong relevance to cell type-specific pathways, indicating its potential in uncovering novel regulatory programs across numerous biological systems.
Neuronal mechanisms enhancing selectivity of the innate number sense via learning
Authors: Nieder Andreas 
Published: January 2025

Abstract
In their feature article, Lorenzi et al. (2025) compiled extensive biological evidence on the ontogenetic origins of the number sense. Drawing on both behavioral and neurobiological data, they convincingly argue that the “number sense” is fundamentally innate and present from birth in numerically competent animals, including humans. At the same time, the authors acknowledge the role of learning and experience in shaping numerical cognition. This commentary builds on the idea of learning-induced changes to the number sense, extending the concept of an innate number sense to one that is modifiable through learning and experience. It summarizes evidence from single-neuron recordings and proposes neurophysiological mechanisms underlying these learning-induced changes in numerical cognition.
Enantiomeric self-aggregation of zinc 132-methyl-bacteriochlorophyll-d analogs with a porphyrin π-skeleton
Authors: Hashimoto Yamato , Tamiaki Hitoshi 
Published: January 2025

Abstract
Zinc dodecyl 3-hydroxymethyl-(132R/S)-methyl-pyroprotopheophorbide-a enantiomers self-aggregated in an aqueous Triton X-100 micellar solution to give chlorosome-like J-aggregates. The chiral supramolecules of the resulting zinc porphyrin self-aggregates were dependent on the stereochemistry of the asymmetric carbon atom at the 132-position. The chiral and steric effects near the 13-carbonyl group on the aggregation confirmed that the 131-oxo group hydrogen-bonded with the 31-OH group, which was requisite for the in vivo production of the chlorosomal aggregates.
Balancing Away from War: How the USA and China Can Side-step the Thucydides’ Trap
Authors: Desch Michael C 
Published: January 2025

Abstract
The most widely discussed contemporary work using Thucydides as a guide for 21st century grand strategy is Graham Allison’s Destined for War: Can America and China Escape Thucydides’ Trap? It is not surprising that Allison and others would look to the Peloponnesian War because another power transition is going on with China “rising” relative to the USA. The question is from a Thucydidean perspective how should major actors like China and the USA respond to these changing power dynamics? Complicating our answer to this question is that there are three ways one could think about power in the context of his History of the Peloponnesian War. Given the striking inconsistencies among them, it is necessary to read Thucydides again to ensure we get him “right” on power. Furthermore, while a few modern readers recognize that Thucydides ultimately offers a plea for moderation and restraint in foreign policy, most, if not all, are skeptical that it can come from a Realist reading of the History of the Peloponnesian War. Ironically, such a reading casts the problem of power transition in a less intractable light.
Associations between initial dialysis access types and death from dialysis withdrawal in incident patients with kidney failure
Authors: Chen Jenny H C , Johnson David W , Roberts Matthew A , Brown Mark A , Brennan Frank , Wong Germaine , Hassan Hicham Cheikh , Yeung Wing-Chi G , Kennard Alice , Davies Christopher E , Boudville Neil , Lok Charmaine E , Lim Wai H 
Published: January 2025

Abstract

Background
Patients receiving haemodialysis via central venous catheter (HD-CVC) have been shown to have an increased risk of all-cause mortality. It is unclear whether death from dialysis withdrawal is associated with the high mortality risk observed in patients initiated on HD-CVC.

Methods
Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we examined the association between initial dialysis access (HD-CVC, haemodialysis via arteriovenous fistula [HD-AVF], and peritoneal dialysis [PD] via PD catheter [PD-PDC]) and death from dialysis withdrawal in adult patients starting dialysis in Australia between 2005 and 2022, analysed by time-stratified adjusted Cox regression with propensity score matched cohorts.

Results
Of 47 412 incident patients followed for a median of 2.65 years (interquartile range 1.19–4.87), 8170 (17%) died from dialysis withdrawal. Compared to patients initiated on HD-AVF, patients initiated on HD-CVC were more likely to experience death from dialysis withdrawal in the first 3 years after dialysis initiation, but not after 3 years (adjusted hazard ratios 2.43 [95% confidence interval 1.95–3.02], 2.06 [1.67–2.53], 1.57 [1.40–1.76], 1.06 [0.97–1.15] for 0–6 months, &gt;6–12 months, &gt;1–3 years, and &gt; 3 years after dialysis initiation, respectively). Comparison between patients initiated on HD-CVD and PD-PDC showed similar estimates. No difference in withdrawal risk was observed between patients initiated on HD-AVF and PD-PDC.

Conclusions
Patients initiated on HD-CVC were twice as likely to experience early death from dialysis withdrawal compared to patients who had initiated dialysis with HD-AVF or PD-PDC. The increased risks diminished over time and were not observed after three years on dialysis.
Longitudinal study on 3D ultrasound-based rupture risk assessment of abdominal aortic aneurysms
Authors: Nievergeld Arjet , Fonken Judith , Thirugnanasambandam Mirunalini , Maas Esther , van Sambeek Marc , Lopata Richard 
Published: January 2025

Abstract

Aims
Image-based, patient-specific rupture risk analysis of abdominal aortic aneurysms (AAAs) is promising but it is limited by invasive and costly imaging modalities. Ultrasound (US) offers a safe, more affordable alternative, allowing multiple assessments during follow-up and enabling longitudinal studies on AAA rupture risk.

Methods and results
This study used time-resolved 3D US to assess AAA rupture risk parameters over time, based on vessel and intraluminal thrombus (ILT) geometry. The locations and magnitude of peak wall rupture index (PWRI), peak wall stress (PWS), and maximum ILT thickness for varying AAA growth rates, and the correlation between PWRI, PWS, and geometric parameters were investigated. This study demonstrated that US-based biomechanical analysis is suitable for assessing rupture potential, providing insights into the evolution through various phases in AAA development. For the fast-growing AAAs, the location of PWRI moved closer to the locations of maximum ILT thickness, whereas the location of PWS moved further away. The newly introduced parameter, i.e. percentage of ILT expected for an aneurysm with a healthy lumen, showed a stronger correlation with PWS and PWRI and was less dependent on AAA size, indicating the potential for further research on ILT's impact on AAA rupture risk.

Conclusion
This study represents a step towards clinical introduction of US-based AAA rupture risk analysis. Further research and randomized trials are required to directly correlate PWRI with rupture risk. Further improvement of ILT visibility and personalization of the US-based models will be required to achieve clinical acceptance of model-based rupture risk predictions.
Segmental post-percutaneous coronary intervention physiological gradients using ultrasonic or optical flow ratio: insights from ASET JAPAN study
Authors: Revaiah Pruthvi C , Miyashita Kotaro , Tsai Tsung-Ying , Bajaj Retesh , Kotoku Nozomi , Tobe Akihiro , Muramatsu Takashi , Tanabe Kengo , Kozuma Ken , Ozaki Yukio , Garg Scot , Tu Shengxian , Dijkstra Jouke , Bourantas Christos V , Onuma Yoshinobu , Serruys Patrick W 
Published: January 2025

Abstract

Aims
Segmental pressure gradients post-percutaneous coronary intervention (PCI) can detect residual disease and optimization targets. Ultrasonic flow ratio (UFR) or optical flow ratio (OFR) offer simultaneous physiological and morphological assessment using a single imaging catheter. This study evaluated the utility of UFR and OFR in identifying residual disease post-PCI.

Methods and results
The study include patients from the Acetyl Salicylic Elimination Trial JAPAN Pilot study with complete intravascular imaging pullback data, where UFR or OFR was obtained post-PCI. Anatomical focal lesions distal and proximal to the stent were analysed in segments ≥5 mm long. UFR or OFR virtual pullback curves assessed intra-stent pressure gradients, defining physiological focal or diffuse by segmental pressure drops ≥0.05 over lengths &lt;10 or ≥10 mm, respectively. The median post-PCI UFR/OFR was 0.93 (0.88–0.96) with 35.4% (69/195) vessels having a UFR/OFR &lt; 0.91. There were significantly more focal lesions, both anatomical and physiological, proximal and distal to the stent in vessels with UFR/OFR &lt; 0.91 compared with those ≥0.91. Agreement between anatomical and physiological focal lesions was moderate proximally (kappa = 0.553, P &lt; 0.001) and fair distally (kappa = 0.219, P = 0.002). The in-stent gradient poorly predicted significant stent under-expansion. However, the virtual fractional flow reserve gradient performed well in detecting proximal or distal focal disease (area under the curve = 0.835 and 0.877, respectively).

Conclusion
UFR/OFR effectively identifies sub-optimal vessel physiology post-PCI and locates precise anatomical issues, validated by intravascular imaging.

Trial registration
The ASET JAPAN ClinicalTrials.gov reference: NCT05117866
Development of the fish invitrome for animal-free environmental risk assessment of chemicals
Authors: Revel Marion , Groh Ksenia , Bertoli Jessica , Degeratu Mihai-Ovidiu , Fischer Melanie , Fischer Stephan , Hoekman Jarno , Jozef Barbara , Li Roman , Mosimann Sven Lukas , vom Berg Colette , Županič Anže , Truffer Bernhard , Schirmer Kristin 
Published: January 2025

Abstract
Given the need to reduce animal testing for environmental risk assessment, we aim to develop a fish invitrome, an alternative fish modular framework capable of predicting chemical toxicity in fish without the use of animals. The central module of the framework is the validated RTgill-W1 cell line assay that predicts fish acute toxicity of chemicals (Organisation for Economic Co-operation and Development test guideline 249). Expanding towards prediction of chronic toxicity, the fish invitrome includes two other well-advanced modules for chemical bioaccumulation/biotransformation and inhibition of fish growth. This framework is expected to continuously evolve with the development of modules that predict, for instance, neurotoxicity and reproductive toxicity. We envisage the fish invitrome framework becoming part of the broader academic field of new approach methodologies (NAMs), where it will remain flexible and open to integration of new developments from research groups around the world. To accelerate the development and uptake of this framework, we strive for transdisciplinarity, integrating both natural and social sciences, along with broader stakeholder interactions. A stepwise socio-technical approach was chosen, where mainstreaming the fish invitrome involves progressive adoption across various ecotoxicological contexts. The framework will be codesigned with stakeholders from academia, industry, and regulatory bodies. Rather than aiming for immediate regulatory acceptance, this approach aims to build trust and familiarity with fish cell line–based testing among stakeholders. By doing so, it encourages broader use of the framework in practical applications while gradually overcoming institutional, cultural, and technical barriers. Additionally, establishing a clear roadmap for mainstreaming the fish invitrome will help identify and address challenges to its uptake, ensuring a smoother transition to nonorganismal testing methodologies.