bluuebunny/crossref_metadata_2025_split huggingface dataset:
‘Frailty as an adjective rather than a diagnosis’—identification of frailty in primary care: a qualitative interview study
Authors: Seeley Anna , Glogowska Margaret , Hayward Gail 
Published: June 2023

Abstract

Introduction
In 2017, NHS England introduced proactive identification of frailty into the General Practitioners (GP) contract. There is currently little information as to how this policy has been operationalised by front-line clinicians, their working understanding of frailty and impact of recognition on patient care. We aimed to explore the conceptualisation and identification of frailty by multidisciplinary primary care clinicians in England.

Methods
Qualitative semi-structured interviews were conducted with primary care staff across England including GPs, physician associates, nurse practitioners, paramedics and pharmacists. Thematic analysis was facilitated through NVivo (Version 12).

Results
Totally, 31 clinicians participated. Frailty was seen as difficult to define, with uncertainty about its value as a medical diagnosis. Clinicians conceptualised frailty differently, dependant on job-role, experience and training. Identification of frailty was most commonly informal and opportunistic, through pattern recognition of a frailty phenotype. Some practices had embedded population screening and structured reviews. Visual assessment and continuity of care were important factors in recognition. Most clinicians were familiar with the electronic frailty index, but described poor accuracy and uncertainty as to how to interpret and use this tool. There were different perspectives amongst professional groups as to whether frailty should be more routinely identified, with concerns of capacity and feasibility in the current climate of primary care workload.

Conclusions
Concepts of frailty in primary care differ. Identification is predominantly ad hoc and opportunistic. A more cohesive approach to frailty, relevant to primary care, together with better diagnostic tools and resource allocation, may encourage wider recognition.
Regional cortical thinning, demyelination and iron loss in cerebral small vessel disease
Authors: Li Hao , Jacob Mina A , Cai Mengfei , Duering Marco , Chamberland Maxime , Norris David G , Kessels Roy P C , de Leeuw Frank-Erik , Marques José P , Tuladhar Anil M 
Published: June 2023

AbstractThe link between white matter hyperintensities (WMH) and cortical thinning is thought to be an important pathway by which WMH contributes to cognitive deficits in cerebral small vessel disease (SVD). However, the mechanism behind this association and the underlying tissue composition abnormalities are unclear. The objective of this study is to determine the association between WMH and cortical thickness, and the in vivo tissue composition abnormalities in the WMH-connected cortical regions.In this cross-sectional study, we included 213 participants with SVD who underwent standardized protocol including multimodal neuroimaging scans and cognitive assessment (i.e. processing speed, executive function and memory). We identified the cortex connected to WMH using probabilistic tractography starting from the WMH and defined the WMH-connected regions at three connectivity levels (low, medium and high connectivity level). We calculated the cortical thickness, myelin and iron of the cortex based on T1-weighted, quantitative R1, R2* and susceptibility maps. We used diffusion-weighted imaging to estimate the mean diffusivity of the connecting white matter tracts.We found that cortical thickness, R1, R2* and susceptibility values in the WMH-connected regions were significantly lower than in the WMH-unconnected regions (all Pcorrected &lt; 0.001). Linear regression analyses showed that higher mean diffusivity of the connecting white matter tracts were related to lower thickness (β = −0.30, Pcorrected &lt; 0.001), lower R1 (β = −0.26, Pcorrected = 0.001), lower R2* (β = −0.32, Pcorrected &lt; 0.001) and lower susceptibility values (β = −0.39, Pcorrected &lt; 0.001) of WMH-connected cortical regions at high connectivity level. In addition, lower scores on processing speed were significantly related to lower cortical thickness (β = 0.20, Pcorrected = 0.030), lower R1 values (β = 0.20, Pcorrected = 0.006), lower R2* values (β = 0.29, Pcorrected = 0.006) and lower susceptibility values (β = 0.19, Pcorrected = 0.024) of the WMH-connected regions at high connectivity level, independent of WMH volumes and the cortical measures of WMH-unconnected regions.Together, our study demonstrated that the microstructural integrity of white matter tracts passing through WMH is related to the regional cortical abnormalities as measured by thickness, R1, R2* and susceptibility values in the connected cortical regions. These findings are indicative of cortical thinning, demyelination and iron loss in the cortex, which is most likely through the disruption of the connecting white matter tracts and may contribute to processing speed impairment in SVD, a key clinical feature of SVD. These findings may have implications for finding intervention targets for the treatment of cognitive impairment in SVD by preventing secondary degeneration.
Juvenile and adult expression of polyglutamine expanded huntingtin produce distinct aggregate distributions inDrosophilamuscle
Authors: Barwell Taylor , Raina Sehaj , Page Austin , MacCharles Hayley , Seroude Laurent 
Published: June 2023

AbstractWhile Huntington’s disease (HD) is widely recognized as a disease affecting the nervous system, much evidence has accumulated to suggest peripheral or non-neuronal tissues are affected as well. Here, we utilize the UAS/GAL4 system to express a pathogenic HD construct in the muscle of the fly and characterize the effects. We observe detrimental phenotypes such as a reduced lifespan, decreased locomotion and accumulation of protein aggregates. Strikingly, depending on the GAL4 driver used to express the construct, we saw different aggregate distributions and severity of phenotypes. These different aggregate distributions were found to be dependent on the expression level and the timing of expression. Hsp70, a well-documented suppressor of polyglutamine aggregates, was found to strongly reduce the accumulation of aggregates in the eye, but in the muscle, it did not prevent the reduction of the lifespan. Therefore, the molecular mechanisms underlying the detrimental effects of aggregates in the muscle are distinct from the nervous system.
HIV-Positive Liver Transplant Does not Alter the Latent Viral Reservoir in Recipients With Antiretroviral Therapy-Suppressed HIV
Authors: Benner Sarah E , Zhu Xianming , Hussain Sarah , Florman Sander , Eby Yolanda , Fernandez Reinaldo E , Ostrander Darin , Rana Meenakshi , Ottmann Shane , Hand Jonathan , Price Jennifer C , Pereira Marcus R , Wojciechowski David , Simkins Jacques , Stosor Valentina , Mehta Sapna A , Aslam Saima , Malinis Maricar , Haidar Ghady , Massie Allan , Smith Melissa L , Odim Jonah , Morsheimer Megan , Quinn Thomas C , Laird Gregory M , Siliciano Robert , Balagopal Ashwin , Segev Dorry L , Durand Christine M , Redd Andrew D , Tobian Aaron A R 
Published: June 2023

Abstract
The latent viral reservoir (LVR) remains a major barrier to HIV-1 curative strategies. It is unknown whether receiving a liver transplant from a donor with HIV might lead to an increase in the LVR because the liver is a large lymphoid organ. We found no differences in intact provirus, defective provirus, or the ratio of intact to defective provirus between recipients with ART-suppressed HIV who received a liver from a donor with (n = 19) or without HIV (n = 10). All measures remained stable from baseline by 1 year posttransplant. These data demonstrate that the LVR is stable after liver transplantation in people with HIV.
Clinical Trials Registration. NCT02602262 and NCT03734393.
Supporting the helpers: what do peer deliverers of HIV interventions need to sustain their implementation efforts?
Authors: Jaramillo Jahn , Harkness Audrey 
Published: June 2023

Abstract
Peer-led HIV interventions are an increasingly common and low-cost strategy to address shortages of professionally trained health workers for implementing evidence-based HIV prevention and treatment interventions to populations who experience health disparities. There is a need to understand the experiences and unmet needs of this essential workforce responsible for implementing and delivering HIV interventions to ensure their implementation efforts are sustainable. This commentary provides a brief overview of barriers to peer deliverers’ sustained engagement in the HIV workforce and potential implementation strategies to promote the sustainment of peer deliverers’ implementation efforts.
Physicians’ Clinical Behavior During Fluid Evaluation Encounters
Authors: Syed Muhammad K. Hayat , Pendleton Kathryn , Park John , Weinert Craig 
Published: June 2023

OBJECTIVES:
We sought to identify factors affecting physicians’ cognition and clinical behavior when evaluating patients that may need fluid therapy.

BACKGROUND:
Proponents of dynamic fluid responsiveness testing advocate measuring cardiac output or stroke volume after a maneuver to prove that further fluids will increase cardiac output. However, surveys suggest that fluid therapy in clinical practice is often given without prior responsiveness testing.

DESIGN:
Thematic analysis of face-to-face structured interviews.

SETTING:
ICUs and medical-surgical wards in acute care hospitals.

SUBJECTS:
Intensivists and hospitalist physicians.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We conducted 43 interviews with experienced physicians in 19 hospitals. Hospitalized patients with hypotension, tachycardia, oliguria, or elevated serum lactate are commonly seen by physicians who weigh the risks and benefits of more fluid therapy. Encounters are often with unfamiliar patients and evaluation and decisions are completed quickly without involving other physicians. Dynamic testing for fluid responsiveness is used much less often than static methods and fluid boluses are often ordered with no testing at all. This approach is rationalized by factors that discourage dynamic testing: unavailability of equipment, time to obtain test results, or lack of expertise in obtaining valid data. Two mental calculations are particularly influential: physicians’ estimate of the base rate of fluid responsiveness (determined by physical examination, chart review, and previous responses to fluid boluses) and physicians’ perception of patient harm if 500 or 1,000 mL fluid boluses are ordered. When the perception of harm is low, physicians use heuristics that rationalize skipping dynamic testing.

LIMITATIONS:
Geographic limitation to hospitals in Minnesota, United States.

CONCLUSIONS:
If dynamic responsiveness testing is to be used more often in routine clinical practice, physicians must be more convinced of the benefits of dynamic testing, that they can obtain valid results quickly and believe that even small fluid boluses harm their patients.
Atypical Erythema Multiforme, a Clinical Mimicker of Monkeypox
Authors: Njoroge Alexander , Maramara Bennadette , Saldivar Miguel 
Published: June 2023

Abstract
Erythema multiforme (EM) is a skin eruption caused by a variety of triggers and may be misdiagnosed. Infection, most commonly with herpes simplex virus, has been linked to the development of EM. Mycoplasma pneumoniae is a rare but known cause in adults. Classically described as target lesions, atypical EM lacks the concentric areas of circular erythema bordered by clear zones. We present a case of atypical EM in a 71-year-old man with acute Mycoplasma pneumoniae to highlight the natural alterations of EM in a nonimmunocompromised host.
Clinical guidelines recommending prosthetics and orthotics in Sweden: Agreement between national and regional guidelines
Authors: Hellstrand Tang Ulla , Jarl Gustav , Eriksson Marie , Johannesson G. Anton , Rusaw David F. 
Published: June 2023

Background:
Despite the presence of both national and regional clinical practical guidelines (CPGs) in Sweden, no previous studies have investigated the quality of CPGs or the level of agreement between national and regional CPGs.

Objective(s):
This study aimed to assess the quality of national CPGs recommending prosthetics and orthotics (P&O) and quantify the agreement between national and regional CPGs in Sweden.

Study design:
Literature Review.

Methods:
National and regional CPGs were identified in public databases and by surveyed local nurse practitioners. Quality of the national guidelines was assessed by using AGREE II. Agreement between recommendations in the national and regional CPGs was quantified on a 4-grade rating scale (“similar,” “partially similar,” “not similar/not present,” and “different”).

Results:
Of 18 national CPGs, 3 CPGs (CPGs of Diabetes, Musculoskeletal disorders, and Stroke) had 9 recommendations related to P&O. The Musculoskeletal disorders and Stroke CPGs had quality scores .60% in all domains, and the Diabetes CPG had scores .60% in 5 of 6 domains according to AGREE II. Seven regional CPGs for P&O treatment were identified. Three national recommendations (in Diabetes CPGs) showed “similar” content for all regions, and 2 national recommendations (in Diabetes CPGs) showed “not similar” content for all regions. The remaining recommendations (Diabetes, Musculoskeletal disorders, and Stroke CPGs) had varying agreement with regional CPGs.

Conclusions:
There is a limited number of national recommendations for treatment within P&O. There was variation in the agreement of P&O–related recommendations in national and regional CPGs, which might lead to unequal care throughout the national healthcare system.
Keep it CooL! Results of a two-year CooL-intervention: a descriptive case series study
Authors: Philippens Nicole , Janssen Ester , Kremers Stef , Crutzen Rik 
Published: June 2023

AbstractBackgroundCoaching on Lifestyle (CooL) is a two-year healthcare intervention for people with overweight or obesity, stimulating weight reduction by promoting sustained healthier behavior. The objective of this study is to investigate the effects of CooL on participants’ anthropometrics, personal factors and behavioral factors over the two-year timeframe of CooL.MethodsA descriptive case series study, using a broad set of routinely collected data on anthropometrics, personal factors and behavioral factors of adults living across the Netherlands. The data were collected between November 2018 and December 2021 among participants of CooL (N=746) at three moments during the intervention: at baseline (T0), at 8 months (T1) after completion of phase 1 and at 24 months (T2) after ending CooL. Changes over time were analyzed using paired t-tests comparing baseline to T1 and baseline to T2. In addition, potential differences on outcomes in subgroups based on education level, weight status and group size were examined using paired t-tests and ANOVA-tests.ResultsThe results showed changes in the desired direction on all outcomes at 24 months compared to baseline. The largest effects were seen on perceived health, attentiveness towards meal size and meal composition (large effect size). Mean weight loss was 4.13 kilograms (SD 7.54), and mean waist circumference decreased with 4.37 centimeters (SD 8.59), indicating a medium to large effect size. Changes in outcomes were similar across all subgroups consisting of participants with different educational level, BMI at baseline and in different group sizes.ConclusionThe study showed sustained effects in weight-related outcomes of CooL over the timeframe of 24 months supporting the two-year set-up of CooL. The outcomes indicate that CooL is appropriate and effective for different group sizes and for a wide variety of participants irrespective of gender, age, BMI at baseline or level of education.
Stimulatory effect of monoacylglycerol lipase inhibitor MJN110 on locomotion and step kinematics demonstrated by high-precision 3D motion capture in mice
Authors: Ignatowska-Jankowska Bogna M. , Gurkan Ozer Aysen , Kuck Alexander , Niphakis Micah J. , Ogasawara Daisuke , Cravatt Benjamin F. , Uusisaari Marylka Y. 
Published: June 2023

AbstractThe neuromodulatory endocannabinoid system is a promising target for therapeutic interventions. One of the well-known behavioral effects of cannabinoid CB1receptor activation with exogenous ligands such as THC is the inhibition of locomotor activity. However, the behavioral effects of endogenous cannabinoids are not understood. Enhancing endocannabinoid signaling offers an advantageous therapeutic strategy with limited cannabimimetic side effects, but their effects on motor function remain unclear. To reveal even the finest changes in motor function during voluntary locomotor tasks in mice, we adapted a high-speed, high-resolution marker-based motion capture, which so far has not been available in freely moving mice. Here we show that inhibition of distinct endocannabinoid metabolic pathways produces opposite effects on locomotor behavior that differ from those induced by exogenous cannabinoid receptor ligands. Selective upregulation of endocannabinoids 2-arachidonoylglycerol (2-AG) or N-arachidonoylethanolamine (AEA, anandamide) with inhibitors of their degradation (MJN110 and PF3845, respectively), produced bidirectional effects: MJN110 enhanced and PF3845 suppressed locomotor activity. Consistent differences in whole-body movement and precise step kinematics were found under distinct treatments, while analysis of locomotory episodes revealed invariant temporal microstructure, pointing towards motivational rather than motor-related mechanisms of action. The results show that the effects of manipulations of endocannabinoid system on locomotion are more diverse than previously assumed and result in distinct kinematic phenotypes.
Self-perceived communication competence of adults who stutter following Communication-Centered Treatment (CCT)
Authors: Coalson Geoffrey A. , Werle Danielle , Croft Robyn , Byrd Courtney T. 
Published: June 2023

AbstractPurposeThe purpose of this study was to assess self-perceived communication competence of adults who stutter following a unique treatment program – Communication-Centered Treatment (CCT) – that focuses on communication competence as one of four clinical goals of the Blank Center CARE Model™(Communication, Advocacy, Resiliency, Education).MethodThirty-three adults who stutter completed the Self-Perceived Communication Competence scale (McCroskey & McCroskey, 1988) before and after their CCT program.ResultsFindings indicate significant gains in self-perceived communication competence post- treatment across four speaking contexts (public presentation, large meeting, small group interaction, dyadic interaction) and three audience types (strangers, acquaintances, friends). Pre- treatment stuttering frequency did not predict post-treatment gains in communication competence.ConclusionsAdults who stutter consider themselves stronger communicators following a treatment designed to increase communication competence. [ClinicalTrials.govNCT05908123;https://clinicaltrials.gov/show/NCT05908123]
Automated Detection of Maternal Vascular Malperfusion Lesions of the Placenta using Machine Learning
Authors: Patnaik Purvasha , Khodee Afsoon , Vasam Goutham , Mukherjee Anika , Salsabili Sina , Ukwatta Eranga , Grynspan David , Chan Adrian D. C. , Bainbridge Shannon 
Published: June 2023

AbstractIntroductionHypertensive disorders of pregnancy (HDP) and fetal growth restriction (FGR) are common obstetrical complications, often with pathological features of maternal vascular malperfusion (MVM) in the placenta. Currently, clinical placental pathology methods involve a manual visual examination of histology sections, a practice that can be resource-intensive and demonstrate moderate-to-poor inter-pathologist agreement on diagnostic outcomes, dependant on the degree of pathologist sub-specialty training.MethodsThis study aims to apply machine learning (ML) feature extraction methods to classify digital images of placental histopathology specimens, collected from cases of HDP [gestational hypertension (GH), preeclampsia (PE), PE + FGR], normotensive FGR, and healthy pregnancies, according to the presence or absence of MVM lesions. 159 digital images were captured from histological placental specimens, manually scored for MVM lesions (MVM- or MVM+) and used to develop a support vector machine (SVM) classifier model, using features extracted from pretrained ResNet18. The model was trained with and without data augmentation, and with and without data shuffling, and the performance of the classifiers assessed and compared through measurements of accuracy, precision, and recall using confusion matrices.ResultsThe SVM model demonstrated accuracies between 7-78% for WSI-level MVM classification, with poorest performance observed on images with borderline MVM presence, as determined through post hoc observation.ConclusionThe results are promising for the integration of ML methods into the placental histopathological examination process. Using this study as a proof-of-concept will lead our group and others to carry ML models further in placental histopathology.
A comprehensive overview of the Chloroflexota community in wastewater treatment plants worldwide
Authors: Petriglieri Francesca , Kondrotaite Zivile , Singleton Caitlin , Nierychlo Marta , Dueholm Morten K. D. , Nielsen Per H. 
Published: June 2023

AbstractFilamentous Chloroflexota are abundant in activated sludge wastewater treatment plants (WWTPs) worldwide and are occasionally associated with poor solid-liquid separation or foaming, but most of the abundant lineages remain undescribed. Here, we present a comprehensive overview of Chloroflexota abundant in WWTPs worldwide, using high-quality metagenome-assembled genomes (MAGs) and 16S rRNA amplicon data from 740 Danish and global WWTPs. Many novel taxa were described, encompassing 4 families, 13 genera and 29 novel species. These were widely distributed across most continents, influenced by factors such as climate zone and WWTP process design. Visualization by fluorescencein situhybridization (FISH) confirmed their high abundances in many WWTPs based on the amplicon data and showed a filamentous morphology for nearly all species. Most formed thin and short trichomes integrated into the floc structure, unlikely to form the typical inter-floc bridging that hinders activated sludge floc settling. Metabolic reconstruction of 53 high-quality MAGs, representing most of the novel genera, offered further insights into their versatile metabolisms and suggested a primary role in carbon removal and involvement in nitrogen and sulfur cycling. The presence of glycogen reserves, detected by FISH-Raman microspectroscopy, seemed widespread across the phylum demonstrating that these bacteria likely utilize glycogen as an energy storage to survive periods with limited resources. This study gives a broad overview of the Chloroflexota community in global activated sludge WWTPs and improves our understanding of their roles in these engineered ecosystems.ImportanceChloroflexota are often abundant members of the biomass in wastewater treatment plants (WWTPs) worldwide, typically with a filamentous morphology, forming the backbones of the activated sludge (AS) floc. However, their overgrowth can often cause operational issues connected to poor settling or foaming, impairing effluent quality and increases operational costs. Despite the importance, few Chloroflexota genera have been characterized so far. Here, we present a comprehensive overview of Chloroflexota abundant in WWTPs worldwide and an in-depth characterization of their morphology, phylogeny, and ecophysiology, obtaining a broad understanding of their ecological role in activated sludge.