bluuebunny/crossref_metadata_2025_split huggingface dataset:
1325 Impact of the VFC in Fracture Clinic Referral Times
Authors: Akhteruzzaman T , Khan O , Zarifian A , Abdus Samee M 
Published: August 2023

Abstract

Aim
According to BOAST guidelines, patients should be seen in fracture clinic within 72 hours of presentation, following acute traumatic orthopaedic injury. Our audit aimed to assess the efficacy of a Virtual Fracture Clinic (VFC) in meeting the standard of care outlined by the guidelines.

Method
A retrospective review of notes was carried out for patients seen in fracture clinic on a random week before the VFC was introduced and a random week after VFC was introduced. Incomplete records and follow up referrals were excluded.

Results
A total of 51 new patients were seen on a random week in clinic prior to VFC introduction. The range of time before clinic review was 1 - 17 days, with a mean of 6 days. 83% of patients were seen later than 72 hours. After introduction of VFC, 44 patients were seen on a random week. Range was 1 - 11 days, with a mean 3.6 days. Only 5% were seen later than 72 hours.

Conclusions
Introduction of the VFC ensured BOAST guidelines for time to be seen in clinic were met for 95% of patients. Delays in seeing patients are generally cut to at least half. Suggestions for further improvement in time to be seen include increasing the capacity of virtual clinics and making a separate triage for trauma patients in A&E.
147 Pre-Operative Urine Culture for Endourology Surgeries
Authors: Maniarasu S , McNicholas D P , Iordan N 
Published: August 2023

Abstract

Aim
Our aim was to reduce post-operative endourology infection rates by screening all patient pre-operatively with urine culture. Our local guidelines recommend single dose Gentamicin for prophylaxis prior to endourology procedures. Pre-operative urine culture can identify patients with positive cultures to be treated prior to surgery and to identify multi-resistant microorganisms to aid alternative antibiotic prophylaxis choice.

Method
We identified patients that underwent elective endourological surgeries in a 3-month period (July-September2021). We identified if pre-operative urine cultures were performed, if the cultures were positive and were they treated appropriately. We identified if any patients had re-admissions postoperatively within 30 days of their procedure with UTI. We identified if the microorganism grown in the culture was resistant to Gentamicin and if an alternative prophylaxis was given pre-operatively.

Results
104 patients were identified. 65 had pre-operative cultures done. Of the 39 patients that did not have cultures done, 2 were re-admitted within 30 days with UTI. 14 pre-operative cultures were positive (21.5%) and was treated with a course of antibiotics per sensitivities and Gentamicin pre-operatively. 4 were resistant to Gentamicin (6.2%). An alternative prophylactic antibiotic was used per microbiologist’s advice for those resistant. No one was re-admitted with a UTI within 30 days in the group that had pre-operative cultures done.

Conclusions
Around 1 in 5 urine cultures done was positive for growth. Almost a third of this was resistant to Gentamicin and this aided our choice of alternative prophylactic treatment. By performing pre-operative cultures, we reduced our postoperative infection complication and re-admission rates.
624 Medication Cessation Post-TURP: Are We Getting It Right?
Authors: Guven T , Gillams K , Pignatari R , Aldesouki A , Beck R 
Published: August 2023

Abstract

Aim
Most patients who have a TURP should be advised to discontinue medication for bladder outflow obstruction secondary to benign prostate hyperplasia (BPH) after their surgery. This closed loop QIP audited whether this was the case, presented the findings to the department and re-audited to see whether there had been a decrease in continuing unnecessary post-TURP medication.

Method
The QIP began in October 2020 with a retrospective review of 50 patients that underwent a TURP at a large district general hospital. Patient records were reviewed to ascertain if patients were taking alpha-blockers (ABs) or 5 alpha-reductase inhibitors (5ARIs) pre-operatively, and if these were discontinued post-procedure. Any instruction to continue medication post-operatively was noted in the data collection.
This data was presented at a departmental research and audit meeting. The second QIP cycle used the same data collection methodology for the subsequent 50 patients who underwent a TURP (June 2021).

Results
The presentation resulted in a statistically significant decrease in unclear documentation 30% to 10% (p = .0124). Although there was an increase medication discontinuation post-TURP (27.3% to 48%) this wasn’t statistically significant (p = .246). The percentage of patients who were continued on an AB or 5ARI post-op without documentation decreased from 63.3% to 48%, but this change was also not statistically significant (p = .384).

Conclusions
Simple departmental audits help improve patient safety through clearer documentation and presentation of new literature. It would be beneficial to produce clear guidelines to patients and their primary care physicians to advise to discontinue BPH medication TURP unless otherwise advised by the urologist.
679 Regional Closed Loop Audits on Quality Predictive Indicators of Renal Cell Carcinoma Management in Northern Ireland
Authors: Simon N , Curry D , Devine A 
Published: August 2023

Abstract

Aim
To conduct a full cycle Regional Audit in Northern Ireland to assess the ten Quality Predictive Indicators (QPI) in the management of Renal Cell Carcinoma (RCC) as per National Cancer Quality Steering Group (NCQSG) of NHS Scotland. Each cycle lasted for 6 months.

Method
QPIs were assessed in four major domains such as radiological, histological, surgical and pre-treatment performance indicators in the management of RCC. Using the Northern Ireland Electronic Care record, data were collected, recorded in MS Excel and analysed and arrived at conclusions. The results were compared with NHS Scotland RCC audit reports published in August 2019 and October 2022.

Results
In audit cycle 1, NCGSQ targets of quality prediction was achieved in 3 QPIs (Nephron Sparing Surgery, Trifecta rate and 30/90 mortality rate) among the 10 QPIs. In Audit Cycle 2, additional 4 NCGSQ targets were achieved namely- pre-treatment CT/MRI, Histodiagnosis in cryotherapy, histodiagnosis in chemotherapy and MDT discussion.

Conclusions
There has been significant improvement in all QPIs in the management of Renal Cell Carcinoma in Northern Ireland during the audited period. We have achieved NCGSQ quality performance indicator targets in 7 among the 10 QPIs that were audited. Further interventions may be required to achieve targets in QPIs such as Leibovich scoring, pre-treatment TNM staging and prognostic scoring in metastatic RCC.
864 Does the PROMIS Trial Deliver What It Promised? Validation in a North West Population
Authors: Brenac S , Nambirajan T 
Published: August 2023

Abstract

Aim
The PROMIS trial changed the landscape on how men with raised PSA are evaluated. We changed the pathway at a North West hospital, utilising multiparametric MRI (MP-MRI) scans and incorporated additional safety parameters (family history and PSA density) to maintain the advantage of avoiding unnecessary biopsy whilst not missing significant cancers. We present the performance of this pathway.

Method
We retrospectively reviewed 596 referrals of men with high PSA level between January - December 2021. Variables audited included demographics, PSA level, PSA density, Prostate Imaging-Reporting and Data System (PI-RADS) score on MP-MRI, biopsy results, Gleason score and prognostic grade grouping.

Results
Of 596 patients, 65.9% of men were aged between 50-75 years. The most common quintile of presenting PSA was 4.00-9.99 (53.2%). Of the 381 patients with non-metastatic prostate cancer who underwent MP-MRI, 38.3% were classed as PI-RAD 1-2, 16% PI-RAD 3 and 45.7% PI-RAD 4-5. Overall, 48.3% of patients did not undergo biopsy. Biopsy rates in PI-RAD 1-5 were 2.3%, 3.9%, 52.5%, 92.5% and 91.5% respectively, the decision made to monitor PSA instead in some cases due to co-morbidities or patient preference. Of 197 biopsies, 79.2% were positive, 87.8% initially classed as PI-RADS 4 or 5. Of the cancers picked up, 82.1% were clinically significant (Gleason score ≥3+4).

Conclusions
This study shows the pathway incorporating MP-MRI, family history and PSA density enables 48.3% of patients to avoid unnecessary biopsy and therefore overdiagnosis of clinically insignificant cancers. The PROMIS trial delivers what it promised.
1270 Elevated PSA in Elderly Men
Authors: Debo-Aina A , Farag F , Rafiq M 
Published: August 2023

Abstract

Introduction
Elevated PSA is a common urological cancer pathway referral. Investigating older men can result in overdiagnosis and overtreatment. Routine screening for prostate cancer is not recommended. Current NICE guidelines advice referring PSAs &gt; 3 in 50-69-years, but no guidelines exist for elderly patients (&gt;80-years).

Aim
1)To identity the number of elderly men investigated under the 2WW pathway for elevated PSA. 2) Review of outcomes of newly diagnosed prostate-cancer in the elderly with PSA &lt;20ng/ml.

Method
Retrospective data between Jan 2020-July 2021 identified 108 patients ≥ 80-years referred with elevated PSA: 38% with PSA ≤10ng/ml (n = 60), 32% with PSA 10ng-19/ml (n = 51). Patients were classified according to age-group; 1) 80-85-years, 2) 86-90-years, 3) &gt;90-years. A further sub-group within each age-group according to PSA: 1) PSA 0-10ng/ml and 2) PSA 10-19ng/ml.

Results
45% (n = 18) of &lt;85-years (n = 40) with PSA &lt;10ng/ml progressed to investigations with MRI (n = 16), TP-biopsy(n = 12) and bone-scan (n = 9). Within this group 17.5%(n = 7) were treated with hormone and/or radiotherapy. In a similar cohort (n = 32) with PSA 10-19ng/ml 56% (n = 18) were investigated (MRI n = 11, TP-biopsy n = 6, and bone-scan n = 13), of which 15.6% (n = 5) had hormone and/or radiotherapy. Men aged 86-90-years 5.6% (n = 1) and 53.8% (n = 7) had bone-scans only for respective PSA &lt;10ng/ml (n = 18), and 10-19ng/ml(n = 13) group. Men &gt;90-years had no investigations. Men &gt;85-years had no treatment.

Conclusions
11% of 80-85 years-old with PSA &lt;20ng/ml received hormone or radiotherapy. Managing elevated PSA in the elderly is a contentious issue, requiring further large-study investigations, and new guidelines to avoid over-diagnosis and investigation.
The EvMed Assessment
Authors: Misheva Taya , Nesse Randolph M , Grunspan Daniel Z , Brownell Sara E 
Published: August 2023

Abstract

Background and objectives
Universities throughout the USA increasingly offer undergraduate courses in evolutionary medicine (EvMed), which creates a need for pedagogical resources. Several resources offer course content (e.g. textbooks) and a previous study identified EvMed core principles to help instructors set learning goals. However, assessment tools are not yet available. In this study, we address this need by developing an assessment that measures students’ ability to apply EvMed core principles to various health-related scenarios.

Methodology
The EvMed Assessment (EMA) consists of questions containing a short description of a health-related scenario followed by several likely/unlikely items. We evaluated the assessment’s validity and reliability using a variety of qualitative (expert reviews and student interviews) and quantitative (Cronbach’s α and classical test theory) methods. We iteratively revised the assessment through several rounds of validation. We then administered the assessment to undergraduates in EvMed and Evolution courses at multiple institutions.

Results
We used results from the pilot to create the EMA final draft. After conducting quantitative validation, we deleted items that failed to meet performance criteria and revised items that exhibited borderline performance. The final version of the EMA consists of six core questions containing 25 items, and five supplemental questions containing 20 items.

Conclusions and implications
The EMA is a pedagogical tool supported by a wide range of validation evidence. Instructors can use it as a pre/post measure of student learning in an EvMed course to inform curriculum revision, or as a test bank to draw upon when developing in-class assessments, quizzes or exams.
DNA cytosine methylation dynamics and functional roles in horticultural crops
Authors: Liu Peipei , Liu Ruie , Xu Yaping , Zhang Caixi , Niu Qingfeng , Lang Zhaobo 
Published: August 2023

Abstract
Methylation of cytosine is a conserved epigenetic modification that maintains the dynamic balance of methylation in plants under the regulation of methyltransferases and demethylases. In recent years, the study of DNA methylation in regulating the growth and development of plants and animals has become a key area of research. This review describes the regulatory mechanisms of DNA cytosine methylation in plants. It summarizes studies on epigenetic modifications of DNA methylation in fruit ripening, development, senescence, plant height, organ size, and under biotic and abiotic stresses in horticultural crops. The review provides a theoretical basis for understanding the mechanisms of DNA methylation and their relevance to breeding, genetic improvement, research, innovation, and exploitation of new cultivars of horticultural crops.
Role of methylation in vernalization and photoperiod pathway: a potential flowering regulator?
Authors: Shi Meimei , Wang Chunlei , Wang Peng , Yun Fahong , Liu Zhiya , Ye Fujin , Wei Lijuan , Liao Weibiao 
Published: August 2023

Abstract
Recognized as a pivotal developmental transition, flowering marks the continuation of a plant’s life cycle. Vernalization and photoperiod are two major flowering pathways orchestrating numerous florigenic signals. Methylation, including histone, DNA and RNA methylation, is one of the recent foci in plant development. Considerable studies reveal that methylation seems to show an increasing potential regulatory role in plant flowering via altering relevant gene expression without altering the genetic basis. However, little has been reviewed about whether and how methylation acts on vernalization- and photoperiod-induced flowering before and after FLOWERING LOCUS C (FLC) reactivation, what role RNA methylation plays in vernalization- and photoperiod-induced flowering, how methylation participates simultaneously in both vernalization- and photoperiod-induced flowering, the heritability of methylation memory under the vernalization/photoperiod pathway, and whether and how methylation replaces vernalization/photoinduction to regulate flowering. Our review provides insight about the crosstalk among the genetic control of the flowering gene network, methylation (methyltransferases/demethylases) and external signals (cold, light, sRNA and phytohormones) in vernalization and photoperiod pathways. The existing evidence that RNA methylation may play a potential regulatory role in vernalization- and photoperiod-induced flowering has been gathered and represented for the first time. This review speculates about and discusses the possibility of substituting methylation for vernalization and photoinduction to promote flowering. Current evidence is utilized to discuss the possibility of future methylation reagents becoming flowering regulators at the molecular level.
Why Pandemics and Climate Change Are Hard to Understand and Make Decision-Making Difficult
Authors: Dix Alan , Bond Raymond , Caraban Ana 
Published: August 2023

AbstractThis paper draws on diverse psychological, behavioural and numerical literature to understand some of the challenges we all face in making sense of large-scale phenomena and use this to create a road map for HCI responses. This body of knowledge offers tools and principles that can help HCI researchers deliver value now, but also highlights challenges for future HCI research. The paper is framed by looking at patterns and information that highlight some of the common misunderstandings that arise—not just for politicians and the general public but also for many in the academic community. This paper does not have all the answers to this, but we hope it provides some and, perhaps more importantly, raises questions that we need to address as scientific and technical communities.
Integrating REDCap patient-reported outcomes with the HealtheIntent population health platform: proof of concept
Authors: Espinoza Juan , Tut Maurice , Shah Payal , Kingsbury Paul , Nagaraj Gayathri , Meeker Daniella , Bahroos Neil 
Published: August 2023

Abstract

Objective
Patient-reported outcome measures (PROMs) are critical to drive patient-centered care and to understanding patients’ perspectives on their health status, quality of life, and the overall effectiveness of the care they receive. PROMs are increasingly being used in clinical and research settings, but the mechanisms to aggregate data from different systems can be cumbersome.

Materials and methods
As part of an FDA Real-World Evidence demonstration project, we enriched routine care clinical data from our Cerner electronic health record (EHR) with PROMs collected using REDCap. We used SSIS, sFTP, and the REDCap Application Programming Interface to aggregate both data sources into the Cerner HealtheIntent Population Health Platform.

Results
We successfully built dashboards, reports, and datasets containing both REDCap and EHR data collected prospectively.

Discussion
This technically straightforward approach using commonly available clinical and research tools can be readily adopted and adapted by others to better integrate PROMs with clinical data sources.
Development and validation of a sensitive LC–MS-MS method to quantify psilocin in authentic oral fluid samples
Authors: Cardoso Marilia Santoro , da Cunha Kelly Francisco , Silva Izabelly Geraldes , Fiorentin Taís Regina , de Campos Eduardo G , Costa Jose Luiz 
Published: August 2023

Abstract
Psilocin is an active substance and a dephosphorylated product of psilocybin formed after the ingestion of mushrooms. The low stability caused by the quick oxidation of this analyte requires sensitive methods for its determination in biological matrices. In this work, we described the development, optimization and validation of a method for the quantification of psilocin in authentic oral fluid samples by liquid chromatography–tandem mass spectrometry. Liquid–liquid extraction was performed using 100 µL of oral fluid samples collected with a Quantisal™ device and t-butyl methyl ether as the extraction solvent. The method showed acceptable performance, with limits of detection and quantification of 0.05 ng/mL, and the calibration model was achieved between 0.05 and 10 ng/mL. Bias and imprecision results were below −14.2% and 10.7%, respectively. Ionization suppression/enhancement was lower than −30.5%, and recovery was &gt;54.5%. Dilution integrity bias was &lt;14.4%. No endogenous and exogenous interferences were observed upon analyzing oral fluid from 10 different sources and 56 pharmaceuticals and drugs of abuse, respectively. No carryover was observed at 10 ng/mL. Psilocin was stable in oral fluid at −20°C, 4°C and 24°C up to 24, 72 and 24 h, respectively, with variations &lt;17.7%. The analyte was not stable after three freeze/thaw cycles, with variations between −73% and −60%. This suggests the instability of psilocin in oral fluid samples, which requires timely analysis, as soon as possible after the collection. The analyte remained stable in processed samples in an autosampler (at 10°C) for up to 18 h. The method was successfully applied for the quantification of five authentic samples collected from volunteers attending parties and electronic music festivals. Psilocin concentrations ranged from 0.08 to 36.4 ng/mL. This is the first work to report psilocin concentrations in authentic oral fluid samples.
Plasma exchange as a tool for removal of bevacizumab: Highlighting application for urgent surgery
Authors: Neth Bryan J , Winters Jeffrey L , Sairaj Revathi Thirumushi , Gharibi Loron Ali , Rahman Masum , Hirte Renee , Riviere-Cazaux Cecile , Ruff Michael W , Burns Terry C 
Published: August 2023

Abstract

Background
Bevacizumab is commonly used to manage cerebral edema associated with brain tumors. However, its long half-life poses challenges for patients requiring urgent surgery due to wound complications. We present a case of utilizing therapeutic plasma exchange (TPE) to remove bevacizumab in a patient with recurrent glioblastoma requiring urgent surgery.

Methods
A 58-year-old male with recurrent glioblastoma, IDH-wildtype, presented with clinical and radiographic concern for ventriculitis requiring urgent wound washout only 4 days after his last bevacizumab infusion. TPE was performed for 3 sessions after surgery using a centrifugation-based cell separator. Replacement fluids included normal serum albumin, normal saline, and fresh frozen plasma. Bevacizumab levels were quantified using an enzyme-linked immunoabsorbent assay before and after each TPE session.

Results
TPE effectively removed bevacizumab, enabling safe surgery without new complications. Plasma bevacizumab levels decreased from 1087.63 to 145.35 ng/mL (13.4% of original) by the end of the last TPE session. This decline is consistent with nearly 3 half-lives, which compares favorably to the expected timeline of natural decline given the 21-day half-life.

Conclusions
We report a complex clinical scenario of a patient requiring urgent wound washout 4 days after last bevacizumab infusion for CNS infection. Surgery was successfully performed without new complications with use of TPE to remove bevacizumab immediately following surgery. This case highlights the feasibility of this approach, which may be utilized effectively in patients requiring surgery after having recently received bevacizumab.
Fear of a Black Neighborhood: Anti-Black Racism and the Health of White Americans
Authors: Louie Patricia , DeAngelis Reed T 
Published: August 2023

Abstract
Does anti-Black racism harm White Americans? We advance hypotheses that address this question within the neighborhood context. Hypotheses are tested with neighborhood and survey data from a probability sample of White residents of Nashville, Tennessee. We find that regardless of neighborhood crime rates or socioeconomic compositions, Whites report heightened perceptions of crime and danger in their neighborhoods as the proportion of Black residents increases. Perceived neighborhood danger, in turn, predicts increased symptoms of psychophysiological distress. When stratified by socioeconomic status (SES), however, low-SES Whites also report perceptions of higher status when living near more Black neighbors, which entirely offsets their distress. We conclude that although anti-Black racism can ironically harm the health of White Americans, compensatory racist ideologies can also offset these harms, particularly for lower-status Whites. We situate our findings within broader discussions of anti-Black racism, residential segregation, and psychiatric disorders commonly observed among White Americans.