bluuebunny/crossref_metadata_2025_split huggingface dataset:
667 EFFECT OF LEUCINE SUPPLEMENTATION ON PHYSICAL PERFORMANCE, MUSCLE MASS AND QUALITY OF LIFE IN OLDER PEOPLE WITH SARCOPENIA
Authors: Witham M D , Adamson S , Avenell A , Band M M , Donnan P T , George J , Hapca A , Hume C , Kemp P , McKenzie E , Pilvinyte K , Smith K , Struthers A D , Sumukadas D ,   for the LACE study group
Published: March 2022

Abstract

Introduction
Leucine supplementation improves muscle protein synthesis in physiological studies and has been proposed as a treatment to improve muscle mass and physical performance. We tested the effects of leucine supplementation in a randomised controlled trial enrolling patients with sarcopenia.

Methods
We conducted a placebo-controlled, parallel group, double-blind, randomised two-by-two factorial trial. Participants aged 70 and over with low muscle mass by bioimpedance and either low grip strength or low walk speed, were recruited from 14 UK sites. Participants were randomised to receive one year of leucine powder 2.5 g three times a day or matching placebo, plus perindopril 4 mg once daily or matching placebo. The primary outcome was the between-group difference in the Short Physical Performance Battery, measured at baseline, 6 and 12 months, analysed using repeated-measures mixed models. Secondary outcomes included grip strength, quadriceps strength, six-minute walk distance, appendicular muscle mass measured by dual x-ray absorptiometry, quality of life measured using the EQ5D tool, falls rates and adverse events.

Results
We screened 320 people and randomised 145 participants, mean age 79 (SD 6) years; 78 (54%) were women and the mean SPPB was 7.0 (SD 2.4). 72 were randomised to leucine and 73 to placebo. Median adherence was the same in both groups (76% vs 76%; p &lt; 0.001). Leucine had no significant effect on the primary outcome (adjusted treatment effect 0.1 points [95%CI -1.0 to 1.1]). No significant treatment effect was seen for any secondary outcome. There were similar numbers of adverse events in both groups (leucine 187, placebo 196) and falls rates were similar (leucine 1.9 [95%CI 0.9 to 2.9] per year; placebo 2.9 [95%CI 0.8 to 5.0] per year).

Conclusion
Leucine did not improve measures of physical performance, muscle mass or quality of life in older people with sarcopenia.
768 PREDICTORS OF INDEPENDENCE IN COMMUNITY-DWELLING OLDER PEOPLE
Authors: Taylor E , Goodwin V , Clegg A , Frost J , Ball S 
Published: March 2022

Abstract

Introduction
Many people wish to retain their independence as they age. Therefore, identifying factors that can predict sustainability of independence for older people over time are essential for preventing functional decline and maintaining quality of life.

Method
Longitudinal, health, social and economic data, from community-dwelling older people aged ≥75 years (collected at baseline (BL), 6, 12, 24 and 48 months), were obtained from the ongoing Community Ageing Research (CARE 75+) cohort study. Linear regression models were used to identify predictors of independence. The Nottingham Extended Activities of Daily Living (NEADL) score (range 0–66) at 12 months from BL was the dependent variable (DV) to indicate independence. Independent variables (IV)s were selected based on interviews with CARE75+ participants and known predictors such as, ethnicity and frailty. Each IV was regressed against the DV in univariable analyses. All IVs with p value &lt;0.1 from univariable analyses, including baseline NEADL score, were included in the multivariable model.

Results
Data from 1,277 participants (mean (SD) age 84.61 (4.95); 49% male) were analysed. The multivariable model (adjusted R2: 0.71) showed that, in addition to higher BL NEADL (estimated effect 0.49, 95% confidence interval (CI) 0.41 to 0.58), white ethnicity, good sight, lower level of frailty, ability to perform basic activities of daily living, lower depression score, lower cognitive impairment, younger age, living circumstances, fewer hours of informal support, greater physical functioning and lower pain scores were predictors of a higher NEADL at 12 months (p &lt; 0.05 for all).

Conclusion
As well as physical health, social and psychological variables are important in predicting independence, based on NEADL score, over time. Further research into the mechanisms behind these relationships will be conducted.
677 UTILITY OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING (ABPM) IN PATIENTS WITH ORTHOSTATIC HYPOTENSION (OH) AT SYNCOPE CLINIC
Authors: Arnott A , Reid G , Godwin J , Anderton L , Mitchell L 
Published: March 2022

Abstract

Introduction
OH is a disabling condition resulting from a sustained reduction in blood pressure (&gt;20 systolic or 10 diastolic) within 3 minutes of standing. It is a common cause of syncope. Patients with concurrent hypertension experiencing syncope present a complex management dilemma where a balance must be established between symptom burden and risk of cardiovascular disease. Current guidance on ABPM use in syncope is limited. European society of cardiology syncope guidelines suggest ABPM in patients with ‘autonomic failure’ to assess nocturnal hypertension or drug-induced hypotension. Could this be improved with further explicit criteria on which patients to assess and how to act on results? The objective of this study is to review the use of 24 hour ABPM in OH within a tertiary referral syncope clinic.

Method
A retrospective analysis was performed electronically for patients with a final diagnosis of OH seen in a syncope clinic between March 2017 and May 2019. Data was collected on comorbidities, medication history, physical mobility, clinic blood pressure, ABPM Results: (if performed) and medication changes. Comparisons were made between patients who had ABPM and those who did not. Statistics were calculated using Fisher’s Exact Test (2 tailed).

Results
119 patients had a final diagnosis of OH in the study period. 45 had ABPM, 74 did not. The ABPM group had a significantly higher proportion of diagnosed hypertension (51.1% vs 23% (p = 0.0025)). A similar proportion of patients in both groups had medication changed however the ABPM group were significantly more likely to have antihypertensive therapy added (19.4% vs 1.8% (p = 0.0053)).

Conclusion
Using 24 hour ABPM in OH patients can aid clinical decision making in the sub-group with hypertension. This can guide the need for alteration/addition of antihypertensive therapy to balance optimum BP control with symptom burden.
697 PATIENTS WITH PARKINSONISM AND THEIR CAREGIVERS: A PROTOCOL FOR THE PRIME-UK CROSS-SECTIONAL STUDY
Authors: Tenison E , Lithander F E , Brazier D , Smith M , Ben-Shlomo Y , Henderson E J 
Published: March 2022

Abstract

Introduction
People with parkinsonism (PwP) are a highly heterogeneous group and the condition encompasses a spectrum of motor and nonmotor symptoms which variably emerge and manifest across the disease course, fluctuate over time and negatively impact quality of life. Whilst parkinsonism is not directly the result of ageing, it is a condition that mostly affects older people, who may also be living with frailty and multimorbidity. This study aims to describe a broad range of PwP in relation to their symptomatology, disability, health needs, disease stage, comorbidities and sociodemographics.

Methods
In this cross-sectional study, performed at one site, PwP (excluding those with drug-induced parkinsonism) will be sent a study information pack for themselves and their primary informal caregiver, if relevant. Data are collected via questionnaire, with additional support if required to maximise participation. A specific strategy has been developed to target and proactively recruit patients lacking capacity to consent, including those in residential care settings, with input from a personal consultee prior to completion of a bespoke questionnaire by a representative. Caregivers are also recruited to look at various health outcomes.

Results
Our primary outcome is the frequency of various health outcomes (e.g. depression) and how they cluster together. Linear and logistic regression models will be used to test simple associations and interactions with gender, age group and socio-economic status.

Conclusion
It is necessary to consider the multifaceted problems that PwP experience, together with frailty and comorbidities, in order to fully appreciate the clinical complexity as well as the impact on caregiver well-being. This information is necessary to inform the development of a person-centered, individualised multicomponent intervention to target patients and caregivers most at risk of adverse outcomes. We hope that these findings will inform future intervention trials and improve accessibility to research participation.
738 DETERMINANTS OF MUSCLE DENSITY IN OLDER PEOPLE: FINDINGS FROM THE HERTFORDSHIRE COHORT STUDY (HCS)
Authors: Laskou F , Westbury L D , Fuggle N , Harvey N C , Patel H P , Cooper C , Ward K , Dennison E M 
Published: March 2022

Abstract

Introduction
Lower calf muscle density (CMD) as assessed by peripheral quantitative computed tomography (pQCT) is associated with greater hip fracture risk, independent of FRAX, falls and bone mineral density. To date, muscle density has been little studied, and its determinants are unknown. In this study, we examine the lifestyle and anthropometric determinants of future muscle density (MD) in the HCS.

Methods
197 men and 178 women, aged 59–70 years, were recruited. A lifestyle questionnaire collected information on physical activity, smoking, alcohol consumption and dietary patterns. Height and weight were measured. pQCT of the radius and tibia was performed a median of 11.5 (IQR 10.9, 12.3) years later. MD was measured at calf and forearm using standard methodology. Baseline characteristics in relation to MD at follow-up were examined separately using linear regression with sex, baseline age and follow-up time included as covariates in all models.

Results
Mean (SD) age at baseline was 64.7 (2.7) years; mean (SD) MD values (mg/cm3) were as follows: forearm [men 79.9 (3.1), women 77.2 (3.2)], calf [men 80.7 (2.6), women 78.5 (2.6)]. Baseline correlates (p &lt; 0.05) of both lower forearm and CMD included female sex, lower weight, and lower BMI. SD difference in CMD for women compared to men, and per SD lower weight and BMI were − 0.84 [95%CI: −1.13, −0.54]), −0.37 [−0.46, −0.27] and − 0.31 [−0.40, −0.23] respectively. Additional correlates of lower CMD included older age and shorter stature. Relationships between MD and age were stronger at the calf (p &lt; 0.001) than the forearm (p = 0.08). Lifestyle measures were not associated with MD.

Conclusion
Female sex, older age, and lower BMI were associated with lower MD in older community-dwelling adults, highlighting the need for sustained muscle conditioning in older individuals. Further studies in larger cohorts are required.
746 VALIDITY OF THE CARER DIRECTED NEEDS ASSESSMENT IN DEMENTIA (CANDID) FOR USE IN ADVANCED STAGE DEMENTIA CARE
Authors: O’Connor M , Glenn A , Elissa C 
Published: March 2022

Abstract

Introduction
End of life care for people dying of dementia and their carer/s is a growing area of importance. Unmet needs are coming amongst this group. A tool to identify the needs of this person-carer dyad is a necessary component for providing this care. The aim of this project was to determine the validity of a new tool, the CArer directed NeeDs assessment In Dementia (CANDID), which was developed for use in a randomised trial of end of life dementia care.

Method
Face validity of CANDID was assessed by an expert panel. A narrative review of the literature to evaluate existing tools available for assessing the needs of carers of people with advanced stage dementia was conducted. A sample of ten trial participants independently completed CANDID and the Carer Specific Needs Assessment Tool (CSNAT), which was selected as the reference tool based on the narrative review. The results from CANDID and CSNAT were compared to assess criterion validity. Participants also completed an evaluation survey to determine which tool they preferred, and why. Responses were compared qualitatively and quantitatively.

Results
CANDID has good face validity. There were insufficient participant numbers to establish criterion validity. The majority (n = 8) of participants preferred CANDID. Participants described a preference for a face to face tool with more specific questions.

Conclusion
Participant carers of people dying of dementia in this trial setting preferred a face to face evaluation of needs. Preliminary results from this study suggest that CANDID has face and content validity, and shows promise for criterion validity.
764 ROCKWOOD CLINICAL FRAILTY SCALE TO PREDICT LENGTH OF STAY,INPATIENT MORTALITY & READMISSION RATE IN A COMMUNITY HOSPITAL SETTING
Authors: Daly D , McSorley A 
Published: March 2022

Abstract

Introduction
Frailty is prevalent in elderly patients in acute medical wards. It is recognised that length of stay (LOS), inpatient mortality and readmission rates rise with increasing frailty. (Reference: Specialised Clinical Frailty Network: Clinical frailty Scale. 2018. https://www.scfn.org.uk/clinical-frailty-scale) The Rockwood clinical frailty scale (CFS) is a well-recognised and validated tool, which can be easily incorporated into the comprehensive geriatric assessment to identify the frailest patients and aid in clinical decision making. We collected data on elderly patients in a non-acute community setting to assess the relationship between degree of frailty and outcomes, in this subset of inpatients.

Methods
Data was collected on 200 patients admitted to a geriatrician led community hospital over an 8 month period. Patients were all transferred from the affiliated acute hospital site (both medical and surgical wards).Commonest acute diagnoses were: falls, fractures, infections, delirium and heart failure. Premorbid CFS was recorded and patients were divided into 2 groups: CFS ≤ 4: versus CFS ≥5, and outcomes compared to degree of frailty.

Results
Of 200 patients, aged ≥65 years, admitted from the acute hospital setting to the community hospital,28.5% had premorbid CFS ≤4,and 71.5% had premorbid CFS ≥5. Median LOS in the community hospital was 10 days in the less frail group compared to 13 days in the frailer group. One year emergency readmission rate was 58.5% in those with CFS ≤4,and 67% in those with CFS ≥5.

Conclusion(s)
Accurate recording of premorbid CFS in the non-acute hospital setting can be used to help predict patient outcomes. Used in conjunction with the CGA it is a tool that can aid decision making and prompt discussions with patients and/or families re advance care planning, specifically re suitability of transfer back to the acute hospital setting in the event of a decline in health.
814 GENERAL INTERNAL MEDICINE AND THE GERIATRIC MEDICINE WORKFORCE: RESULTS: OF THE RCP CENSUS AND WELLBEING SURVEY
Authors: Welch C , Copeland C 
Published: March 2022

Abstract

Background
In the UK, most geriatric medicine consultants also contribute to general internal medicine (‘acute take’) services. However, impact on workforce was unclear.

Methods
We used anonymised data available from the Royal College of Physicians (RCP) 2019 census, and the RCP wellbeing snapshot survey conducted in early 2020. We used multivariable analysis of covariance (adjusting for age, gender, nation, NHS academic or other contract type, contribution to general or acute medicine services, and less than full-time working) to assess for differences in mean excess Programmed Activities (PAs) worked above contracted PAs between geriatric medicine and other physician specialties. We used binary logistic regression analysis to assess for satisfaction in own specialty and general medicine (adjusting for variables above), and in perceived excess workload and excess hours (adjusting for age, gender, and nation).

Results
The RCP census included 16,746 consultant physicians, including 1,677 (10%) geriatricians. The wellbeing survey included 2,670 respondents, including 343 (12.8%) geriatricians. Geriatricians reported working excess programmed activities, but fewer than other specialties (adjusted means: 0.74, CI 0.59–0.89 vs. 0.95, CI 0.82–1.07; p &lt; 0.001). Geriatricians were also less likely to report always or often working excess hours (OR 0.61, CI 0.47–0.78; p &lt; 0.001) or having an excess workload (OR 0.60, CI 0.47–0.78; p &lt; 0.001). There were no differences in satisfaction with their own specialty, but geriatricians were more likely to report increased satisfaction with general medicine (OR 1.65, CI 1.30–2.09; p &lt; 0.001).

Conclusion
Physicians, in the UK, frequently report working excess hours beyond their contracted job plans. However, geriatricians report fewer excess hours than other specialties. Geriatricians also report greater perceived satisfaction working in general medicine than other physician specialties.
Prognostic impact of neurohormonal modulation in very old patients with chronic heart failure
Authors: Silva João Enes , Melo Nuno , Ferreira Ana Isabel , Silva Clara , Oliveira Diana , Lume Maria João , Pereira Joana , Araújo José Paulo , Lourenço Patrícia 
Published: March 2022

Abstract

Background
A gap in evidence exists concerning the survival-benefit of neurohormonal blockade in older patients with chronic heart failure (HF). The purpose of our study was to investigate the neurohormonal modulation therapy in older HF patients.

Methods
We retrospectively analysed data on chronic HF patients with systolic dysfunction from January 2012 to May 2018 at a central tertiary academic hospital in Porto, Portugal. Very old (VO) patients were those ≥80 years. Endpoint under analysis: all-cause mortality; patients were followed until January 2021. The prognostic impact of beta-blockers (BBs) and renin-angiotensin system inhibitors (RASi) use was assessed with a Cox-regression analysis adjusting for confounders.

Results
We studied 934 patients, 65.5% male; 45.3% had ischemic HF. BBs were used in 92.2% and RASi in 83.5%; 255 (27.3%) were VO patients. VO more often presented co-morbidities, were more symptomatic, presented worse renal function and higher BNP levels. BB prescription was similar in VO and non-VO patients, however RASi were less used in VO: 74.9% versus 86.7%, respectively. During a median follow-up of 47 months, 479 (51.3%) patients died: 71.4% among VO versus 43.7% in non-VO. BBs increased survival both in non-VO and VO—multivariate adjusted HRs of 0.57 (95% CI: 0.38–0.85) and 0.59 (0.36–0.97), respectively. A survival-benefit was also observed with RASi—adjusted HR of 0.71 (0.50–1.01) and 0.59 (0.42–0.83) in non-VO and VO.

Conclusions
VO patients with chronic HF with systolic dysfunction have a very ominous outcome. Neurohormonal modulation therapy appears to portend survival-benefit also in this particularly vulnerable subgroup of patients.
Epidemiological Survey of Hypertension Among Adolescents in Xuzhou, China
Authors: Zhang Ying , Wang Pei-an , Liu Zhao-qin , Qi Yao , Li Chun-mei , Wang Lei , Xiao Jun-ying , Gong Hai-bin 
Published: March 2022

Abstract

Background
To investigate the regional prevalence of hypertension, overweight, and obesity among adolescents aged 11–17 years in Xuzhou. The relationships between overweight, obesity, abdominal obesity, age, gender, grades, and hypertension were studied.

Methods
The stratified cluster random sampling method was used and the middle school students from the first to the third grade of 10 junior and senior middle schools in Xuzhou were involved. Blood pressure, weight, height, and waist circumference were measured for each participant. Hypertension was diagnosed according to the standards of high blood pressure by gender, age, and height of children aged 3–17 in China in 2017. Overweight and obesity were defined based on the standards of the Chinese Obesity Working Group. Abdominal obesity was defined as waist-to-height ratio &gt;0.46.

Results
A total of 10,004 students aged 11–17 years were enrolled with 4,774 females and 5,230 males. The prevalence of hypertension was 9.8% in all participants, 7.2% in females, and 12.2% in males. There were 1,495 students with obesity (14.9%), and 1,698 with overweight (17.0%). The prevalence of hypertension was 5.6%, 12.8%, and 25.4% in normal weight, overweight, and obese adolescents, respectively. A multivariate analysis showed that males (odd ratio, 95% confidence interval: 1.450, 1.256–1.674), age (1.770, 1.537–2.037), overweight (1.858, 1.465–2.357), obesity (4.010, 3.084–5.214), abdominal obesity (1.497, 1.184–1.892), and third grade (1.488, 1.250–1.772) were risk factors for adolescent hypertension. The risk of hypertension in male adolescents over 14 years old was 2.456 times than that of adolescents under 14 years old, while there was no significant difference in the risk of hypertension between female adolescents over and under 14 years old. In adolescents with normal weight, subjects with abdominal obesity had a much higher risk of hypertension compared with those without abdominal obesity (1.848, 1.334–2.559).

Conclusions
The prevalence of hypertension among adolescent school students in Xuzhou is high. Overweight and obesity are independent risk factors of hypertension in adolescents.
NewWave: a scalable R/Bioconductor package for the dimensionality reduction and batch effect removal of single-cell RNA-seq data
Authors: Agostinis Federico , Romualdi Chiara , Sales Gabriele , Risso Davide 
Published: March 2022

AbstractSummaryWe present NewWave, a scalable R/Bioconductor package for the dimensionality reduction and batch effect removal of single-cell RNA sequencing data. To achieve scalability, NewWave uses mini-batch optimization and can work with out-of-memory data, enabling users to analyze datasets with millions of cells.Availability and implementationNewWave is implemented as an open-source R package available through the Bioconductor project at https://bioconductor.org/packages/NewWave/Supplementary informationSupplementary data are available at Bioinformatics online.
Human cytomegalovirus alters immune cell profile with potential implications for patient survival in head and neck cancer
Authors: Nelson Heather H , Contestabile Emma , Hunter-Schlichting DeVon , Koestler Devin , Pawlita Michael , Waterboer Tim , Christensen Brock C , Petersen Curtis L , Miller Jeffrey S , Kelsey Karl T 
Published: March 2022

AbstractCytomegalovirus (CMV) is a highly prevalent human herpes virus that exerts a strong influence on immune repertoire which may influence cancer risk. We have tested whether CMV immunoglobulin G (IgG) serostatus is associated with immune cell proportions (n = 132 population controls), human papillomavirus (HPV) co-infection and head and neck cancer risk (n = 184 cancer cases and 188 controls) and patient survival. CMV status was not associated with the proportion of Natural Killer cells, B cells or the neutrophil-to-lymphocyte ratio. However, CD8+ T cells increased with increasing categories of IgG titers (P =1.7 × 10−10), and titers were inversely associated with the CD4:CD8 ratio (P = 5.6 × 10−5). Despite these differences in T cell proportions, CMV was not associated with HPV16 co-infection. CMV seropositivity was similar in cases (52%) and controls (47%) and was not associated with patient survival (hazard ratio [HR] 1.14, 95% confidence interval [CI]: 0.70 to 1.86). However, those patients with the highest titers had the worst survival (HR 1.91, 95% CI: 1.13 to 3.23). Tumor-based data from The Cancer Genome Atlas demonstrated that the presence of CMV transcripts was associated with worse patient survival (HR 1.79, 95% CI: 0.96 to 2.78). These findings confirm that a history of CMV infection alters T cell proportions, but this does not translate to HPV16 co-infection or head and neck cancer risk. Our data suggest that high titers and active CMV virus in the tumor environment may confer worse survival.