bluuebunny/crossref_metadata_2025_split huggingface dataset:
776 INTRODUCING TREATMENT ESCALATION PLANS (TEP) FOR OLDER PERSONS: RESPONSE TO THE COVID-19 PANDEMIC
Authors: Woolford S J , Patel H P 
Published: March 2022

Abstract

Introduction
TEP detail appropriate ceilings of care and guide treatment of patients based on shared decision making. TEP documentation was not standard within our trust up to 2018. We aimed to design and introduce a standardised TEP proforma and evaluate its use in older persons aged ≥80.

Methods
Data was obtained from patient notes and questionnaires within the Medicine for Older Persons department (MOP) from four PDSA cycles between 2018–2020. Cycle 1 was a service evaluation. Based on this data, a TEP form was created and approved for use in all adult patients. Cycles 2, 3 and 4 evaluated TEP after introduction of the proforma.

Results
There was a 239% increase in TEP after introduction of the proforma, compared to baseline (cycle 1: n = 14/47 [29.8%], cycle 2: n = 17/112 [15.2%], cycle 3: n = 30/97 [30.9%], cycle 4: n = 42/59 [71.2%]). The increase in TEP between cycles 3 and 4 coincided with the COVID-19 epidemic. Clinicians were more confident in actioning TEP based on the proforma, compared to those written in the notes (cycle 2: 83% confidence vs 54%, cycle 3: 100% vs 35%, Cycle 4: 98% vs none written in the notes). An improvement in understanding the purpose, comprehensiveness and location of TEP forms was observed. Feedback suggested TEP provided clear guidance for 1. ceilings of care; especially useful out of hours 2. discussions with critical care and 3. patient handover between staff and successive shifts.

Conclusion
TEP forms offer clear guidance on ceilings of care. Introduction of the TEP proforma has led to more frequent and proactive discussions with patients on ceilings of care and have facilitated a culture change in the management of older persons. Use of the forms increased during the COVID-19 pandemic but are now viewed as an essential component of patient safety and have been successfully implemented trustwide.
759 RELATIONSHIP BETWEEN G8 AND CFS IN A COHORT OF LUNG CANCER PATIENTS REFERRED TO A SPECIALISED ONCO-GERIATRIC CLINIC
Authors: Dunnett-Kane V , Ayrton L , Ng C 
Published: March 2022

Abstract

Introduction
The International Society of Geriatric Oncology recommends using screening tools to identify cancer patients who would benefit from a comprehensive geriatric assessment. G8, a tool specifically designed for oncology, has been well validated in this setting (1). Rockwood Clinical frailty score (CFS) is a widely used tool to assess frailty, and has been adopted into standard assessments at many sites (2). However, this tool is less well validated in patients with cancer.

Methods
In this single site observational study we recorded CFS and G8 in 89 patients with lung cancer referred to a local onco-geriatrics clinic between 21/10/20 and 5/2/21. Both scores were available for 82 patients. We aimed to measure the correlation between G8 and CFS in this cohort.

Results
G8 score ≤ 14 is a referral criteria for the clinic, therefore 100% (82/82) of patients were classified as ‘frail’ using G8. Of these, only 23.2% (19/82) were classified as ‘mildly frail’ or worse using CFS (scores ≥5). Using Spearman’s rank correlation we found a very weak/negligible negative correlation between CFS and G8 (−0.2519, p = 0.0224).

Conclusion
The small proportion of patients (23.2%) classified as frail by CFS suggests that a G8 cut off of 14 may overestimate frailty. Previous work by our group has found that using a cut off of 13 is better able to predict chemotherapy outcomes(3). However, considering the lack of evidence for CFS in oncology, this poor correlation between G8 and CFS may question the usefulness of CFS in this context. (1) Decoster L, Puyvelde K, Mohile S, et al. Ann Oncol. 2015 Feb; 26(2): 288–300 (2) NHS Elect. [Online].; 2018 [cited 16/2/21] (3) A. Tivey, M. Ullah, A. Beech, et al. J Geriatr Oncol. 2020 Mar; 11(7).
801 EFFECTIVENESS OF HEARING REHABILITATION FOR CARE HOME RESIDENTS WITH DEMENTIA: A SYSTEMATIC REVIEW
Authors: Cross H , Dawes P , Hooper E , Armitage C J , Leroi I , Millman R E 
Published: March 2022

Abstract

Introduction
Hearing loss is common among people with dementia living in long-term care homes, leading to poorer quality of life, communication difficulties and exacerbated dementia-related symptoms. Hearing rehabilitation may improve outcomes; however, evidence suggests hearing is poorly managed in care homes.

Methods
A systematic review reporting on the effectiveness of, and barriers and facilitators to, hearing rehabilitation for residents with dementia was conducted. No restrictions on publication date or language were set and grey literature was considered. Eligible studies were critically appraised and presented via a narrative review.

Results
Sixteen studies, most of low-to-moderate quality, were identified. Hearing rehabilitation, including hearing devices, communication techniques and visual aids (e.g. flashcards), were reported to improve residents’ communication, quality of life and reduce agitation, with improvements in staff knowledge of hearing loss and job satisfaction. Residents’ symptoms of dementia presented barriers, e.g. losing or not tolerating hearing aids. Low staff prioritization of hearing loss due to time-pressures and lack of hearing-related training for staff were further barriers, particularly for residents who required assistance with hearing devices. Adopting a person-centered approach based on residents’ capabilities and preferences and involving family members facilitated hearing device use.

Conclusions
Residents with dementia can benefit from hearing rehabilitation. Identifying and implementing efficient, individualized hearing rehabilitation is necessary for those with complex cognitive needs. Increased funding and support for the social care sector is required to address systemic issues that pose barriers to hearing rehabilitation, including time-pressures, lack of training for staff and access to audiology services for residents.
803 QUALITY OF LIFE IN OLDER TRAUMA PATIENTS AFTER INJURY: FINDINGS FROM THE FRAILTY IN MAJOR TRAUMA STUDY (FRAIL-T)
Authors: Jarman H , Crouch R , Baxter M , Wang C , Cole E 
Published: March 2022

Abstract

Introduction
Major trauma is a substantial health burden for older patients with a significant proportion having ongoing functional and psychological difficulties long after their injury. Frailty impacts adversely on outcome after trauma but the longer term effects are unknown. This study aimed to determine differences in health related quality of life (HRQoL) and change in dependence for frail and non-frail patients aged 65 or over discharged from Major Trauma Centres (MTCs) following injury.

Methods
This prospective multi-centre study recruited from five UK MTCs between June 2019 and March 2020. Eligible patients were aged 65 or over requiring ‘trauma team activation’ and admitted to hospital. Follow-up data was collected via questionnaire at two time points: on day of hospital discharge and at 6 months. Primary outcome at follow-up was patient reported health-related quality of life (HRQoL) using the EQ-5D-5L measure.

Results
Data were analysed from 181 patients. 54 died in the follow-up period and HRQoL data was available for 127 patients. Of these 16% were identified as frail during the trauma hospital admission using the Clinical Frailty Scale. On average, frail patients were older (82 years) compared to non-frail (77 years). HRQoL was rated similarly at discharge in both groups (Non-Frail: 60, Frail: 65, p = 0.137), but at follow-up non-frail patients reported improvement whilst those who were frail had deteriorated from the discharge base-line (Non-Frail: 70, Frail: 50, p = 0.01). At 6 months post injury, half of the frail cohort (49%) were more dependent on care than pre-trauma compared to less than a third of non-frail patients (29%).

Conclusion
Patients who were frail in-hospital had worse HQRoL than non-frail patients 6 months after discharge from hospital, with increased dependence. Understanding the impact of injury on quality of life is important in planning for, and supporting, the ongoing care of frail older trauma patients.
Is the Rise in Reported Dementia Mortality Real? Analysis of Multiple-Cause-of-Death Data for Australia and the United States
Authors: Adair Tim , Temple Jeromey , Anstey Kaarin J , Lopez Alan D 
Published: March 2022

Abstract
Official statistics in Australia and the United States show large recent increases in dementia mortality rates. In this study, we assessed whether these trends are biased by an increasing tendency of medical certifiers (predominantly physicians) to report on the death certificate that dementia was a direct cause of death. Regression models of multiple-cause-of-death data in Australia (2006–2016) and the United States (2006–2017) were constructed to adjust dementia mortality rates for changes in death certification practices. Compared with official statistics, the recent increase in adjusted age-standardized dementia death rates was less than half as large in Australia and about two-thirds as large in the United States. Further adjustment for changes in reporting of dementia anywhere on the death certificate implied even lower increases in dementia mortality. Declines in reporting of cardiovascular diseases as comorbid conditions also contributed to rises in dementia mortality rates. The increasing likelihood of dementia’s being reported as directly leading to death largely explains recent increases in dementia mortality rates in both countries. However, studies have found that reported dementia on death certificates remains low compared with clinical evaluations of its prevalence. Improved guidance and training for certifiers in reporting of dementia on death certificates will help standardize mortality statistics within and between countries.
CellWalkR: an R package for integrating and visualizing single-cell and bulk data to resolve regulatory elements
Authors: Przytycki Pawel F , Pollard Katherine S 
Published: March 2022

AbstractSummaryCellWalkR is an R package that integrates single-cell open chromatin data with cell type labels and bulk epigenetic data to identify cell type-specific regulatory regions. A Graphics Processing Unit (GPU) implementation and downsampling strategies enable thousands of cells to be processed in seconds. CellWalkR’s user-friendly interface provides interactive analysis and visualization of cell labels and regulatory region mappings.Availability and implementationCellWalkR is freely available as an R package under a GNU GPL-2.0 License and can be accessed from https://github.com/PFPrzytycki/CellWalkR with an accompanying vignette.Supplementary informationSupplementary data are available at Bioinformatics online.
Functional lateralization of the medial temporal lobe in novel associative processing during creativity evaluation
Authors: Ren Jingyuan , Huang Furong , Gao Chuanji , Gott Jarrod , Schoch Sarah F , Qin Shaozheng , Dresler Martin , Luo Jing 
Published: March 2022

AbstractAlthough hemispheric lateralization of creativity has been a longstanding topic of debate, the underlying neurocognitive mechanism remains poorly understood. Here we designed 2 types of novel stimuli—“novel useful and novel useless,” adapted from “familiar useful” designs taken from daily life—to demonstrate how the left and right medial temporal lobe (MTL) respond to novel designs of different usefulness. Taking the “familiar useful” design as a baseline, we found that the right MTL showed increased activation in response to “novel useful” designs, followed by “novel useless” ones, while the left MTL only showed increased activation in response to “novel useful” designs. Calculating an asymmetry index suggests that usefulness processing is predominant in the left MTL, whereas the right MTL is predominantly involved in novelty processing. Moreover, the left parahippocampal gyrus (PHG) showed stronger functional connectivity with the anterior cingulate cortex when responding to “novel useless” designs. In contrast, the right PHG showed stronger connectivity with the amygdala, midbrain, and hippocampus. Critically, multivoxel representational similarity analyses revealed that the left MTL was more effective than the right MTL at distinguishing the usefulness differences in novel stimuli, while representational patterns in the left PHG positively predicted the post-behavior evaluation of “truly creative” products. These findings suggest an apparent dissociation of the left and right MTL in integrating the novelty and usefulness information and novel associative processing during creativity evaluation, respectively. Our results provide novel insights into a longstanding and controversial question in creativity research by demonstrating functional lateralization of the MTL in processing novel associations.
Sign of the Times: Updating Infective Endocarditis Diagnostic Criteria to Recognize Enterococcus faecalis as a Typical Endocarditis Bacterium
Authors: Dahl Anders , Fowler Vance G , Miro José M , Bruun Niels E 
Published: March 2022

Abstract
The modified Duke criteria requires that Enterococcus faecalis bacteremia must be both community-acquired and without known focus in order to be considered a microbiological “Major” diagnostic criterion in the diagnosis of infective endocarditis. We believe that the microbiological diagnostic criteria should be updated to regard E. faecalis as a “typical” endocarditis bacterium as is currently the case, for example, viridans group streptococci and Staphylococcus aureus. Using data from a prospective study of 344 patients with E. faecalis bacteremia evaluated with echocardiography, we demonstrate that designating E. faecalis as a “typical” endocarditis pathogen, regardless the place of acquisition or the portal of entry, improved the sensitivity to correctly identify definite endocarditis from 70% (modified Duke criteria) to 96% (enterococcal adjusted Duke criteria).
Evaluating the Benefits and Risks of Ex Vivo Liver Resection and Autotransplantation in Treating Hepatic End-stage Alveolar Echinococcosis
Authors: Qiu Yiwen , Huang Bin , Yang Xianwei , Wang Tao , Shen Shu , Yang Yi , Wang Wentao 
Published: March 2022

AbstractBackgroundEx vivo liver resection and autotransplantation (ELRA) has shown promising outcomes in treating end-stage hepatic alveolar echinococcosis (AE). However, the actual benefits and risks remain unclear. This study aims to analyze the benefits and risks of ELRA.MethodsThis retrospective cohort analysis included 228 patients with end-stage hepatic AE who underwent ELRA or nonsurgical treatment between 2014 and 2020. Propensity score matching was used. Long-term survival was compared in the matched cohorts using Kaplan-Meier curves generated with the log-rank test. Short-term mortality in entire cohort was predicted based on the nonsurgical group, and the interaction between the predicted mortality risk and observed mortality was tested. Risk factors for postoperative major morbidity in the ELRA group were evaluated using logistic regression analyses.ResultsThe long-term overall survival of the ELRA group was superior to that of the nonsurgical group (82.1% vs 19.1%, 5-year survival). Regarding short-term outcomes, the basic risk of 12-month mortality exerted a significant effect on the benefit of ELRA in entire cohort (per 1%, odds ratio, 1.043; 95% confidence interval [CI]: 1.007–1.082; P = .021). Patients with a predicted 12-month mortality risk &gt;75% would significantly benefit from ELRA. Combined resection (hazard ratio [HR], 3.32; 95% CI: 1.01–10.99; P = .049) and overall surgery time (per hour, HR, 1.41; 95% CI: 1.09–1.82; P = .009) were identified as independent risk factors for postoperative major morbidity.ConclusionsELRA was significantly beneficial in selected patients with end-stage AE compared with nonsurgical treatment. The timing of conducting ELRA remarkably affected the short-term risk of mortality and should be carefully determined.
Severe Acute Respiratory Syndrome Coronavirus 2 Delta Vaccine Breakthrough Transmissibility in Alachua County, Florida
Authors: Rife Magalis Brittany , Rich Shannan , Tagliamonte Massimiliano S , Mavian Carla , Cash Melanie N , Riva Alberto , Marini Simone , Amador David Moraga , Zhang Yanping , Shapiro Jerne , Horine Amelia , Starostik Petr , Pieretti Maura , Vega Samantha , Paula Lacombe Ana , Salinas Jessica , Stevenson Mario , Myers Paul , Glenn Morris J , Lauzardo Michael , Prosperi Mattia , Salemi Marco 
Published: March 2022

Abstract

Background
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant has caused a dramatic resurgence in infections in the United Sates, raising questions regarding potential transmissibility among vaccinated individuals.

Methods
Between October 2020 and July 2021, we sequenced 4439 SARS-CoV-2 full genomes, 23% of all known infections in Alachua County, Florida, including 109 vaccine breakthrough cases. Univariate and multivariate regression analyses were conducted to evaluate associations between viral RNA burden and patient characteristics. Contact tracing and phylogenetic analysis were used to investigate direct transmissions involving vaccinated individuals.

Results
The majority of breakthrough sequences with lineage assignment were classified as Delta variants (74.6%) and occurred, on average, about 3 months (104 ± 57.5 days) after full vaccination, at the same time (June-July 2021) of Delta variant exponential spread within the county. Six Delta variant transmission pairs between fully vaccinated individuals were identified through contact tracing, 3 of which were confirmed by phylogenetic analysis. Delta breakthroughs exhibited broad viral RNA copy number values during acute infection (interquartile range, 1.2-8.64 Log copies/mL), on average 38% lower than matched unvaccinated patients (3.29-10.81 Log copies/mL, P &lt; .00001). Nevertheless, 49% to 50% of all breakthroughs, and 56% to 60% of Delta-infected breakthroughs exhibited viral RNA levels above the transmissibility threshold (4 Log copies/mL) irrespective of time after vaccination.

Conclusions
Delta infection transmissibility and general viral RNA quantification patterns in vaccinated individuals suggest limited levels of sterilizing immunity that need to be considered by public health policies. In particular, ongoing evaluation of vaccine boosters should specifically address whether extra vaccine doses curb breakthrough contribution to epidemic spread.
Cluster ofBurkholderia cepaciaComplex Infections Associated With Extracorporeal Membrane Oxygenation Water Heater Devices
Authors: Rhee Chanu , Baker Meghan A , Tucker Robert , Vaidya Vineeta , Holtzman Meghan , Seethala Raghu R , Bentain-Melanson Maria , Lenox Jesslyn , Smith Adam R , Boyer Jon C , Gassett Alison , Brigl Manfred , Sater Mohamad , Huntley Miriam , Woolley Ann E , Goldberg Hilary J , Reilly Karen , Resnick Andrew , Pearson Madelyn , Klompas Michael 
Published: March 2022

AbstractBackgroundBurkholderia cepacia complex is a group of potential nosocomial pathogens often linked to contaminated water. We report on a cluster of 8 B. cepacia complex infections in cardiothoracic intensive care unit patients, which were attributed to contaminated extracorporeal membrane oxygenation (ECMO) water heaters.MethodsIn December 2020, we identified an increase in B. cepacia complex infections in the cardiothoracic intensive care unit at Brigham and Women’s Hospital. We sought commonalities, sequenced isolates, obtained environmental specimens, and enacted mitigation measures.ResultsWhole-genome sequencing of 13 B. cepacia complex clinical specimens between November 2020 and February 2021 identified 6 clonally related isolates, speciated as Burkholderia contaminans. All 6 occurred in patients on ECMO. Microbiology review identified 2 additional B. contaminans cases from June 2020 that may have also been cluster related, including 1 in a patient receiving ECMO. All 8 definite or probable cluster cases required treatment; 3 patients died, and 3 experienced recurrent infections. After ECMO was identified as the major commonality, all 9 of the hospital’s ECMO water heaters were cultured, and B. contaminans grew in all cultures. Cultures from air sampled adjacent to the water heaters were negative. Water heater touch screens were culture positive for B. contaminans, and the sink drain in the ECMO heater reprocessing room also grew clonal B. contaminans. Observations of reprocessing revealed opportunities for cross-contamination between devices through splashing from the contaminated sink. The cluster was aborted by removing all water heaters from clinical service.ConclusionsWe identified a cluster of 8 B. cepacia complex infections associated with contaminated ECMO water heaters. This cluster underscores the potential risks associated with water-based ECMO heaters and, more broadly, water-based care for vulnerable patients.
Chick Lit Meets Silicon Valley: Ana Yen’s Sophia of Silicon Valley and Elisabeth Cohen’s The Glitch
Authors: Quassdorf Sixta 
Published: March 2022

Abstract
Alongside the stereotypically feminine themes of personal relationships and consumption, chick lit also addresses work, which often leads to the question of “can a woman have it all?” Anna Yen’s Sophia of Silicon Valley (2018) and Elisabeth Cohen’s The Glitch (2018) take up this theme in Silicon Valley, where every aspect of life is damagingly subordinated to work and “having it all” comes to mean at best “having a job.” It emerges that, despite its overtly progressive, “cool” image, Silicon Valley perpetuates paternalistic structures. Although their rise to CEO status might appear to illustrate women’s empowerment, both protagonists remain unable or unwilling to transform the underlying values and power structures of their male-dominated organizations.