bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spannungsfeld endoskopische Resektionsverfahren bei GEP-NET // Endoscopic resection for GEP-NET
Authors: Ehlken Hanno , Younis Fadi , Wolter Stefan , Schrader Jörg 
Published: June 2022

ZusammenfassungNeuroendokrine Tumoren des Verdauungstraktes (GEP-NET) sind eine seltene Tumorentität, die häufig als Zufallsbefund diagnostiziert werden. Ein großer Teil dieser Zufallsdiagnosen wird im
Rahmen einer endoskopischen Untersuchung gestellt. Während die vollständige Entfernung des Tumors im Sinne einer kurativen chirurgischen Resektion nach onkologischen Kriterien das
Standardvorgehen für lokalisierte Tumorerkrankungen ist, kann bei kleinen Tumoren ohne Hinweis und Risiko für eine lymphogene Metastasierung eine endoskopische Abtragung in gleicher
Intention erfolgen. Während dies für Magen-, Duodenum- und Rektum-NET der Standard ist, sollten NET des Jejunums und Ileums aufgrund der hohen Metastasierungsrate trotz geringer Tumorgröße
regelhaft nicht endoskopisch angegangen werden. Die Grenze für eine endoskopische Resektion ergibt sich sowohl durch die technische Machbarkeit im Sinne des Erreichens einer R0-Resektion,
der erwarteten Komplikationen im Sinne von Blutung und Perforationen als auch durch das vermutete Risiko für eine lymphogene Metastasierung. Generell wird eine endoskopische Resektion bei
Befunden < 1 cm regelhaft empfohlen, da sowohl die gute technische Machbarkeit als auch das geringe Metastasierungsrisiko für eine endoskopische Resektion sprechen. Bei allen Befunden
über 2 cm Größe sind sowohl die technischen Erfolgsaussichten so niedrig als auch das Metastasierungsrisiko so hoch, dass in dieser Situation regelhaft ein chirurgisches Vorgehen erfolgen
sollte. Es bleibt somit ein Graubereich bei der Tumorgröße zwischen 1 und 2 cm, wo sowohl endoskopische, aber auch chirurgische Resektionsverfahren sinnvoll eingesetzt werden können.
Zunehmend kommen auch gemeinsame Eingriffe im Sinne eines endoskopisch-laparoskopischen Rendezvous-Verfahrens zum Einsatz – insbesondere im Duodenum bieten sich diese Eingriffe an, um eine
minimale Resektion mit größtmöglicher R0-Erfolgsrate und niedriger Perforationsrate zu erreichen.
Translators’ ideology in Shakespeare’sOthello
Authors: Alowais Fatima A. , Abdulla Adnan K. 
Published: June 2022

AbstractThe phenomenon that this study seeks to investigate is viewed in many different ways by scholars of Translation Studies. Sometimes, it is seen as “mediation”, or “intervention” and other times, it is seen as sheer “manipulation”, however, these terms all seem to describe the shifts that are found in the target-text, reflecting an ideology not found in the source text. The significance of these kinds of shifts, lies in the fact that they serve to either endorse or resist prevalent ideologies among the audience of the target culture. Applying Teun van Dijk’s multidisciplinary socio-cognitive approach of the ‘ideological square’ (1998; 2011) as well asHatim & Mason’s (2005)model of the degrees of translators’ mediation, this paper explores how discriminatory ideologies such as racism, misogyny and xenophobia are dealt with in the process of translating Shakespeare’sOthello.
“It is still light outside”
Authors: Hui Isaac 
Published: June 2022

AbstractIn the film adaptation ofLust, Caution, the importance of sex is apparent. This is not necessarily the case inSe, Jie. In Eileen Chang’s story, there is an interconnection between sex, death, and a ring. This relationship is portrayed differently in Julia Lovell’sLust, Caution. Viewing Eileen Chang as world literature reveals similarities and differences betweenSe, JieandLust, Cautionand their different thematic emphases. This article explores how the imageries of the ring, sex, and death are interrelated. The transaction involving the ring in Chang’s text is similar to a sexual transaction. Analyzing the difference between the source and the target texts reveals how Lovell places a “heavier” emphasis on women’s bodies, suggesting the suppression women suffer in a patriarchal society. While the thematic importance of death is also present inLust, Caution, it is brought out by the notion of foreignness and undecipherability.
Translating to hegemonize
Authors: Emam Abbas 
Published: June 2022

Abstract
Among the diverse varieties of translation, one is institutional translation, i.e., a type of translation done
either in or for a particular institution. In contemporary Iran after the victory of the Islamic Revolution of 1979, a large
number of social, religious, political, cultural, and artistic works have been translated from Persian into a long array of other
languages within such a framework. The implementation of such trans-national projects has involved hundreds of translators/
interpreters, allocation of billions of dollars, and making use of a wide network of international publishers and distributors.
Numerous motives could be enumerated for such undertakings; however, the effects of such endeavors appear not to have been
addressed in Translation Studies as yet. This research aims at pinpointing the mechanisms of such institutions, in particular
relying on concepts such as ideology, hegemony and translational discourse-propagating network to contribute to evaluation of such
a phenomenon. To this end, 11 Iranian post-revolutionary institutions with translational agendas were identified, demonstrated to
have been following double objectives across the world; ideological identity-based discourse to propagate Islamic revolutionary
Shia inclinations as well as to support consolidate the hegemony of the Islamic Republic of Iran.
Does maternity during sports career jeopardize future athletic success in elite marathon runners?
Authors: Forstmann Nicolas , Meignié Alice , De Larochelambert Quentin , Duncombe Stephanie , Schaal Karine , Maître Carole , Toussaint Jean‐François , Antero Juliana 
Published: June 2022

ABSTRACTThe impact of maternity (Mat) on subsequent athletic performance is not well known. This study aims to investigate the impact of maternity among elite marathoners on their overall performance progression. For each runner listed in the top 150 female marathoners, who had experienced a mid‐career maternity, performance development was reconstituted throughout the career. Maternity data and career break time span (Ttotal) were collected from publicly available informations. Performances were modelled according to the known age‐performance relationship and the impact of maternity was added into the model. Linear mixed effect model was used to study the influence of maternity on the overall career. Among this sample, 37 runners had at least 1 child during her career. Among them, 14 had 2 children. Eleven runners (29.72%) made their personal best performance before Mat, which occurred at an average age of 28.40 ± 4.00 years. Twenty‐six runners (70.28%) establish their best performances after Mat, at an average age of 32.20 ± 4.28. The age‐performance relationship model explains 92% of the performance variability during the career's progression. When age is considered, maternity does not have significant impact on performance development. World's most competitive marathoners can still perform at their best level after pregnancy. The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance during career development.Highlights
Mid‐career maternity does not have a significant impact on overall progression in high level runners, who return to official races.
The ability to return and surpass previous performance level is influenced by the age at which pregnancy occurs, relative to the age of peak performance.
Age is the variable that explains most of performance progression, independently of mid‐career maternity occurrence(s).
953 PREVIOUS SARS-COV2 INFECTION, AGE AND FRAILTY PREDICT 6-MONTH BNT162B2 VACCINE-INDUCED ANTIBODY TITRE IN NURSING HOME RESIDENTS
Authors: Dyer A , Noonan C , Pierpoint R , Leonard A , Boran G , Brady G , Fallon A , O'Farrelly C , Bourke N , Kennelly  
Published: June 2022

Abstract

Introduction
Older nursing home residents are the population at greatest risk of morbidity and mortality from SARS-CoV-2 infection. No studies have examined the determinants of long-term antibody responses post-vaccination in this group.

Method
Longitudinal cohort study in residents of 5 nursing homes assessed prior to vaccination and at both 5-weeks and 6-months post SARS-CoV2 vaccine (BNT162b2). Comprehensive clinical assessment was performed, including assessment for comorbidity, frailty (NH-FRAIL) and SARS-CoV-2 infection history. Serum Nucleocapsid and Anti-Spike Receptor Binding Domain (RBD) antibodies were analysed at all timepoints and an in vitro Angiotensin Converting Enzyme (ACE2) Receptor-Spike RBD neutralisation assay used to assess serum neutralisation capacity.

Results
Of 86 participants (81.1 ± 10.8 years; 65% female), just-under half (45.4%; 39/86) had evidence of previous SARS-CoV-2 infection. All participants demonstrated a significant antibody response to vaccination at 5-weeks and a significant decline in this response by 6-months. SARS-CoV-2 infection history was the strongest predictor of antibody titre (log-transformed) at both 5-weeks (β: 3.00; 95% CI [Confidence Interval]: 2.32, 3.70; p &lt; 0.001) and 6-months (β: 3.59; 95% CI: 2.89, 4.28; p &lt; 0.001). Independent of SARS-CoV-2 infection history, both age in years (β: -0.05; 95% CI: −0.08, −0.02; p &lt; 0.001) and frailty (β: -0.22; 95% CI: −0.33, −0.11; p &lt; 0.001) were associated with a lower antibody titre at 6-months. Antibody titres at both 5-weeks and 6-months significantly correlated with in vitro neutralisation capacity.

Conclusion and Implications
In older nursing home residents, SARS-CoV-2 infection history was the strongest predictor of anti-spike antibody titres at 6-months, whilst age and frailty were independently associated with lower titres at 6-months. Antibody titres significantly correlated with in vitro neutralisation capacity. Whilst older SARS-CoV-2 naïve nursing home residents may be particularly vulnerable to breakthrough SARS-CoV-2 infection, the relationship between antibody titres, SARS-CoV-2 infection and clinical outcomes remains to be fully elucidated in this cohort.
983 LEARNING FROM THE EXPERIENCES OF NURSES IN CARE HOMES DURING COVID-19 (THRIVE STUDY): STEERING THE SHIP THROUGH THE STORM
Authors: Birt L , Lane K , Corner J , Sanderson K , Deakins A , Bunn D 
Published: June 2022

Abstract

Background
Nurses practising in older people’s care homes are often the only trained nurse on shift, undertaking leadership roles while also supporting residents with complex clinical needs. The study aimed to explore Nursing and Midwifery Council (NMC)-registered nurses’ experiences of working in older people’s care homes during the COVID-19 pandemic.

Method
Recruitment used direct contact with care homes, social media and links provided by national partners, then purposive sampling for age, gender, type of care home and location. Data collected through one-to-one on-line interviews using a topic guide developed collaboratively with care home nurses, focusing on how COVID-19 impacted on nurses’ resilience and mental well-being. Data were analysed thematically.

Results
18 nurses interviewed between March–July 2021: female 16, majority aged between 46–55 years; mean time registered with NMC 19 years (range 18 months-45 years); one had not nursed residents with COVID-19. Preliminary findings indicate that nurses developed enhanced clinical skills, which increased their professional standing. Many nurses were in leadership roles responsible for processing and sharing rapidly-changing guidance, making judgements on how to manage infection risk within the home. Nurses reported balancing information-assimilation and reporting with providing direct care due to staff shortages. All nurses provided emotional support to other staff. They sought support from their peers, namely nurses inside and outside their workplace. As leaders, many of the nurses spoke about the emotional impact of having to manage relatives’ expectations and make decisions on whether a relative could be with a dying resident.

Conclusion
Understanding the types of support that might best increase resilience and well-being for nurses in care homes now and in the future is essential to maintain a healthy, stable workforce. Support for nurses will likely benefit other care workers either directly through wider roll-out, or indirectly through improved well-being of the nurse leaders.
979 FACTORS THAT INFLUENCE OLDER ADULTS’ PARTICIPATION IN PHYSICAL ACTIVITY: A SYSTEMATIC REVIEW OF QUALITATIVE STUDIES
Authors: Meredith S J , Cox N , Ibrahim K , Higson J , McNiff J , Mitchell  , Rutherford M , Wijayendran A , Shenkin  , Kilgour A , Lim S E R 
Published: June 2022

Abstract

Introduction
Despite the myriad advantages associated with physical activity (PA), older adults are often insufficiently active to maximise health benefits. Understanding factors that influence engagement in PA will support practitioners in providing well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adult’s engagement in PA.

Method
Four electronic databases were searched: CINAHL, Embase, MEDLINE and PsycINFO. Inclusion criteria were community-dwelling older adults (≥70 years), and studies including qualitative method. Exclusion criteria were studies examining a single disease group, individuals with cognitive impairment, care home residents, and PA interventions. The Critical Appraisal Skills Programme (CASP) checklist was used to assess methodological rigour. Framework synthesis using the COM-B model was applied to analyse data, and the GRADE-CERQual approach was used to assess confidence in findings. (PROSPERO: CRD42021160503).

Results
Twenty-one studies were included in the review. Participants (N = 3,955; mean age 78.9 years) included 64% female and 36% male older adults. Most studies were methodologically rigorous (17/21 scored ≥8 CASP). We identified 32 themes mapped against the COM-B framework (16 high confidence). Older adult’s perceived capability was influenced by their functional capacity, illness symptoms and perceived risk of injury from PA. PA was motivated by identifying as an ‘exerciser’, health gains and positive emotions (e.g. enjoyment), while negative sensations reduced motivation (e.g. pain). Opportunity was impacted by the weather, the environment ‘fit’, and the availability of social interaction during PA. Moreover, social opportunity was impacted by socio-cultural ageing stereotypes and discourses, influencing older adults’ PA through media outlets, social norms, and self-stigma.

Conclusion
The review found a complex web of interacting factors that influenced older people’s PA between the sub-domains of capability, motivation, and opportunity. Future initiatives to increase PA in older adults should focus on social influences, environmental barriers, and physical limitations.
1069 ESSENTIAL FRAILTY TOOLSET AS A PREDICTOR OF PROLONGED LENGTH OF STAY AND DISCHARGE DESTINATION AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION
Authors: Patel N , Teh W , Omoniyi O , Martin W , Weir-McCall J , D’Errico L , O’Sullivan M , Davies W , Costopoulos C , Costanzo P 
Published: June 2022

Abstract

Introduction
Frailty is associated with poor outcomes following transcatheter aortic valve implantation (TAVI). Rockwood is the widely used score for this population. In a recent trial, a more objective score, the Essential Frailty Toolset (EFT) outperformed Rockwood’s in predicting mortality and disability 1-year post-TAVI. Whether it predicts in-hospital length of stay (LOS) and discharge destination post-TAVI remains unclear.

Method
A cohort of patients undergoing TAVI for aortic stenosis was recruited, demographic characteristics collected, and frailty assessed with EFT and Rockwood scores. Primary outcomes were LOS post-TAVI, categorised as ‘not prolonged’ (≤2 days) or ‘prolonged’ (&gt;2 days) and discharge destination, characterised as ‘home’ or ‘non-home’.

Results
86 patients were recruited, with median age 82 years (IQR 78–86). 54% were male. EFT identified 35% and Rockwood 11% as frail. 19% were cognitively impaired. 5 chair rises were completed by 70%, with 30% managing under 15 seconds. Median haemoglobin was 121 g/L (IQR 109.5–136). Median albumin was 36 g/L (IQR 33–39). 84% of procedures were transfemoral. 20% had moderate–severe left ventricular systolic dysfunction. Median LOS post-TAVI was 2 days (IQR 2–5). 94% were discharged home, 6% to referring local hospital or rehabilitation centre. 46% were NYHA class III-IV. A model for prolonged LOS including comorbidities, showed frailty determined by EFT (OR 4.80, CI 95% 1.52–15.2, p = 0.008) but not Rockwood (OR 5.00, CI 95% 0.865–29.0, p = 0.072) was the only significant independent predictor for prolonged LOS. A model adjusting for comorbidities also showed EFT to be an independent predictor for non-home discharge destination of borderline significance (OR 2.57 CI 95% 0.994–6.66, p = 0.051) but Rockwood was not (OR 1.38 CI95% 0.485–3.91, p = 0.548).

Conclusion
In a real-world elderly population, EFT score was a stronger, more independent predictor of prolonged LOS and non-home discharge post-TAVI, than Rockwood’s. EFT would be an effective pre-operative assessment tool for LOS and discharge destination for TAVI.
911 EVALUATION OF TYPE/LOCATION OF CLINIC APPOINTMENTS IN OLDER PERSONS SERVICES PARKINSON DISEASE PATIENTS IN RURAL EAST SUFFOLK
Authors: Blows S , Thapa A , Lae-Phyo W 
Published: June 2022

Abstract

Introduction
We have 262 patients under the care of older persons movement disorders service in East Suffolk, whom due to a combination of retirement and COVID pandemic hadn’t seen a consultant for their follow up in up to 18 months. There are the facilities to see patients closer to their homes with satellite outpatient clinics in Eye, Stowmarket, Felixstowe and Aldeburgh, and via telephone and video consultation. We found that 137 of these patients live in rural areas closer to these satellite clinics. An opportunity was sensed to tailor the future service to the preferences of our patients, with the aim of improving experience and satisfaction.

Method
We sent a postal survey to these 137 patients asking them about the importance of having one responsible consultant, the type and location of their appointment.

Results
We sent a postal survey to these 137 patients, we received 81 Reponses. 91% of respondents ranked it either important, quite important or very important that they see the same consultant. It was the 1st preference to be seen at a local healthcare facility with 71% of patients choosing this as their first choice versus 22% for Ipswich hospital. 7% had a 1st preference of telephone appointment. 0 patients had a 1st choice preference of video conference it was the least favourable preference for 52% of respondents.

Conclusion
Our cohort of patients place a high value on continuity of care and would prefer to be seen at a community clinic that is closer to home. These preferences have been discussed with PDUK and CCG and have informed how we deliver our service as of August 2021 with all patients having a locality based clinic and named consultant. Our results are at odds with the ethos of NHSX [1] and the drive to see patients virtually.
951 SETTING UP A GERIATRIC LIAISON SERVICE WITHIN UROLOGY IN A DISTRICT GENERAL HOSPITAL
Authors: Alexander H , Manning J 
Published: June 2022

Abstract

Introduction
One might refer to urologists as the ‘hidden providers’ of geriatric care, ultimately sought out by many geriatric patients. POPS, the Peri-Operative care of Older People’s Service started at Guys Hospital in London is often quoted as the gold standard for liaison services. Having set up liaison services in Orthopaedics and General Surgery in my previous job, an exciting opportunity arose after the first COVID—19 wave when I found my new office directly under the Urology Assessment Unit.

Method
A Geriatric Urology liaison service was set up by a Consultant Geriatrician with SpR support. One hour per week was agreed within the department to pilot the service. By May 2021 the service had been running for 8 months. During this period 30 patients had been seen (36 patient visits).

Results
The patient’s mean age was 82 years. The advice given included: O Stopping medication (7 cases) O Recommending iron infusions instead of tablets (5 cases) O Adjusting analgesia (4 cases) O Ordering brain imaging (3 cases) Commonly there was the recognition of the need for palliative care in this frail population. There have been complex cases: O A gentleman with a large perinephric bleed. O A young man with seizures and cognitive issues following renal stones. O A patient with post-operative rhabdomyolysis following nephrectomy. Pre-operative assessments have now been started as part of enhanced care: O Two cystectomy patients (one ward/one telephone) O Two TURBT patients (one with low sodium).

Conclusion
Staff feedback has been excellent especially linking to the Palliative Care Team. We presented our data at the Urology governance meeting in September 2021 and again received excellent feedback. The urology staff have felt increasingly supported. Data collection has helped build a business case for two Consultant posts in surgical liaison.
955 ANALYSIS OF RANDOMISED CONTROLLED TRIAL SERIOUS ADVERSE EVENT RATES AS A MARKER OF TRIAL REPRESENTATIVENESS
Authors: Hanlon P , Butterly E , Shah A V , Hannigan L J , Wild S H , Guthrie B , Mair F , Dias S , Welton N J , McAllister D A 
Published: June 2022

Abstract

Introduction
The applicability of randomised controlled trials of pharmacological agents to older people with frailty/multimorbidity is often uncertain, due to concerns that trials are not representative. However, assessing trial representativeness is challenging and complex. We explore an approach assessing trial representativeness by comparing rates of trial Serious Adverse Events (SAEs: most of which reflect hospitalisations/deaths) to rates of hospitalisation/death in routine care (which, in a trial setting, would be SAEs be definition).

Method
We identified 483 trials (n = 636,267) from clinicaltrials.gov across 21 index conditions. A routine care comparison was identified from SAIL databank (n = 2.3 M). SAIL data were used to derive the expected rate of hospitalisations/deaths by age, sex and index condition. We then calculated the expected number of SAEs for each trial compared to the observed number of SAEs (observed/expected SAE ratio). We then re-calculated the observed/expected SAE ratio additionally accounting for comorbidity count in 125 trials for which we accessed individual participant data.

Results
For 12/21 index conditions the observed/expected SAE ratio was &lt;1, indicating fewer SAEs in trials than expected given community rates of hospitalisations and deaths. A further 6/21 had point estimates &lt;1 but the 95% CI included the null. The median observed/expected SAE ratio was 0.60 (95% CI 0.56–0.65; COPD) and the interquartile range was 0.44 (0.34–0.55; Parkinson’s disease) to 0.88 (0.59–1.33; IBD). Higher comorbidity count was associated with SAEs and hospitalisations/deaths across index conditions. For most trials, the observed/expected ratio was attenuated but remained &lt;1 after additionally accounting for comorbidity count.

Conclusion
Trial participants experience fewer SAEs than expected based on age/sex/condition specific hospitalisation/death rates in routine care, confirming the predicted lack of representativeness. This difference is only partially explained by differences in multimorbidity. Assessing observed/expected SAE may help assess applicability of trial findings to older populations in whom multimorbidity and frailty are common.