Prevalence and assessment of frailty in interstitial lung disease - a systematic review and meta-analysis.

BACKGROUND Frailty is a multisystem dysregulation that challenges homeostasis and increases vulnerability towards stressors. In patients with interstitial lung diseases (ILD) frailty is associated with poorer lung function, greater physical impairment, and higher symptom burden. Our understanding of the prevalence of frailty in ILD and consequently its impact on the ILD population is limited. OBJECTIVE AND METHODS We aimed to systematically review frailty assessment tools and to determine frailty prevalence across different ILD cohorts. Meta-analyses were used to calculate the pooled prevalence of frailty in the ILD population. RESULTS We identified 26 studies (15 full-texts, 11 conference abstracts) including a total of 4614 patients with ILD. The most commonly used frailty assessment tools were the Fried Frailty Phenotype (FFP), the Short Physical Performance Battery (SPPB), and the cumulative Frailty Index (FI). Data allowed for meta-analyses of FFP and SPPB prevalence. The pooled prevalence of frailty was 35% (95% CI 25%-45%) by FFP, and 19% (95% CI 12%-28%) by SPPB. CONCLUSIONS Frailty is common in ILD, with considerable variability of frailty prevalence depending on the frailty assessment tool used. These findings highlight the importance of frailty in ILD and the need for a standardized approach to frailty assessment in this population

Caught between 'Dublin' and the deep blue sea: 'small' Member States and European Union 'burden-sharing' responses to the unauthorized entry of seabourne asylum seekers in the Mediterranean from 2005-2010.

The Dublin Regulation determines the Member State responsible for accepting and making a decision on asylum claims lodged in the European Union (‘EU’), Norway and Iceland. It aims to ensure that each asylum claim is examined by one and only one Member State, to put an end to the practice of ‘asylum shopping’ and to prevent repeated applications, both of which have been costly for the receiving Member States and caused severe inefficiencies in the determination processes in the EU in the past. With the first Member State of entry being the major determinant for the allocation of asylum responsibility under the Dublin Regulation, there has been growing discontent among Member States at the external borders of the EU, particularly the southern Member States in the Mediterranean, over what they see as a system that has unjustly placed disproportionate burdens on them regarding the admission of seaborne asylum seekers and the costs associated with it. As a result of changes in migration rules and consequent adjustments in the entry strategy employed by irregular migrants and people smugglers, the Member States at the EU’s ‘southern frontline’ have unwillingly played the role of reluctant hosts to boatloads of unwelcome asylum seekers. This thesis aims to examine how the EU has attempted to tackle the challenging situation of the unauthorised migration of asylum seekers into its territory by sea, and in particular, how it has responded to demands from affected Member States for a more equitable system of asylum responsibility allocation in spite of and outside the Dublin framework. It would argue that the ‘small’ EU Member States in the Mediterranean themselves have, over the last five years at least, become the unexpected drivers of the EU’s declared commitment to the principles of ‘solidarity’, ‘fair sharing of responsibility’ and ‘effective multilateralism’. ‘ Small’ as they may be in terms of resources, size or influence vis-à-vis the larger Member States, the former have been able to create their own mark in a global regime that has traditionally been resistant to the idea of burden-sharing. The measures taken by the EU’s ‘southern frontline’ have collectively changed the landscape of a global protection regime where not only is asylum ‘burden sharing’ highly elusive – its terms and conditions are also dictated by the more powerful sovereign states. While the theoretical point of departure in this study is the influence wielded by the ‘small’ EU Member States in the burden-sharing debate, the degree or level of ‘influence’ small Mediterranean Member States can exercise in pushing for cooperative arrangements is itself determined by a system that is biased towards large states, increasingly securitised, and is therefore limited in both nature and scope. Nevertheless, the experience of ‘burden-sharing’ in the EU between 2005 and 2010 demonstrates that the Member States at the periphery have proactively taken the responsibility for the operationalisation of the founding values and principles of the EU, and through active norm advocacy and related strategies, have been able to achieve what has eluded the global protection regime so far – a refugee burden sharing scheme

UPV-Symanto at eRisk 2021: Mental Health Author Profiling for Early Risk Prediction on the Internet

[EN] This paper presents the contributions of the UPV-Symanto team, a collaboration between Symanto Research and the PRHLT Center, in the eRisk 2021 shared tasks on gambling addiction, self-harm detection and prediction of depression levels. We have used a variety of models and techniques, including Transformers, hierarchical attention networks with multiple linguistic features, a dedicated early alert decision mechanism, and temporal modelling of emotions. We trained the models using additional training data that we collected and annotated thanks to expert psychologists. Our emotions-over-time model obtained the best results for the depression severity task in terms of ACR (and second best according to ADODL). For the self-harm detection task, our Transformer-based model obtained the best absolute result in terms of ERDE5 and we ranked equal first in terms of speed and latency.The authors from Universitat Politècnica de València thank the EU-FEDER Comunitat Valenciana 2014-2020 grant IDIFEDER/2018/025. The work of Paolo Rosso was in the framework of the research project PROMETEO/2019/121 (DeepPattern) by the Generalitat Valenciana. We would like to thank the two anonymous reviewers who helped us improve this paper.Basile, A.; Chinea-Ríos, M.; Uban, A.; Müller, T.; Rössler, L.; Yenikent, S.; Chulvi-Ferriols, MA.... (2021). UPV-Symanto at eRisk 2021: Mental Health Author Profiling for Early Risk Prediction on the Internet. CEUR. 908-927. http://hdl.handle.net/10251/19067090892

Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A Systematic Review and Meta-analysis

For some patients, survival with good neurologic function after cardiopulmonary resuscitation (CPR) is highly unlikely, thus CPR would be considered medically futile. Yet, in clinical practice, there are no well-established criteria, guidelines or measures to determine futility. We aimed to investigate how medical futility for CPR in adult patients is defined, measured, and associated with do-not-resuscitate (DNR) code status as well as to evaluate through meta-analysis the predictive value of clinical risk scores.; We searched Embase, PubMed, CINAHL, and PsycINFO from the inception of each database up to January 22, 2021. Data were pooled using a fixed-effects model. Data collection and reporting followed the PRISMA guidelines.; Thirty-one studies were included in the systematic review and 11 in the meta-analysis. Medical futility defined by risk scores was associated with a significantly higher risk of in-hospital mortality (5 studies, 3102 participants with Pre-Arrest Morbidity (PAM) and Prognosis After Resuscitation (PAR) score; overall RR 3.38 [95% CI 1.92-5.97]) and poor neurologic outcome/in-hospital mortality (6 studies, 115213 participants with Good Outcome Following Attempted Resuscitation (GO-FAR) and Prediction of Outcome for In-Hospital Cardiac Arrest (PIHCA) score; RR 6.93 [95% CI 6.43-7.47]). All showed high specificity (>90%) for identifying patients with poor outcome.; There is no international consensus and a lack of specific definitions of CPR futility in adult patients. Clinical risk scores might aid decision-making when CPR is assumed to be futile. Future studies are needed to assess their clinical value and reliability as a measure of futility regarding CPR

Design and methodology of the Swiss Transplant Cohort Study (STCS): a comprehensive prospective nationwide long-term follow-up cohort

In Switzerland, organ procurement is well organized at the national-level but transplant outcomes have not been systematically monitored so far. Therefore, a novel project, the Swiss Transplant Cohort Study (STCS), was established. The STCS is a prospective multicentre study, designed as a dynamic cohort, which enrolls all solid organ recipients at the national level. The features of the STCS are a flexible patient-case system that allows capturing all transplant scenarios and collection of patient-specific and allograft-specific data. Beyond comprehensive clinical data, specific focus is directed at psychosocial and behavioral factors, infectious disease development, and bio-banking. Between May 2008 and end of 2011, the six Swiss transplant centers recruited 1,677 patients involving 1,721 transplantations, and a total of 1,800 organs implanted in 15 different transplantation scenarios. 10% of all patients underwent re-transplantation and 3% had a second transplantation, either in the past or during follow-up. 34% of all kidney allografts originated from living donation. Until the end of 2011 we observed 4,385 infection episodes in our patient population. The STCS showed operative capabilities to collect high-quality data and to adequately reflect the complexity of the post-transplantation process. The STCS represents a promising novel project for comparative effectiveness research in transplantation medicin

Which patients with lower respiratory tract infections need inpatient treatment? Perceptions of physicians, nurses, patients and relatives

Despite recommendations for outpatient management, low risk patients with lower respiratory tract infections (LRTIs) are often hospitalized. This survey analyzed perceptions of physicians, nurses, patients and relatives about feasibility of outpatient management and required duration of hospital stay

Pathogenesis and Current Treatment Strategies of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most frequent liver cancer with high lethality and low five-year survival rates leading to a substantial worldwide burden for healthcare systems. HCC initiation and progression are favored by different etiological risk factors including hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, non-/and alcoholic fatty liver disease (N/AFLD), and tobacco smoking. In molecular pathogenesis, endogenous alteration in genetics (TP53, TERT, CTNNB1, etc.), epigenetics (DNA-methylation, miRNA, lncRNA, etc.), and dysregulation of key signaling pathways (Wnt/β-catenin, JAK/STAT, etc.) strongly contribute to the development of HCC. The multitude and complexity of different pathomechanisms also reflect the difficulties in tailored medical therapy of HCC. Treatment options for HCC are strictly dependent on tumor staging and liver function, which are structured by the updated Barcelona Clinic Liver Cancer classification system. Surgical resection, local ablative techniques, and liver transplantation are valid and curative therapeutic options for early tumor stages. For multifocal and metastatic diseases, systemic therapy is recommended. While Sorafenib had been the standalone HCC first-line therapy for decades, recent developments had led to the approval of new treatment options as first-line as well as second-line treatment. Anti-PD-L1 directed combination therapies either with anti-VEGF directed agents or with anti-CTLA-4 active substances have been implemented as the new treatment standard in the first-line setting. However, data from clinical trials indicate different responses on specific therapeutic regimens depending on the underlying pathogenesis of hepatocellular cancer. Therefore, histopathological examinations have been re-emphasized by current international clinical guidelines in addition to the standardized radiological diagnosis using contrast-enhanced cross-sectional imaging. In this review, we emphasize the current knowledge on molecular pathogenesis of hepatocellular carcinoma. On this occasion, the treatment sequences for early and advanced tumor stages according to the recently updated Barcelona Clinic Liver Cancer classification system and the current algorithm of systemic therapy (first-, second-, and third-line treatment) are summarized. Furthermore, we discuss novel precautional and pre-therapeutic approaches including therapeutic vaccination, adoptive cell transfer, locoregional therapy enhancement, and non-coding RNA-based therapy as promising treatment options. These novel treatments may prolong overall survival rates in regard with quality of life and liver function as mainstay of HCC therapy