bluuebunny/crossref_metadata_2025 huggingface dataset:
Re-Audit of Prescribing Responsibility for Antipsychotic Depots for Shared Care Patients(PRAD-SCP)
Authors: Ziriki Ayebakari , Webb Cara , Olowoyo Oluwabunmi , Lee Kenn
Published: July 2023

Aims

To re-audit whether community teams are requesting GPs to take over the prescribing of antipsychotic depots for patients who have been stabilised on treatment, in line with Shared Care Pathway protocols by Greater Manchester Medicines Management Group (GMMMG).

Methods

The sample size was 199 patients open to Rochdale, Heywood and Middleton community mental health team antipsychotic depot clinics. Information was gathered from depot cards, care records and clinical entries on Paris and imputed on an Excel spreadsheet. This was a prospective audit and data collection took place between 01/11/22 and 30/12/22 by the auditors. Microsoft Excel was used to carry out simple percentage analysis by the authors and presented using charts.

Results

Transfer of prescribing responsibility for first generation antipsychotic had the highest compliance rate with 98% prescribed by GP on shared care protocol for stable patients followed by Paliperidone and Risperidone at 94%. Aripiprazole was the least compliant with 91% prescribed by GP for stable patients as against 100% target.

Overall compliance rate for all depot antipsychotics was 96% compared with 83% from original audit in 2020. In comparing the different community teams, one team was compliant by 99% overall in transferring prescribing responsibility to the GP for stable patients and 100% compliant with 1st generation antipsychotics, paliperidone and risperidone.

The data showed that CMHT prescribed higher proportion of 2nd generation antipsychotics when compared to original audit.

Conclusion

This re-audit has demonstrated that overall, there was significant improvement in compliance with GMMMG shared care guidelines by Rochdale community teams from 83% in 2020 to 96% in 2022. However, this does not meet the standard of 100% target for depot antipsychotics as per GMMMG guidelines. In other to ensure that target standards are met a 100%, secondary care prescribers should ensure appropriate transfer of prescribing responsibilities via the shared care protocol to the GP for stable patients are done and also shared with the new team particularly during the transition phase for patients transferred from one team to another who are stable on their current medication.
Challenges of Chemsex in Health, Justice, and Social Care Settings: Developing a Coordinated Response
Authors: Hillier Bradley , Carthy Elliott , Pakianathan Mark , Tracy Derek , Hickson Ford , Forrester Andrew
Published: July 2023

Aims

Chemsex refers to the use of specific drugs before or during sex to sustain, enhance, disinhibit, or facilitate the sexual experience, primarily amongst gay, bisexual and other men who have sex with men. The main drugs associated with Chemsex are crystal methamphetamine, gamma-hydroxybutyrate/gamma-butyrolactone, mephedrone and ketamine. There are complex biological, psychological, and social factors that influence why someone may choose to engage in Chemsex that are yet to be fully elucidated. However, there are global concerns that such harm is increasing both in prevalence and complexity, including interfaces between the health, social care and criminal justice systems. Chemsex has been identified as a priority for the UK Home Office Drug Strategy since 2017; however, the response to date has lacked a coordinated approach between the multiple services and agencies where Chemsex can present.

Methods

West London NHS Trust hosted a day-long meeting of the Chemsex Expert Reference Group (ERG) on 27th July 2022 at the London School of Hygiene and Tropical Medicine. This comprised of a group of clinicians and academics across the NHS, criminal justice system and third sector, with the meeting focused on three main clinical questions: what do we need to know about working with this complex and vulnerable group of people?; What is the research needed to improve this?; What are the aspiration clinical pathways that should be developed?

Results

The ERG identified several gaps in our knowledge including a paucity of epidemiological data, the importance of cultural competency around the health needs of LGBTQ+ people, inconsistencies in the knowledge of healthcare professionals on how to manage emergency presentations such as methamphetamine-induced psychosis, GHB withdrawal and GHB overdose and risk assessment and risk management for those who may also be a victim and/or a perpetrator of a criminal offence in the Chemsex context. The group's core values for service and pathway development were identified as to be authentic, competent, non-judgemental and that lived experience should be at the centre of service development, as well as being evidence-based and supported by national clinical guidelines.

Conclusion

What was apparent was the ambition and interest from across so many clinical specialities, and some incredibly positive work that is already ongoing. It is hoped that the outcomes of this ERG can help progress this to a more cohesive set of responses, and the development of an evidence-based, multi-agency approach to assessment and treatment for this complex group.
Testogel Application in the Menopause: Making a Difference to the Lives of Women
Authors: Heald Adrian , Ghaffari Parisa , Naseem Asma , Zaidi Naseem
Published: July 2023

Aims

Benefit has been shown from testosterone therapy given to postmenopausal women experiencing reduced sexual desire. Specifically, an increased frequency of satisfying sexual encounters and intensity of sexual desire and better sexual response has been shown with testosterone therapy in a number of studies spanning more than 35 years. Androgen therapy has been related to improvement in energy, mood, well-being, self-perception, and some parameters of sexuality (libido, activity, sexual arousal, excitability and satisfaction.

Methods

In a group of 10 menopausal women applying Testogel 16.2mg/g at the dose of 20.25 mg every 3-4 days as part of their usual care together with oestrogen +/- progestogen HRT, we measured serum testosterone and free androgen index (FAI) pre-application of Testogel and 24 hours after its application. Testosterone was measured by mass spectrometry. The Female Sexual functioning Index (FSFI) was completed by the women.

Results

The range of duration of treatment with testosterone was 6 months-23 years. All women subjectively reported an improvement in sexual function with testosterone administered most recently as Testogel.

Female Sexual functioning Index (FSFI) median score was 24.5/36 (25-75% interquartile range 18-28) with highest domain scores for sexual satisfaction and arousal (4.2/6) and moderate scores for orgasm and desire (3.6/6) with lowest domain score for lubrication (2.4/6) and no reported issues re pain on intercourse, All women subjectively reported an improvement in sexual function with testosterone supplementation.

Mean pre-Testogel administration testosterone level (corresponding to a trough level) was 0.85: 0.6-1.2 nmol/L (median: 25-75% interquartile range) rising at 24 hours post Testogel to 3.6: 1.9-4.8 nmol/L (median: 25-75% interquartile range) (Reference range for testosterone is women is up to1.4 nmol/L).

The rise in serum testosterone was not associated with any untoward effects in terms of hirsutism/acne.

Conclusion

All the women in our case series experienced benefit with testosterone gel in terms of sexual function. FSFI score indicated reasonable sexual function in this group of women treated with Testogel for HSDD.

The increase in serum testosterone level and FAI at 24 hours after application of Testogel was not associated with untoward reported / manifest consequences.

Testosterone supplementation is not approved for treatment of hypoactive sexual desire disorder (HSDD) in the UK / other parts of Europe. This matter needs to be addressed as a priority by all stakeholders so that this medication can be made more freely available.
Rapid Clozapine Blood Level Determination in a National Health Service Trust
Authors: Taylor David , Courtney Jodi , Hilaire Mary Rose , Atkins Matthew
Published: July 2023

Aims

The use of clozapine demands regular monitoring of patients’ clozapine blood levels. Assays are usually performed in a central laboratory with results available only after several days. The South London and Maudsley NHS Trust wanted to implement a clozapine Point-of-Care (POC) capillary blood test that would provide the benefits of immediate results.

Methods

The MyCare Insite, a small (2.2 kg) tabletop analyser was used. The Insite can readily be connected to electronic health records. Insite device has been fully validated but to achieve the benefit of clozapine POC testing, other factors beyond the test validation needed to be considered. We developed tools, software, and processes to guide health professionals on why and when to measure clozapine blood levels, on what to do with test results, and systems for documentation and tracking of patients’ test results. In addition, the device supplier conducted staff training to ensure consistent and correct testing. Finally, users were certified as qualified based on demonstrated proficiency.

Results

We have fully implemented POC capillary clozapine testing across four geographic sites.. Patients and staff preferred capillary finger stick testing over venous draws. Patients’ engagement with their results was better than with laboratory testing. Real-time testing for adherence was possible for patients admitted on clozapine. It was also possible to make rapid dose adjustments based on near immediate plasma level results. Patient safety was increased since toxic levels could be quickly detected. Clinical decision-making was expedited as results were available immediately (< 7 minutes). The utility of the testing meant that the length of hospital stays was reduced as discharges were not delayed pending a laboratory result.

Conclusion

Clozapine POC blood level testing was successfully implemented at our institution achieving the expected benefits of clozapine POC testing with near immediate results. The new process improves clozapine management, patient engagement and reduces inpatient bed stays.
Risk Factors for Self-Harm and Suicide Upon Release From Prison: A Systematic Review
Authors: Abdou Nouran , Robinson Louise , Gutridge Kerry
Published: July 2023

Aims

As of 2018, there were over 11 million people imprisoned globally. Suicide and self-harm rates have been found to be markedly elevated among imprisoned individuals, however there is much less literature reporting on risk factors for suicide and self-harm following prison release. The immediate post-release period has been found to be a particularly high-risk period for suicide and self-harm. Since many more people are released into the community every year than people kept imprisoned, released prisoners' health is a matter of public health concern. With the societal impact of this topic in mind, this systematic review aims to collate the risk factors for suicide and self-harm upon release from prison.

Methods

PubMed, PsycINFO, MEDLINE, and Cochrane were systematically searched using keywords relating to prison release, self-harm and suicide for articles published since 1/1/12. Studies were included if they reported data on risk factors for self-harm or suicide and followed prespecified inclusion criteria. Articles were screened by the author and uncertainty was settled by two independent reviewers. Included studies were evaluated using standardised quality assessment tools. Quantitative data were narratively synthesised due to a high level of heterogeneity in between studies.

Results

248 articles were identified in total. 10 articles were included, reporting data on self-harm and suicide risk factors from 5 countries. Studies ranged from moderate (n = 2) to high quality (n = 8). Risk factors were categorised into the following: demographic characteristics, psychiatric history, conviction type, and imprisonment history. Risk factors which did not fit into any of these categories were categorised into an ”other” group. It was found that there were many non-modifiable factors such as violent convictions, female sex, Indigenous (Torres Strait Islander or Aboriginal) ethnicity, and single relationship status which increase self-harm or suicide risk upon release.

Conclusion

To our knowledge, this is the first systematic review to collate the risk factors for suicide and self-harm following prison release. The results show a complex variety of risk factors. The high mortality rate in this group necessitates the need for strategies to intervene before community re-entry. Study into risk factors post-release may guide identification of at-risk groups to target with proactive, coordinated care pre- and post-release. It is likely this will require a multifactorial approach including health, social and community programmes.
Supporting Physical Health in Addiction Recovery - No Wrong Door
Authors: Arogunmati Olubunmi , Jackson Emily , Buzzeo Claire , Hearn Andrea
Published: July 2023

Aims

Substance use disorders are associated with significant physical health comorbidities, necessitating an integrated treatment response. However, service fragmentation can preclude the management of physical health problems during addiction treatment. (Osborne et al, 2022). Northeast England continues to have the highest morbidity /mortality with regards to substance use (ONS, 2022). Therefore, it is essential that staff in addiction health settings innovate to address physical health.

Methods

A review of the literature identified little research relating to physical health care in addiction and recovery settings. Our service protocol for blood testing was used to set the audit standards. The blood testing assessed electronic communication and electronic records. Physical health nurses take blood on request and email blood results to a medical/clinician inbox. The total sample was 1128 since pathway inception in March 2022.A sample size of 70 was selected via systematic sampling using n-15th person. Descriptive analyses of data followed by qualitative exploration with the physical health team was completed. The audit was registered locally.

Results

Of the sample size of 70 whose records were reviewed, we noted that blood tests were reviewed by medics (100%) with 98.6% of these reviews being within 6 hours of notification by the physical health team. Action plans were documented for blood results requests and communicated by email to physical health team (100%). 84.3% of the action plans were completed by physical health team on receipt of emails. Non completion of action plans in 15.7% of cases was related to client being hospitalised or disengaging from services (which might include relocation out of area or transfer into the criminal justice system).

Conclusion

Within our service, we have patients who struggle to attend conventional pathways e.g., GP. In view of the previously stated morbidity and mortality it is important that we are able to offer blood testing with timely follow up and action plans when appropriate to these patients.

Our service has good liaison with local services and bespoke partnerships to cater for the homeless amongst other subgroups. We used this audit to also improve processes and patient safety with plans for a re-audit. There was no previous nor national comparison for these data.
Sleep Problems and Gambling Disorder: Findings in Non-Treatment Seeking Young Adults
Authors: Austin Holly , Chamberlain Samuel , Grant Jon , Baldwin David
Published: July 2023

Aims

The aim of the study was to investigate the potential association between gambling disorder and symptoms of sleep problems including insomnia and hypersomnolence. Gambling disorder is a behavioural addiction featuring persistent, recurrent gambling resulting in distress and impairment of function. Lifetime prevalence of gambling disorder is estimated at 0.6–0.9%, though high quality data in the UK are lacking. Psychiatric comorbidity is common; as are physical health problems such as hypertension. The association between sleep problems and other addictions such as alcohol misuse disorder, smoking and substance misuse has been established; however, research into gambling disorder and sleep problems is limited. It was hypothesised that, compared to controls, individuals with gambling disorder would have significantly greater disturbance of sleep, as indicated by increased scores in: 1) specific sleep items on the Hamilton Anxiety Rating Scale (HAMA) and Hamilton Rating Scale for Depression (HAMD), 2) total score on the HAMA and HAMD and 3) the Epworth Sleepiness Scale (ESS).

Methods

A secondary analysis of a subset of previously published data by Grant and Chamberlain (2018) on gambling and impulsivity. A total of 152 non-treatment seeking adults, aged 18–29 years, who had gambled at least five times in the past year were recruited. Individuals were stratified into three groups: controls, those at risk of gambling disorder, and those with gambling disorder, as per DSM-5 criteria. One-way ANOVAs with post-hoc tests were conducted. These were used to show whether the three groups differed significantly in their scores in the sleep items and total scores of the HAMA and HAMD, and the ESS.

Results

The HAMD scale demonstrated a significant increase in all patterns of insomnia for members of the disorder group, when compared to controls. The increase was particularly marked for middle and late insomnia. The HAMA item score demonstrated significantly worse sleep quality in the disorder group, compared to at risk and control groups. Total scores on the HAMA and HAMD scales were also significantly higher in the disorder group, reaching the thresholds for clinical significance for anxiety and depression. ESS scores were not significantly different between groups.

Conclusion

Global disruptions in sleep, as well late- and middle-insomnia, were found to be significantly higher in gambling disorder than controls. Symptoms of anxiety and depression were also significantly higher in the gambling disorder group. Further research could have implications for the identification and treatment of sleep disorders and psychiatric comorbidities in gambling disorder.
Outcomes of Pre-Existing Diabetes in People With/without New Onset Severe Mental Illness: A Primary-Secondary Mental Healthcare Linkage in South London, United Kingdom
Authors: Bell Nikeysha , Perera Gayan , Ashworth Mark , Boradbent Matthew , Stubbs Brendon , Gaughran Fiona , Stewart Robert
Published: July 2023

Aims

To compare people with diabetes developing severe mental illness (SMI) to those with diabetes alone with respect to risk status, diabetes care receipt, and diabetes-relevant outcomes in primary care.

Methods

Data from mental health care (Clinical Record Interactive Search; CRIS) linked to primary care (Lambeth DataNet; LDN) were used. From patients with a type 2 diabetes mellitus (T2DM) diagnosis in primary care, those with a new SMI diagnosis were matched (by age, gender, and practice) with up to five randomly selected controls. Mixed models were used to estimate associations with trajectories of recorded HbA1c levels; Poisson regression models compared total and cardiovascular comorbidity levels and number of diabetes complications; linear regression models compared BMI and total cholesterol levels; conditional logistic regression models investigated microalbuminuria, receipt of a foot or retinal examination, use of statins and receipt of insulin; Cox proportional hazards were used to model incident microvascular and macrovascular events, foot morbidity and mortality.

Results

In a cohort of 693 cases with SMI (122 bipolar disorder, 571 schizophrenia and related) and T2DM compared to 3366 controls, all-cause mortality was increased substantially in the cohort with SMI (adjusted hazard ratio 4.52, 95% CI 3.73–5.47; for bipolar 5.59, 3.37–9.28; for schizophrenia 4.42, 3.60–5.44). However, for all the other outcome comparisons, the only significant findings were of reduced foot examination (adjusted odds ratio 0.75, 0.54–0.98) and reduced retinal screening (0.77, 0.61–0.96).

Conclusion

Higher mortality suggests increased risk of adverse outcomes for people with pre-existing T2DM who develop SMI, and reduced foot/retinal examinations suggest disadvantaged healthcare receipt. However, other potential explanations for the mortality difference could not be identified from the outcomes analysed, so further investigation is needed into underlying causal pathways.
Effects of Transauricular Vagus Nerve Stimulation on Heart Rate Variability: Wearable Sensor Data in Healthy Volunteers
Authors: Costa Tiago , Smith Billy , Cave Hannah , Ahmed Sharmin , Wang Yujiang , Baker Mark R , Watson Stuart , McAllister-Williams R Hamish
Published: July 2023

Aims

Surgically implanted vagus nerve stimulation (VNS) is a recognised treatment for depression. The vagus nerve can also be stimulated non-invasively via its auricular branch, using transauricular vagus nerve stimulation (taVNS). Heart rate variability (HRV) is a putative biomarker of autonomic nervous system (ANS) engagement. We aimed to test the impact of taVNS on the ANS of healthy volunteers by measuring HRV using a double-blind, sham-controlled, longitudinal design to acquire data over 7 days using wearable cardiac sensors.

Methods

taVNS was delivered to the left ear of healthy volunteers using a transcutaneous electrical nerve stimulation (TENS) device via a custom clip electrode (developed at Newcastle University). All participants were stimulated at 10 Hz, with pulse widths of 300 ms and variable current outputs, depending on perceptual thresholds. We delivered double-blinded active and sham taVNS for hour-long periods, in the morning and evening. We also recorded an electrocardiogram (ECG) lead I using a VitalPatch for 7 consecutive days. Python scripts were developed to produce HRV timeseries and plot data. ECG frequency domain parameters – low- (LF) (0.05–0.15 Hz) and high-frequency (HF) power (0.15–0.4 Hz) – were calculated for each stimulation period. The LF/HF ratio was used as a marker of autonomic modulation. The Wilcoxon signed-rank test was used to compare LF/HF ratio distributions.

Results

Initial data from the wearable sensors were used to develop interpolation scripts to improve the processing of noise, missed R waves and ectopic beats, to reduce errors when estimating HRV from the heart rate signal. Initial results from 97 individual 1-hour long stimulation periods, from 18 participants, show that active stimulation in the morning, when compared with sham stimulation in the same period, significantly reduces the LF/HF ratio. The median and interquartile range (IQR) of the LF/HF ratio for the active and sham periods was, respectively, 1.72 (1.99) and 2.75 (2.82), a statistically significant difference (p = 0.043).

Conclusion

taVNS modulates HRV frequency domains, suggestive of vagal cardiac effects, and replicates findings from previous taVNS studies. Reductions in the LF/HF ratio are suggestive of increased parasympathetic tone. As the auricular branch of the vagus does not have any direct cardiac efferents, this suggests central ANS modulation using taVNS. Secondly, it suggests that cardiac ANS modulation could be used as a proxy measure of afferent vagal stimulation, which could be of clinical utility. These effects warrant exploration in a larger cohort study, including wider demographics (including age range) and improved processing pipelines.
The New 2022 Curriculum for Postgraduate Training in Psychiatry in the UK – Experiences of Trainees Within a London Deanery
Authors: Dionelis Karolos , Varvari Ioana , Ranjith Gopinath
Published: July 2023

Aims

The Royal College of Psychiatry introduced a new postgraduate training curriculum in August 2022. One of the main changes is the introduction of a new collaborative tool between supervisor and trainee, the placement-specific personal development plan (PSPDP). The aim of this project is to locally explore trainee's views and experiences with the PSPDP.

Methods

We explored the views and experiences of seven psychiatry trainees within the South London and Maudsley NHS Foundation Trust in a single 60-minute focus group, co-facilitated by two authors over Microsoft Teams. The participants were purposively identified to have started core and higher training under the new curricula and a snowballing approach was used to recruit them. The data were recorded, transcribed, and analysed in line with ethical guidelines. The analysis was done by using Clarke and Braun's approach to thematic analysis.

Results

Three overarching themes were identified:

1.

Positives of using a collaborative tool with a psychiatric supervisor (PS),

2.

Challenges in implementation and

3.

Trainees’ perspectives on directions forward.

The most notable subtheme of theme one was the improved curricular alignment between learning opportunities, curriculum content, and assessment tools. As one participant mentioned: “When we were going through [the PSPDP], it definitely guided us, what we wanted to (…) get out of this placement in particular, and also the kind of workplace-based assessments needed.”. The time-effective and structured approach to learning, regular progress follow-up, as well as improved motivation to engage with the placement were further subthemes mentioned. Examples of subthemes emerging from theme two were lack of PS knowledge about the PSPDP, as well as lack of training and information for trainees. Participants commented that “supervisors really didn't know what they were supposed to do” and that “the information [shared during induction] was outdated”. One example of subthemes from theme three was the need for additional training both for trainees and PSs. As one participant mentioned: “Training is required for supervisors (…) and for us as well to get really used to the system. Because it's a good system if we know how to use it.”

Conclusion

To the best of our knowledge this is the first study exploring trainees’ views on the new PSPDP. Whilst trainees appreciated the potential benefits of working through the PSPDP together with their supervisor, significant challenges remained and may hinder its meaningful use. Our next steps are designing and running a hybrid questionnaire to gather views from a larger sample.
The Prevalence of Traumatic Brain Injury and ADHD in Secure Settings
Authors: Kelsey David , Berry Alex J. , Alves-Costa Filipa , Loughran Matthew , Ameir Salma , Taylor Richard
Published: July 2023

Aims

Traumatic brain injury (TBI) is highly prevalent in prison populations, with an estimated prevalence of 51%-82% according to a 2018 review. TBI has been linked to higher rates of interpersonal violence, recidivism, suicide, higher drop-out rates in rehabilitation programmes, and lower age of first conviction. Attention deficit hyperactivity disorder (ADHD) has been shown to be associated with an increased risk of interpersonal violence, and previous TBI. Little is known about prevalence of TBI or ADHD amongst inpatients in secure psychiatric settings in the UK. We aimed to estimate the prevalence of TBI and ADHD in inpatients admitted to a psychiatric intensive care unit (PICU) and to low and medium secure units across three London mental health NHS trusts.

Methods

60 male participants were identified through prospective purposive sampling. Three questionnaires were administered: the Brain Injury screening Index (BISI); Adult ADHD Self-Report Scale v1.1 (ASRS); and the Brief-Barkley Adult ADHD Rating scale (B-BAARS). We also reviewed medical records of participants, age, psychiatric diagnoses, level of education, and convictions for violent and/or non-violent offences, number of admissions, and length of current admission. Ethical approval was granted by the local research ethics committee

Results

67.8% of participants screened positive for a history of head injury, and 68.3% and 32.2% screened positive on the ASRS and B-BAARS respectively. 38.33% recorded greater than one head injury on the BISI. The most commonly recorded psychiatric diagnoses were schizophrenia (43.33%), schizoaffective disorder (23.33%), Bipolar Affective Disorder (11.67%), and Unspecified Non-Organic Psychosis (10.00%). Screening positive on ASRS was associated with screening positive for previous head injuries BISI (p = 0.01, ꭕ2). No other statistical associations were identified.

Conclusion

A relatively high proportion of participants screened positive for head injury and ADHD in this population. A history of head injury was associated with positive screening on the ASRS, which is consistent with previously reported associations between these conditions in other populations. A similar relationship was not seen with the B-BAARS however, and it is notable that fewer participants in the sample screened positive on the B-BAARS than using the ASRS. Few (n = 5) patients were able to provide detailed descriptions of head injuries using the BISI, suggesting that the BISI may not be suitable in this specific population as a screening tool.
Abundance
Authors: Arondekar Anjali
Published: July 2023

In Abundance, Anjali Arondekar refuses the historical common sense that archival loss is foundational to a subaltern history of sexuality, and that the deficit of our minoritized pasts can be redeemed through acquisitions of lost pasts. Instead, Arondekar theorizes the radical abundance of sexuality through the archives of the Gomantak Maratha Samaj—a caste-oppressed devadasi collective in South Asia—that are plentiful and quotidian, imaginative and ordinary. For Arondekar, abundance is inextricably linked to the histories of subordinated groups in ways that challenge narratives of their constant devaluation. Summoning abundance over loss upends settled genealogies of historical recuperation and representation and works against the imperative to fix sexuality within wider structures of vulnerability, damage, and precarity. Multigeneric and multilingual, transregional and historically supple, Abundance centers sexuality within area, post/colonial, and anti/caste histories.
Exploring the Intersection of Artificial Intelligence and Neurosurgery: Let us be Cautious With ChatGPT
Authors: Mishra Akash , Begley Sabrina L. , Chen Adrian , Rob Moontahinaz , Pelcher Isabelle , Ward Max , Schulder Michael
Published: July 2023

BACKGROUND AND OBJECTIVES:

ChatGPT is a novel natural language processing artificial intelligence (AI) module where users enter any question or command and receive a single text response within seconds. As AI becomes more accessible, patients may begin to use it as a resource for medical information and advice. This is the first study to assess the neurosurgical information that is provided by ChatGPT.

METHODS:

ChatGPT was accessed in January 2023, and prompts were created requesting treatment information for 40 common neurosurgical conditions. Quantitative characteristics were collected, and four independent reviewers evaluated the responses using the DISCERN tool. Prompts were compared against the American Association of Neurological Surgeons (AANS) “For Patients” webpages.

RESULTS:

ChatGPT returned text organized in paragraph and bullet-point lists. ChatGPT responses were shorter (mean 270.1 ± 41.9 words; AANS webpage 1634.5 ± 891.3 words) but more difficult to read (mean Flesch-Kincaid score 32.4 ± 6.7; AANS webpage 37.1 ± 7.0). ChatGPT output was found to be of “fair” quality (mean DISCERN score 44.2 ± 4.1) and significantly inferior to the “good” overall quality of the AANS patient website (57.7 ± 4.4). ChatGPT was poor in providing references/resources and describing treatment risks. ChatGPT provided 177 references, of which 68.9% were inaccurate and 33.9% were completely falsified.

CONCLUSION:

ChatGPT is an adaptive resource for neurosurgical information but has shortcomings that limit the quality of its responses, including poor readability, lack of references, and failure to fully describe treatment options. Hence, patients and providers should remain wary of the provided content. As ChatGPT or other AI search algorithms continue to improve, they may become a reliable alternative for medical information.
Εφαρμογή και αποτίμηση της μεθόδου «Μετασχηματίζουσα Μάθηση μέσα από την Αισθητική Εμπειρία» στην Πρωτοβάθμια Εκπαίδευση
Authors: Χρήστου Μαρία
Published: July 2023

Σκοπός του παρόντος άρθρου είναι η παρουσίαση της έρευνας που εκπονήθηκε από την υπογράφουσα με θέμα τον τρόπο εφαρμογής της μεθόδου «Μετασχηματίζουσα Μάθηση μέσα από την Αισθητική Εμπειρία», σε ομάδα μόνιμων εκπαιδευτικών Πρωτοβάθμιας Εκπαίδευσης δημοσίων σχολείων της Αθήνας και του Πειραιά, αφού είχε προηγηθεί επιμόρφωσή τους στη συγκεκριμένη μέθοδο. Στόχοι της έρευνας ήταν οι εξής: α) η διερεύνηση της δυνατότητας αποτελεσματικής εφαρμογής όλων των σταδίων της μεθόδου από τους εκπαιδευτικούς, ώστε να επιτυγχάνεται ο μετασχηματισμός των στερεοτυπικών απόψεων των μαθητών, και β) η διερεύνηση του κατά πόσο η επιμόρφωση των εκπαιδευτικών συντελεί στην αποτελεσματική εφαρμογή της μεθόδου σε πραγματικές συνθήκες διδασκαλίας. Αρχικά παρουσιάζεται συνοπτικά το θεωρητικό πλαίσιο της έρευνας, το οποίο εστιάζει σε πέντε βασικούς τομείς: Στη Θεωρία Μετασχηματισμού και τη Δομο-αναπτυξιακή προσέγγιση της μετασχηματίζουσας μάθησης, στην επιμόρφωση των εκπαιδευτικών Πρωτοβάθμιας Εκπαίδευσης, στη θέση που κατέχει η Μετασχηματίζουσα Μάθηση στην Πρωτοβάθμια Εκπαίδευση, στη δυνατότητα αξιοποίησης της Τέχνης ως μέσο ανάπτυξης μετασχηματίζουσας μάθησης και στην ίδια τη μέθοδο «Μετασχηματίζουσα Μάθηση μέσα από την Αισθητική Εμπειρία». Σχετικά με τη μεθοδολογία της έρευνας που ακολουθήθηκε, λαμβάνοντας υπόψη τον στόχο της έρευνας, η έρευνα-δράση κρίθηκε ως πλέον κατάλληλη και αποτελεσματική. Ακολουθεί παρουσίαση της μεθόδου της έρευνας, των ευρημάτων και των αποτελεσμάτων της έρευνας, συζήτηση και προτάσεις. Επισημαίνεται ότι το παρόν κείμενο αποτελεί συνοπτική παρουσίαση της διδακτορικής διατριβής «Αποτίμηση της εφαρμογής της μεθόδου «Μετασχηματίζουσα Μάθηση μέσα από την Αισθητική Εμπειρία» στην Πρωτοβάθμια Εκπαίδευση», η οποία εκπονήθηκε από τη συγγραφέα στο Ελληνικό Ανοικτό Πανεπιστήμιο την περίοδο 2016–2020. Σε όλο το κείμενο χρησιμοποιείται ένα γένος, χάριν οικονομίας του λόγου, χωρίς αυτό να παραπέμπει σε οποιαδήποτε διάκριση με βάση το φύλο.
A survey of security, privacy and trust issues in vehicular computation offloading and their solutions using blockchain.
Authors: Fayi Sharifah Yaqoub , Sheng Zhengguo
Published: July 2023

Continuous improvement in transportation systems and smart vehicles' appearance make new highly intensive applications. Complex applications need high-performance capabilities, real-time responses, and generate massive amounts of data to process and exchange. This presents the idea of vehicular edge computing (VEC), which is proposed to handle complex applications and satisfy smart vehicle processing requirements. VEC enables computation offloading to an edge server to reduce communication latency, execution cost and energy consumption greatly. However, offloading to another node opens up new vulnerabilities regarding security and privacy. Moreover, trust issues in such an untrustworthy environment need an effective trust management solution and incentive mechanisms to improve overall security. This will increase the computation offloading success rate and the vehicles' willingness to share their resources. Particularly given the high transportability and heterogeneity of vehicular networks, the conventional security and trust management methods are inadequate. Blockchain, the rapidly emerging trend technology, is a unique solution that can help overcome security and privacy issues and meet trust management and incentive mechanism goals. Blockchain’s immutable distributed ledger, traceability, consensus validation system and smart contract features can improve vehicular network security. Although most research is focused on enhancing the performance of computation offloading algorithms, blockchain security solutions in computation offloading scenarios are not fully discussed. Thus, security and trust issues related to computation offloading in VEC environments need more consideration since supporting the new complex vehicular applications is essential. Therefore, this paper provides a review of recent surveys and studies, an overview of VEC, computation offloading and blockchain, in addition to discussing security, privacy and trust in vehicular networks and computation offloading while considering blockchain as a distributed security solution. We propose a new paradigm called blockchain edge of vehicle (BEoV) at the end, which enables several blockchain-based security services for vehicular computation offloading in particular.
The genome sequence of a tachinid fly, Tachina lurida (Fabricius, 1781)
Authors: Falk Steven , Smith Matthew N. ,   University of Oxford and Wytham Woods Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life programme,   Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: July 2023

We present a genome assembly from an individual female Tachina lurida (a tachinid fly; Arthropoda; Insecta; Diptera; Tachinidae). The genome sequence is 899.2 megabases in span. Most of the assembly is scaffolded into 6 chromosomal pseudomolecules, including the X sex chromosome. The mitochondrial genome has also been assembled and is 17.3 kilobases in length. Gene annotation of this assembly on Ensembl identified 12,127 protein coding genes.
Frontal cortex functional activity modulation impact on the stereotypic, emotional and postural behavior in rats during the interictal period of pilocarpine-induced chronic epileptogenesis
Authors: Kashchenko O. , Stoyanov O. , Volokhova G. , Berbek V. , Voloshchuk D. , Pryshchepa O. , Zayats L. , Tatarko S.
Published: July 2023

The cholinergic mechanisms role determination in epileptogenesis attracts the attention of researchers. Pilocarpine administration in rats contributes to chronic form of epileptiform activity development characterized by the presence of a pronounced acute stage and an interictal period - free from behavioral convulsive reactions. We consider the most important feature of the pilocarpine-induced seizures interictal period might be the change of various forms of nonconvulsive behavior. Attempts to investigate the animals’ behavioral reactions details during the seizure-free interictal period, as well as to determine the mechanisms of similar types of behavior formation, are interesting. The purpose of the work is to investigate the motor, stereotypic and aggressive-defensive behavior of rats throughout the interictal period of pilocarpine-induced convulsive syndrome with a frontal cortex functional activity change. It was found that the severity of non-convulsive behavioral reactions in the interictal period during pilocarpine-induced chronic seizures is mostly determined by the frontal cortex functional state. At the same time, the frontal cortex hyperactivation is an important feature of pilocarpine-induced chronic epileptogenesis.  The authors proved that when the frontal cortex is activated in rats, there is an increase in horizontal and vertical motor activity, as well as the expressiveness of emotional reactions in the “open field” test and the strengthening of the aggressive-defensive behavior. In conditions of this part of the cortex selective destruction the opposite behavioral effects are noted which confirms the important role of the frontal cortex in the interictal non-convulsive behavior formation. Observed behavioral effects during the frontal cortex functional activity modulation, according to the authors, indicate the reasonability of regulatory influences searching aiming forward this brain part to activate complex mechanisms aimed to pilocarpine-induced chronic epileptiform activity elimination.
Emergency Preparation and Uncertainty Persistence
Authors: Sundaresan Savitar
Published: July 2023

Unusual events trigger persistent spikes in uncertainty. Standard models cannot match these dynamic patterns. This paper presents a unified framework, motivated by the literature on inattention. Agents choose whether and how to prepare for different possible states of the world by collecting information. Agents optimally ignore sufficiently unlikely events, so the occurrence of such events does not resolve, but rather increases, uncertainty. Uncertain agents have dispersed beliefs, making it harder to focus future preparation. Thus, uncertainty begets uncertainty for an inattentive agent, endogenously persisting. In a financial application, this framework matches patterns in volatility, volume of trade, belief dispersion, and spreads.

This paper was accepted by Victoria Ivashina, finance.

Supplemental Material: The data file is available at https://doi.org/10.1287/mnsc.2023.4836 .
Delivering community-focused diabetes care to tackle health inequalities
Authors: Phillips Anne
Published: July 2023

Anne Phillips highlights disparities in diabetes care across the UK, emphasising the need for community-focused services design and integrated working to reduce the impact on patients and NHS services.
Neurological Complications of Primary Varicella Zoster Virus Infection in Children- Case Reports
Authors: Mihai Raluca , Mavrodin Mihaela , Fabrian Mihalcea , Dumitrescu Anca , Cambrea Simona Claudia
Published: July 2023

Introduction: VZV is a human neurotropic alpha herpes virus, and humans are the only reservoir. Infection can involve any part of the nervous system. The incidence of neurological manifestations associated with VZV is 1-3 per 10,000 cases.

The clinical manifestations of varicella-zoster virus (VZV) infections of the central nervous system (CNS) include aseptic meningitis, encephalitis, cerebral infarction associated with granulomatous vasculitis, myelitis, and multiple cranial neuropathies.

The aim of this study, by reporting a series of 5 cases of chickenpox hospitalized in the Clinical Infectious Diseases Hospital from Constanta, is to demonstrate some of the neurological complications of varicella zoster virus infection in children, highlighting the importance in early recognition and prompt initiation of specific treatment.

Case reports: Two cases of acute post-infectious cerebellitis in children aged 7 and 9 years were hospitalized in our clinic.

The clinical picture presented by the 2 patients consisted of fever, headache, altered consciousness with coordination and gait disorders.

Other two cases of acute transverse myelitis, a 12-year-old boy, with onset in a febrile state at 9 days post varicella, initially with left knee pain associated with hypo-hyperaesthesia-like tenderness disorders, subsequently decreased lower limb muscle strength and bladder sphincter disorders. In the case of the second patient, the onset was on day 12 of evolution, with gait and balance disorders, with acute urine retention.

A fifth case, a 2-year-old child, hospitalized for altered consciousness with drowsiness, listlessness, photophobia and fever with suspicion of encephalitis.

Neither of the children didn’t reciveoral acyclovir from de onset of the rash.

Conclusion; Clinicians should be aware of the neurologic complications of VZV infection, because early recognition and initiation of acyclovir therapy is necessary for these disorders.
Evaluating Draft EPA Emissions Models for Laying Hen Facilities
Authors: Xiong Yijie , Li Guoming , Ramirez Brett C. , Burns Robert T. , Gates Richard S.
Published: July 2023

Highlights

Draft EPA emission models for laying hen facilities were systematically evaluated.

The models performed poorly on predicting the air pollutants when input variables were out of the NAEMS data range.

A key finding was the unanticipated sensitivity of the draft model outputs to bird inventory and climate zones.

Further revision and improvement may be necessary for draft models before they can be adopted by the egg industry.

Abstract. In August 2021, the U.S. Environmental Protection Agency (EPA) released draft models to estimate daily NH3, H2S, PM10, PM2.5, and TSP emissions from egg-layer houses (high-rise and manure-belt) and manure storage using inputs of daily mean ambient temperature, relative humidity (RH), and hen inventory. These models were developed from refined datasets generated by the National Air Emissions Monitoring Study fieldwork completed in 2009. Notably, they do not include data for cage-free housing. Currently, 66% of U.S. laying hens are housed in cages; thus, these models, if adopted, will have a substantial impact on the U.S. egg industry. This study evaluated the EPA draft models’ robustness and assessed model outputs for egg production systems under differing climate scenarios. The EPA draft models distort emission factors for bird inventories to be lower or higher than those used to develop the models. With inventory held constant, the marginal influence of ambient temperature and RH on daily emissions varied substantially, with some values falling below the measurement detection threshold while others exceeding literature findings. For twelve representative U.S. locations representing differing climates, substantial differences in emission factors were found for bird inventories outside the range in the database. Annual emissions estimated from inventories used to develop the EPA models also varied by location. We conclude that the current draft EPA emission models cannot be used to the degree of precision that is suitable to apply to a wide range of layer facilities, particularly cage-free systems. Revisions are suggested to accommodate a greater range of climates, laying hen facility types, and inventories for practical emission estimations. Keywords: Air quality, Ammonia, Egg production, Emission model, Hydrogen sulfide, Particulate matter, Poultry.
A Novel Ultra-Wideband Wide-angle Scanning Sparse Array Antenna using Genetic Algorithm
Authors: Jiang Z. N. , Zheng Y. , Xuan X. F. , Nie N. Y.
Published: July 2023

A single-element antenna is usually unable to meet the communication requirements of the wireless system, and the main solution is to use array antenna. The desire to reduce weight and cost of array antenna gave rise to sparse array. A linearly polarized sparse array antenna with ultra-wideband wide-angle scanning characteristics based on genetic algorithm (GA) is developed in this paper. The antenna array consists of 40 units, which is arranged by rectangular array with side length of 300 mm. Compared to the conventional periodic array, the proposed sparse array has reduced about 190 antenna elements. The sparse array can achieve S11 < -10 dB in the ultra-wideband of 3–12 GHz (120%). Experimental results for proposed antenna exhibit azimuth scanning angle of ±45°, pitching scanning angle of ±30°.
CONTORNOS DA GESTÃO DO ENSINO FUNDAMENTAL EM FEIRA DE SANTANA (1985-1996)
Authors: Almeida Silva Antonia
Published: July 2023

Tematizamos a gestão do ensino na rede municipal de Feira de Santana, entre  1985  e 1996.  No contexto  da redemocratização  do país, setores educacionais mobilizados conquistaram avanços significativos no plano da legislação  municipal,  no que toca  à democratização da gestão. Fica evidente a relevância das conquistas se comparamos as leis municipais  com outros  documentos  legais  sobre educação.  No entanto, a ruptura legal com a estrutura de ensino anterior não se fez acompanhar por uma ruptura na prática efetiva da gestão da escola. Ao contrário, percebe-se a permanência de valores e atitudes que paralisam a experiência concreta de democratização. As mudanças na legislação, obtidas  num contexto especial da vida política do país, permanecem como testemunhos da existência de esforços emancipatórios reais, mas, não hegemônicos.
ALFABETIZAÇÃO NA DISCIPLINA GEOGRAFIA: UMA DISCUSSÃO NECESSÁRIA
Authors: Regina Batista dos Santos Célia , B. Braga Maria Cleonice
Published: July 2023

O objetivo do presente artigo  é discutir  o conceito  e o sentido de alfabetização na disciplina  Geografia.  Entendemos que as séries iniciais do Ensino Fundamental  estão voltadas para alfabetizar  a criança (ou o adulto) na leitura   e   na   escrita;   é   preciso   compreender  o que é leitura e o que é escrita na disciplina ora em questão.