bluuebunny/crossref_metadata_2025 huggingface dataset:
Free dance as a cultural-historical practice of improvisation
Authors: Ailamazjan Aida M.
Published: June 2021

Background. Plastic, expressive aspects of human behaviour remain underresearched by psychologists. The focus on practices of improvisation is determined by the fact that they show most vividly how expressive movement comes into being. Objective. The aim of the study is to provide psychological analysis of improvised dance action, to identify the conditions of its generation. The hypothesis put forward concerns the formation of overall personal attitude that makes one ready to perform expressive movement in the context of musical-motional improvisation. It seems probable that the principles of movement organisation within free dance practices concern the formation of attitude that lets one perceive spontaneous, involuntary impulses to movement, changes of tonus and breath. Design. The study is a piece of theoretic-psychological analysis of improvisation dance practice. In terms of methodological and theoretical basis the study relies on cultural-historical psychology and theory of action, as well as on N.A. Bernstein’s conception of movement building. There theories allow to reconstruct the conditions of expressive movement generation in the context of musical-motional improvisation. Results. The analysis performed has shown that the principles of movement organisation, the technical aspects of the practices studied are aimed at increasing the degree of freedom of movement. It allows to enhance the receptivity to spontaneous reactions and impulses and to widen the orientation within the context of musical-motional improvisation. It makes one move in a more meaningful way and to integrate the personality into improvisation. Conclusions. Alongside with the practices of structured dances and reproductive approaches to mastering expressive movement, there are cultural-historical practices of improvisation dances. The analysis of such practices allows to single out psychological conditions and and peculiarities of movement organisation that make one generate spontaneous actions, find and try new objectives, plastic forms. Generation of spontaneous movement and musical-plastic improvisation are possible due to tuning up the whole human personality. Openness as personal attitude has its meaningful as well as motional component.
Co-radicalisation of Islamist and Nativist Extremists in Europe
Authors: Kaya Ayhan , Adam-Troian Jais
Published: June 2021

A vast amount of social science research has been dedicated to the study of Islamist extremism – in particular, to uncover its psychological and structural drivers. However, the recent revival of extreme-right extremism points to the need to investigate this re-emerging phenomenon. This article highlights some of the characteristics of the extremisation of Islamism in Europe in parallel with the rise of the extremisation of right-wing extremist groups. In doing so, we explore similarities between Islamist and right-wing extremist individuals and groups. The main premise of the article is that a threat-regulation approach fails to understand the role of contextual and structural factors in the political and religious extremisation of individuals. Instead, the article claims that a reciprocal-threat model can better explain extremist violence since it is based on the idea that nativist and Islamist extremist individuals/groups are mutually threatening each other.
Description of two new species of ants of the genus Myrmecina Curtis, 1829 (Hymenoptera: Formicidae: Myrmicinae) from the Eastern Himalayas
Authors: ASWAJ PUNNATH , ANOOP KARUNAKARAN , PRIYADARSANAN DHARMA RAJAN
Published: June 2021

Two new species of the ant genus Myrmecina Curtis, 1829, M. bawai sp. nov. and M. reticulata sp. nov., are described and illustrated based on the worker caste from Mizoram, Northeast India. The genus is reported for the first time from Mizoram, the Indian state with the highest percentage of forest cover. A key to the Indian fauna of Myrmecina is also provided based on the worker caste.
Description of a new species of the genus Pseudepitettix Zheng (Orthoptera: Tetrigoidea: Cladonotinae) from China
Authors: HUANG CHAO-MEI , DENG WEI-AN
Published: June 2021

Pseudepitettix convexa Deng, sp. nov. is described with detailed illustrations of external morphology. Comparison between new species and other species of the genus Pseudepitettix Zheng, 1995 is compiled into a table for identification. An updated key to species of the genus is given.
Gigantometopus coronobtectus sp. nov., the first Isometopinae (Hemiptera: Cimicomorpha: Miridae) from Vietnam
Authors: KIM JUNGGON , TASZAKOWSKI ARTUR , HERCZEK ALEKSANDER , JUNG SUNGHOON
Published: June 2021

The new isometopine Gigantometopus coronobtectus sp. nov. from Vietnam is described and illustrated. A revised diagnosis of Gigantometopus and detailed information on nymphal morphology based on the last-instar nymph and description of the female genitalia are presented. A key to the species of the genus is provided and the position of G. schuhi is discussed based on the morphology of pronotum and scutellum.
Taxonomy of genus Orophyllus Beier, 1954 (Orthoptera: Tettigoniidae: Pseudophyllinae)
Authors: XIE HUI-CONG , WANG HAN-QIANG , LI KAI , HE ZHU-QING
Published: June 2021

Only one species, Orophyllus montanus occurring in southern China is placed in Orophyllus. In this study, we studied samples from Hainan, Guangdong, Guangxi, Guizhou, Sichuan and Zhejiang enabling us to provide new information on this genus. Gene tree was constructed by COI gene. The results showed that there were new taxa other than the type species, namely O. grandivalvatus sp. nov. (巨瓣丽叶螽), O. nigrisartorius sp. nov. (黑缝丽叶螽), O. supeciliarilamellatus sp. nov. (眉板丽叶螽), O. guttatus sp. nov. (腹斑丽叶螽) All materials were deposited in Biological History Museum of East China Normal University (ECNU) and the Shanghai Entomological Museum, Chinese Academy of Sciences (SEM).
Impacts of a Midlatitude Oceanic Frontal Zone for the Baroclinic Annular Mode in the Southern Hemisphere
Authors: Nakayama Morio , Nakamura Hisashi , Ogawa Fumiaki
Published: June 2021

As a major mode of annular variability in the Southern Hemisphere, the baroclinic annular mode (BAM) represents the pulsing of extratropical eddy activity. Focusing mainly on subweekly disturbances, this study assesses the impacts of a midlatitude oceanic frontal zone on the BAM and its dynamics through a set of “aquaplanet” atmospheric general circulation model experiments with zonally uniform sea surface temperature (SST) profiles prescribed. Though idealized, one experiment with realistic frontal SST gradient reasonably well reproduces observed BAM-associated anomalies as a manifestation of a typical life cycle of migratory baroclinic disturbances. Qualitatively, these BAM features are also simulated in the other experiment where the frontal SST gradient is removed. However, the BAM-associated variability weakens markedly and shifts equatorward, in association with the corresponding modifications in the climatological-mean storm track activity. The midlatitude oceanic frontal zone amplifies and anchors the BAM variability by restoring near-surface baroclinicity through anomalous sensible heat supply from the ocean and moisture supply to cyclones, although the BAM is essentially a manifestation of atmospheric internal dynamics. Those experiments and observations further indicate that the BAM modulates momentum flux associated with transient disturbances to induce a modest but robust meridional shift of the polar-front jet, suggesting that the BAM can help maintain the southern annular mode. They also indicate that the quasi-periodic behavior of the BAM is likely to reflect internal dynamics in which atmospheric disturbances on both subweekly and longer time scales are involved.
Accounting for land model error in numerical weather prediction ensemble systems: toward ensemble-based coupled land/atmosphere data assimilation
Authors: Draper Clara Sophie
Published: June 2021

The ensembles used in the NOAA National Centers for Environmental Prediction (NCEP) global data assimilation and numerical weather prediction (NWP) system are under-dispersed at and near the land surface, preventing their use in ensemble-based land data assimilation. Comparison to offline (land-only) data assimilation ensemble systems suggests that while the relevant atmospheric fields are under-dispersed in NCEP’s system, this alone cannot explain the under-dispersed land component, and an additional scheme is required to explicitly account for land model error. This study then investigates several schemes for perturbing the soil (moisture and temperature) states in NCEP’s system, qualitatively comparing the induced ensemble spread to independent estimates of the forecast error standard deviation in soil moisture, soil temperature, 2m temperature, and 2m humidity. Directly adding perturbations to the soil states, as is commonly done in offline systems, generated unrealistic spatial patterns in the soil moisture ensemble spread. Application of a Stochastically Perturbed Physics Tendencies scheme to the soil states is inherently limited in the amount of soil moisture spread that it can induce. Perturbing the land model parameters, in this case vegetation fraction, generated a realistic distribution in the ensemble spread, while also inducing perturbations in the land (soil states) and atmosphere (2m states) that are consistent with errors in the land/atmosphere fluxes. The parameter perturbation method is then recommended for NCEP’s ensemble system, and it is currently being refined within the development of an ensemble-based coupled land/atmosphere data assimilation for NCEP’s NWP system.
Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) – study protocol for a randomised controlled trial
Authors: Kelly Peter , Weimar Christian , Lemmens Robin , Murphy Sean , Purroy Francisco , Arsovska Anita , Bornstein Natan M , Czlonkowska Anna , Fischer Urs , Fonseca Ana Catarina , Forbes John , Hill Michael D , Jatuzis Dalius , Kõrv Janika , Kruuse Christina , Mikulik Robert , J Nederkoorn Paul , O’Donnell Martin , Sandercock Peter , Tanne David , Tsivgoulis Georgios , Walsh Cathal , Williams David , Zedde Marialuisa , Price Christopher I
Published: June 2021

Background

Inflammation contributes to unstable atherosclerotic plaque and stroke. In randomised trials in patients with coronary disease, canukinumab (an interleukin-1B antagonist) and colchicine (a tubulin inhibitor with pleiotropic anti-inflammatory effects) reduced recurrent vascular events. Hypothesis: Anti-inflammatory therapy with low-dose colchicine plus usual care will reduce recurrent vascular events in patients with non-severe, non-cardioembolic stroke and TIA compared with usual care alone.

Design

CONVINCE is a multi-centre international (in 17 countries) Prospective, Randomised Open-label, Blinded-Endpoint assessment (PROBE) controlled Phase 3 clinical trial in 3154 participants. The intervention is colchicine 0.5 mg/day and usual care versus usual care alone (antiplatelet, lipid-lowering, antihypertensive treatment, lifestyle advice). Included patients are at least 40 years, with non-severe ischaemic stroke (modified Rankin score ≤3) or high-risk TIA (ABCD2 > 3, or positive DWI, or cranio-cervical artery stenosis) within 72 hours-28 days of randomisation, with qualifying stroke/TIA most likely caused by large artery stenosis, lacunar disease, or cryptogenic embolism. Exclusions are stroke/TIA caused by cardio-embolism or other defined cause (e.g. dissection), contra-indication to colchicine (including potential drug interactions), or incapacity for participation in a clinical trial. The anticipated median follow-up will be 36 months. The primary analysis will be by intention-to-treat.

Outcome

The primary outcome is time to first recurrent ischaemic stroke, myocardial infarction, cardiac arrest, or hospitalisation with unstable angina (non-fatal or fatal).

CONVINCE will provide high-quality randomised data on the efficacy and safety of anti-inflammatory therapy with colchicine for secondary prevention after stroke.

Schedule

First-patient first-visit was December 2016. Recruitment to complete in 2021, follow-up to complete in 2023.
Enhanced Recovery After Surgery Nutrition Protocol for Major Head and Neck Cancer Surgery
Authors: Moore Cindy , Pegues J’undra , Narisetty Vamsi , Spankovich Christopher , Jackson Lana , Jefferson Gina D.
Published: June 2021

Objective

To determine whether an enhanced recovery after surgery (ERAS) nutrition protocol is reasonably possible among our head and neck cancer (HNC) population with respect to system feasibility and patient compliance. Second, we aim to identify improvements in patient outcomes as a result.

Methods

Preexperimental research design among patients undergoing major HNC surgery after implementation of the ERAS nutrition protocol from July 2018 to July 2019 as quality improvement (QI). Preoperative clinical nutritional assessment and laboratory values were completed the same day as informed surgical consent in the clinic. Protocol focus was patient consumption of nutritional supplements perioperatively, monitored by our outpatient dietitian. Early postoperative enteral nutrition was initiated with monitoring of nutritional laboratory values. To support our model, we provide preliminary analysis of HNC patient outcomes after implementation of the ERAS nutritional protocol.

Results

Twenty‐five patients were enrolled. Preoperatively, 40% of patients were malnourished, and 100% complied with perioperative nutrition supplementation. Health care provider compliance obtaining preoperative laboratory values was 56%. There was a strong negative correlation between modified Nutrition‐Related Index (mNRI) and number of complications (P =. 01), specifically, fistula rate (P =. 04) and unplanned reoperation (P =. 04). Enrolled patient average length of stay was 7 ± 4.4 days.

Discussion

Our patients demonstrated compliance with implementation of an ERAS nutrition protocol likely facilitated by dietitian engagement. mNRI potentially reflects risk for head and neck surgery complications.

Implications for Practice

QI processes demand reassessment and modification to ensure efficient and targeted approaches to improving patient care.
Online database for brain cancer-implicated genes: exploring the subtype-specific mechanisms of brain cancer
Authors: Zhao Min , Liu Yining , Ding Guiqiong , Qu Dacheng , Qu Hong
Published: June 2021

Background

Brain cancer is one of the eight most common cancers occurring in people aged 40+ and is the fifth-leading cause of cancer-related deaths for males aged 40–59. Accurate subtype identification is crucial for precise therapeutic treatment, which largely depends on understanding the biological pathways and regulatory mechanisms associated with different brain cancer subtypes. Unfortunately, the subtype-implicated genes that have been identified are scattered in thousands of published studies. So, systematic literature curation and cross-validation could provide a solid base for comparative genetic studies about major subtypes.

Results

Here, we constructed a literature-based brain cancer gene database (BCGene). In the current release, we have a collection of 1421 unique human genes gathered through an extensive manual examination of over 6000 PubMed abstracts. We comprehensively annotated those curated genes to facilitate biological pathway identification, cancer genomic comparison, and differential expression analysis in various anatomical brain regions. By curating cancer subtypes from the literature, our database provides a basis for exploring the common and unique genetic mechanisms among 40 brain cancer subtypes. By further prioritizing the relative importance of those curated genes in the development of brain cancer, we identified 33 top-ranked genes with evidence mentioned only once in the literature, which were significantly associated with survival rates in a combined dataset of 2997 brain cancer cases.

Conclusion

BCGene provides a useful tool for exploring the genetic mechanisms of and gene priorities in brain cancer. BCGene is freely available to academic users at http://soft.bioinfo-minzhao.org/bcgene/.
Prevalence and determinants of chronic kidney disease in women with hypertensive disorders in pregnancy in Nigeria: a cohort study
Authors: Ishaku Salisu M. , Olanrewaju Timothy Olusegun , Browne Joyce L. , Klipstein-Grobusch Kerstin , Kayode Gbenga A. , Franx Arie , Grobbee Diederick E. , Warren Charlotte E.
Published: June 2021

Background

Worldwide, hypertensive disorders in pregnancy (HDPs) complicate between 5 and 10% of pregnancies. Sub-Saharan Africa (SSA) is disproportionately affected by a high burden of HDPs and chronic kidney disease (CKD). Despite mounting evidence associating HDPs with the development of CKD, data from SSA are scarce.

Methods

Women with HDPs (n = 410) and normotensive women (n = 78) were recruited at delivery and prospectively followed-up at 9 weeks, 6 months and 1 year postpartum. Serum creatinine was measured at all time points and the estimated glomerular filtration rates (eGFR) using CKD-Epidemiology equation determined. CKD was defined as decreased eGFR< 60 mL/min/1.73m2 lasting for ≥ 3 months. Prevalence of CKD at 6 months and 1 year after delivery was estimated. Logistic regression analyses were conducted to evaluate risk factors for CKD at 6 months and 1 year postpartum.

Results

Within 24 h of delivery, 9 weeks, and 6 months postpartum, women with HDPs were more likely to have a decreased eGFR compared to normotensive women (12, 5.7, 4.3% versus 0, 2 and 2.4%, respectively). The prevalence of CKD in HDPs at 6 months and 1 year postpartum was 6.1 and 7.6%, respectively, as opposed to zero prevalence in the normotensive women for the corresponding periods. Proportions of decreased eGFR varied with HDP sub-types and intervening postpartum time since delivery, with pre-eclampsia/eclampsia showing higher prevalence than chronic and gestational hypertension. Only maternal age was independently shown to be a risk factor for decreased eGFR at 6 months postpartum (aOR = 1.18/year; 95%CI 1.04–1.34).

Conclusion

Prior HDP was associated with risk of future CKD, with prior HDPs being more likely to experience evidence of CKD over periods of postpartum follow-up. Routine screening of women following HDP-complicated pregnancies should be part of a postpartum monitoring program to identify women at higher risk. Future research should report on both the eGFR and total urinary albumin excretion to enable detection of women at risk of future deterioration of renal function.
“Saint Google, now we have information!”: a qualitative study on narratives of trust and attitudes towards maternal vaccination in Mexico City and Toluca
Authors: Simas Clarissa , Larson Heidi J. , Paterson Pauline
Published: June 2021

Background

Maternal vaccination is key to decreasing maternal and infant mortality globally. Yet perceptions about maternal vaccines and immunization among pregnant women are often understudied, particularly in low- and middle- income countries. This qualitative study explored trust, views, and attitudes towards maternal immunization among pregnant women in Mexico. A total of 54 women from Mexico City and Toluca participated in the in-depth interviews and focus groups. We explored participants’ experiences with maternal vaccination, as well as how they navigated the health system, searched for information, and made decisions around maternal immunization.

Results

Our findings point to issues around access and quality of maternal healthcare, including immunizations services. While healthcare professionals were recognized for their expertise, participants reported not receiving enough information to make informed decisions and used online search engines and digital media to obtain more information about maternal healthcare. Some participants held strong doubts over the benefits of vaccination and were hesitant about the safety and efficacy of maternal vaccines. These concerns were also shared by pregnant women who had been vaccinated. Some participants disclosed low levels of trust in government and vaccination campaigns.

Conclusion

Pregnant women, soon to be parents and making vaccination decisions for their child, constitute an important target group for policymakers seeking optimal maternal as well as childhood immunization coverage. Our findings highlight the importance of targeted communication, trust-building and engagement strategies to strengthen confidence in immunization amongst this group.
Supporting parents and healthy behaviours through parent-child meetings – a qualitative study in the Netherlands
Authors: Bektas Gülcan , Boelsma Femke , Wesdorp Carline L. , Seidell Jacob C. , Baur Vivianne E. , Dijkstra S. Coosje
Published: June 2021

Background

The first 2 years of a child’s life have been found to be crucial to healthy growth and development. Parent support groups can help parents to promote health-related behaviours during this crucial period. The aim of this study was to explore the experiences of parents who participated in a parent support group (Parent-Child Meetings) which promoted health-related behaviours of their children, and to determine whether and how these meetings supported them in promoting these behaviours.

Methods

We used a qualitative study design. The parent support group consisted of weekly Parent-Child Meetings organized in a multi-ethnic, relatively low-income neighbourhood in Amsterdam, the Netherlands. Data on the experiences of parents was collected through participatory observations, informal conversations (n = 30 sessions) and semi-structured interviews (n = 13) between April 2019 and March 2020. The data was analysed using thematic content analysis.

Results

Parents indicated that they experienced the parent-child meetings as enjoyable and as providing them with socio-emotional support. They reported that the meetings increased their parenting knowledge, skills and practices regarding healthy behaviours of their children and that they used this knowledge in their daily lives. They also appreciated the practical information and advice provided by experts in the meetings. Parents indicated that the positive attitude of the experts was crucial in accepting and adopting their advice. Additionally, parents valued the interactive and hands-on workshops, which integrated health-related behaviours and active play with children, as it enabled them to learn while they played with their children.

Conclusion

This study indicated that parent-child meetings contributed to enhancing parental knowledge, skills and practices regarding healthy behaviours of their children. This could potentially benefit the health of children during the first 2 years of their lives. In particular, the peer support of other parents, the hands-on workshops, and the concrete advice and information provided in an informal setting were highly valued by parents. Future parent support groups could use these findings to improve their meetings or to start meetings that better suit the needs of parents with young children.
Monitoring work-related physical activity and estimating lower-limb loading: a proof-of-concept study
Authors: Wang Xia , Perry Thomas A , Caroupapoullé Jimmy , Forrester Alexander , Arden Nigel K , Hunter David J
Published: June 2021

Background

Physical activity (PA) is important to general health and knee osteoarthritis (OA). Excessive workplace PA is an established risk factor for knee OA however, appropriate methods of measurement are unclear. There is a need to examine and assess the utility of new methods of measuring workplace PA and estimating knee load prior to application to large-scale, knee OA cohorts. Our aims, therefore, were to monitor workplace PA and estimate lower-limb loading across different occupations in health participants.

Methods

Twenty-four healthy adults, currently working full-time in a single occupation (≥ 35 h/week) and free of musculoskeletal disease, comorbidity and had no history of lower-limb injury/surgery (past 12-months) were recruited across New South Wales (Australia). A convenience sample was recruited with occupations assigned to levels of workload; sedentary, light manual and heavy manual. Metrics of workplace PA including tasks performed (i.e., sitting), step-count and lower-limb loading were monitored over 10 working days using a daily survey, smartwatch, and a smartphone.

Results

Participants of light manual occupations had the greatest between-person variations in mean lower-limb load (from 2 to 59 kg*m/s3). Lower-limb load for most participants of the light manual group was similar to a single participant in heavy manual work (30 kg*m/s3) and was at least three times greater than the sedentary group (2 kg*m/s3). The trends of workplace PA over working hours were largely consistent, per individual, but rare events of extreme loads were observed across all participants (up to 760 kg*m/s3).

Conclusions

There are large interpersonal variations in metrics of workplace PA, particularly among light and heavy manual occupations. Our estimates of lower-limb loading were largely consistent with pre-conceived levels of physical demand. We present a new approach to monitoring PA and estimating lower-limb loading, which could be applied to future occupational studies of knee OA.
Debridement, antibiotics, and implant retention combined with direct intra-articular antibiotic infusion in patients with acute hematogenous periprosthetic joint infection of the knee
Authors: Chaiyakit Pruk , Meknavin Surapoj , Hongku Natthapong , Onklin Ittiwat
Published: June 2021

Background

Debridement, antibiotics, and implant retention (DAIR) is the recommended treatment for acute hematogenous periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). However, DAIR is associated with a high percentage of unsuccessful outcomes. Since 2007, direct intra-articular antibiotic infusion, which can provide a high concentration of intra-articular antibiotic, has been used in combination with DAIR to improve treatment outcomes among patients in our institution. This study aimed to assess the outcomes of DAIR combined with direct intra-articular antibiotic infusion in patients who presented with acute hematogenous PJI after TKA.

Methods

We reviewed the data of all patients diagnosed with acute hematogenous PJI after primary TKA (from 2008 to 2015) who received DAIR combined with direct intra-articular antibiotic infusion.

Results

In total, 15 knees in 12 patients were semi-urgently treated with this method. The mean follow-up time was 93.3 (minimum: 56) months, and the longest follow-up time was 11 years. Two patients (n = 3 knees) had a well-functioning, non-infected prosthesis 6 and 10 years after the procedure. Two patients (n = 2 knees) had re-infection 2 and 5 years after surgery, and they required two-stage revision. None of the patients were lost to follow-up. Finally, 13 (86.6%) of 15 infected knees were successfully treated with this method.

Conclusions

DAIR combined with direct intra-articular antibiotic infusion is an effective treatment for acute hematogenous PJI after TKA.
Inclusion of oral health teams in primary health care promotes early diagnosis of oral and oropharyngeal cancers: a nationwide study
Authors: Vargas Deborah Gomes de Miranda , Probst Livia Fernandes , da Cunha Amanda Ramos , Tagliaferro Elaine Pereira da Silva , Zafalon Edílson José , Zárate-Pereira Paulo , De-Carli Alessandro Diogo
Published: June 2021

Background

Oral and oropharyngeal cancers are considered important public health problems worldwide. This study aims to analyze the association between late diagnosis of oral and oropharyngeal cancers in Brazil and the contextual indicators of socioeconomic variables and coverage of Primary Health Care (PHC), and to assess the temporal trend of late diagnosis.

Methods

In this cross-sectional observational study, secondary data were evaluated with a time series analysis. All Brazilian cities that reported at least one case of oral and oropharyngeal cancers each year in the period between 2000 and 2013 were included; and the staging was analyzed by calculating the ratio risk for late diagnosis for each municipality. The association between staging and socioeconomic variables and offer of PHC was calculated using multiple linear regression. The time trend of the risk ratio for late-stage diagnosis was calculated using the Prais–Winsten method.

Results

One hundred and sixty Brazilian municipalities had at least one annual case of oral and oropharyngeal cancers notified to the INCA hospital system between 2000 and 2013. The adjusted model showed that the higher the Gini value (greater social inequality) and the lower the HDI value (less human development) was, the higher was the number of tumors diagnosed at a late stage, considering the size of the tumor. A greater risk for late diagnosis was identified, as early as at the stage of lymph node involvement, when there was a higher level of social inequality and lower level of coverage by Oral Health Teams (OHT) in PHC. The greater the social inequality, the greater was the risk of late diagnosis, as early as in the stage of metastasis.

Conclusions

We concluded that, during the evaluated period, there was an increase in the number of cases diagnosed at the most advanced stage. Furthermore, there was association between higher levels of social inequality and an increase in the proportion of late diagnosis of oral and oropharyngeal cancers. In addition, the inclusion of Oral Health Teams in Primary Health Care promoted the early diagnosis of these types of cancers.
Exploring the views of university students with experience of common mental health disorders about support provided within primary care community settings
Authors: D'Arcy-Smith Mikaela , Buszewicz Marta
Published: June 2021

Aims

To assess the impact of common mental health disorders (CMHDs) on university students’ function and wellbeing. To understand the barriers to receiving adequate support for CMHDs during both adolescence and at university. To provide feedback to healthcare professionals about how young people perceive the support provided when initially seeking help for psychological distress. To explore which forms of support students find the most useful.

Method

A literature review was initially undertaken, identifying the lack of prior research in this area. The current study addressed the gap by considering the needs of students with CMHDs in the context of primary care services, with a retrospective exploration of their views about support received during adolescence. 15 semi-structured qualitative interviews were conducted with both current university students and recent graduates from across the UK, transcribed verbatim and subjected to thematic analysis. The study population included 7 men and 8 women, between the ages of 18–25 years.

Result

Five main themes emerged from the data:

The Journey to Disorder – Explored the difficulties faced by adolescents, and how these might contribute to their experience of CMHDs and their management.

Attitudes Towards Help-Seeking – Many participants had little trust in healthcare professionals as adolescents. This contributed to limited trust in university support systems as young adults.

Primary Care Support - Perceived effectiveness of General Practitioner (GP) support during adolescence in this cohort was highly variable. Although some participants described good experiences, others felt their views were ignored, with responsibility diverted to their caregivers. A lack of understanding from GPs about CMHDs in adolescents resulted in trust issues for them as young adults.

Recommendations for Change - Participants reflected on their previous and current experiences to inform suggestions for changes to tackle issue of psychological distress in adolescents.

Conclusion

Previous experiences of the care they had received when presenting with CMHDs during adolescence potentially affected the long-term wellbeing of university students and graduates; the initial support received was inconsistent with the needs of this age group. Recommendations for change included a greater emphasis on the importance of adolescent mental health education, tailoring interventions to personal growth and maturity, and ensuring primary healthcare providers are equipped with the skills required to manage psychological distress in young people.
Listening to voices: understanding and self-management of auditory verbal hallucinations in young adults
Authors: Denno Peter , Wallis Stephanie , Caldwell Kimberly , Ives Jonathan , Wood Stephen , Broome Matthew , Mallikarjun Pavan , Oyebode Femi , Upthegrove Rachel
Published: June 2021

Aims

Auditory Verbal Hallucinations (AVH) are a hallmark of psychosis, but affect many other clinical populations. Patients’ understanding and self-management of AVH may differ between diagnostic groups, change over time, and influence clinical outcomes.

We aimed to explore patients’ understanding and self-management of AVH in a young adult clinical population.

Method

35 participants reporting frequent AVH were purposively sampled from a youth mental health service, to capture experiences across psychosis and non-psychosis diagnoses. Diary and photo-elicitation methodologies were used – participants were asked to complete diaries documenting experiences of AVH, and to take photographs representing these experiences. In-depth, unstructured interviews were held, using participant-produced materials as a topic guide. Conventional content analysis was conducted, deriving results from the data in the form of themes.

Result

Three themes emerged:

(1)

Searching for answers, forming identities – voice-hearers sought to explain their experiences, resulting in the construction of identities for voices, and descriptions of relationships with them. These identities were drawn from participants’ life-stories (e.g., reflecting trauma), and belief-systems (e.g., reflecting supernatural beliefs, or mental illness). Some described this process as active / volitional. Participants described re-defining their own identities in relation to those constructed for AVH (e.g. as diseased, 'chosen', or persecuted), others considered AVH explicitly as aspects of, or changes in, their personality.

(2)

Coping strategies and goals – patients’ self-management strategies were diverse, reflecting the diverse negative experiences of AVH. Strategies were related to a smaller number of goals, e.g. distraction, soothing overwhelming emotions, 'reality-checking', and retaining agency.

(3)

Outlook – participants formed an overall outlook reflecting their self-efficacy in managing AVH. Resignation and hopelessness in connection with disabling AVH are contrasted with outlooks of “acceptance” or integration, which were described as positive, ideal, or mature.

Conclusion

Trans-diagnostic commonalities in understanding and self-management of AVH are highlighted - answer-seeking and identity-formation processes; a diversity of coping strategies and goals; and striving to accept the symptom. Descriptions of “voices-as-self”, and dysfunctional relationships with AVH, could represent specific features of voice-hearing in personality disorder, whereas certain supernatural/paranormal identities and explanations were clearly delusional. However, no aspect of identity-formation was completely unique to psychosis or non-psychosis diagnostic groups. The identity-formation process, coping strategies, and outlooks can be seen as a framework both for individual therapies and further research.
To resuscitate or not to resuscitate; a question for old age psychiatrists
Authors: Embliss Liam , Bhat Mohan
Published: June 2021

Aims

The inpatient population of an older adult psychiatric ward will include people with physical and mental health conditions which affect life span and quality of life. Patients may be frail, acutely unwell, or have terminal illnesses such as dementia. It is therefore essential that clinicians review resuscitation status as part of their routine practice. However, we are aware that advanced decision-making – to resuscitate or not to resuscitate – is not routine practice across older adult psychiatric wards in the UK. Our 2017 audit reflected this, demonstrating a very low rate of resuscitation decisions at NELFT.

This re-audit aimed to measure the frequency and quality of resuscitation decisions on an older adult psychiatric ward. We expected improvements in these areas, subsequent to changes implemented from the initial audit. We also sought to identify which patient factors influenced clinicians’ decision-making on resuscitation.

Please note, this audit was completed prior to the COVID-19 pandemic.

Method

In June 2017, an audit of 25 patients admitted to two older adult psychiatric acute wards was completed. In December 2019, a retrospective analysis of the last 25 admissions to one older adult ward was undertaken. Electronic patient notes and DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) orders were examined. The audit measured frequency of resuscitation decisions and quality of documentation against current standards. DNACPR orders were analysed and clinicians were interviewed to identify the reasons for such decisions.

Result

There was an increase in the number of patients for which resuscitation decisions were made, from 4% in 2017 to 40% (n = 10) in 2019. The majority of patients with a DNACPR decision (n = 8) had a diagnosis of dementia. Prospective quality of life, with this diagnosis, was the most frequent determinant of DNACPR decisions (n = 7). Qualitative analysis indicated that clinicians were more likely to consider a resuscitation decision for patients with an organic disorder rather than functional disorder.

Adequate completion of DNACPR orders was seen in each case. Either the patient, a family member or carer was involved in every decision. The standard for recording decisions on the electronic patient record was not met.

Conclusion

It is good practice to consider resuscitation decisions for patients admitted to older adult psychiatric wards. This re-audit found an improvement in frequency of resuscitation decisions and also revealed differences in decision-making for patients with organic and functional disorders. Implementation of further change is indicated; decision-making can be improved through reflection, teaching, changes to practice, and technologies.
Patterns of antipsychotic prescribing in first episode psychosis – differences between acute and early intervention services
Authors: Fallon James , McBrien Sophie , Curlewis Keegan
Published: June 2021

Aims

This study aimed to evaluate the patterns of antipsychotic prescribing in patients with first episode psychosis (FEP) at the time of their initial treatment and over the first year with the Early Intervention Service (EIS). It was hypothesised that different care teams would have a preference for certain antipsychotic medications and that initial medication choice would be continued through the first year.

Background

Research indicates that with the exception of clozapine, all antipsychotics are equally as effective. However, anecdotally it has been observed that inpatient and crisis teams and EIS have differing initial medication choices.

Method

An analysis of the North West Sussex EIS caseload (n = 67) was conducted. The first antipsychotic prescribed and initiating team was recorded. Prescribed medication for those that had completed 12 months (n = 43) with EIS after initial prescription was recorded. An analysis was performed of prescribing choice by initial care team (acute vs EIS vs other community services) with the frequency with which medication was changed during treatment.

Result

97% (n = 65) of patients were started on an antipsychotic. Initial medication choice was olanzapine (44.8%, n = 30), aripiprazole (22.4%, n = 15), risperidone (20.9%, n = 14), quetiapine (6%, n = 4) and zuclopenthixol were least common (1.5%, n = 2). At the 12 month point 51.2% (n = 22 of 43) had switched and 16.3% (n = 7 of 43) had discontinued.

The most common medication started by acute services was olanzapine (56.0%, n = 28 of 50), though of those who completed 12 months this had been switched in 53% of cases (n = 9 of 17). EIS most commonly initiated aripiprazole or risperidone (37.5% each n = 4). At 6 and 12 month follow-up by EIS, the most commonly prescribed antipsychotic was aripiprazole (24 patients 40.7%, and 14 patients 32.6% respectively).

Conclusion

There was a clear preference for olanzapine as initial treatment of First Episode of Psychosis in the region. On breakdown it was apparent that there was a split in prescribing choices between more sedating medication in acute services and less sedating medication in EIS. Given that most patients changed to less sedating and less metabolic active medications over their first year it is not clear why alternative options are not used at the start of treatment. Future research will focus on clinician's rationale for initial prescribing choice. This will look for any underlying bias toward specific medications.
A neuropsychological study of chromatin disorders
Authors: Geers Benjamin , Banka Siddhartha , Weisburg Daniel
Published: June 2021

Aims

Analyse neuropsychological assessment data collected from a chromatin disorder clinic to determine the neuropsychological profile associated with chromatin disorders. Assess for differences in neuropsychological profile by diagnostic group and gender. Hypothesis: A systematic neuropsychological review of chromatin disorders will reveal previously unknown patterns.

Background

Chromatin disorders (CD) are a group of genetic conditions that result in developmental delay and intellectual disability. Thus far the neuropsychological profile of CDs has been poorly studied.

Method

Cognitive functioning, adaptive behaviour, psychosocial difficulties and perceived impact on the family were systematically assessed in a cohort of 42 patients with CDs from November 2016 to February 2019. Cognitive functioning was assessed via Full-Scale Intelligence Quotient (FSIQ), adaptive behaviour was assessed via Vineland's Adaptive Behaviour Scores (VABS), anxiety and depression was assessed via the Revised Children's Anxiety and Depression Scale (RCADS) and communication skills were assessed via the Social Responsiveness Scale-2 (SRS-2). Family Impact Scale was used to assess for the perceived impact on the family. Mean scores for each neuropsychological domain were calculated firstly sorting patients by diagnosis, and then by gender. Unpaired t-tests were run to asses for statistically significant differences in mean scores by diagnosis and gender. Spearman's correlation was used to determine and potential correlations between FSIQ, VABS, RCADS and SRS-2 scores and Family Impact Score.

Result

Patients with CDs were found generally to have mild intellectual disability (mean FSIQ = 64.57) and markedly deficient adaptive behaviour functioning (mean VABS = 50.19). Patients had a mean SRS-2 score of 70, indicative of high rates of autism spectrum disorder associated symptoms. RCADS and SRS-2 scores were negatively correlated with Family Impact Score with statistical significance (–0.562 and –0.429 Correlation coefficient for RCADS and SRS-2 respectively). Females had statistically significant average higher RCADS scores than males. CHARGE Syndrome was frequently an outlier having a mean higher FSIQ score, lower adaptive functioning and lower psychosocial impairment; however, these differences were not statistically significant.

Conclusion

Adaptive behaviour functioning of patients with CDs is lower than expected for their FSIQ. Females with chromatin disorders have higher levels of anxiety and depression than males however the reasons for this are unknown. The psychosocial challenges and family's impact should be considered in the clinical management of CDs. Further research with a larger data set is needed to identify the neuropsychological profiles of different CDs and to confirm whether the observed differences in CHARGE Syndrome are significant.
Assessing the compliance of accurately documenting medication history in CAMHS – completion of the audit cycle
Authors: Guest Laura , Mudiyanselage Irangani , Ambekar Swetangi , Lankappa Sudheer
Published: June 2021

Aims

To assess the documentation of medication across all Child and Adolescent Mental Health Service (CAMHS) teams in the south region of Derbyshire Healthcare NHS Foundation Trust against a locally agreed protocol. The aim is to ensure accurate and timely documentation of medication history in a standardised way to reduce the risk of medication errors.

Method

We randomly selected 78 patients across seven teams within CAMHS that were currently prescribed medication as of November 2020. We reviewed each patient to see if medication history had been recorded in the specified section of the trust's patient database PARIS. We then cross referenced this information with the patient notes, clinic letters and prescriptions to review accuracy of information in terms of recording of drug name, dose, frequency, and whether the medication was regular or as required. We compared the data to the results of a previous audit in 2017 which used the same methods.

Result

Of the 78 patients, 74% (n = 58) had medication recorded in the correct section of PARIS compared to 13% in the 2017 audit. We found that compliance varied between different CAMHS teams ranging from 0% to 100%. Of those with medication history recorded, 86% had all drug names listed correctly, 79% had all drugs listed at the correct dose, 71% had the correct frequency recorded and 81% had whether the medication was regular, or PRN recorded.

Conclusion

Although we have seen improvement in standardised documentation of medication history since 2017, it remains difficult to rely on this information being up to date and reliable. There was a wide range of compliance in documentation of medication history across different teams, possibly reflecting how effectively the teaching following the previous 2017 audit had been delivered to each team. We have completed more teaching for medical and non-medical prescribers across all localities to highlight the importance of timely and standardised documentation. This is particularly important in CAMHS where the prescribing of medication often remains the responsibility of secondary care, with clinicians regularly prescribing on behalf of colleagues from other teams. Our findings support the move within the Trust towards a system where medication can be both documented and electronically prescribed in the same place (System One).