bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges and Delay in Treatment With Clozapine Due to Thrombocytopenia: A Case Study
Authors: Thapaliya Suresh , Boutell Glenda , Firdosi Mudasir
Published: August 2024

Aims

Clozapine is the most effective antipsychotic medication for patients with treatment-resistant psychotic disorders. Its discontinuation can precipitate relapse that can be often challenging to treat.

Methods

This is a case study of a female patient in her early 40s who is known to the mental health services with a diagnosis of schizoaffective disorder. She was admitted to acute psychiatric inpatient unit due to relapse characterised by psychotic, catatonic features and poor physical health condition due to refusal to eat and drink. She was stable on clozapine for more than a decade and had become unwell after discontinuation of clozapine in the community due to platelet count below 50 × 109/L with normal other parameters. Low platelet count was detected during routine monthly blood monitoring after a few years of commencing clozapine.

Whilst an inpatient, there were several trials of re-titration of clozapine which had to be withheld because of ambiguity regarding the cause of persistent thrombocytopenia. Other treatment options including alternative antipsychotics and 12 sessions of ECT were tried without any success. Haematologist opinion was sought at early stage of admission and blood investigations were done but there was delay in bone marrow biopsy due to practical issues.

The treating team re-commenced oral clozapine to which she remained initially non-compliant due to catatonic features. With advice from the specialist psychosis services a few doses of intramuscular clozapine was used to facilitate re-titration. Following regular compliance and optimisation of oral clozapine, there was significant remission of clinical symptoms, with patient returning to her baseline mental state and functioning. During the period of admission, platelet counts were closely monitored which kept fluctuating reaching sometimes below 30 × 109/L without any clear association with clozapine dose. No bleeding symptoms or signs were ever reported.

Results

Clozapine is a medication with haematological side effects; however, low platelet count is very rare. This patient ultimately underwent bone marrow biopsy which established Immune thrombocytopenia. She was discharged to the community with a plan of continuing clozapine, close monitoring of blood count and regular follow-up with haematology services for further clinical management.

Conclusion

Careful clinical evaluation and timely investigation is important to establish the cause for side effects before associating it with clozapine and discontinuing the treatment. This helps in ensuring continuity of clozapine in patients who clearly benefit from long-term use of clozapine.
Systematic Literature Review and Meta-Analysis of Anti-Psychotic Use in Parkinson's Disease Psychosis
Authors: McKeown Christopher , Salmoiraghi Alberto
Published: August 2024

Aims

Psychosis is a common neuropsychiatric symptom associated with Parkinson's disease (PD), with prevalence rates of up to 75%. Parkinson's disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of antipsychotics for PDP is common, with up to 35% of PD patients prescribed at least one antipsychotic within 7 years of PD diagnosis. This systematic literature review aims to search, appraise and synthesise the best available and most up-to-date evidence for the use of antipsychotics in the treatment of PDP, and their effects on PD motor symptoms.

Methods

We carried out a comprehensive literature review and meta-analysis following the PRISMA statement for systematic reviews.

Results

Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Both quetiapine and olanzapine showed no significant improvement for PDP over placebo, however meta-analysis of olanzapine groups showed significant motor worsening, UPDRS +2.89 (95% CI 1.22 to 4.56) compared with placebo. Clozapine showed a significant improvement in psychosis vs placebo in both studies, with a large effect size in their primary outcome measure; -0.82 (95% CI -1.37 to -0.26), -0.89 (95% CI -1.42 to - 0.36). Pimavanserin showed significant improvement in psychosis vs placebo -0.48 (95% CI -0.77 to -0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores vs placebo group.

Conclusion

Although Olanzapine and Quetiapine are commonly used to treat psychotic symptoms in Parkinson's Disease, the only medication with robust evidence is Clozapine. This finding may have implications for service delivery.
Modulating N-Methyl D-Aspartate Receptors to Enhance Learning of Safety Memories in a Rodent Model of Exposure Therapy
Authors: Thursby Alice , Sherman Emily , Cahill Emma
Published: August 2024

Aims

Overactive negative memories are thought to contribute to the core symptoms of psychiatric conditions such as anxiety disorders or post-traumatic stress disorder (PTSD). For talking therapies, such as exposure therapy, there are high rates of relapse demonstrating the necessity for innovative new treatments. It is thought that enhancing the ability to extinguish fear responses to the reactivation of these memories in patients with pharmacological adjunct treatments will enhance the efficacy of interventions.

N-methyl D-aspartate receptors (NMDARs) regulate the process of memory formation and consolidation. It is hypothesised that increasing the function of NMDARs would augment the consolidation of safety learning, during treatment sessions. NMDARs require the co-agonists glycine or d-serine to function. Bitopertin, a GlyT-1 inhibitor, increases the availability of glycine. Bitopertin has been studied in the context of schizophrenia, and therefore has been demonstrated to be safe for use in humans. In this preclinical study, we aim to determine if bitopertin can enhance safety learning, so-called extinction, in rodent models.

Methods

24 Lister Hooded rats (male, n = 12) will undergo aversive Pavlovian conditioning to form an associative memory. Rats will then be administered with saline or bitopertin systemically, prior to a session to extinguish fear responses. The strength of the extinction of responses will be measured the following day with a rapid re-acquisition test.

Results

This study is being carried out as part of an intercalated master's degree, so the final results will be available in spring 2024. Given pilot data, it is expected that we will observe that the rats administered with bitopertin exhibit lower levels of fear responses on the rapid reacquisition test than the rats administered with saline. We do not predict any sex difference in responses. This would demonstrate bitopertin has the potential to enhance and safety memory consolidation in rats.

Conclusion

This is an exciting area of research for which results could provide a break-through in improving talking therapies and adjunct treatments offered to patients with anxiety disorders. Negative results would be informative as this allows neurobiologists to refine the search for a pharmacological agent which could be used as a cognitive enhancer in this manner.
Review of Rapid Tranquillisation Guidelines Across NHS Trusts in England
Authors: Chavasse Claudia , O'Neill James , Romeu Daniel , Graham Alex
Published: August 2024

Aims

Rapid tranquillisation – the parenteral administration of a sedating psychotropic – is frequently utilised to manage acute behavioural disturbances. Each mental health trust in England utilises independent guidelines for rapid tranquillisation, which vary geographically in both recommendations for therapeutic agents, as well as the format in which this information presented. Audits have identified that there is currently poor adherence to rapid tranquillisation protocol guidelines; this may be due to a lack of guideline clarity allowing for personal interpretation. This service evaluation aims to determine the clarity and uniformity of protocols outlined in mental health trust guidelines, in addition to analysing the outcomes of guideline testing to identify if there is consistency between policies, or whether outcomes varied depending on the trust guidelines used.

Methods

Five reviewers (of differing positions throughout clinical training) utilised 52 guidelines from each mental health trust in England, as well as Maudsley and NICE. These were assessed using the same fictional scenario, which simulated a common presentation in which the use of rapid tranquillisation is required. Reviewers deduced the most appropriate therapeutic agent according to the guideline, rated the clarity of each guideline and were invited to leave comments highlighting the guideline's useability.

Results

Seven different management plans were generated by the majority of respondents from the 52 guidelines. Lorazepam was the most frequently selected therapeutic agent. Guidelines with better subjective ratings of clarity had more agreement between reviewers, but full agreement between reviewers was only present for 10 out of 52 guidelines. For 11 guidelines, consensual agreement between reviewers was not reached. Qualitative analysis of comments identified the inclusion of past medical history, drug history and flow charts as positive sub-themes. Redundant language, contradictions and the suggestion to seek senior intervention before trialling a second agent were viewed negatively. Many guidelines did not sufficiently emphasise the need for performing an ECG before administering therapeutic agents, such as haloperidol, which may lead to potentially fatal arrhythmias.

Conclusion

There is no national consensus on the most appropriate rapid tranquillisation agents, with the available evidence being interpreted variously by different trusts and organisations. Poor guideline comprehensibility impacts clinician adherence and allows for personal preference to influence choice of drug. Clear guidelines utilising flow charts to succinctly outline relevant doses and absolute contraindications were viewed favourably by reviewers. The findings of this project highlights to relevant stakeholders the attributes that should be implemented when improving guidelines for the future.
Disease Course and Treatment Outcomes in Patients With De Novo Small-Cell Lung Cancer and Epidermal Growth Factor Receptor Exon 20 Insertion: Two Case Reports
Authors: Zullo Lodovica , Castanet Elora , Maaradji Zineb , Ghigna Maria Rosa , Bonhomme Benjamin , Alamé Melissa , Besse Benjamin , Cousin Sophie , Aldea Mihaela
Published: August 2024

We report the first two cases of EGFR exon20ins SCLC, treated with amivantamab and TKIs.
Paraneoplastic Neurologic Disorders
Authors: Zekeridou Anastasia
Published: August 2024

OBJECTIVE

This article reviews the clinical presentations, neural antibody associations, and oncologic accompaniments of paraneoplastic neurologic syndromes and neurologic autoimmunity in the context of immune checkpoint inhibitor (ICI) cancer immunotherapy.

LATEST DEVELOPMENTS

Neural antibody discovery has improved the diagnosis of paraneoplastic neurologic syndromes. Neural antibodies also delineate the underlying disease pathophysiology and thus inform outcomes and treatments. Neural antibodies specific for extracellular proteins have pathogenic potential, whereas antibodies specific for intracellular targets are biomarkers of a cytotoxic T-cell immune response. A recent update in paraneoplastic neurologic syndrome criteria suggests high- and intermediate-risk phenotypes as well as neural antibodies to improve diagnostic accuracy in patients with paraneoplastic neurologic syndromes; a score was created based on this categorization. The introduction of ICI cancer immunotherapy has led to an increase in cancer-related neurologic autoimmunity with distinct clinical phenotypes.

ESSENTIAL POINTS

Paraneoplastic neurologic syndromes reflect an ongoing immunologic response to cancer mediated by effector T cells or antibodies. Paraneoplastic neurologic syndromes can present with manifestations at any level of the neuraxis, and neural antibodies aid diagnosis, focus cancer screening, and inform prognosis and therapy. In patients with high clinical suspicion of a paraneoplastic neurologic syndrome, cancer screening and treatment should be undertaken, regardless of the presence of a neural antibody. ICI therapy has led to immune-mediated neurologic complications. Recognition and treatment lead to improved outcomes.
The Neurologist’s Guide to Drug Pricing in the United States
Authors: Nair Kavita V. , Santoro Jonathan D.
Published: August 2024

As newer, innovative neurology drugs enter the US health care system, neurologists should consider the cost of these treatments in addition to their efficacy, safety, and tolerability. To do so thoughtfully requires an understanding of how prescription drugs are priced in the United States. The process of drug pricing is linked to the distribution supply chain and the many stakeholders involved. Stakeholders include pharmaceutical manufacturers; wholesalers; pharmacies; pharmacy benefit managers; payers, including health insurers; hospital systems; neurologists and other clinicians; and patients. Drug pricing has taken center stage as the Inflation Reduction Act of 2022 has set maximum out-of-pocket expenses for Medicare beneficiaries for the first time in the program’s history and limits drug price increases for a select group of Medicare Part D drugs. This article describes the US drug distribution supply chain and its stakeholders and introduces key drug pricing terms; a brief description of how rebates are generally estimated will also be discussed. Finally, as newer neurology outpatient drugs enter the market, the “value” of drugs will be described through cost-effectiveness terminology and their utility for the clinical neurologist.
Therapeutic Approach to Autoimmune Neurologic Disorders
Authors: Clardy Stacey L. , Smith Tammy L.
Published: August 2024

OBJECTIVE

Autoimmune neurologic disorders encompass a broad category of diseases characterized by immune system attack of the central, peripheral, or autonomic nervous systems. This article provides information on both acute and maintenance immunotherapy used to treat autoimmune neurologic disorders as well as a review of symptomatic management and special considerations when caring for patients with these diseases.

LATEST DEVELOPMENTS

Over the past 20 years, more than 50 antibodies have been identified and associated with autoimmune neurologic disorders. Although advances in diagnostic testing have allowed for more rapid diagnosis, the therapeutic approach to these disorders has largely continued to rely on expert opinion, case series, and case reports. With US Food and Drug Administration (FDA) approval of biologic agents to treat neuromyelitis optica spectrum disorder (NMOSD) and myasthenia gravis as well as ongoing clinical trials for the treatment of autoimmune encephalitis, the landscape of immunotherapy options continues to expand. Consideration of the unique pathogenesis of individual autoimmune neurologic disorders as well as the mechanism of action of the diverse range of treatment options can help guide treatment decisions today while evidence from clinical trials informs new therapeutics in the future.

ESSENTIAL POINTS

Recognizing patients who have a clinical history and examination findings concerning for autoimmune neurologic disorders and conducting a thorough and directed imaging and laboratory evaluation aimed at ruling out mimics, identifying specific autoimmune syndromes, and screening for factors that may have an impact on immunotherapy choices early in the clinical course are essential to providing optimal care for these patients. Providers must consider immunotherapy, symptomatic treatment, and a multidisciplinary approach that addresses each patient’s unique needs when treating patients with autoimmune neurologic disorders.
Electroencephalogram-Based Anesthesia Indices Differently React to Modulations of Alpha-Oscillatory Activity
Authors: Kinateder Thomas , Kratzer Stephan , Husemann Cornelius , Hautmann Hubert , García Paul S. , Schneider Gerhard , Kreuzer Matthias
Published: August 2024

BACKGROUND:

The electroencephalographic (EEG) provides the anesthesiologist with information regarding the level of anesthesia. Processed EEG indices are available that reflect the level of anesthesia as a single number. Strong oscillatory EEG activity in the alpha-band may be associated with an adequate level of anesthesia and a lower incidence of cognitive sequelae. So far, we do not know how the processed indices would react to changes in the alpha-band activity. Hence, we modulated the alpha-oscillatory activity of intraoperative EEG to assess possible index changes.

METHODS:

We performed our analyses based on data from 2 studies. Intraoperative EEG was extracted, and we isolated the alpha-band activity by band-pass filtering (8–12 Hz). We added or subtracted this activity to the original EEG in different steps with different amplifications of the alpha signal. We then replayed these signals to the bispectral index (BIS), the Entropy Module (state entropy [SE]), the CONOX (qCON), and the SEDLine (patient state index [PSI]); and evaluated the alpha-band modulation’s impact on the respective index.

RESULTS:

The indices behaved differently to the modulation. In general, indices decreased with stronger alpha-band activity, but the rate of change was different with SE showing the strongest change (9% per step) and PSI and BIS (<5% per step) showing the weakest change. A simple regression analysis revealed a decrease of 0.02 to 0.09 index points with increasing alpha amplification.

CONCLUSIONS:

While the alpha-band in the intraoperative EEG seems to carry information regarding the quality of anesthesia, changes in the alpha-band activity do neither strongly nor uniformly influence processed EEG indices. Hence, to assess alpha-oscillatory activity’s strength, the user needs to focus on the raw EEG or its spectral representation also displayed on the monitoring systems.
On the Economics of Extinction and Possible Mass Extinctions
Authors: Taylor M. Scott , Weder Rolf
Published: August 2024

Human beings’ domination of the planet has not been kind to many species. This is to be expected. Humans have radically altered natural landscapes, harvested heavily from the ocean, and altered the climate in an unprecedented way. Recent concerns over the extent and rate of biodiversity loss have led to renewed interest in extinction outcomes and speculation concerning humans’ potential role in any future mass extinction. In this paper, we discuss the economic causes of extinction in two high-profile cases—Sharks and the North American Buffalo—and then extend our analysis to multiple species and discuss the possibility of mass extinction. Throughout, we present evidence drawn from authoritative data sources with a focus on shark populations to ground our analysis. Despite large gaps in our data, the available evidence reveals a worrisome trend: extinction risks are rising for many species and policymakers have been very slow to react.
Sweeping Changes and an Uncertain Legacy: The Tax Cuts and Jobs Act of 2017
Authors: Gale William G. , Hoopes Jeffrey L. , Pomerleau Kyle
Published: August 2024

The Tax Cuts and Jobs Act (TCJA) of 2017 introduced sweeping changes to individual and corporate taxation. We summarize the major provisions, trace the origins of the Act, and compare it to previous tax changes. We also examine the effects on the government budget, economic activity, and distribution of resources. Based on evidence through 2019, we find that the TCJA clearly raised federal debt and increased after-tax incomes, disproportionately increasing incomes for the most affluent. Its effects on GDP and median wages seem modest at best, although clear counterfactuals are difficult to identify. The impact on investment is less certain, and research is only recently emerging that addresses this question. Empirical analysis of longer-term effects may prove difficult due to the disruptions created by the COVID-19 pandemic starting in 2020.
Scientific Preservation Treatment of Artifacts of the Late Second Sergeant, Kim Ki-bong, Silled in Action During the Korean War
Authors: Lee Ho-Yeon , Wi Koang-Chu
Published: August 2024

Of the 25 artifacts of the late second sergeant, Kim Ki-bong, excavated from the Arrowhead Hill, 19 artifacts with the exclusion of those delivered to the ordinance disposal team and his bereaved family were subjected to scientific analysis and preservation treatment such as chromaticity XRF comparison spectroscopy, etc. to confirm the material and condition of the artifacts. The colorimetric analysis confirmed that the pattern of the iron helmet was a circle composed of red, blue and white colors, which was the unit mark of the 2nd Infantry Division of the Army during the Korean War. The P-XRF analysis confirmed that the iron helmet was made of austenitic stainless steel. In addition, the image comparison spectroscopy analysis confirmed that the contents of the wallet were a medal certificate. By categorizing the artifacts into 5 groups according to their materials, it was possible to establish a treatment plan appropriate for each group and proceed with stable treatment. If the establishment of a database on the preservation treatment of each of the artifacts from the Korean War and the study of scientific preservation treatment methods were to be continued, it would form a very important foundation from the perspective of the basic data for modern and contemporary excavated artifacts.
Smoking has detrimental effects on voice related Quality of Life of University Teachers
Authors: Mehmood Maham , Mumtaz Nazia , Saqulain Ghulam
Published: August 2024

Objective: To compare voice related quality of life of smoker and non-smoker university teachers.
Method: This Cross-Sectional descriptive study was conducted at Riphah International University over a period of six months January to June, 2022. A sample of N=352 University teachers of both genders, aged 25 to 65 years, who were faculty members and working at least 8 hours per day in teaching positions with at least one-year experience were included in the study. Demographic sheet, Voice Related Quality of Life (VRQOL) and Voice Handicap Index (VHI) were used for data collection and analysis conducted on SPSS Version 21. Mean scores of VRQOL and VHI for smokers and non-smokers were compared using Mann Whitney U Test. & Spearman’s correlation was utilized to determine any association between the tool scores. P<0.01 was considered significant.
Results: Results reveal that the mean score of Voice related quality of life scale was significantly (p=0.000) higher in smokers compared to non–smokers indicating worse voice quality in smokers. Similarly, voice handicap index scores were much higher in smokers (p=0.000) indicating more handicap in the smokers.
Conclusion: The study concludes that smoking has a detrimental effect on voice and voice related quality of life of university teachers and voice related quality of life as determined by VRQOL scale is significantly better in non-smokers.
doi: https://doi.org/10.12669/pjms.40.8.8631
How to cite this: Mehmood M, Mumtaz N, Saqulain G. Smoking has detrimental effects on voice related Quality of Life of University Teachers. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.8631
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Genetic analysis of patients with clinical features of autoinflammatory disorders plus pyrin gene mutations using next generation sequencing (NGS)
Authors: Καραμανάκος Αναστάσιος
Published: August 2024

Σκοπός: Να εκτιμηθούν οι πιθανές επιδράσεις που έχει στο φαινότυπο των συστηματικών αυτοφλεφμονωδλων νοσημάτων (SAID) η συνύπαρξη παραλλαγής στο γονίδιο Mediterranean FeVer (MEFV) και παραλλαγών σε επιπρόσθετα σχετικά γονίδια. Μέθοδοι: Διαδοχικοί ασθενείς (n = 42) με κλινική υποψία SAID οι οποίοι υποβλήθηκαν σε έλεγχο DNA με αλληλούχιση επόμενης γενιάς (NGS) με στόχο 26 σχετικά γονίδια, και είχαν τουλάχιστον μία παραλλαγή στο γονίδιο MEFV, μελετήθηκαν αναδρομικά. Συνολικά, σε 21 ασθενείς με νεανική και 21 ασθενείς με ενήλικη έναρξη νόσου εντοπίστηκαν 63 παραλλαγές στο γονίδιο MEFV, κυριως στα εξόνια 10 (n= 29) και 2 (n= 19). Αποτελέσματα: Η κλινική διάγνωση ήταν ο Οικογενής Μεσογειακός Πυρετός (FMF) σε 11/42 ασθενείς, πολυγονιδιακά SAIDs (PFAPA, νόσος Still, άτυπη SAPHO και φλεγμονώδης νόσος του εντέρου) σε 9/42, ενώ το νόσημα δεν καθορίστηκε κλινικά σε 22/42 ασθενείς. Συγκεκριμένα, 33 από τους 42 ασθενείς (79%) είχαν τουλάχιστον μία συνυπάρχουσα παραλλαγή σε άλλα 19/25 γονίδια, εκτός του MEFV. Η ανάλυση NGS επιβεβαίωσε όλες τις κλινικές διαγνώσεις και βοήθησε στον καθορισμό της διάγνωσης στο 59% των υπολοίπων περιπτώσεων. Ασθενείς με μη-καθορισμένα SAIDs (n = 9) ή άτυπο φαινότυπο FMF ( n = 12) είχαν σημαντικά περισσότερες νοσογόνες παραλλαγές σε γονίδια άλλα από το MEFV, σε σύγκριση με τους ασθενείς που είχαν τυπικό FMF (n = 9). Περισσότερες από μία παραλλαγές σε αυτά τα γονίδια συσχετίστηκαν σημαντικά με έναρξη της κλινικής νόσου στην ενήλικη ζωή, ενώ νοσογόνες παραλλαγές στα ίδια γονίδια σχετίστηκαν επίσης με γενικά σοβαρότερο φαινότυπο SAID. Συμπέρασμα: Οι συνυπάρχουσες παραλλαγές στα γονίδια που σχετίζονται με SAID μπορεί να εξηγήσουν τη μεταβλητότητα του φαινοτύπου αυτών των νοσημάτων, μέσω σωρευτικής επίδρασης. Περαιτέρω μελέτες θα πρέπει να επικυρώσουν τα συνδυασμένα μοριακά και κλινικά δεδομένα, ώστε να κατανοηθεί καλύτερα η επίδραση των αθροιστικών γονιδιακών παραλλαγών, αλλά και να βελτιστοποιηθεί η ταξινόμηση αυτών των ασθενών.
Recent results in the study of the 20Ne + 130Te collision within the NUMEN project and future perspectives
Authors: Soukeras Vasileios , Cappuzzello F. , Carbone D. , Cavallaro M. , Agodi C. , Acosta L. , Boztosun I. , Brischetto G. A. , Calvo D. , Chavez – Lomeli E. R. , Ciraldo I. , Delaunay F. , Finocchiaro P. , Fisichella M. , Hacisalihoglu A. , Lanzalone G. , Linares R. , Oliveira J. R. B. , Pakou A. , Pandola L. , Petrascu H. , Pinna F. , Sgouros O. , Solakci S. O. , Souliotis G. , Spatafora A. , Torresi D. , Tudisco S. , Yildirim A. , Zagatto V. A. B.
Published: August 2024

The NUMEN (Nuclear Matrix Elements for Neutrinoless double beta decay) project aims to investigate specific heavy–ion double charge exchange reactions to provide experimentally data driven information about nuclear matrix elements of interest in the context of neutrinoless double beta decay (0νββ). Taking into consideration that 130Te is a candidate nucleus for double beta decay, the 20Ne + 130Te system was experimentally investigated in a multi-channel approach by measuring the complete net of reaction channels, namely elastic and inelastic scattering, double charge exchange, single charge exchange, one– and two–nucleon transfer reactions, characterized by the same initial state interaction. The relevant experimental campaign was carried out at INFN – Laboratori Nazionali del Sud (LNS) in Catania using the Superconducting Cyclotron to accelerate the beams and the MAGNEX magnetic spectrometer to detect the reaction ejectiles. The experimental challenges and the obtained results for the 20Ne + 130Te system are presented and discussed. Since a deeper investigation of the 130Te nucleus as well as all the nuclei which are candidates for 0νββ decay is foreseen within the next phase of NUMEN, the Research and Development activity relevant to the facility upgrade is also discussed.
Signatures of Clustering and Cluster Transfer in Peripheral Collisions of 40Ar on 64Ni at 15 MeV/nucleon
Authors: Giannitsa Chrysi , Souliotis Georgios , Koulouris Stergios , Depastas Theodoros-Michail , Gkatzogias Konstantinos , Fasoula Olga , Veselsky Martin , Yennello Sherry , Bonasera Aldo
Published: August 2024

We study the momentum distributions of several projectile-like fragments resulting from the reaction of an 40Ar beam with a 64Ni target at 15 MeV/nucleon. The data, obtained at the Cyclotron Institute of Texas A&M University, refer to products corresponding to light cluster pick-up or removal. We thoroughly study the momentum distributions and the production cross sections for various cluster transfer channels. Comparisons with the Deep-Inelastic Transfer (DIT) and Constrained Molecular Dynamics (CoMD) models reveal partial agreement and an inability to fully describe the quasi–elastic part. We tentatively attribute this discrepancy as an indication of direct cluster transfer or breakup. By comparing our experimental data with appropriate models, we anticipate gaining valuable insight into the mechanisms governing clustering and cluster transfer in peripheral collisions within the Fermi energy regime.
Covariant density functional description of shape phase transitions and shape coexistence in heavy nuclei
Authors: Prassa Vaia , Karakatsanis Konstantinos
Published: August 2024

The phenomena of shape phase transitions and shape coexistence in even-even heavy nuclei are analysed within the covariant density functional framework. Spectroscopic observables that characterize low-lying collective excitations associated with order parameters are computed using the corresponding generalized microscopic collective Hamiltonians with deformations as dynamical collective coordinates. The parameters of the Hamiltonians are determined by relativistic Hartree-Bogoliubov calculations based on the energy density functional DD-PC1, and a finite-range pairing interaction.
Differential cross section measurements of the 18O(p, a0)15N reaction at 170º and 160º, in the energy range Ep=1-2MeV
Authors: Kotsovolou Anastasia , Axiotis Michail , Karakaxi Anna , Kokkoris Michail , Lagoyannis Anastasios , Taimpiri E. , Ziagkova Anastasia
Published: August 2024

In the present work, the differential cross-sections of the 18O(p,α0)15N reaction were determined using the absolute measurement technique, in the proton energy range Ep=1–2 MeV for NRA purposes. The experiment was carried out in energy steps of 10 or 20 keV. Two detection angles, 170° and 160°, were measured, employing 500 μm thick Surface-Barrier-Back-Scattering detectors in a high-precision goniometric chamber. The target, a thin layer of Ta2O5 highly enriched in 18O, was deposited ona thick tantalum foil via anodization. Its thickness was provided by the manufacturer and independently verified experimentally using the 18O(d,α0) reaction. SIMNRA simulations were performed to determine the Q•Ω value, incorporating a pile-up calculation routine. The obtained results were compared with previously published data, allowing for a comprehensive analysis of both similarities and discrepancies. The reaction’s differential cross-section was determined using the absolute measurement technique. The final results revealed larger cross-section values compared to the existing literature ones. Some of the observed discrepancies were attributed to inaccuracies in the database entries. These coherent differential cross-section datasets are expected to facilitate the extension of the existing SigmaCalc evaluation of the 18O(p,α0) reaction to higher energies in the near future.
Case Report: Activated B-cell-diffuse large B-cell lymphoma
Authors: Kalmegh Padmashri , Hande Alka , Gawande Madhuri , Patil Swati , Sonone Archana , Pakhale Aayushi
Published: August 2024

Lymphomas of the oral and oropharyngeal regions are rather uncommon, and diagnosis can be challenging and confusing due to the multiple histological subgroups. Lymphomas are the third most common type of tumor in the head and neck region and are brought on by the lymphoreticular system. The two forms of lymphoma are Hodgkin’s lymphoma and non-Hodgkin’s lymphoma (NHL). Herein, we present a case report of oropharyngeal lymphoma. The female patient reported with a complaint of swelling over the palatal region for two to three months. An ulceroproliferative lesion was evident over the posterior palatal region. We diagnosed reactive lymphadenitis based on an incisional biopsy. To confirm the diagnosis and rule out other conditions, a punch biopsy followed by immunohistochemical studies were done. Features suggestive of activated B-cell-diffuse large B-cell lymphoma were confirmed. Among malignant lymphomas, diffuse large B-cell lymphoma is the most prevalent variety. Much progress has been made in recent years in understanding the molecular pathophysiology of this disease. In this case report, we aim to correlate the clinical presentation, histology features and immunohistochemical significance in order to promote early discovery, diagnosis, and treatment for a better prognosis of the patient.
The role of medical students in junior doctors’ strikes: A cross-sectional online survey
Authors: Novintan Shonnelly , Okechukwu Hannah
Published: August 2024

Objectives The British Medical Association announced a successful vote towards industrial action to achieve ‘pay restoration’ on 20 February 2023; with 11 walkout periods occurring in the following months. During industrial action, concerns arose about the role medical students would play and the pressure placed upon them to ‘act up’. The objective of this study was to assess the guidance issued by medical schools and local placement sites during industrial action. Design, setting and participants This cross-sectional study collected online survey data between 7 March 2023 and 7 April 2023 from medical students across England. Main outcome measures Reports about guidance issued by medical schools and hospital placements. Results 62% of the medical schools issued guidance stating they were not cancelling clinical placements; of these, 10% said attendance was a personal choice. 17% of medical schools cancelled all clinical placements and 7% did not issue guidance. 52% of medical schools monitored attendance on strike days. 1 medical school and 3 clinical placement sites advertised paid work for students during the industrial action. Conclusion The impact industrial action has on medical students has not been examined. Our results show mixed guidance from medical schools that can contradict local placement guidance. This lack of guidance is mirrored in the existing, yet limited, literature. If students feel pressured to perform tasks outside their remit, with inadequate supervision, it can impact patient safety and their license to practice. For the safeguarding of patients, and students, further work is needed to produce standardised guidance during industrial action.
Research on the Application of Node Importance Assessment based on HITs Algorithm in Power Grid Planning
Authors: Fu Gaoshan , Xiang Yin  , Yue Gao  , Dan Meng  , Liang Chen
Published: August 2024

Power grid planning needs to be strong and effective as the world’s energy environment shifts to include more renewable energy sources and smart technology. This study explores the use of the HITS (Hyperlink-Induced Topic Search) algorithm to apply node importance assessment in the context of power grid planning. The HITS method provides a new way of looking at the importance of nodes in power grid networks. It was initially developed for online link analysis. The first section of the paper offers a thorough analysis of the power grid planning techniques now in use, highlighting the crucial role that nodes play in guaranteeing flexible and resilient systems. Next, the HITS method is modified and used in power grid networks, taking dependability, interaction, and node centrality into account. As part of the research process, a mathematical model that combines the HITS method with important variables unique to power grid planning is developed. On real-world power grid datasets, simulation tests are carried out to evaluate the algorithm’s performance in identifying nodes that are critical to fault tolerance, overall performance, and system stability. The study’s findings go beyond conventional power grid planning techniques by providing a sophisticated method of evaluating node relevance that is in line with the dynamic and interdependent character of contemporary energy networks. The results aid in the infrastructure optimization of the power grid, allowing planners and managers to better prioritize expenditures, increase resilience to disturbances, and make it easier to integrate energy from renewable sources smoothly.
Implementation and Optimization of Probabilistic and Mathematical Statistical Algorithms under Distributive Architecture
Authors: Li Shengbiao , Jiankui Peng
Published: August 2024

Statistical methods must be developed and optimized in distributed systems due to the increasing amount of data and processing demands in modern applications. The application and optimization of mathematical and probabilistic statistical methods in distributed computing settings is the main topic of this study. Algorithms like these have the potential to improve performance, scalability, and parallel processing abilities when integrated into distributed systems. We commence our investigation by reviewing current mathematical and probabilistic statistical algorithms, determining their advantages and disadvantages, and evaluating their suitability for distributed architectures. We then suggest new approaches for their smooth incorporation into distributed computing structures, making use of distributed storage and parallel processing to effectively manage massive datasets. Improving these algorithms’ performance in distributed environments is the focus of this research’s refinement phase. We seek to optimize the use of distributed infrastructures by minimizing latency and maximizing computational resources by investigating efficient communication protocols, load balancing mechanisms, and parallelization approaches. The suggested algorithms are put into practice inside a distributed structure for empirical confirmation, and their effectiveness is evaluated in comparison to more conventional, non-distributed competitors. We test the scaling, precision, and effectiveness of the methods in practical scenarios using a variety of datasets and use cases.
Research on Planning and Path Optimization of Leisure Sports Activities based on Multi-objective Genetic Algorithm
Authors: Yang Xu
Published: August 2024

Recreational sports are essential for boosting physical health and improving quality of life. The goal of this research is to optimize the planning of leisure sports by presenting a new method based on a multi-objective genetic algorithm. Acknowledging the intricacy of organizing recreational sports events, we suggest an approach that concurrently maximizes several goals, such as the use of resources, player happiness, and ecological impact. The topic is first formulated as a multi-objective optimization task in the paper, and a genetic algorithm is used to handle the objectives’ inherent conflict. With its ability to effectively explore the solution space, the genetic algorithm produces a set of Pareto-optimal solutions that show trade-offs for the conflicting goals. The integration of several factors, including time preferences, geographical limitations, and environmental sustainability, guarantees a thorough and equitable strategy for leisure sports scheduling. In the area of leisure sports planning, the use of a multi-objective genetic algorithm offers a reliable solution that can be tailored to meet various circumstances and goals. As the need of encouraging healthy lifestyles becomes more widely acknowledged, this research offers a useful tool for maximizing the organization and performance of recreational sports activities, enhancing the overall wellbeing of people and communities.
Brain Tumor Classification using Region-based CNN with Chicken Swarm Optimization
Authors: Peddinti A Sravanthi , Maloji Suman , Mannepalli Kasiprasad
Published: August 2024

Diagnosing and segmenting brain tumors manually through MRI imaging is a complex and time-consuming process. However, advancements in machine learning (ML) and deep learning (DL) technologies have enabled the automatic identification and categorization of brain tumors using computer-aided design. This study utilizes MRI data to develop a system for the automatic identification and categorization of brain tumors based on region-based convolutional neural networks (R-CNN). The proposed RCNN approach, coupled with Chicken Swarm Optimization (CSO) technique, enables the identification and classification of brain tumors into stages. This method involves processing, segmenting, extracting features, and organizing the MRI images. Image preparation includes adaptive fuzzy filtering (AFF) to eliminate noise and enhance the quality of MRI images. To detect regions of brain injury, MRI scans undergo cranial segmentation and classification (CSO) based on Tsallis entropy-based image segmentation. A Residual Network (ResNet) is employed to fuse handcrafted and deep features, generating a meaningful set of feature vectors. Extensive simulations are conducted on the BRATS 2015 dataset to evaluate the improved performance in classifying brain tumors. The RCNN-CSO method demonstrates superior performance compared to other contemporary techniques, achieving a precision of 92.35%, sensitivity of 93.52%, specificity of 94.52 % and an accuracy of 96 % . This represents a significant improvement in brain tumor classification and its outomst accuracy.
Human-Computer Interaction Interface Design in the Cab of New Energy Vehicles
Authors: Zhang Yanxue , Zhang Nanmei , Yang Hui , Ren Yanyu
Published: August 2024

A new energy vehicle cab control platform based on human-computer interaction is proposed from control device design and control signal acquisition design. A driving mode conversion algorithm based on the threshold is combined with the existing intelligent vehicle driving mode conversion. The MATLAB and Python hybrid program is used to realize the simulation experiment of the driving control algorithm of new energy vehicles. The system can conduct interactive simulations of various typical driving scenarios. Data acquisition and dynamic display functions can present the operating status of new energy vehicles most directly and efficiently. The system can integrate and intelligently process vehicle driving data, road environment data and external data from multiple dimensions of the ”vehicle-road-network”. The experimental results show that the system enhances the user experience of new energy vehicles and improves the efficiency of human-computer interaction.
Holy Bishops, Papal Canonisation and the Legitimisation of Power in Thirteenth-Century Norway and Poland: The Cases of Eystein Erlendsson of Nidaros and Stanislaus of Kraków
Authors: Hope Steffen , Pac Grzegorz
Published: August 2024

This article explores two mid-thirteenth-century attempts to canonise holy bishops from the so-called peripheries of Latin Christendom. That two ecclesiastical centres – the metropolitan see of the Nidaros Church Province and the episcopal see of Kraków – both sought to attain papal acknowledgement of the veneration of a holy episcopal predecessor and did so in the same historical period, is understood to be a response to a general trend in the Latin Church. More specifically, we interpret these attempts in light of the paradigm of the holy episcopal champion fighting for the freedom of the Church, a recalibration of the idea of the holy bishop that emerged as a result of the canonisation of Thomas of Canterbury in 1173, and which was promoted throughout the Latin Church from that point onward. Due to the popularity of the new type of the holy bishop, the episcopal champion became a form of symbolic capital that conferred greater prestige onto the saints, their cult centres, and the guardians of those cult centres, i.e., the clergy. Through a comparative study of two unconnected cases, we see how peripheral agents could actively adopt central trends to strengthen their own legitimisation of power vis-à-vis both rulers and other ecclesiastical institutions.
Zakaz nagrywania pacjentów bez uprzedniego uzyskania ich zgody – czy wciąż aktualny? – uwagi na tle wyroku Naczelnego Sądu Administracyjnego z dnia 23 maja 2023 r., II OSK 1761/20
Authors: Adrych-Brzezińska Izabela
Published: August 2024

Naczelny Sąd Administracyjny wyrokiem z dnia 23 maja 2023 r. w sprawie o sygnaturze II OSK 1761/20 oddalił skargę kasacyjną względem wyroku WSA w Warszawie, który to sąd oddalił skargę na decyzję Rzecznika Praw Pacjenta w przedmiocie uznania praktyki za naruszającą zbiorowe prawa pacjentów. Decyzja Rzecznika została wydana w związku z monitorowaniem pacjentów podmiotu w trakcie udzielania im świadczeń zdrowotnych bez uprzedniego uzyskania ich zgody. Niniejsze opracowanie stanowi analizę stanowiska przyjętego przez sąd przez pryzmat obowiązujących, a znowelizowanych w ostatnim czasie przepisów w tym zakresie. Artykuł wskazuje także liczne implikacje prawne, które wiążą się z możliwością rejestrowania procesu udzielania świadczeń zdrowotnych, a w przytoczonym orzeczeniu zostały pominięte.
Określanie kryteriów nadzoru sprawowanego przez organy gminy nad działalnością organów jednostek pomocniczych gminy
Authors: Misiejko Adrian
Published: August 2024

Przedmiotem artykułu jest kwestia określania kryteriów nadzoru organów gminy nad działalnością organów jednostek pomocniczych gminy. W literaturze wyrażane są rozbieżne stanowiska dotyczące tego, czy nadzór ów jest ograniczony wyłącznie do kryterium legalności. Celem badawczym jest rozstrzygnięcie tego problemu z uwzględnieniem analizy Europejskiej Karty Samorządu Lokalnego.
Błąd weryfikacyjny i błąd w nadzorze- nowe rodzaje błędów lekarskich powstałe w wyniku korzystania z systemów sztucznej inteligencji przy udzielaniu świadczeń zdrowotnych
Authors: Wałdoch Katarzyna
Published: August 2024

Wyroby medyczne oparte na sztucznej inteligencji od kliku lat wykorzystywane są przy udzielaniu świadczeń zdrowotnych. Zmiany w procesie diagnostycznym i leczniczym spowodowały, że konieczne wydaje się wyodrębnienie nowych rodzajów błędu lekarskiego, tj. błędu weryfikacyjnego jako podkategorii błędu diagnostycznego oraz błędu w nadzorze jako podkategorii błędu terapeutycznego. Sztuczna inteligencja stanowi jedynie narzędzie stosowane przez lekarza. Ma on obowiązek zweryfikowania poprawności diagnozy stawianej przez SI. Jeśli aktualny stan wiedzy medycznej pozwala na stwierdzenie, że wyniki analizy dokonanej przez sztuczną inteligencję są nieprawidłowe, a lekarz mimo to stawia diagnozę zgodnie z rozpoznaniem SI, dojdzie do popełnienia błędu weryfikacyjnego. W przypadku gdy chirurg będzie mógł korzystać z w pełni autonomicznego robota, jego zadania zmienią się całkowicie. Pozostanie mu jedynie obowiązek nadzoru robota chirurgicznego i przejęcia prowadzenia zabiegu w razie zaobserwowania nieprawidłowości w jego działaniu. Jeśli lekarz nie zatrzyma autonomicznego robota, mimo że zgodnie z aktualnym stanem wiedzy medycznej jego działanie jest nieprawidłowe lub mógłby za pomocą własnych rąk wykonać zabieg z większą precyzją lub zabieg skutkujący mniejszym uszczerbkiem na zdrowiu pacjenta, popełni błąd w nadzorze.
Kilka uwag na temat prawnokarnych aspektów postmortalnego stosowania technik medycznie wspomaganej prokreacji na gruncie ustawy o leczeniu niepłodności
Authors: Wojewoda Ewelina
Published: August 2024

Techniki medycznie wspomaganej prokreacji, w tym zapłodnienie pozaustrojowe, stanowią standardowe procedury medyczne stosowane w leczeniu niepłodności. Ich rozwój stworzył jednak także wiele nowych wyzwań stojących przed ustawodawcą. Jednym z problemów jest właśnie możliwość powołania na świat dziecka post mortem. W pracy analizie poddano problematykę zapłodnienia postmortalnego, transferu zarodka post mortem, jak również pobierania gamet ze zwłok w celu zastosowania w procedurze medycznie wspomaganej prokreacji w świetle przepisów penalnych ustawy o leczeniu niepłodności. Podjęto też próbę dokonania ich oceny i wskazania nieścisłości, które może wzbudzać ich interpretacja.