bluuebunny/crossref_metadata_2025 huggingface dataset:
Cilostazol is a promising anti-pseudomonal virulence drug by disruption of quorum sensing
Authors: Al-Rabia Mohammed W. , Asfour Hani Z. , Alhakamy Nabil A. , Bazuhair Mohammed A. , Ibrahim Tarek S. , Abbas Hisham A. , Mansour Basem , Hegazy Wael A. H. , Seleem Noura M.
Published: August 2024

Resistance to antibiotics is a critical growing public health problem that desires urgent action to combat. To avoid the stress on bacterial growth that evokes the resistance development, anti-virulence agents can be an attractive strategy as they do not target bacterial growth. Quorum sensing (QS) systems play main roles in controlling the production of diverse virulence factors and biofilm formation in bacteria. Thus, interfering with QS systems could result in mitigation of the bacterial virulence. Cilostazol is an antiplatelet and a vasodilator FDA approved drug. This study aimed to evaluate the anti-virulence activities of cilostazol in the light of its possible interference with QS systems in Pseudomonas aeruginosa. Additionally, the study examines cilostazol’s impact on the bacterium’s ability to induce infection in vivo, using sub-inhibitory concentrations to minimize the risk of resistance development. In this context, the biofilm formation, the production of virulence factors and influence on the in vivo ability to induce infection were assessed in the presence of cilostazol at sub-inhibitory concentration. Furthermore, the outcome of combination with antibiotics was evaluated. Cilostazol interfered with biofilm formation in P. aeruginosa. Moreover, swarming motility, biofilm formation and production of virulence factors were significantly diminished. Histopathological investigation revealed that liver, spleen and kidney tissues damage was abolished in mice injected with cilostazol-treated bacteria. Cilostazol exhibited a synergistic outcome when used in combination with antibiotics. At the molecular level, cilostazol downregulated the QS genes and showed considerable affinity to QS receptors. In conclusion, Cilostazol could be used as adjunct therapy with antibiotics for treating Pseudomonal infections. This research highlights cilostazol’s potential to combat bacterial infections by targeting virulence mechanisms, reducing the risk of antibiotic resistance, and enhancing treatment efficacy against P. aeruginosa. These findings open avenues for repurposing existing drugs, offering new, safer, and more effective infection control strategies.
Balint groups: an effective tool for improving health professionals’ perceived well-being
Authors: Kannai Ruth , Krontal Shai , Freud Tamar , Biderman Aya
Published: August 2024

Background

Physician burnout is a common problem that negatively impacts their well-being and patient care. Balint groups (BGs) deal with doctor-patient relationships. Previous studies that have demonstrated the positive effects of BGs are descriptive and based on small sample sizes. This study aims to evaluate the perceptions of health professionals who participated in BGs, determine the impact of BGs on their personal and professional well-being, and identify the factors related to these positive outcomes.

Methods

On January and February 2023 the authors have distributed a questionnaire to 142 healthcare providers in a conference and internet networks. Most respondents were family physicians.

Results

Participation in BGs is seen to have a positive impact on healthcare professionals’ perceived well-being and professional development. Respondents who had participated in the BG reported a reduction in burnout, increased empathy, and enhanced professional identity and relationships with patients and colleagues. The study also highlighted the importance of duration of participation in BG, with attendance longer than 5 years linked to significantly more positive outcomes compared to less than 1 year. In a logistic regression analysis two factors were significantly associated with self-reported well-being: attending BGs for more than five years and perceiving BGs as a means of relieving burnout.

Conclusions

The findings suggest that medical organizations should encourage the regular availability of BGs to support physicians’ well-being.
Moment dynamics of oligomer formation in protein amyloid aggregation with secondary nucleation
Authors: Ding Yamin , Cai Liming , Kang Yanmei
Published: August 2024

The abnormal aggregation of proteins into amyloid fibrils, usually implemented by a series of biochemical reactions, is associated with various neurodegenerative disorders. Considering the intrinsic stochasticity in the involving biochemical reactions, a general chemical master equation model for describing the process from oligomer production to fibril formation is established, and then the lower-order statistical moments of different molecule species are captured by the derivative matching closed system, and the long-time accuracy is verified using the Gillespie algorithm. It is revealed that the aggregation of monomers into oligomers is highly dependent on the initial number of misfolded monomers; the formation of oligomers can be effectively inhibited by reducing the misfolding rate, the primary nucleation rate, elongation rate, and secondary nucleation rate; as the conversion rate decreases, the number of oligomers increases over a long time scale. In particular, sensitivity analysis shows that the quantities of oligomers are more sensitive to monomer production and protein misfolding; the secondary nucleation is more important than the primary nucleation in oligomer formation. These findings are helpful for understanding and predicting the dynamic mechanism of amyloid aggregation from the viewpoint of quantitative analysis.
Immunosuppressive tumor microenvironment in the progression, metastasis, and therapy of hepatocellular carcinoma: from bench to bedside
Authors: Yin Yue , Feng Weibo , Chen Jie , Chen Xilang , Wang Guodong , Wang Shuai , Xu Xiao , Nie Yongzhan , Fan Daiming , Wu Kaichun , Xia Limin
Published: August 2024

Hepatocellular carcinoma (HCC) is a highly heterogeneous malignancy with high incidence, recurrence, and metastasis rates. The emergence of immunotherapy has improved the treatment of advanced HCC, but problems such as drug resistance and immune-related adverse events still exist in clinical practice. The immunosuppressive tumor microenvironment (TME) of HCC restricts the efficacy of immunotherapy and is essential for HCC progression and metastasis. Therefore, it is necessary to elucidate the mechanisms behind immunosuppressive TME to develop and apply immunotherapy. This review systematically summarizes the pathogenesis of HCC, the formation of the highly heterogeneous TME, and the mechanisms by which the immunosuppressive TME accelerates HCC progression and metastasis. We also review the status of HCC immunotherapy and further discuss the existing challenges and potential therapeutic strategies targeting immunosuppressive TME. We hope to inspire optimizing and innovating immunotherapeutic strategies by comprehensively understanding the structure and function of immunosuppressive TME in HCC.
A valid and reliable explanatory model of learning processes in heritage education
Authors: Fontal Olaia , Arias Víctor B. , Arias Benito
Published: August 2024

Background

The main challenge in heritage education is to identify the verbs—and their hierarchical relations—that explain heritage learning as based on empirical evidence. The Heritage Learning Sequence (HLS) selects seven verbs (Knowing-Understanding-Respecting-Valuing-Caring-Enjoying-Transmitting) on the basis of (a) theoretical studies, (b) analyses of international standards, and (c) evaluation of heritage education programs. The study has the following objectives: (a) to clarify the heritage learning process; (b) to test a theoretical model that groups the verbs that make up the Heritage Learning Sequence (HLS), as well as the relationships between them; (c) to identify possible sub-models that explain the different heritage learning itineraries.

Methods

The Q-Herilearn scale (previously calibrated using SEM and IRT models) was administered to

$$N = 1454$$

N
=
1454

individuals, focusing on seven factors (corresponding to each HLS verb) that measure heritage learning. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used as a general analytical strategy.

Findings

The results obtained provided sufficient guarantees to validate the HLS and showed the adequate explanatory and predictive power and general fit of the proposed model (Heritage Learning Model); all twelve hypothesized direct influence relations between the main verbs that define heritage learning were confirmed. The statistical significance values suggested the existence of other internal subsequences that could be explored in further studies.

Contribution

Learning modeling provides a key structural framework for (a) the design of effective, efficient, and comprehensive tools to measure heritage learning and (b) their operationalization in heritage education designs.
Combined studies on glazed ceramic bodies from the Middle and Neo-Elamite periods (1500–539 BCE)
Authors: Aarab Ali , Cormier Laurent , Firoozmandi Bahman , Gérard Martine
Published: August 2024

The Elamites have assigned specialized names for different types of ceramics, signaling a specialized approach to ceramic production during the Middle and Neo-Elamite periods. They were pioneers in the use of glazed ceramics on the Iranian Plateau. This investigation focuses on the examination of 29 samples of glazed ceramic bodies originating from the Middle-Elamite (~ 1500–1100 BCE) and Neo-Elamite periods (~ 1100–539 BCE). The objective of this analysis, centered on the earliest instances of glazed ceramic bodies in Iran, is to obtain a comparative examination of the ceramic bodies. Such an approach can be useful for understanding the diverse production techniques used by Elamites in the Middle-Elamite and Neo-Elamite periods. To achieve this purpose, X-ray diffraction and petrography was used to determine the mineralogical characteristics of the ceramic bodies. Further insight into the chemical analysis of the samples was obtained through Electron Probe Micro-Analysis. The experimental data allowed the classification of the samples into four distinct groups. Particularly noteworthy in this categorization is the diversity observed in the Neo-Elamite samples. This diversity of Neo-Elamite ceramic bodies can be attributed to two primary factors. Firstly, the Neo-Elamite period witnessed a more varied array of techniques for producing glazed ceramic bodies compared to the Middle-Elamite period. Unlike the Middle-Elamite glazed ceramics, which were solely utilized for architectural decoration (glazed bricks) and were locally produced, the Neo-Elamite period marked the first instance of glazed ceramic vessels being used in the southwest of Iranian plateau, leading to a higher technological diversity. Secondly, the frequency of trade and importation of glazed ceramics from other regions to the southwest of Iran was notably higher during the Neo-Elamite period compared to the Middle-Elamite one. A notable distinction emerges in the Middle-Elam period, where exclusively quartz-based ceramic bodies were referenced, setting it apart from other sample types.
The biological contribution to the weathering of limestone monuments in a vegetated urban area: results of a 5-year exposure
Authors: Reboah Paloma , Verney-Carron Aurélie , Abbad Andaloussi Samir , Alphonse Vanessa , Lauret Olivier , Nowak Sophie , Chabas Anne , Saheb Mandana , Balland-Bolou-Bi Clarisse
Published: August 2024

Biological activity, climate and pollution are responsible for the degradation of building stones, especially limestone, which is widely used in the Paris region. In order to determine the respective contribution of physicochemical and biological processes to the degradation of limestone, limestone specimens from the Père-Lachaise cemetery (Paris, France) were exposed for five years under different conditions: sheltered from or exposed to rain and in horizontal or vertical position. After exposure, the collected samples were characterized by light and electron microscopy, X-Ray diffraction and ion chromatography after elution. The results showed an intense biocolonization of the samples exposed to rain, while the sheltered samples were more affected by the pollution (soiling). The characterization of the bacterial and fungal communities using Next Generation Sequencing Illumina 16S for bacteria and ITS for fungi highlighted that five main bacterial phyla were identified: Actinobacteriota, Bacteroidota, Cyanobacteria, Proteobacteria and Deinococcota (major genera Flavobacterium, Methylobacterium-Methylobacter, Sphingomonas, Roseomonas and Nocardiodes). Among the fungi, the phylum Ascomycota was predominant with the genera Cladosporium, Ramularia, Aureobasidium and Lecania. However, the alteration of the limestone is difficult to quantify at this stage. Potassium nitrate of rain origin has been found in the sheltered area, but no gypsum. Therefore, the biocolonization is a fast phenomenon on the stone and the physico-chemical processes derived from it, caused by climate and pollution, are slower. This is in agreement with the long-term observations made on old and unrestored graves of the cemetery described in the literature.
Doing the month (Zuo Yuezi): postpartum embodied practices and subjectivity among urban white-collar Chinese women
Authors: Chai Xiangnan , Xu Dexin
Published: August 2024

In China, the postnatal bodily experiences of urban white-collar women intricately relate to the tradition of “doing the month” (DTM). The DTM guidelines serve a dual purpose: they aid women in recuperating from postnatal frailty and act as cultural restrictions that govern women’s bodies as bearers of fertility for patrilineal families. This research delves into the postnatal embodied practices of white-collar Chinese women and their articulations of subjectivity during DTM. The findings enrich the theory of embodiment with empirical materials in terms of embodied cultural practice by illustrating how women exhibit embodied subjectivity at the intersections of traditional, modern, and gendered discourses. The findings reveal the affirmative bodily practices of women we interviewed: (i) They astutely employ both beneficial DTM regulations and non-DTM knowledge to support their own body’s recovery. They also procure professional services for enhanced recovery. (ii) They express embodied subjectivity during postnatal breastfeeding, which serves as a way to adapt to motherhood. (iii) From the viewpoint of social relations, mothers can devise coping mechanisms to assert agency during interactions with primary family members concerning breastfeeding and infant care. These findings transcend the literature on women’s body–self relations and extend to the examination of body–self–family relations from a postfeminist standpoint, thereby enriching embodiment theory by suggesting that cultural values and disciplines shape and inform the expression of subjectivity through the body–mind connection during embodied practices.
A case of opioid-induced rigidity requiring naloxone administration at the time of anesthesia emergence
Authors: Fukasawa Ryohei , Oishi Ayumi , Nemoto Chiaki , Inoue Satoki
Published: August 2024

Background

Opioid-induced rigidity is typically observed during rapid administration of fentanyl. Herein, we present a case in which rigidity occurred after reversal of rocuronium during emergence from anesthesia.

Case presentation

A 73-year-old man underwent video-assisted partial lung resection. General anesthesia was induced with propofol, remimazolam, remifentanil, and rocuronium. Fentanyl was administered early during anesthesia. The surgery was completed without complications, and sugammadex sodium was administered for rocuronium reversal. The patient became agitated, but spontaneous breathing was maintained; therefore, the intratracheal tube was removed after the administration of flumazenil. The patient developed stiffness in the neck and jaw muscles along with remarkable skeletal muscle contractions. Dramatic improvement was observed immediately after administration of naloxone.

Conclusions

Even as the simulated effect site concentration of fentanyl decreases during anesthesia emergence, opioid-induced rigidity may still occur. Rapid reversal of remimazolam by flumazenil might have contributed to the rigidity in this case.
A controlled vocabulary and taxonomy for the submission of quality attributes for therapeutic proteins
Authors: Welch Joel T. , Kozlowski Steven , Damdinsuren Bazarragchaa , Roelofs Brian A.
Published: August 2024

Structured product quality data offer tremendous promise to revolutionize the submission of drug applications. However, the quality attributes for biological products do not have a systematic naming taxonomy, and consequently this limit poses a critical challenge in the development of systems for structured regulatory submissions. Here, we describe the creation of a controlled vocabulary with a structured taxonomical naming approach for quality attributes of therapeutic proteins. Additionally, we endeavor to make the case for why such systematic harmonized naming is required to support the successful implementation of structured data systems. We also describe the key principles of our structured naming approach, including a top-down view of the product and protein structure and a distinction between a quality attribute and the test to evaluate the attribute. Finally, we describe how this approach can accommodate emerging product types, advanced manufacturing technologies, and be used across the variety of submission sections in a regulatory dossier that discusses quality attributes.
Intra-arterial PSMA injection using hepatic arterial infusion pump in intrahepatic cholangiocarcinoma: a proof-of-concept study
Authors: Veenstra Mara Marieke Katrien , Vegt Erik , Segbers Marcel , Franssen Stijn , Koerkamp Bas Groot , Verburg Frederik Anton , Thomeer Maarten Guillaume Josephus
Published: August 2024

Prostate-specific membrane antigen (PSMA) targeted tracers show increased uptake in several malignancies, indicating a potential for peptide radioligand therapy. Intra-arterial injection of radiotracers can increase the therapeutic window. This study aimed to evaluate the feasibility of intra-arterial injection of [68Ga]Ga-PSMA-11 for intrahepatic cholangiocarcinoma and compare tracer uptake after intrahepatic arterial injection and intravenous injection. Three patients with intrahepatic cholangiocarcinoma received [68Ga]Ga-PSMA-11 through a hepatic arterial infusion pump, followed by positron emission tomography/computed tomography (PET/CT). Two-three days later, patients underwent PET/CT after intravenous [68Ga]Ga-PSMA-11 injection. All tumours showed higher uptake on the intra-arterial scan compared with the intravenous scan: the intra-arterial / intravenous standardised uptake value normalised by lean body mass ratios were 1.40, 1.46, and 1.54. Local intra-arterial PSMA injection is possible in patients with intrahepatic cholangiocarcinoma. Local injection increases tumour-to-normal tissue ratios, increasing the therapeutic window for theranostic applications.

Relevance statement

Intra-arterial Prostate specific membrane antigen (PSMA) injection increases the therapeutic window for potential theranostic application in intrahepatic cholangiocarcinoma.

Key Points

Three patients with intrahepatic cholangiocarcinoma underwent PET/CT after intra-arterial and intravenous injection of [68Ga]Ga-PSMA-11.

Intra-arterial injection showed higher uptake than intravenous injection.

PSMA-targeted imaging could be valuable for a subset of intrahepatic cholangiocarcinoma patients.

Graphical Abstract
Is HALP score a predictor of poor prognosis in patients with hematologic malignancies admitted to the intensive care unit?
Authors: Sadri Sevil , Tunay Burcu
Published: August 2024

Background

The Hemoglobin, Albumin, Lymphocyte, Platelet Score (HALP) is a novel predictive biomarker that has surfaced in the literature in recent years. It has been applied to the prediction of many clinical outcomes related to different neoplasms. Each of these inflammatory and nutritional markers is taken into account by the HALP score, which provides an overall prognosis for patients with cancer.

Methods

Retrospective data was collected on the demographics of patients hospitalized to our hospital's intensive care unit (ICU) for hematologic malignancies between January 2014 and March 2021. To measure the prognostic value of the HALP score, it was retrospectively calculated for patients with hematologic malignancies on the first day of ICU admission.

This study looked into the link between the HALP score and general prognostic characteristics because it has been suggested that the HALP score is a relevant prognostic marker.

Results

Patients with an HALP score <37.10 had significantly higher APACHE II scores (p < 0.001). They also had significantly higher rates of qSOFA score ≥2 (89.3%), as well as statistically significantly higher rates of intubation (96%) and death (96.1%) (p < 0.001). Our study found that a HALP score <37.1 was associated with a 47.04-fold increase in mortality risk.

Conclusion

In patients with hematologic malignancies, the prognosis is strongly correlated with the HALP score. When validated in large cohorts, the HALP score, APACHE II, and q SOFA scores, either individually or collectively, can be used to guide prognostic evaluation of patients and act as a reliable predictor of unfavorable clinical outcomes in patients with hematologic malignancies.
On-demand high-resolution areal scouting via unmanned aerial vehicles enables sustainable near-surface geoscience data acquisition
Authors: Ramdani Ahmad Ihsan , Golikov Pavel , Alsoqair Khaled , Serpiva Valerii , Alfataierge Ezzedeen
Published: August 2024

An accurate data acquisition plan is critical for near-surface geoscience investigations. Detailed understanding of the terrain and land cover of the survey area is essential to designing a data acquisition layout that efficiently meets the objective while mapping potential obstacles. Using satellite-based data is the most affordable and straightforward method to obtain this information. However, near-surface geoscience investigations demand a higher-resolution map than commonly available satellite imagery to design a detailed acquisition plan. This paper presents a concept that utilizes unmanned aerial vehicles (UAVs) to successfully and sustainably perform on-demand high-resolution areal scouting to aid near-surface geoscience data acquisition campaigns and seismic drone deployment. We share the results of two field trial cases where the presented concept was evaluated. Case A is a 16 km2 extensive outcrop investigation in an arid desert environment. The initial satellite-based acquisition plan was changed considerably when UAV data sets became available. This led to an approximately 60% improvement in data productivity and efficiency, effectively reducing the carbon footprint of conventional scouting operations. Case B utilizes high-resolution areal scouting to determine the safe landing zone for autonomous seismic drone swarms to further support sustainable geophysical data acquisition. The UAV data enable seismic drone swarms to land optimally on preprogrammed landing points while navigating subsatellite-resolution obstacles. These two successful cases suggest that analogous productivity and efficiency improvements may be achieved in industrial-scale land seismic data acquisition planning that utilizes the UAV data set.
Time-lapse full-waveform permeability inversion: A feasibility study
Authors: Yin Ziyi , Louboutin Mathias , Møyner Olav , Herrmann Felix J.
Published: August 2024

Time-lapse seismic monitoring necessitates integrated workflows that combine seismic and reservoir modeling to enhance reservoir property estimation. We present a feasibility study of an end-to-end inversion framework that directly inverts for permeability from multiple prestack time-lapse seismic data sets. To assess the method's robustness, we design experiments focusing on its sensitivity to initial models, potential errors in modeling, and crosstalk during multiparameter inversion. Our study leverages the publicly available Compass model to simulate CO2 storage in saline aquifers. This model is derived from well and seismic data from the North Sea in an area that is currently considered for geologic carbon storage.
Improving Acute Treatment of Alcohol Withdrawal at an Inpatient De-addiction Ward (‘Vimukthi’) at Kerala State, India: Full Cycle of a Clinical Audit
Authors: S Achu , Kuriakose Ajay , Sathiaseelan Ramkumar
Published: August 2024

Aims

Long-acting benzodiazepine is the treatment standard for alcohol withdrawal and three regimens are defined – fixed-dose (for outpatient and inpatient settings with untrained staff), symptom-triggered (inpatient setting with trained staff) and front-loading (when a severe withdrawal state is anticipated). Standards in this regard are published by ASAM, NICE and guidelines by Govt. of India. A clinical audit was performed to explore the treatment strategy used in a de-addiction centre in India.

Methods

Description of the initial audit cycle.

Setting: Dedicated 10-bed de-addiction ward, attached to a general hospital, with an average of 15 admissions/month of patients with disorders of alcohol use. The centre was established as a special project (‘Vimukthi’) in 2018 and is serviced by a team of three nurses, one doctor and one clinical psychologist, and visited by psychiatrists from the general hospital.

Measurement of performance and comparison with standards: Measurement was done in May 2023 after the authors took charge of the ward. The centre used a fixed-dose regimen of short-acting lorazepam for all patients to manage withdrawal symptoms. There was no documentation of risk profiling. We therefore recommended that tailored treatment based on patient profile be introduced. Risk profiling based on symptoms, signs and history and a symptom-triggered regimen for withdrawal management using nurse-administered CIWA-AR rating could be incorporated into a standard operating procedure (SOP). An SOP was developed and after team discussion and training it was introduced in October 2023.

Results

Re-audit of the implementation phase of SOP over three months (Oct 2023 to Dec 2023) was conducted. Case files were noted to document risk stratification as 34% low risk, 52% intermediate risk and 14% high risk. Symptom-triggered regimen was administered to all patients with added front-loading for all high-risk and some moderate-risk patients. Staff and patients expressed satisfaction with the new protocol. We noticed a significant reduction in the use of oral lorazepam (from 3324 mg for 63 patients during the comparative period of Oct 2022–Dec 2022 to 10 mg for 39 patients), while the use of injectable lorazepam increased by 25% (0.8 mg/patient to 1 mg/patient). Use of oral diazepam increased from nil to 170 mg with one patient receiving injectable diazepam.

Conclusion

Introducing an SOP that incorporated risk profiling, use of long-acting benzodiazepines, symptom-triggered and front-loading regimens and nurse-administered CIWA-Ar monitoring led to the reduced use of short-acting and uptake of long-acting oral benzodiazepines in inpatient alcohol withdrawal management. Decisions based on risk profiling led to an increase in the use of injectable benzodiazepines. We report that conducting this audit cycle led to the improvement of treatment standards in a specialized inpatient de-addiction centre in India.
The Emotional Experiences of Women Suffering From Premenstrual Dysphoric Disorder in the United Kingdom
Authors: Al-Hassan Nasara , Hockham Carinna , Matthews Lynsay , Norton Robyn , Womersley Kate
Published: August 2024

Aims

1)

To hear directly from women suffering from PMDD about their lived experiences of PMDD and the impacts that it has on their daily lives.

2)

To raise awareness about the impacts that PMDD can have on patients' quality of life, relationships, and productivity, to improve clinicians’ understanding of patients' needs.

3)

To identify a gap in research into PMDD within the UK and highlight the need for further research.

4)

To improve awareness of PMDD amongst diverse stakeholders, including women who are not yet diagnosed with PMDD, employers, and policymakers.

Methods

Participants were recruited from the UK's PMDD Patient Insight Group and screened using the Premenstrual Symptom Screening Tool (PSST) for PMDD. Eligible participants were purposively sampled, and 15 participants were invited to a semi-structured scheduled interview on Zoom. Interviews were transcribed using NVivo transcription software, and inductively analyzed using reflexive thematic analysis in NVivo 14.

Results

Thirteen subthemes were identified and organised around four main themes: Theme 1: ‘Jekyll and Hyde’, Life with PMDD, Theme 2: ‘The Aftermath’, The Impact of Living with PMDD, Theme 3: ‘Surviving PMDD’, Coping Strategies, and Theme 4: ‘Seeking Treatment’, Experiences with Healthcare. The themes identified in this study highlight the negative experiences of women living with debilitating symptoms that appear during the luteal phase and disappear following the onset of menstruation. Themes also capture the immense burden PMDD places on a sufferer by uncovering how exactly these symptoms affect interpersonal relationships, career progression, quality of education received, and relationship with oneself. Theme 4 focuses on women's negative experiences with healthcare stemming from a lack of awareness of PMDD in the medical community.

Conclusion

The findings of this study highlight the critical importance of understanding the contextualized experiences of women living with PMDD in the UK and bringing to light the immense monthly burden sufferers face. To prevent women and Assigned Female At Birth (AFAB) individuals from experiencing severe and prolonged psychological distress which can have fatal consequences, there needs to be greater understanding and awareness of PMDD in both medical and lay communities. In addition to this, clinicians must be trained in PMDD assessment and research should be encouraged to introduce new treatments and to implement policies that minimize the burden of PMDD in the workplace.
What Are the Psychological and Behavioural Outcomes of Vagal Nerve Stimulation and Ketogenic Diet in Children and Young People With Drug-Resistant Epilepsy?
Authors: Batham Oliver
Published: August 2024

Aims

To systematically review current quantitative evidence for psychological and behavioural outcomes for children with drug-resistant epilepsy being treated with either the ketogenic diet (KD) or vagal nerve stimulation (VNS).

Methods

The review was conducted with a systematic review methodology and the Preferred Reporting Items for Systematic Reviews (PRISMA) tool. The methodology was developed by the author using the PICOS (population, intervention, comparison, outcome, study, design) framework.

Eligibility criteria included children up to 18 years old with epilepsy treated with KD or VNS, and studies which assessed psychological and behavioural outcomes, with validated tools, before and after treatment. Any quantitative design was included. Review articles, meta-analyses, case studies, and case series without a reported mean were excluded. Searches were conducted in four main databases (GlobalHealth, Medline, PsychInfo, Embase) and two grey literature databases (Scopus, Web of Science).

Duplicates were screened using automated processes and then manually. Titles and abstracts were reviewed against eligibility criteria, followed by full texts. Risk of bias was assessed using tools appropriate for the study (the Risk of Bias-2 tool for randomised controlled trials, the JBI checklist for quasi-experimental studies, and the JBI checklist for case series). Included articles were grouped by intervention and by study design for data extraction.

Results

22 studies were identified: 11 for KD, comprising of two randomised controlled trials, one retrospective quasi-experimental study, one retrospective study, two prospective studies, one cross-sectional survey, and four case series; and 11 for VNS, comprising of one randomised controlled trial, two longitudinal observational studies, one prospective observational study, one retrospective study, and six case series.

These studies included a total of 655 participants (523 KD, 132 VNS). There was weak evidence for an improvement in cognitive and behavioural outcomes with both KD and VNS although most studies had methodological weaknesses and were at risk of bias. For both interventions, some studies showed that improvements in outcomes were not related to improvement in seizures, or to reduction in medications.

Conclusion

The evidence base for cognitive and behavioural outcomes following KD or VNS treatment is limited and studies are generally weak and underpowered. Psychological measures used across studies are heterogeneous and difficult to compare. There are little data, but studies raise the possibility that both VNS and KD may affect psychological and behavioural outcomes independently of their effect on seizures. This review supports the need for further research into this area with larger, methodologically robust studies.
Exploring the Feasibility of Suicide Prevention Intervention for Individuals With First Episode Psychosis Experiencing Suicidal Ideation: A Multi-Center, Mixed Method Study From Pakistan
Authors: un Nisa Zaib , Kiran Tayyeba , Bamford Jordan , Chaudhry Imran Bashir , Husain Nusrat
Published: August 2024

Aims

First Episode Psychosis (FEP) emerges at a young age, significantly shaping the trajectory of the disorder. Literature indicates a 60% increased risk of suicide within the initial year of diagnosis in FEP, early intervention in psychosis reduces the risk of suicide. Therefore, this study aims to co-adapt an existing culturally appropriate suicide prevention intervention (CMAP) and integrate this with a culturally adapted Cognitive Behavioral Therapy for Psychosis (CaCBTp) for individuals with FEP experiencing suicidal ideation and to test its feasibility and acceptability in Pakistan.

Methods

This is a mixed-method study that involves two stages. Stage 1 was co-adaptation of the CMAP intervention for people with FEP patients. This involved one-to-one, in-depth interviews with individuals with FEP (n = 5), carers (n = 5) and a focus group discussion with 10 healthcare professionals. The second stage involves feasibility testing of the intervention. Participants are being recruited (n = 90) from outpatient psychiatric units across the cities of Karachi, Lahore, Rawalpindi, Multan, and Hyderabad in Pakistan. Eligible, consented participants are being randomized into either of two trial arms; intervention arm or treatment as usual arm (TAU). All participants are being assessed at baseline and at 3-month post-randomization on assessing participants on severity of suicidal ideation, severity of symptoms, functionality and quality of life using different scales. The intervention is comprised of 12 one-to-one sessions delivered over 3 months by trained therapists. Participants (n = 15) from the intervention arm will be interviewed at the end of intervention to explore the acceptance.

Results

Qualitative analysis of stage 1, utilizing thematic framework analysis, highlights barriers to help-seeking such as lack of awareness, inadequate social support, and mental health stigma. To adapt CMAP intervention, participants suggested changes in the use of Urdu words to make content simple for patients to understand, increase number of family sessions, include information about possible risk and protective factors of self-harm in this population and emphasize the addition of resilience-building messages in the manual. Stage 2 is currently ongoing, and we have successfully recruited healthcare facilities across all sites and randomized 12 participants into the trial.

Conclusion

This study will add valuable insights for refinement of existing interventions to address the unique needs of individuals with FEP in Pakistan. Intervention with suicide preventive strategies may help in reducing the risk of suicide. The culturally grounded approach ensures relevance, contributing to the global discourse on evidence-based mental health interventions.
Co-Development of a Bereavement Support Program for Parents With Lived Experience of Stillbirth or Neonatal Death in Pakistan
Authors: Naz Subia , Ali Tazeen , Chaudhry Nasim , Hussain Nusrat , Mills Tracey
Published: August 2024

Aims

Rates of stillbirth and neonatal deaths are high in low- and middle-income countries including Pakistan and these are one of the most stressful life-events for parents and families. Society does not appropriately recognize perinatal loss and support from healthcare professionals is often very limited or non-existent in Pakistan. Therefore, we aimed to co-develop and assess the feasibility of a bereavement support program for parents who experienced stillbirth/neonatal death in a public health facility in Pakistan.

Methods

This study adopted a sequential mixed-method design. The first phase involved co-development of a bereavement support program through a consensus process involving multidisciplinary health professionals, stakeholders and parents with previous experience of perinatal death (n = 23) using the Nominal Group Technique. Phase 2 includes a feasibility assessment using before and after cohort design. Sixty women (30 per phase) with recent experience of stillbirth and/or neonatal death will be recruited, from a public hospital in Pakistan. The main outcome measures will include recruitment and retention and acceptability of the study processes and data collection.

Results

Following the consensus process, agreed intervention components included an educational workshop for healthcare staff, creation of a bereavement champion group of health workers in the facility and offering post-natal telephone peer support to bereaved mothers. The educational component for healthcare staff includes Advance Bereavement Care (ABC) workshop for all staff and bereavement champions (n = 15 healthcare workers) who later received one day's training and one-day training refresher. This component aims to improve care, act individually and as a group to identify areas for development, encourage good practice and support colleagues. The peer support component includes telephone support provided by women with previous experience of perinatal death (n = 7) trained by the research team. Supervision arrangements are in place for champions and peer supporters. The feasibility study is ongoing.

Conclusion

The co-development process ensured the cultural relevance of both components of the bereavement support program. The process also contributed to improving the sense of ownership by healthcare facility. Feasibility study will confirm whether parents are willing to take part, acceptability and whether future research to assess the effectiveness of the intervention on improving care after SB/NND is feasible.
A Multicenter Randomized Controlled Trial of Measurement-Based Care for Major Depressive Disorder in Pakistan
Authors: Nigah Zahra , Chaudhry Nasim , Husain Nusrat , Chaudhry Imran , Husain Ishrat
Published: August 2024

Aims

A worldwide public health concern is major depressive disorder (MDD) with limited availability and access to evidence-based treatment in low- and middle-income countries (LMICs) such as Pakistan. Measurement-based care (MBC) is a low-cost strategy to improve clinical outcomes for people with MDD that involves the systematic administration of validated outcome measures to inform treatment decisions. However, research on MBC's effectiveness in LMICs is scarce. This paper aims to evaluate the feasibility and clinical effectiveness of MBC against standard care for patients with moderate to severe MDD in Pakistan.

Methods

This is a multicenter randomized control trial. Participants (n = 154) of 18 to 65 years of age recruited from psychiatric units of teaching and non-teaching hospitals and primary care settings such as General Physician (GP) clinics and Basic Health Units (BHUs) from 6 cities were randomised to receive MBC (guided by a schedule), or standard treatment (guided by clinicians’ judgement). Patients were prescribed by treating clinicians either with mirtazapine (7.5–45 mg/day) or paroxetine (10–60 mg/day) for a period of 12 weeks. All participants, regardless of their treatment arm, were followed-up till 24 weeks post-randomization and assessed for severity of depression. Side effects were regularly monitored using standard checklist. Outcome assessors were blind to treatment allocation.

Results

The Pakistani National Bioethics Committee (NBC) has granted complete ethical approval. A total of 15 psychiatrists and 4 General Practitioners (GPs) were approached and invited to participate in the study and consent was given by 9 psychiatrists and 2 GPs. A total of 351 patients were screened against eligibility criteria and 177 were eligible to participate. A total of 154 eligible participants consented (87%) to participate and were recruited and randomized into the trial. A total of 131 randomized participants (85%) completed 24-month follow-up. Only two adverse events were reported during the trial period. Recruitment, retention and safety analysis indicates feasibility of the trial in Pakistani healthcare context. The data are being analyzed for effectiveness outcomes.

Conclusion

It is essential to investigate the viability, usefulness, and efficacy of MBC for MDD in low-resource settings due to mounting data from high-income settings confirming its effectiveness. The planned trial's outcomes may help build a scalable, low-cost method for effectively improving outcomes for MDD patients in Pakistan.
Functions, Characteristics, and Experiences of Non-Suicidal Self-Injury: A Cross-Sectional Study of Youth and Adolescents in Singapore
Authors: Lin Xiaowen , Ling Neo Michelle Hui , Ong Jamie Jiehan , Fong Ying Jie , Chee Tji Tjian
Published: August 2024

Aims

Non-Suicidal Self-Injury (NSSI) occurs when direct, deliberate harm is caused to one's physical body without intention of suicide. Approximately 22.1% of youth worldwide would engage in NSSI in their lifetimes. Due to the increased risk of harm and future suicide attempts, NSSI is a behaviour that warrants attention and has been identified as a condition in need of further study. While some studies have examined the prevalence and experiences of NSSI in Singapore, there is a lack of detailed studies on the presentation and overall phenomenology of NSSI in the local context. This study aims to assess the characteristics of NSSI using the Non-Suicidal Self-Injury – Assessment Tool (NSSI-AT) in a cross-sectional design. We investigated the functions, characteristics, and personal experiences of local youths who engage in NSSI for the development and improvement of patient-centred care.

Methods

121 youths between 12 and 25 years old were recruited from the National University Health System. The study included patients seeking treatment for mood disorders and have self-reported NSSI behaviours such as cutting, hitting, and scratching prior to or at the time of visit. Outcomes for the NSSI–AT, including the actions, functions, frequency, age of onset, initial motivations, severity, practice patterns, disclosure, and treatment experiences of self-harm, were reported using descriptive analysis. Personal reflections were analysed using thematic analysis.

Results

Participants were mostly female (n = 86, 71.1%) with a mean age of 16.2 years (SD = 2.33). Many participants engaged in NSSI actions such as cutting, scratching, and banging on objects, to manage high-pressure agitating and low-pressure depressive emotional states. Most participants started engaging in NSSI in early adolescence (mean = 13.0 years old, SD = 2.37, range = 7–23) and have hurt themselves more severely than intended (n = 79, 65.3%). When reflecting on overall NSSI experiences, participants had similar levels of ambivalence toward NSSI and growth due to NSSI. Participants also gave encouragement to others going through similar experiences and reported the negative aspects of self-harm.

Conclusion

Findings support emotional regulation as a function of NSSI in the local population, where self-harm was not generally used for social communication purposes. Findings also suggest that youths may be more vulnerable to NSSI during early adolescence, corresponding to a time of substantial life changes. This study also demonstrated the individuality of NSSI experiences among the local youth, highlighting the importance of having a person-centred approach in NSSI treatment. Taken together, this highlights the need to develop interventions that can effectively serve this age group and their specific challenges.
A Comparison of the Use of Handheld KardiaMobile ECG Devices With 12-Lead ECGs in an Older Adult Psychiatric Setting
Authors: Cross Ben , Leadbetter Jane , Richman Anna
Published: August 2024

Aims

To establish the usability and tolerability, as well as accuracy of measurements of a handheld KardiaMobile ECG device in an inpatient older adult dementia ward.

Methods

Between February 2023 and April 2023, KardiaMobile ECGs and 12-lead ECGs were taken for patients admitted within a dementia ward in Liverpool. The standard 12-lead ECGs were analysed as per current practice, by Broomwell Health Watch. The KardiaMobile ECGs were read manually, by two independent raters, for heart rate and QTc. The user-rated tolerability was measured out of 5, 5 being the most tolerable, and was measured for both KardiaMobile and 12-lead ECGs, allowing comparison. The QTc and heart rate were calculated for both methods, and then compared. QTc was calculated using Bazett's formula.

Results

13 inpatients had a 12-lead ECG, and a KardiaMobile ECG performed. Both were tolerated by all patients, except one who tolerated neither, leaving 12 ECGs for comparison. KardiaMobile ECGs were quicker to obtain, more well tolerated, and easy to use. However, manual calculation of QTc, versus expert and computer analysis for 12-lead ECGs, led to some variability between QTc measurements. Inter-rater reliability between raters for the KardiaMobile QTc was poor, however, when both were combined, correlation with 12-lead ECG QTc was moderate. KardiaMobile ECGs were harder to obtain in those with tremors, and the lack of computerised readings made interpretation more difficult. 12-lead ECGs also offer reassurance in the form of a fully interpreted, more detailed ECG.

Conclusion

KardiaMobile devices are faster to use and as/more tolerable in a dementia ward setting than 12-lead ECGs. The ECG trace is fed back instantly to the mobile device, however, automatic interpretation is limited and QTc calculation relies on the operator. Visual inspection of QTc can be difficult, and unreliable. However, the combination of two different raters led to more reliable results. The device has potential for use in this setting, however, an increase in automatic interpretation, or interpretation by a third party such as with Broomwell Health Watch, would increase its usability.