bluuebunny/crossref_metadata_2025 huggingface dataset:
High dose antipsychotic treatment monitoring audit
Authors: Scott Jake , Belda Jose
Published: June 2021

Aims

To quantify how many patients were prescribed high dose antipsychotic treatment (HDAT) and establish whether guidance for monitoring HDAT was being followed in an Assertive Outreach Team.

Background

Severe mental health disorders are associated with significant premature mortality, predominantly due to physical health conditions. Antipsychotic medications are associated with side effects, including metabolic syndrome and QT prolongation, which increase the risk of serious physical illness. HDAT is defined as when the total dose of antipsychotics prescribed exceeds 100% of the maximum BNF dose, if each dose is expressed a percentage of its maximum dose. There is limited evidence of clinical benefit with HDAT but an increased risk of side effects. Patients prescribed HDAT should therefore be monitored for side effects and clinical benefit. Sussex Partnership NHS Foundation Trust developed a form specifically for this purpose, to be completed in addition to a physical health assessment.

Method

All patients on caseload were audited using the electronic notes. Current inpatients were excluded, as inpatient HDAT monitoring forms are attached to paper drug charts and therefore were not available for review.

Result

A total of 61 patients were audited. Nine were excluded due to being inpatients. 16 were on community treatment orders and 26 were prescribed a long-acting antipsychotic injection. 10 were prescribed clozapine. The median number of medications prescribed was one. Four patients were prescribed HDAT ranging from 117-150% of the maximum BNF dose. Of these four, one had a HDAT form but this was out of date. 39 of 52 (75%) patients audited had had a physical health assessment in the past 12 months. Two of the 13 missing a physical health assessment were on HDAT.

Conclusion

Physical health monitoring should be carried out for all patients on antipsychotics, but is particularly important for patients on HDAT. This audit identified a problem in both general physical health checks and HDAT monitoring. On discussion with the multi-disciplinary team a number of barriers to appropriate physical health monitoring were identified. There was a lack of awareness within the multi-disciplinary team that patients were receiving HDAT and regarding the implications for side effects. A reliable system to highlight the need for physical health checks was also missing and the team did not have sufficient equipment to perform the necessary checks. Identifying these barriers should enable improvements in physical health and HDAT monitoring which can be re-audited.
A new handover protocol between old age admission and rehab wards
Authors: Carmen Aileen , Mahenthran Thanurshan , Hazan Jemma , Popescu Ioana
Published: June 2021

Aims

Efficient handovers are integral to patient care. Challenges to handover for wards include high patient turnover and varied handover approaches between wards, as well as admissions out of hours. Patients on Old Age Wards often have multiple comorbidities and can deteriorate rapidly without coordinated care. Our focus was on improving handover of patients transferred between the Old Age Admissions Ward and Rehabilitation Ward. We aimed to create a ward handover protocol to improve compliance with documenting a pretransfer plan and ensure there was an 80% compliance with completing this plan within 3 months.

Method

An MDT discussion took place in order to explore change ideas. Questionnaires were filled out post implementation of protocol. A handover proforma was designed to capture important patient data and continuing plans. A PDSA cycle was designed to deliver a structured handover.

Per patient measures were collected including: whether a handover took place, recording of current medical and psychiatric issues, documentation of plan and was the plan put into action or reviewed.

MDT feedback was collected on satisfaction with the protocol and handover process using open questions and Likert scale.

Result

Prior to the establishment of the proforma there was no verbal or written handover between wards. In 28% of cases prior to the intervention, blood results were checked and medication reviews took place within the timeframe written in the patient's notes. A proforma was initiated and used for 93% of patient handovers between wards. Blood results were checked according to the planned timeframe in 86% of cases. Where the handover proforma took place, 100% of patients had a medications review. Qualitative detail revealed that key patient appointments such as MRI Brain scans and important plans such as fluid restriction limits were missed before implementing the protocol. Aftewards complex patient plans were recorded and implemented accordingly.

Questionnaire feedback was positive and MDT found the proforma to be helpful and to improve patient safety.

Conclusion

The team viewed the new handover pathway as a positive patient safety tool. Compliance with completing the protocol in the longer term and maintaining change is an area for ongoing improvement.
Service evaluation of the mental health assessment service (MHAS) in Dudley, West Midlands
Authors: Winchester Mark , Narula Amitav , Davis Rachel , McGowan Ella
Published: June 2021

Aims

To assess how well MHAS meets the service specification

To ascertain areas of good practice

To examine whether the referral form is being used in an appropriate manner

To elucidate areas of good communication and whether any improvement can be made

Background

Launched in 2012, MHAS is the single point of access service for mental health services for patients aged 16–65 years, with a general practitioner (GP) in Dudley, who are not currently open to secondary care. Assessments are completed by a medic, community psychiatric nurse or jointly. It aims to identify the most appropriate care pathway for patients. This audit was a comprehensive assessment of how effective MHAS is at ensuring patients are adequately triaged.

Method

10 cases from each month between April 2018 and March 2019 were randomly selected from all 980 anonymised MHAS referrals. A proforma was developed based on current practice, previous audits and service specification. A team of four doctors assisted in the data collection and only electronic health records (EHR) were reviewed.

Result

88.3% of referrals were recorded on the EHR. Only 61.7% of referrals used the proforma with the other referrals mostly being in the form of a letter, which often missed out information vital to the triaging process. Only 4.2% of referrals are from Primary Care Mental Health Nurses (PCMHN) with 85.8% arising from GPs. Urgent referrals were not discussed with MHAS via telephone contact in about 60% of cases. The majority of patients had telephone screening completed the same day and were then discussed the next working day at the daily referral meeting. Although a brief summary for the GP was being sent the same day in all cases, over half of the comprehensive assessments were not being sent within the five day timeframe.

Conclusion

All referrals must be uploaded to the EHR and completed using the service's proforma. PCMHNs may be currently under-utilised or effectively doing their jobs at managing mental health patients in primary care. GPs regularly referring via letter require further training and support to use the proforma. The proforma may require simplification to make it easier to complete. The service specification requires review as it makes unrealistic demands of the service. All referrals must be discussed at the daily referral meeting. Further investigation is required to understand why MHAS is struggling to meet timeframes for appointments and letters.
Fruit and vegetable intake among psychiatric inpatients: an electronic health record-based study
Authors: Yue Adelaide , Seyedsalehi Aida , Lewis Jonathan , Ioannidis Konstantinos , Deakin Julia
Published: June 2021

Aims

Psychiatric illness is associated with premature mortality, which is largely attributable to physical health conditions. Low fruit and vegetable intake is a risk factor for cardiovascular disease, which contributes significantly to this disparity in physical health. This study used routinely collected data from electronic health records to assess fruit and vegetable intake among psychiatric inpatients across a UK mental health trust.

Method

We conducted an anonymised search of de-identified electronic patient records from the Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) research database. We collected data on ICD-10 diagnosis and fruit and vegetable intake for patients aged 18 years or over, with a recorded ICD-10 psychiatric diagnosis, admitted to CPFT inpatient facilities between March 2013 and January 2019 inclusive (n = 1031). Information on fruit and vegetable intake is recorded as part of a General Health and Lifestyle questionnaire, routinely performed within a week of admission. Fruit and vegetable intake in different ICD-10 diagnostic categories was compared using a one-way ANOVA.

Result

Among patients for whom data on fruit and vegetable intake was recorded (n = 768), the prevalence of low fruit and vegetable intake (defined as <5 portions/day) was 75.9%, and mean fruit and vegetable intake was 2.85 portions/day (95% CI 2.72-2.98). Fruit and vegetable intake was lowest among patients with schizophrenia (mean = 2.3 portions/day), significantly worse than other diagnostic groups. In patients with schizophrenia, prevalence of low fruit and vegetable intake was 86.5%.

Conclusion

Low fruit and vegetable intake is common among CPFT psychiatric inpatients, particularly those with schizophrenia. Interventions to improve dietary habits, such as increasing tailored for individuals with psychiatric illness may help to reduce the risk of physical illness.
Psychiatric liaison referrals and the 4PM Rush
Authors: Svedberg Kaj
Published: June 2021

Aims

Referrals to the psychiatric Liaison team in A&E seem to come in the afternoon in kismet as the day shift is ending. This study looked at the timing distribution of referrals to try improve amount of jobs being handed over to the evening shifts.

Method

Referrals made to Homerton University Hospital (HUH) psychiatric liaison was parsed into 1 hour bins and plotted as a histogram (data between August 2016–October 2019. N = 14182). The data were compared to diurnal human body temperature variation, as well as data published on Hospital Accident & Emergency Activity 2019–20 (digital.nhs.uk) for Ambulance attendances.

Result

Referrals to HUH liaison team appear to closely follow the average human body temperature variations per hour (Pearson Correlation coefficient = 0.90). A peak appears to occur around 4 PM, and a low at 7AM. The referrals data also mirrored timings of official Hospital Episode Statistics (HES) reports 2019–2020 for ambulance attendance in England (Pearson Correlation coefficient = 0.94).

Conclusion

Attendance to A&E and referrals to psychiatric liaison appear correlated to a circadian bound rhythm. “The 4PM referrals rush” appears to be a genuine phenomenon replicated in not only HUH mental health referrals, but general ambulance attendance throughout all of England. The body temperature analogue for circadian rhythm may be humorously applied here to correlate with the increased referral rates to A&E; the emergency department could be said to be truly heating up in the afternoon. Indeed temperature and activity has already been shown to link strongly via the Arrhenius equation in cricket activity such as chirps per minute. The conclusions drawn here are that acute mental health attendances, like general health attendances as a whole follow underlying but powerful patterns, and provisions might best be allocated to address this rather than thinking of fixed 9-5 working schedules.
Attitudes of medical students to electroconvulsive therapy
Authors: Clements Patrick , Turkington Aidan
Published: June 2021

Aims

This study explores the different attitudes among fourth year medical students in Queen's University Belfast to Electroconvulsive Therapy (ECT) and investigates whether these are influenced by teaching and exposure to ECT during their undergraduate psychiatry placement. In particular we sought to determine firstly, correlates of baseline attitudes to ECT and secondly, whether specific forms of ECT teaching improved attitudes to ECT during their placement.

Method

This study was conducted in Queen's University Belfast and agreed with their ethics committee. Participants completed a questionnaire at the beginning of their psychiatry placement and another questionnaire in the second half of their placement. The first questionnaire captured background information and baseline attitudes. The second questionnaire recorded the educational and clinical experience gained on ECT during placement (for example lectures, tutorials, informal teaching, observing ECT and interacting with ECT patients), in addition to attitudes to ECT at this timepoint. Attitudes to ECT were assessed on a 5-point Likert scale. A positive attitude to ECT was defined as scoring agree/strongly agree on a 5-point Likert scale to the statement “I would recommend ECT for a patient if clinically indicated”.

Result

187 students were interviewed at both time points. At the outset of the psychiatry placement 66% of students reported a positive attitude to ECT. Positive attitude was associated with age: 72% of students under 24 had a positive attitude to ECT vs 58% of students over 24 (χ2 = 3.5; P < 0.05). Of students who had previously attended a lecture on ECT (n = 117) 83% had a positive attitude to ECT vs 42% of those who had not previously attended a lecture (χ2 = 33.5; P < 0.001).

Attitudes to ECT significantly improved during the placement (66% vs 94% positive; t = 7.97; P < 0.001). Students who attended a lecture on ECT during the psychiatry placement were more likely to have a positive shift in attitude (67% vs 49%; F = 6.0; P = 0.01). No other specific teaching modality was associated with a positive shift in attitude.

Conclusion

We conclude that undertaking a Psychiatry placement and particularly having a lecture on ECT significantly improves attitudes of medical students to ECT. It is therefore important that lectures on ECT are included in the medical undergraduate curriculum to allow students to be accurately informed about this essential treatment for a number of psychiatric disorders.
Is attachment style in early childhood associated with mental health difficulties in late adolescence?
Authors: Clery Philippa , Rowe Angela , Munafò Marcus , Mahedy Liam
Published: June 2021

Aims

Identifying factors that contribute to mental health difficulties in young people as early in life as possible are needed to inform prevention strategies. One area of interest is attachment. Although existing research has suggested an association between insecure attachment styles and mental health difficulties, these studies often have small sample sizes, use cross-sectional designs, and measure attachment as a discrete variable at a single point or use romantic relationship attachment as a proxy for childhood attachment. It is also unclear whether these associations persist into late adolescence. In this large prospective study we aimed to determine whether an insecure attachment style measured at repeated points in early childhood, is associated with depression and self-harm at 18 years.

Method

We used data from the Avon Longitudinal Study of Parents and Children cohort. Mothers completed attachment related questionnaires when their child was 18, 30, and 42 months old. Offspring depression and lifetime self-harm was assessed at 18 years in clinic using the Clinical Interview Schedule-Revised. Attachment was derived as a continuous latent variable in a structural equation modelling framework. Logistic regression was performed on participants with complete attachment data (n = 7032) to examine the association between attachment style and depression and self-harm, with adjustment for potential confounders. Differential dropout was accounted for using multiple imputation.

Result

We found some evidence for an association between a more insecure attachment style in childhood, and a diagnosis of depression and life-time self-harm at age 18. In the fully adjusted imputed model, a one standard deviation increase in insecure attachment was associated with a 13% increase in the odds of depression (OR = 1.13; 95%CI = 1.00 to 1.27) and a 14% increase in the odds of self-harm at age 18 (OR = 1.14; 95%CI = 1.02 to 1.25), for children who had more insecure attachment in early childhood, compared with children who had more secure attachment.

Conclusion

This is the largest longitudinal study to examine the prospective association between childhood attachment and depression and self-harm in late adolescence. Our findings strengthen the evidence suggesting that a childhood insecure attachment style is associated with mental health difficulties in late adolescence. Policies and interventions to support parenting behaviours that foster the development of secure attachment styles, or attachment-based therapies to improve attachment quality, could help reduce depression and self-harm in adolescence/young adulthood.

Philippa Clery is supported by the Elizabeth Blackwell Institute for Health Research at the University of Bristol and the Wellcome Trust Institutional Strategic Support Fund.
Induction shouldn't be painful: improving psychiatry local induction for junior doctors across the South West
Authors: Cole Bethany , Greenstone Harriet
Published: June 2021

Aims

The GMC recommends that organisations ensure learners have an induction in preparation for each placement. We aimed to ensure that high quality induction was being delivered in psychiatry posts across the whole of the Severn Deanery. This included multiple localities (Bristol, Bath, Swindon, Devizes, Weston-Super-Mare, Gloucester, Cheltenham, Taunton and Yeovil) across three NHS trusts.

Background

Induction plays a vital role in preparing doctors for their new roles. Crucially, some doctors are not only new to the specific role and site, but also new to the specialty (for example, Foundation Doctors and GP Trainees). In Severn, each locality takes responsibility for providing Junior Doctors with a locality-specific induction; these occur four times per year. Previous feedback from trainees in Severn was poor; as demonstrated by informal feedback and the August 2018's GMC survey results, showing some localities ‘required improvement’.

Method

Pre- and post-intervention measurements were ascertained by written questionnaires for Foundation Doctors, GP Trainees and Core Trainees in Psychiatry. Baseline questionnaires were completed in August/September 2019. Five ‘Plan, Do, Study, Act’ Cycles were completed over the following eighteen months. Examples of the changes made included incorporating ‘missed’ topics (such as wellbeing, seclusion reviews and exception reporting) and specific information to on-call responsibilities, reducing replicated information, and touring clinical sites. These changes were coordinated via monthly meetings between Locality Trainee Leads (LTLs).

Result

There was an overall improvement in trainee's satisfaction with induction. Outcomes also included the development of an induction checklist specific to each locality and a ‘gold standard’ list for what local induction should involve. This is hopefully soon to be ratified by the Medical Education department and Severn Deanery.

Conclusion

Having worked on this project for over 18 months, sustainability of change remains a crucial issue. In response to this, we have established several recommendations: the LTL job role needs to be revised to include updating the written induction handbook in each locality and delivering face-to-face induction. Outgoing and incoming LTLs will plan each induction together, at least 4 to 8 weeks before the start date. Support from Medical Education regarding attendees at each induction is to be put in place. Handbooks will be shared across localities, so that the ‘core’ information is consistent. Ongoing feedback will ensure that Junior Doctors continue to receive a high quality and relevant induction.
Identification of New Rare Variants Associated With Familial Autoimmune Thyroid Diseases by Deep Sequencing of Linked Loci
Authors: Li Cheuk Wun , Sachidanandam Ravi , Jayaprakash Anitha , Yi Zhengzi , Zhang Weijia , Stefan-Lifshitz Mihaela , Concepcion Erlinda , Tomer Yaron
Published: June 2021

Context

Genetic risk factors play a major role in the pathoetiology of autoimmune thyroid diseases (AITD). So far, only common risk variants have been identified in AITD susceptibility genes. Recently, rare genetic variants have emerged as important contributors to complex diseases, and we hypothesized that rare variants play a key role in the genetic susceptibility to AITD.

Objective

We aimed to identify new rare variants that are associated with familial AITD.

Methods

We performed deep sequencing of 3 previously mapped AITD-linked loci (10q, 12q, and 14q) in a dataset of 34 families in which AITD clustered (familial AITD).

Results

We identified 13 rare variants, located in the inositol polyphosphate multikinase (IPMK) gene, that were associated with AITD (ie, both Graves’ disease [GD] and Hashimoto’s thyroiditis [HT]); 2 rare variants, within the dihydrolipoamide S-succinyltransferase (DLST) and zinc-finger FYVE domain-containing protein (ZFYVE1) genes, that were associated with GD only; and 3 rare variants, within the phosphoglycerate mutase 1 pseudogene 5 (PGAM1P5), LOC105369879, and methionine aminopeptidase 2 (METAP2) genes, that were associated with HT only.

Conclusion

Our study demonstrates that, in addition to common variants, rare variants also contribute to the genetic susceptibility to AITD. We identified new rare variants in 6 AITD susceptibility genes that predispose to familial AITD. Of these, 3 genes, IPMK, ZFYVE1, and METAP2, are mechanistically involved in immune pathways and have been previously shown to be associated with autoimmunity. These genes predispose to thyroid autoimmunity and may serve as potential therapeutic targets in the future.
A Faithful Response to Disagreement
Authors: Buchak Lara
Published: June 2021

In the peer disagreement debate, three intuitively attractive claims seem to conflict: there is disagreement among peers on many important matters; peer disagreement is a serious challenge to one's own opinion; and yet one should be able to maintain one's opinion on important matters. This article shows that contrary to initial appearances, we can accept all three of these claims. Disagreement significantly shifts the balance of the evidence; but with respect to certain kinds of claims, one should nonetheless retain one's beliefs. And one should retain them even though these beliefs would not be supported by the new total evidence if one didn't already hold them.
A transgenic system for targeted ablation of reproductive and maternal-effect genes
Authors: Bertho Sylvain , Kaufman Odelya , Lee KathyAnn , Santos-Ledo Adrian , Dellal Daniel , Marlow Florence L.
Published: June 2021

Maternally provided gene products regulate the earliest events of embryonic life, including formation of the oocyte that will develop into an egg, and eventually into an embryo. Forward genetic screens have provided invaluable insights into the molecular regulation of embryonic development, including the essential contributions of some genes whose products must be provided to the transcriptionally silent early embryo for normal embryogenesis, called maternal-effect genes. However, other maternal-effect genes are not accessible due to their essential zygotic functions during embryonic development. Identifying these regulators is essential to fill the large gaps in our understanding of the mechanisms and molecular pathways contributing to fertility and to maternally regulated developmental processes. To identify these maternal factors, it is necessary to bypass the earlier requirement for these genes so that their potential later functions can be investigated. Here, we report reverse genetic systems to identify genes with essential roles in zebrafish reproductive and maternal-effect processes. As proof of principle and to assess the efficiency and robustness of mutagenesis, we used these transgenic systems to disrupt two genes with known maternal-effect functions: kif5ba and bucky ball.
Axial elongation of caudalized human organoids mimics aspects of neural tube development
Authors: Libby Ashley R. G. , Joy David A. , Elder Nicholas H. , Bulger Emily A. , Krakora Martina Z. , Gaylord Eliza A. , Mendoza-Camacho Frederico , Butts Jessica C. , McDevitt Todd C.
Published: June 2021

Axial elongation of the neural tube is crucial during mammalian embryogenesis for anterior-posterior body axis establishment and subsequent spinal cord development, but these processes cannot be interrogated directly in humans as they occur post-implantation. Here, we report an organoid model of neural tube extension derived from human pluripotent stem cell (hPSC) aggregates that have been caudalized with Wnt agonism, enabling them to recapitulate aspects of the morphological and temporal gene expression patterns of neural tube development. Elongating organoids consist largely of neuroepithelial compartments and contain TBXT+SOX2+ neuro-mesodermal progenitors in addition to PAX6+NES+ neural progenitors. A critical threshold of Wnt agonism stimulated singular axial extensions while maintaining multiple cell lineages, such that organoids displayed regionalized anterior-to-posterior HOX gene expression with hindbrain (HOXB1) regions spatially distinct from brachial (HOXC6) and thoracic (HOXB9) regions. CRISPR interference-mediated silencing of TBXT, a Wnt pathway target, increased neuroepithelial compartmentalization, abrogated HOX expression and disrupted uniaxial elongation. Together, these results demonstrate the potent capacity of caudalized hPSC organoids to undergo axial elongation in a manner that can be used to dissect the cellular organization and patterning decisions that dictate early human nervous system development.
Proleg retractor muscles inManduca sextalarvae are segmentally different, suggesting anteroposterior specialization
Authors: Scibelli Anthony E. , Caron Daniel P. , Aonuma Hitoshi , Trimmer Barry A.
Published: June 2021

Manduca sexta larvae are an important model system for studying the neuromechanics of soft body locomotion. They climb on plants using the abdominal prolegs to grip and maneuver in any orientation and on different surfaces. The prolegs grip passively with an array of cuticular hooks, and grip release is actively controlled by retractor muscles inserted into the soft planta membrane at the proleg tip. Until now, the principal planta retractor muscles (PPRMs) in each body segment were thought to be a single fiber bundle originating on the lateral body wall. Here, using high resolution X-ray microtomography of intact animals, we show that the PPRM is a more complex muscle consisting of multiple contractile fibers originating at several distinct sites on the proleg. Furthermore, we show that there are segmental differences in the number and size of some of these fiber groups which suggests that the prolegs may operate differently along the anterior–posterior axis.
Air/Water Interfacial Monolayer Assembly of Peptide-Conjugated Liquid-Crystalline Molecules
Authors: Makiura Rie , Niwa Anna , Eimura Hiroki , Uchida Junya , Kato Takashi
Published: June 2021

Potential applications of functional liquid crystals such as biosensors strongly rely on control of the molecular orientation at interfaces. However, little knowledge regarding detailed molecular arrangements at such interfaces is available. In this work, two-dimensional self-assembling behavior at air/water interfaces of two types of amphiphilic mesogens with different peptide chains, arginine-glycine-aspartic acid and glycine-glycine-aspartic acid is investigated. Surface pressure–mean molecular area isotherms indicate that both bioconjugated mesogens are in the liquid expanded state to high surface compression conditions. The monolayer thickness of 16–19 Å derived by atomic force microscopic images is much smaller than the molecular length of ∼50 Å of a completely stretched motif. This implies that the bioconjugated molecules align in an inflected manner where tetraethylene glycol connecting hydrophobic rigid-rod and hydrophilic peptides is the inflection point. Contact angles of water for substrate surface with monolayers remarkably change depending on the surface pressure at the substrate transfer. This can be explained by the varied molecular arrangements with surface compression at the air/water interfaces. Understanding of molecular orientation at air/water interfaces is of fundamental importance for study of the ordering of liquid crystals at various other interfaces, leading to the design and further development of functional liquid-crystalline molecules for attractive sensor platforms.
APQS consensus regarding patient shielding during routine radiographic imaging
Authors: Kosik Russell Oliver , Quek Swee-Tian , Kan Elaine , Aoki Shigeki , Yang Chin Hua , Pongnapang Napapong , Setioko Maryastuti , Chan Wing P.
Published: June 2021

Shielding, particularly of the gonads, has been a routine part of diagnostic radiographic imaging for many years. However, recent thinking suggests that such shielding may offer little benefit, and in some cases may actually cause harm, e.g. by obscuring anatomy or paradoxically increasing patient radiation dose secondary to the need for repeat imaging. This thinking has led many institutions in the West to abandon routine shielding. However, in Asia, shielding is still commonplace. It was felt that the Asia-Pacific Forum on Quality and Safety in Medical Imaging (APQS) was an ideal place to discuss the merits of shielding and deliver a pan-Asian consensus. The APQS is an annual meeting that convenes radiation safety and imaging quality experts from all of the major Asian regions. During the 2020 APQS meeting, radiation safety experts from each region discussed their opinions of shielding during a dedicated session. These experts’ views were mostly in line with the views of Western radiologists. However, important country specific and cultural factors were noted by each of the experts. A pan-Asian consensus was issued by the forum. It is hoped that this consensus will guide the development of future shielding policies throughout Asia.
Application of solar-based oxidation to the management of empty pesticide container rinse water in Bolivia
Authors: Mencia Torrico Raquel , Micó Reche María del Mar , Cruz Alcalde Alberto , Romero Olarte Rossmary Violette , Antezana Fernández Henry , Álvarez Caero María Mercedes , Sans Mazón Carmen
Published: June 2021

Background: The management of empty pesticide containers (EPC) in Bolivia has been recently promoted as a control strategy for dispersed pollution in surface and underground water bodies, as well as in soil. It comprises the rinsing and proper disposal or reuse of clean EPC. However, the rinsing transfers the hazard to water, which must be properly treated before being discharged.

Methods: In this study, solar photo-Fenton at low Fe2+ doses were tested at pilot plant scale in Cochabamba (Bolivia) for the removal of pesticides dimethoate and atrazine in their commercial form, spiked in river water.

Results: The results demonstrated that solar photo-Fenton ([H2O2]0 = 200 mg L-1) with Fe2+ concentrations between 0.5 and 1.5 mg L-1 is an effective method to remove dimethoate and atrazine, at an initial concentration of 10 mg L-1 each. Efficiency increased when increasing Fe2+ doses, achieving a removal over 99% of both pesticides after a solar irradiation period of 60 minutes (corresponding to an accumulated energy of 4.96 kJ L-1).

Conclusions: The presence of high concentrations of natural components of river water, mainly organic and inorganic carbon species, would have contributed to hydroxyl radical scavenging, explaining, together with the low iron dose applied, the high energy (irradiation time) and high hydrogen peroxide concentration required to produce pesticide depletion. Additionally, the relatively low oxidant consumption and mineralization observed leave room for process optimization regarding oxidant and catalyst doses and warrant further studies on its coupling with biological or other post-treatments for the removal of transformation products.
Hematological consequences of malaria in mice previously treated for visceral leishmaniasis
Authors: Rani Gulab Fatima , Ashwin Helen , Brown Najmeeyah , Hitchcock Ian S. , Kaye Paul M.
Published: June 2021

Background: Polyparasitism is commonplace in countries where endemicity for multiple parasites exists, and studies in animal models of coinfection have made significant inroads into understanding the impact of often competing demands on the immune system. However, few studies have addressed how previous exposure to and treatment for one infection impacts a subsequent heterologous infection.  

Methods: We used a C57BL/6 mouse model of drug-treated Leishmania donovani infection followed by experimental Plasmodium chabaudi AS malaria, focusing on hematological dysfunction as a common attribute of both infections. We measured parasite burden, blood parameters associated with anemia and thrombocytopenia, and serum thrombopoietin. In addition, we quantified macrophage iNOS expression through immunohistological analysis of the liver and spleen.  

Results: We found that the thrombocytopenia and anemia that accompanies primary L. donovani infection was rapidly reversed following single dose AmBisome® treatment, along with multiple other markers associated with immune activation (including restoration of tissue microarchitecture and reduced macrophage iNOS expression). Compared to naive mice, mice cured of previous L. donovani infection showed comparable albeit delayed clinical responses (including peak parasitemia and anemia) to P. chabaudi AS infection. Thrombocytopenia was also evident in these sequentially infected mice, consistent with a decrease in circulating levels of thrombopoietin. Architectural changes to the spleen were also comparable in sequentially infected mice compared to those with Plasmodium infection alone.

Conclusions: Our data suggest that in this sequential infection model, previously-treated L. donovani infection has limited impact on the subsequent development of Plasmodium infection, but this issue deserves further attention in models of more severe disease or through longitudinal population studies in humans.
On the Connection Between Quantum Probability and Geometry
Authors: Holik Federico Hernán
Published: June 2021

We discuss the mathematical structures that underlie quantum probabilities. More specifically, we explore possible connections between logic, geometry and probability theory. We propose an interpretation that generalizes the method developed by R. T. Cox to the quantum logical approach to physical theories. We stress the relevance of developing a geometrical interpretation of quantum mechanics.Quanta 2021; 10: 1–14.
Community-acquired Klebsiella spp Meningitis/Invasive Infection in Filipino-descent Patients Living in Greece: A Case Series
Authors: Marinakis Giorgos , Kassianidis Georgios , Kafkoula Eleni , Stamatopoulou Christina , Kavallieratos Fotios , Patrani Maria , Katsenos Chrysostomos
Published: June 2021

Klebsiella spp community-acquired meningitis caused by hypervirulent strains is well described as part of a distinct syndrome consisting of liver abscess and multiple septic metastatic lesions (Klebsiella pneumoniae invasive syndrome) occurring usually in diabetic, alcoholic, elderly or cancer patients, in Taiwan and other South-East Asian countries. In Western countries, these infections are very rare in natives and usually occur in patients of Asian origin. We report three cases of Filipino-origin patients, residents of Greece, with community-acquired invasive Klebsiella meningitis, who were treated in our ICU over a 10-year period.
Unusual Fatal Outcome Following Administration of a Combination of anti-PD1 and anti-CTLA4 in Metastatic Renal Cell Carcinoma: Liver Toxicity Case Report and a Literature Review
Authors: Denaro Nerina , Garrone Ornella , Occelli Marcella , Fea Elena , Granetto Cristina , Merlano Marco Carlo , Numico Gianmauro
Published: June 2021

Hepatic dysfunction, in the absence of liver metastases, occurs in 10–15% of renal cell carcinoma (RCC) patients, while immune hepatitis due to anti-CTLA4 and anti-PD1 administration affects about 3–9% and 0.7–1.8% of treated patients, respectively. Liver toxicity following combination therapy (anti-CTLA4 and anti-PD1) is seen in 29% of patients overall and grade 3–4 toxicity in 14% of patients. Stauffer’s syndrome is a rare para-neoplastic phenomenon associated with RCC and characterized by abnormal liver function tests, hepato-splenomegaly and histological changes consistent with non-specific hepatitis. We describe a case of RCC treated with anti-CTLA4 and anti-PD1 therapy resulting in immediate liver toxicity and death after 2 months of progressive hepatic impairment. We hypothesize that high IL-6 levels due to Stauffer’s syndrome might have contributed to immune-related hepatic failure.
HORROR, VIOLÊNCIA E EPIDEMIA: O INSÓLITO NAS NARRATIVAS DE MARIANA ENRÍQUEZ E JUAN MIGUEL AGUILERA
Authors: Marinho Ivan Rodrigues , Trevisan Ana Lúcia
Published: June 2021

Os textos literários permitem situar – narrativa e discursivamente – as doenças e as epidemias no âmbito de suas tramas ficcionais, construindo, a sua maneira, distintos mosaicos que refletem o mais imediato e o mais profundo dos tempos de ameaça pandêmica. Por sua vez, o horror, entendido como gênero, ao longo da história literária também instrumentaliza de maneira expressiva a imagem e a presença da doença, seja como tema, metáfora ou estrutura linguístico-literária. A partir dessa ideia, este trabalho estuda os contos “Las cosas que perdimos en el fuego” da argentina Mariana Enríquez e “Pureza de sangre” do espanhol Juan Miguel Aguilera buscando perceber como se propõe o tema da epidemia, bem como suas problematizações, utilizando o horror para compor as dimensões imagináveis e inimagináveis. Nas narrativas estudadas, o insólito se instaura e revela a opressão social e o silenciamento feminino, vistos como fenômenos doentios, patológicos, epidêmicos e imanentes às realidades contemporâneas. Uma epidemia de mulheres queimadas em Buenos Aires e una pandemia do vírus ebola, localizada em um mundo tomado por uma ditadura teocrática, são as realidades que se apresentam nos contos e provocam a leitura crítica dos sentidos do insólito e do horror, formas possíveis para compreender os muitos sentidos do medo e da ameaça.
Desigualdad social y políticas públicas: impacto del Covid-19 en España
Authors: Oliver Miguel Ángel
Published: June 2021

El Covid-19 si bien representa una pandemia global, sus efectos se reparten de manera desigual. España es uno de los países del continente europeo donde mayor ha resultado, hasta el momento, el impacto de la misma a nivel económico, sanitario y social. En este escenario cabe preguntarse: ¿cuál era el contexto socioeconómico de España con la llegada del Covid-19? ¿Qué medidas se adoptaron a partir de la crisis de 2008 en el Estado español? ¿En qué sentido han evolucionado las Políticas Públicas desde entonces? Algunas reflexiones en torno a estas preguntas señalan la existencia de déficits estructurales en diversas áreas, pero también que las respuestas políticas a la crisis de 2008, contribuyeron a acentuar con la adopción de medidas de austeridad favorecedoras de los intereses de clase, la desigualdad social existente, debiendo también por ello ser consideradas elementos esenciales de análisis en el impacto del Covid-19 en España. Palabras clave: desigualdad social; pandemia; España; políticas públicas, servicios sociales.
A relevância do passado na compreensão do presente: pesquisa e resistência ao conservadorismo intelectual no Serviço Social
Authors: Freire Silene De Moraes
Published: June 2021

Resenha deIAMAMOTO, M. V., DOS SANTOS, C., and EIRAS, A. A. L. T. S., (org.) Social work in Latin America: historical factors, memory and international connections, Critical and Radical Social Work, vol. 9, n. 1, 1–10, 2021, DOI: 10.1332/204986021X16115145109789
Current concepts in total knee arthroplasty
Authors: Begum Fahima A. , Kayani Babar , Magan Ahmed A. , Chang Justin S. , Haddad Fares S.
Published: June 2021

Limb alignment in total knee arthroplasty (TKA) influences periarticular soft-tissue tension, biomechanics through knee flexion, and implant survival. Despite this, there is no uniform consensus on the optimal alignment technique for TKA. Neutral mechanical alignment facilitates knee flexion and symmetrical component wear but forces the limb into an unnatural position that alters native knee kinematics through the arc of knee flexion. Kinematic alignment aims to restore native limb alignment, but the safe ranges with this technique remain uncertain and the effects of this alignment technique on component survivorship remain unknown. Anatomical alignment aims to restore predisease limb alignment and knee geometry, but existing studies using this technique are based on cadaveric specimens or clinical trials with limited follow-up times. Functional alignment aims to restore the native plane and obliquity of the joint by manipulating implant positioning while limiting soft tissue releases, but the results of high-quality studies with long-term outcomes are still awaited. The drawbacks of existing studies on alignment include the use of surgical techniques with limited accuracy and reproducibility of achieving the planned alignment, poor correlation of intraoperative data to long-term functional outcomes and implant survivorship, and a paucity of studies on the safe ranges of limb alignment. Further studies on alignment in TKA should use surgical adjuncts (e.g. robotic technology) to help execute the planned alignment with improved accuracy, include intraoperative assessments of knee biomechanics and periarticular soft-tissue tension, and correlate alignment to long-term functional outcomes and survivorship.
Evaluation of Novel Portable Passive and Cabinet Solar Dryers in Sun Drying of Mint Leaves under Indiana Weather Conditions
Authors: Ramirez-Gutierrez Diana M. , Ileleji Klein E. , Deering Amanda J.
Published: June 2021

Highlights

The Page model best predicted the drying rates of mint leaves in thin-layer laboratory experiments under cyclical temperature change and in field experiments using open-air sun drying and Dehytray and Dehymeleon solar dryers.

The total time for drying mint leaves with all solar drying methods was the same (48 h).

For all drying methods, the aerobic bacterial count was significantly less on dried mint leaves than on fresh leaves.

Color change was less impacted by sunlight with the Dehymeleon than with the Dehytray and open-air sun drying.

Abstract. The drying kinetics and quality attributes of mint leaves (Mentha spitaca) were studied to determine the drying performance of two solar drying technologies (Dehymeleon V.2 and Dehytray) and their effect on dried mint quality. Field drying experiments were carried out under weather conditions at Purdue University, West Lafayette, Indiana. Thin-layer laboratory drying experiments were conducted for whole mint leaves at three temperatures [24°C (75°F), 35°C (95°F), and 54°C (130°F)] and airflow velocity of 1 m s-1 to determine the drying kinetics for the diurnal cycles typical for solar drying. The Page model was the most suitable model to predict the drying behavior of mint leaves for both the lab and field experiments. Even though the drying rate was higher with open-air sun drying on uncovered Dehytrays than with covered Dehytrays and the Dehymeleon, the total drying time for all methods was the same (48 h). Color change in mint leaves was less impacted by sunlight for mint leaves dried using the Dehymeleon, while the Dehytray and open-air sun drying had similar results due to their exposure to direct sunlight. For all drying methods, the aerobic bacterial count was significantly less for dried mint leaves than for fresh mint leaves. The log reductions in aerobic bacterial count achieved with open-air sun drying, Dehymeleon, and Dehytray were 0.47, 2.3, and 0.40, respectively. Keywords: Diffusion, Drying kinetics, Food quality, Mint leaves, Solar drying, Sun drying, Thin-layer drying.
Predicting Particle Separation and Sieve Blinding During Wheat Flour Sifting
Authors: Siliveru Kaliramesh , Ambrose R. P. Kingsly
Published: June 2021

Highlights

Wheat flour cohesion was modeled using the Johnson-Kendall-Roberts (JKR) contact model.

The size-based separation was highly influenced by particle size, particle roughness, cohesion, and sieve opening size.

Sieve blinding happened at 15.25 and 10.32 s of sieving for hard red winter (HRW) and soft red winter (SRW) wheat flour particles, respectively.

Abstract. Sifting or size-based separation of flour particles is an important operation in the wheat milling process. During the separation process, the flour particles often behave as imperfect solids with discontinuous flow and tend to form agglomerates due to interparticle cohesion. Interparticle cohesion in flours is highly dependent on the particle physical and chemical parameters and influences the sieving process. This study presents the development of a discrete element method (DEM) model to predict the size-based separation of wheat flours at 10% and 14% moisture contents (wet basis). DEM models of the size-based separation process were developed using the Hertz-Mindlin contact model. To account for the interparticle cohesion, the Johnson-Kendall-Roberts (JKR) model was coupled with the contact model. The size-based separation of hard red winter (HRW) and soft red winter (SRW) wheat flours was simulated and then validated using lab-scale experiments. Both the modeling and experimental approaches indicated that the percent particle separation was higher in the sieves with larger openings. Particle size, roughness, and cohesion affected the size-based separation in sieves with smaller openings. The model simulation results for the percent mass retained on the screens and the sieve blinding time were comparable with the experimental results. The standard error of prediction (SEP) ranged from 0.13 to 8.27, which indicates that this approach will be useful to predict the size-based separation of cohesive fine particles. The developed model will also be useful to estimate the sieve blinding time during sifting processes. Keywords: Cohesion, Johnson-Kendall-Roberts model, Sifting, Wheat milling.