bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opinions of key stakeholders regarding the inpatient Individual Care Plan
Authors: Nikkhah A. , Hallahan B. , McDonald C. 
Published: May 2021

AbstractObjectives:In Ireland, regularly reviewed Individual Care Plans (ICPs) for inpatients at all acute psychiatric inpatient units are a requirement of the Mental Health Act 2001. In this study, we comprehensively evaluated and compared opinions of key stakeholders in relation to the ICP as a care delivery tool.Methods:We employed a descriptive survey design. Questionnaires were distributed to 123 stakeholders (patients and mental health professionals (MHPs)) to evaluate and compare opinions regarding the impact of the ICP in relation to healthcare delivery and health outcomes, and regarding the structure and frequency of use of the ICP.Results:Ninety-eight stakeholders (80%) completed study questionnaires. Stakeholders (patients (58%) and MHPs (85%)) reported that the ICP assisted in healthcare delivery. However, different attitudes between groups were noted in relation to whether the ICP contributed towards healthcare outcomes, with 64% of patients, but only 41% of MHPs reporting that the ICP positively contributed to mental healthcare outcomes. Some free-text comments described patient dissatisfaction with the role of the ICP for healthcare delivery, and MHP dissatisfaction that the ICP was time-consuming and did not significantly enhance standard patient care.Conclusion:Whilst the implementation of the ICP is generally viewed positively by both patients and MHPs, considerable dissatisfaction by MHPs was also noted with certain aspects of how the ICP was delivered in practice. Practical adjustments to the implementation of ICP in order to build more positive stakeholder experiences appear warranted and worthy of further research.
Combining UAV and Landsat data to assess glacier changes on the central Tibetan Plateau
Authors: Xue Yuang , Jing Zhefan , Kang Shichang , He Xiaobo , Li Chenyu 
Published: May 2021

AbstractIn recent years, researchers have focused on the applications of uncrewed aerial vehicles (UAVs) in environmental remote sensing tasks. However, studies on glacier monitoring using UAV technology are relatively scarce, especially for high mountain glacier monitoring. To explore the feasibility of UAV technology for high mountain glaciers, four UAV surveys were deployed on two glaciers of the central Tibetan Plateau. Based on the images retrieved by UAV in 2017 and 2019, orthomosaics and digital elevation models were produced to quantify the length, area and elevation changes in the ablation zone of these two glaciers at different times. Additionally, we utilized several Landsat scenes to derive glacier changes over the last 30 years and combined these with the UAV data to assess the advantages and disadvantages of UAV technology in mountain glacier monitoring.
The Failed Globalization of Psychedelic Drugs in the Early Modern World
Authors: Breen Benjamin 
Published: May 2021

AbstractThis article reassesses what has been called ‘the puzzle of distribution’: why did some drugs rapidly emerge as global consumer goods in the era of the Columbian Exchange, whereas others remained restricted to regional centres of usage? I argue here that the early modern concept of transplantation allows us to approach the puzzle of distribution from a novel perspective. Early modern intoxicants were not disaggregated, free-floating commodities. Their consumption and trade took place within a larger constellation of social codes, cultural practices, ecologies, and built environments. Psychedelic compounds such as peyote and ayahuasca serve here as case studies for examining how the globalization of drugs involved far more than the transport of the substances themselves. Despite their centrality to numerous societies throughout the pre-Columbian Americas, the larger ‘assemblage’ of material cultures, cultural assumptions, and religious meanings that accrued around these substances made it difficult for them to follow the same paths as commodified drugs like cacao or tobacco.
Does the prenatal factor or the postnatal factor contribute more to changes in the child sex ratio in India? An investigation in the context of fertility and mortality transition
Authors: Yadav Ajit Kumar , Ram Faujdar , Singh Akansha , Shekhar Chander 
Published: May 2021

AbstractThere has been a drastic decline in the child sex ratio (number of females per 1000 males between ages 0 and 4) in India and many of its states. This study aimed to examine if prenatal factors, such as change in sex ratio at birth, or postnatal factors, such as change in relative mortality of females and males, contribute to this more by analysing the dynamics of the child sex ratio. Changes in the child sex ratio during 2001–2011 were decomposed into a ‘fertility’ component attributable to prenatal sex selection and a ‘mortality’ component attributable to sex differentials in postnatal survival at the country as well as the state level. Between the prenatal factor and the postnatal factor, the contribution of the latter to the declining child sex ratio has been greater than the former in India as a whole and in most of the states. By focusing on both prenatal and postnatal factors, the imbalance in the child sex ratio in the country can be reduced to a large extent.
Four Frankish gravestones from medieval Ephesus
Authors: Laflı Ergün , Buora Maurizio , Pringle Denys 
Published: May 2021

AbstractThis paper presents and discusses four Latin tombstones relating to Italian residents of medieval Ephesus that have been recovered from properties on the terrace of Ayasuluk (Selçuk), near the Byzantine Church of St John the Evangelist. Two of them, dating from the late 14th century, were originally published in 1937, while the other two, from the mid- 15th century, came to light more recently in January 2017.
Feeding Roman Silchester: Querns and Millstones in and around Roman Towns
Authors: Shaffrey Ruth 
Published: May 2021

ABSTRACTQuerns and millstones were central to the Roman agricultural economy, but are still relatively poorly understood. Using an exceptionally detailed dataset from the Roman town of Silchester as its main case study, this paper explores the supply of querns and the supply of flour in Romano-British urban sites and their rural hinterlands. The first part of the paper focuses on the assemblage of 715 querns and millstones from Silchester as commodities in their own right. It describes the stone types used for querns in the region, how the use of these changed over time, within and outside the town, and how the supply of querns to the town differed to that of the hinterland. These patterns of exploitation are used to make inferences about social and economic behaviour. Querns and millstones are also evidence for the preparation of flour and can be used to help us understand food-supply mechanisms, especially when considered together with archaeobotanical evidence. Analysis of the querns and millstones from closely dated contexts demonstrates that use of hand-powered rotary querns peaked in the town during the latest Iron Age and earliest Roman period. The use of rotary querns decreased significantly thereafter until, by the third century, the use of hand-operated rotary querns within the town was probably confined to a very basic household level in a domestic setting. At the same time, during the second or third century, powered millstones were introduced, with the archaeobotanical evidence suggesting a mill at an out-of-town location. Analysis of querns and millstones from a 20 km hinterland around Silchester suggests that household-level grinding was common, but that centralised milling was operating at a very low level and only to the north-west of the town. It is suggested that some flour was produced at centralised locations further afield and brought into the town ready ground. Supplementary material is available online (https://doi.org/10.1017/S0068113X21000040) and comprises detailed information on the lithologies of the querns and millstones from Silchester (including photographs), publication details of the sites in the town's hinterland and a spreadsheet recording the material.
COVID-19 in the WHO African region: using risk assessment to inform decisions on public health and social measures
Authors: Impouma Benido , Mboussou Franck , Wolfe Caitlin M. , Farham Bridget , Williams George Sie , Ogundiran Opeayo , Ngom Roland , Nzingou Milse , Flahault Antoine , Codeço Cláudia Torres , Talisuna Ambrose , Yoti Zabulon , Keiser Olivia 
Published: May 2021

Abstract
Successive waves of COVID-19 transmission have led to exponential increases in new infections globally. In this study, we have applied a decision-making tool to assess the risk of continuing transmission to inform decisions on tailored public health and social measures (PHSM) using data on cases and deaths reported by Member States to the WHO Regional Office for Africa as of 31 December 2020. Transmission classification and health system capacity were used to assess the risk level of each country to guide implementation and adjustments to PHSM. Two countries out of 46 assessed met the criteria for sporadic transmission, one for clusters of cases, and 43 (93.5%) for community transmission (CT) including three with uncontrolled disease incidence (Eswatini, Namibia and South Africa). Health system response's capacities were assessed as adequate in two countries (4.3%), moderate in 13 countries (28.3%) and limited in 31 countries (64.4%). The risk level, calculated as a combination of transmission classification and health system response's capacities, was assessed at level 0 in one country (2.1%), level 1 in two countries (4.3%), level 2 in 11 countries (23.9%) and level 3 in 32 (69.6%) countries. The scale of severity ranged from 0 to 4, with 0 the lowest. CT coupled with limited response capacity resulted in a level 3 risk assessment in most countries. Countries at level 3 should be considered as priority focus for additional assistance, in order to prevent the risk rising to level 4, which may necessitate enforcing hard and costly lockdown measures. The large number of countries at level 3 indicates the need for an effective risk management system to be used as a basis for adjusting PHSM at national and sub-national levels.
Developing an adolescent and adult Fontan Management Programme
Authors: Lubert Adam M. , Alsaied Tarek , Trout Andrew T. , Dillman Jonathan R. , Palermo Joseph J. , Eichelbrenner Felicia , Kleier Kelly , Lorts Angela , Anwar Nadeem , Schecter Marc G. , Tiao Gregory M. , Chin Clifford , Feldman David S. , Jenkins Meredith , Morales David LS , Opotowsky Alexander R. , Bucuvalas John C. , Veldtman Gruschen R. , Goldstein Stuart L. 
Published: May 2021

AbstractPatients with single-ventricle CHD undergo a series of palliative surgeries that culminate in the Fontan procedure. While the Fontan procedure allows most patients to survive to adulthood, the Fontan circulation can eventually lead to multiple cardiac complications and multi-organ dysfunction. Care for adolescents and adults with a Fontan circulation has begun to transition from a primarily cardiac-focused model to care models, which are designed to monitor multiple organ systems, and using clues from this screening, identify patients who are at risk for adverse outcomes. The complexity of care required for these patients led our centre to develop a multidisciplinary Fontan Management Programme with the primary goals of earlier detection and treatment of complications through the development of a cohesive network of diverse medical subspecialists with Fontan expertise.
Meningitis and high-grade, second-degree atrioventricular block in an adolescent: causal effect or coincidence?
Authors: Murphy Lee D , Florez Amy R , Czosek Richard J , Cooper David S , Mah Kenneth E 
Published: May 2021

AbstractWe describe an adolescent withStreptococcus pneumoniaemeningitis and symptomatic high-grade, second-degree atrioventricular block requiring permanent pacemaker placement. It is difficult to ascertain if these two diagnoses were independent or had a causal relationship though ongoing symptoms were not present prior to the infection. Because of this uncertainty, awareness that rhythm disturbances can be cardiac in origin but also secondary to other aetiologies, such as infection, is warranted.
Evidence Based Approach to Capacity Assessment for Hospitalized Patients
Authors: Zulkosky Julie , Harms Ann 
Published: May 2021

AbstractMedical decision-making capacity (MDMC) is inherent to the legal and ethical principles of respect for autonomy and is an essential element of informed consent. Qualitative and quantitative evidence to support a final decision of capacity should be the gold standard. General hospital policies and state laws mandate that a licensed provider make the final determination of capacity, but they do not specifically mandate who is responsible for those assessments. When a patient s decisional capacity fluctuates, the role of the nurse in a hospital setting is valuable because they have the most direct contact with the patient. Objective: Determine receptiveness of nursing staff to assessing capacity, to gather feedback on the Aid to Capacity Evaluation (ACE) tool, and to ascertain awareness of capacity by sixty nurses working on progressive care, trauma orthopedic, and medical/surgical units. Method: This project was completed at a Midwestern academic level I trauma center. Nurses on a medical/surgical, orthopedic trauma, and progressive care unit participated. Education about MDMC and the ACE tool were given to nurses verbally and in writing. They were asked to utilize the Aide to Capacity Evaluation (ACE) tool to assess patients whom they believed lacked decision-making capacity. After four weeks the nurses completed an evaluation. Results: Thirty nurses (50%) responded. Over 70% of those respondents used the tool at least once. 63% agreed that the format helped to systematically evaluate a patient and they found it easy to incorporate into practice. Overall, 73% of respondents would welcome more education about capacity. Conclusion: Given a standardized tool in conjunction with proper and continuous education, bedside nurses are in an optimal position to identify mental changes early, alert the provider so steps can be taken to optimize mental capacity, and assist with assessment of capacity with minimal disruption of care. Implementation of a tool such as the ACE can ensure accurate, reliable, and consistent assessments. Furthermore, providers would benefit from the extra time to gather information and complete focused assessments to make a determination of capacity with confidence.
Safety and Tolerability of Aripiprazole Lauroxil 2-Month Formulation With 1-Day Initiation for Treatment of Schizophrenia in the ALPINE Study
Authors: Bidollari Ilda , Vasios Alexa , Claxton Amy 
Published: May 2021

AbstractObjectiveEvaluate safety and tolerability of an aripiprazole lauroxil (AL) 2-month regimen using 1-day initiation in patients hospitalized for acute exacerbation of schizophrenia and transitioned to outpatient care.MethodsIn the 25-week, double-blind ALPINE study, adults hospitalized for an acute exacerbation of schizophrenia were randomized to AL (AL NanoCrystal Dispersion + oral aripiprazole 30 mg day 1; AL 1064 mg day 8 and q8wk) or the active control paliperidone palmitate (PP 234 mg day 1; PP 156 mg day 8 and q4wk), discharged after 2 weeks if clinically stable, and followed through the end of the study. Adverse events, including adverse events of special interest (AESIs; extrapyramidal symptoms [identified by non-mutually exclusive standardized MedDRA queries], sedation, hypotension, injection site reactions [ISRs], suicidal ideation and behavior) were monitored throughout the study.ResultsIn total, 200 patients were randomized (AL, n=99; PP, n=101); 99 patients (AL, n= 56; PP, n=43) completed the study. Rates of AESIs in AL-treated patients were akathisia, 10%; Parkinson-like events, 2%; dyskinesia, 3%; dystonia, 9%; sedation, 7%; hypotension, 6%; ISRs, 18 % (including placebo); and suicidal ideation and behavior, 2 %. In PP-treated patients, AESI rates were akathisia, 12%; Parkinson-like events, 4%; dyskinesia, 5%; dystonia, 11%; sedation, 7%; hypotension, 4%; ISRs, 27% (including placebo); and suicidal ideation and behavior, 3%.Conclusion(s)No unexpected safety and tolerability findings were identified in patients treated with AL or PP who were hospitalized for acute schizophrenia exacerbation and transitioned to outpatient care in ALPINE. AESI profiles were consistent with each treatment’s respective known safety profile.FundingAlkermes, Inc.DisclosuresAll authors are employees of Alkermes, Inc., and may own stock/options in the company.
Evaluation of the Safety of Deutetrabenazine at Higher Doses to Treat Chorea in Huntington’s Disease
Authors: Frank Samuel , Vaughan Christina , Stamler David , Oakes David , Davis Mat D. , Gross Nicholas , Gordon Mark Forrest , Savola Juha-Matti , Wieman Maria , Eberly Shirley , Kayson Elise , Whaley Jacquelyn , Goldstein Jody , Testa Claudia M. ,   on behalf of the Huntington Study Group ARC-HD Investigators
Published: May 2021

AbstractBackgroundIn the First-HD pivotal trial, the maximum deutetrabenazine dose evaluated to treat chorea associated with Huntington’s disease (HD chorea) was 48 mg/d, which is the approved maximum dose for this population. In ARC-HD, an open-label extension study evaluating the long-term efficacy and safety of deutetrabenazine to treat HD chorea, dosage ranged from 6 mg/d to 72 mg/d, with doses ≥12 mg/d administered twice daily. Doses in ARC-HD were increased by 6 mg/d per week in a response-driven manner based on efficacy and tolerability until 48 mg/d (Week 8). At the investigator’s discretion, further increases were permitted by 12 mg/d per week to a maximum of 72 mg/d. This post-hoc analysis evaluates the safety and tolerability of deutetrabenazine >48 mg/d compared to ≤48 mg/d to treat HD chorea in ARC-HD.MethodsPatient counts and safety assessments were attributed to patients when they received a dose of either ≤48 mg/d or >48 mg/d. For 9 selected adverse events (AEs), we compared AE rates adjusted for duration of drug exposure (as number of AEs/year) at ≤48 mg/d or >48 mg/d. The AE rates were determined after titration when participants were on stable doses of deutetrabenazine.ResultsAll 113 patients were exposed to doses ≤48 mg/d (177.1 patient-years) and 49 patients were ever exposed to doses >48 mg/d (74.1 patient-years). In patients taking deutetrabenazine >48 mg/d compared to ≤48 mg/d after the titration period, there were no apparent differences in exposure-adjusted AE rates.ConclusionsBased on clinical experience, some patients with HD may benefit from doses higher than 48 mg/d to adequately control chorea. These doses were tolerated without apparent increase in the exposure-adjusted rates of selected AEs after titration. This analysis does not address the occurrence of other AEs or whether adequate efficacy was achieved at lower doses, factors that may have influenced dose increases.FundingTeva Pharmaceutical Industries Ltd., Petach Tikva, Israel
Quantifying Psychopathology in Rapid Readmissions
Authors: Suhail Sam K. , Sandhu Harpinder , Mellacheruvu Sandeep 
Published: May 2021

AbstractPsychiatric readmissions contribute to a significant cost and healthcare burden to physicians, hospitals, and the healthcare system as an entity. Furthermore, as part of the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) began to reduce financial coverage to hospitals with overwhelming rehospitalization rates. The purpose of this study was to do a systematic analysis on inpatient psychiatric readmission data and identify co-morbidities and risk factors that lead to high readmission rates. The data collection includes 163 patients with a total of 348 readmissions over the span of 90 days at one inner-city hospital in the Chicagoland area. Study findings suggest that higher rates of readmission are linked to cocaine abuse in both male and female populations. Diagnosis of bipolar in females and schizoaffective disorder in male populations were the among the highest for readmission. Key social factors such as homelessness and low socioeconomic status were identified to contribute to a large proportion of psychiatric readmission burden. However, an overwhelming amount of information was missing due to unobtained labs and lack of current patient social history. By using this data as well as data from electronic medical records (EMRs) to further investigate and identify other features of at-risk patients, hospitals can potentially address these markers to lower readmission rates. Ultimately, a higher understanding of the patients’ needs can be understood and can help develop standardized plans of care for prevalent psychiatric illnesses in these populations.
The Rapid Mood Screener: A Novel and Pragmatic Screener Tool for Bipolar I Disorder
Authors: Montano C. Brendan , Patel Mehul , Jain Rakesh , Masand Prakash S. , Harrington Amanda , Gillard Patrick , Sullivan Kate , McElroy Susan L. , Brown T. Michelle , Nelson Lauren , McIntyre Roger S. 
Published: May 2021

AbstractIntroductionApproximately 70% of patients with bipolar disorder (BPD) are initially misdiagnosed, resulting in significantly delayed diagnosis of 7–10 years on average. Misdiagnosis and diagnostic delay adversely affect health outcomes and lead to the use of inappropriate treatments. As depressive episodes and symptoms are the predominant symptom presentation in BPD, misdiagnosis as major depressive disorder (MDD) is common. Self-rated screening instruments for BPD exist but their length and reliance on past manic symptoms are barriers to implementation, especially in primary care settings where many of these patients initially present. We developed a brief, pragmatic bipolar I disorder (BPD-I) screening tool that not only screens for manic symptoms but also includes risk factors for BPD-I (eg, age of depression onset) to help clinicians reduce the misdiagnosis of BPD-I as MDD.MethodsExisting questionnaires and risk factors were identified through a targeted literature search; a multidisciplinary panel of experts participated in 2 modified Delphi panels to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD participated in cognitive debriefing interviews (N=12) to test and refine item wording. A multisite, cross-sectional, observational study was conducted to evaluate the screening tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a draft 10-item screening tool and additional questionnaires/questions. Different combinations of item sets with various item permutations (eg, number of depressive episodes, age of onset) were simultaneously tested. The final combination of items and thresholds was selected based on multiple considerations including clinical validity, optimization of sensitivity and specificity, and pragmatism.ResultsA total of 160 clinical interviews were conducted; 139 patients had clinical interview-confirmed BPD-I (n=67) or MDD (n=72). The screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 items or more were endorsed (yes) in this analysis sample, the sensitivity of this tool for identifying patients with BPD-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire, while using >50% fewer items.ConclusionThis new 6-item BPD-I screening tool serves to differentiate BPD-I from MDD in patients with depressive symptoms. Use of this tool can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted. Use of a brief and valid tool provides an opportunity to reduce misdiagnosis, improve treatment selection, and enhance health outcomes in busy clinical practices.FundingAbbVie Inc.