bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

AimsTo assess how well MHAS meets the service specificationTo ascertain areas of good practiceTo examine whether the referral form is being used in an appropriate mannerTo elucidate areas of good communication and whether any improvement can be madeBackgroundLaunched 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.Method10 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.Result88.3% 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.ConclusionAll 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

AimsPsychiatric 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.MethodWe 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.ResultAmong 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%.ConclusionLow 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

AimsReferrals 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.MethodReferrals 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.ResultReferrals 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).ConclusionAttendance 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

AimsThis 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.MethodThis 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”.Result187 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.ConclusionWe 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

AimsIdentifying 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.MethodWe 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.ResultWe 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.ConclusionThis 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

AimsThe 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.BackgroundInduction 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’.MethodPre- 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).ResultThere 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.ConclusionHaving 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

Abstract

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 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

ABSTRACT
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

ABSTRACT
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

ABSTRACTManduca 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

Abstract
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.