bluuebunny/crossref_metadata_2025_split huggingface dataset:
Confidence in Adherence to Antidepressant Prescribing Guidelines Among Liaison Psychiatrists
Authors: Zac-Williams Lois , Smith Gareth 
Published: August 2024

AimsThis project aims to increase confidence among Liaison Psychiatrists (LPs) in North East London Foundation Trust (NELFT) regarding their adherence to the prescribing guidelines for antidepressants by 25% in accordance with the standard set by Psychiatric Liaison Accreditation Network (PLAN).Background The prescribing guidelines in this project are based on Standard 21 from 7th Edition Standards as devised by PLAN which states:“When medication is prescribed, specific treatment goals are set with the patient, the risks (including interactions) and benefits are discussed, a timescale for response is set and patient consent is recorded.”This project focuses on antidepressants because they are one of the widely used medications in psychiatry that doctors of all grades working in Liaison Psychiatry will be familiar with to some extent. Adhering to this validated guideline would promote gaining informed consent and patients’ involvement in their care, which studies have shown can increase adherence to treatment.MethodsCirculated an eight-question survey by email based on Standard 21 of 7th Edition Standards document by PLAN to LPs in NELFT. Conducted two Plan-Do-Study-Act (PDSA) cycles. The first PDSA uses a teaching session as the intervention and explained the importance of antidepressant guidelines and what areas LPs need to address with patients. The second intervention uses a poster to reinforce the key points. After each intervention a reissued survey assesses the change in responses.ResultsThe baseline survey response rate was 10 out of 15 LPs, made up of seven consultants, two registrars and one foundation year doctor. The lowest levels of confidence were reported around providing patients with printed information on their prescribed antidepressant with the majority of consultants reporting the lowest level of confidence. The highest levels of confidence across all medical grades were reported around discussing a specific treatment goal and explaining the benefits of treatment with antidepressant medication.ConclusionFrom the baseline data, it can be concluded that providing patients with printed information on newly prescribed antidepressants is the area that LPs, particularly consultants, are the least confident about regarding their adherence to prescribing guidelines. Future cycles of this quality improvement project can assess how incorporating teaching on antidepressant prescribing guidelines into trust induction sessions impacts LPs confidence in their adherence.
Harm-Reduction for Substance Misuse in Young People: A Service Evaluation of Southampton's Drug and Alcohol Support Hub (DASH)
Authors: Walker Camilla , Primavesi Charlotte , Popoola Pelumi , Walmsley Emily 
Published: August 2024

AimsThis project aims to evaluate Southampton's Drugs and Alcohol Support Hub Service (DASH) for young people (YP) provided by the charity, No Limits. It aims to produce insights and recommendations for No Limits to improve their service for YPs and positively influence local commissioning and governmental bodies. This project was part of the Wessex Public Health Fellowship for Junior Doctors, which aims to provide experience of working in public health and teach relevant research skills.MethodsAn adapted-Donabedian framework was implemented and a review of the literature informed a ‘harm-reduction’ lens for analysis. Mixed methods were used: Quantitative analysis reviewed data from 50 (anonymised) YPs. All data were routinely collected by No Limit's staff as Young People Outcome Records (YPORs) and Client Information Reviews (CIRs), as well as outcome measures collected quarterly for the National Drug Treatment Monitoring Service (NDTMS). Qualitative methods included a thematic analysis of five semi-structured interviews with service providers.ResultsCannabis and alcohol were the most commonly reported problem drugs for YP (48% and 36%, respectively). In terms of smoking per weekdays, 67% of YPs were using cannabis for the same number of days and 15% had decreased smoking days. For smoking in grams, 26% were smoking the same amount of cannabis compared with 41% smoking less. For alcohol, 41% consumed fewer units and 44% had increased alcohol-free days. Importantly, 63% of YPs reported increased quality of life and 59% increased happiness.Thematic analysis generated seven themes: harm reduction, mental health, relationships and trust, inter-agency working, YP-led care, individual outcomes and differences between reported outcomes and care provided. Harm reduction for most meant helping the YP build healthier relationships with drugs vis-à-vis enforcing abstinence. Trust was necessary for service providers to support YP reach their goals and YP-led, individualised goals benefitted most. Next, service providers often supported YP with mental health and sometimes this created challenges beyond their professional capabilities, thus emphasising the importance of collaborative inter-agency working. Lastly, providers were frustrated with required NDTMS outcome measures given they failed to capture service benefits.ConclusionDASH service's ‘harm reduction’ approach to supporting YP with substance misuse is in-line with evidence-based best practice guidance. However, reported NDTMS outcomes remain driven by an abstinence-informed agenda. This policy is grounded in governmental policies that do not consider the nuance of substance misuse disorders and are reflective of Nancy Reagan's 1980s ‘Just say No’ campaign. To prioritise the health and mental health of young people, government must reframe their policy on substance misuse.
Evaluation of Tertiary Neuropsychiatry Pilot Service: Pitfalls, Challenges, Outcomes and Success
Authors: Rudrappa Roopa , Jawahar Kaanthan , Andrews Nicholas , French Katie , Rathnaiah Mohanbabu 
Published: August 2024

AimsNeuropsychiatry, being at the interface between Neurology and Psychiatry, can fulfil the unmet needs of a cohort of people with complex presentations including psychiatry symptoms associated with neurological diseases and atypical psychiatry presentations with possible underlying aberrant brain processes. However, the development and provision of Neuropsychiatry services have lagged behind in the United Kingdom and some parts of the world, at the cost of ongoing symptom burden and reduced quality of life for vulnerable groups of patients. We set up a tertiary pilot service of Neuropsychiatry in Derbyshire from March 2022 and have been successfully operating both outpatient Neuropsychiatry clinics as well as inreach on to psychiatric wards. We set out to evaluate our service and explore the challenges and outcomes associated with our service development.MethodsA mixed methods evaluation was completed, and the data were extracted from patient records and assessments. Feedback responses were obtained from referring clinicians and service users utilising structured feedback forms for each group. A thematic analysis approach was completed for qualitative responses. More than 140 patients have already been assessed by our Neuropsychiatry service to date, out of which we completed an initial analysis of records of 70 patients referred between March 2022 and February 2023. We further revisited the challenges (lack of resources including clinic space, admin and dedicated electronic medical records (EMR) section).Results67% of referrals were from Neurology services with Functional Neurological Disorder (FND) predominating. 74% of patients referred had more than one diagnosis/symptom cluster. Patients reported significant benefits and overall positive experiences from the service. One patient reported, “After 3 years I finally not only have answers to my symptoms but also an explanation as to why. Without this service, I believe I would be still struggling.” Similar positive feedback was obtained from referring clinicians.ConclusionOur results demonstrate that a successful tertiary Neuropsychiatry service can be established and run even under challenging circumstances including lack of resources. Our service now has a dedicated clinic running every week, a dedicated EMR section and we are currently in the process of submitting business plans towards sustainable commissioning. Furthermore, our service has been instrumental in reducing the length of inpatient stay, facilitating early discharges, diagnosing and treating reversible conditions that mimicked primary psychiatric issues, as well as improving the quality of life of a vulnerable cohort of people previously diagnosed with complex conditions such as FND and personality disorders.
Factors Influencing Time From Diagnosis to Treatment of Breast Cancer and the Impact of Longer Waiting Time on Survival in Kathmandu Valley, Nepal: A Population-Based Study
Authors: Subedi Ranjeeta , Houssami Nehmat , Nickson Carolyn , Dhimal Meghnath , David Michael , Yu Xue Qin 
Published: August 2024

PURPOSE Longer time between breast cancer (BC) diagnosis and treatment initiation is associated with poorer survival, and this may be a factor behind disparities in global survival rates. We assessed time to BC treatment in the Kathmandu Valley, Nepal, including factors associated with longer waiting times and their impact on survival. METHODS We conducted a retrospective population-based study of BC cases recorded in the Kathmandu Valley Population-Based Cancer Registry between 2018 and 2019. Fieldwork survey through telephone was undertaken to collect additional sociodemographic and clinical information. Logistic regression was performed to identify factors associated with longer time to treatment, and Kaplan-Meier and Cox proportional hazard regression was used to examine survival time and evaluate the association between longer time to treatment and survival. RESULTS Among the 385 patients with BC, one third waited >4 weeks from diagnosis to initial treatment. Lower education was associated with longer time to treatment (adjusted odds ratio, 1.63 [95% CI, 1.03 to 2.60]). The overall 3-year survival rate was 88.6% and survival was not associated with time to treatment ( P = .50). However, advanced stage at diagnosis was associated with poorer survival (adjusted hazard ratio, 4.09 [95% CI, 1.27 to 13.23]). There was some indication that longer time to treatment was associated with poorer survival for advanced-stage patients, but data quality limited that analysis. CONCLUSION In the Kathmandu Valley, Nepal, women with a lower education tend to wait longer from BC diagnosis to treatment. Patients with advanced-stage BC had poorer survival, and longer waiting time may be associated with poorer survival for women diagnosed with advanced-stage disease.
Neurologic Manifestations of Rheumatologic Disorders
Authors: McCombe Jennifer A. 
Published: August 2024

ABSTRACT

OBJECTIVE
This article provides an overview of the neurologic manifestations of sarcoidosis and select rheumatologic disorders. An approach to the assessment and differential diagnosis of characteristic clinical presentations, including meningitis and vasculitis, is also reviewed. A review of treatment options is included as well as discussion of distinct areas of overlap, including rheumatologic disease in the setting of neuromyelitis spectrum disorder and demyelinating disease in the setting of tumor necrosis factor-α inhibitors.

LATEST DEVELOPMENTS
An increased understanding of the immune mechanisms involved in sarcoidosis and rheumatologic diseases has resulted in a greater diversity of therapeutic options for their treatment. Evidence directing the treatment of the central nervous system (CNS) manifestations of these same diseases is lacking, with a paucity of controlled trials.

ESSENTIAL POINTS
It is important to have a basic knowledge of the common CNS manifestations of rheumatologic diseases and sarcoidosis so that they can be recognized when encountered. In the context of many systemic inflammatory diseases, including systemic lupus erythematosus, IgG4-related disease, and sarcoidosis, CNS disease may be a presenting feature or occur without systemic manifestations of the disease, making familiarity with these diseases even more important.
Autoimmune Neuromuscular Disorders Associated With Neural Antibodies
Authors: Dubey Divyanshu 
Published: August 2024

ABSTRACT

OBJECTIVE
This article reviews autoimmune neuromuscular disorders and includes an overview of the diagnostic approach, especially the role of antibody testing in a variety of neuropathies and some other neuromuscular disorders.

LATEST DEVELOPMENTS
In the past few decades, multiple antibody biomarkers associated with immune-mediated neuromuscular disorders have been reported. These biomarkers are not only useful for better understanding of disease pathogenesis and allowing more timely diagnosis but may also aid in the selection of an optimal treatment strategy.

ESSENTIAL POINTS
Recognition of autoimmune neuromuscular conditions encountered in inpatient or outpatient neurologic practice is very important because many of these disorders are reversible with prompt diagnosis and early treatment. Antibodies are often helpful in making this diagnosis. However, the clinical phenotype and electrodiagnostic testing should be taken into account when ordering antibody tests or panels and interpreting the subsequent results. Similar to other laboratory investigations, understanding the potential utility and limitations of antibody testing in each clinical setting is critical for practicing neurologists.
Safety and Efficacy of Management for Intraprocedural Rupture During Endovascular Treatment for Intracranial Aneurysms
Authors: Hirai Sakyo , Hanazawa Ryoichi , Yoshimura Masataka , Shigeta Keigo , Sato Yohei , Taira Naoki , Kawano Yoshihisa , Karakama Jun , Obata Yoshiki , Hara Mutsuya , Yamada Kenji , Ishii Yosuke , Sawada Kana , Imae Shogo , Wakabayashi Hikaru , Sagawa Hirotaka , Fujita Kyohei , Fujii Shoko , Takahashi Satoru , Hirakawa Akihiro , Nemoto Shigeru , Sumita Kazutaka 
Published: August 2024

BACKGROUND AND OBJECTIVES:
Although intraprocedural rupture (IPR) is rare, it is a devastating complication of endovascular treatment (EVT) for intracranial aneurysms. Very few studies have been conducted on IPR, and the safety and efficacy of management techniques of IPR have not been investigated.

METHODS:
Patients who experienced IPR during EVT between 2013 and 2022 were enrolled from a multicenter observational registry. We examined the safety and efficacy of the management of IPR using imaging markers, including increased hemorrhage and ischemic lesions, which were evaluated using postoperative computed tomography and diffusion-weighted imaging, respectively.

RESULTS:
Of the 3269 EVTs for intracranial aneurysms, 74 patients who experienced IPR (2.26%) were analyzed. Fifty-five patients (3.36%) experienced IPR among 1636 EVT cases for ruptured aneurysms. Multivariate analysis revealed that increased hemorrhage was significantly associated with poor outcomes (odds ratio [OR], 6.37 [95% CI, 1.00-40.51], P = .050), whereas ischemic lesions were not. Regarding management techniques of IPR, antihypertensive medication use was significantly associated with increased hemorrhage (OR, 14.16 [95% CI, 2.35-85.34], P = .004). Heparin reversal was an independent factor for ischemic lesions (OR, 8.92 [95% CI, 1.54-51.58], P = .014).

CONCLUSION:
Although the setting of IPR may be miscellaneous, and optimal management varies depending on individual cases, heparin reversal might be associated with ischemic complications, and its role in the successful hemostasis in IPR during EVT for ruptured aneurysms remains unclear.
What Are We Transfusing? Evaluating the Quality and Clinical Utility of Intraoperatively Salvaged Red Blood Cells in Spinal Deformity Surgery: A Nonrandomized Controlled Trial
Authors: Kurland David B. , Alber Daniel , Smith Andrew , Ahmed Shah , Orringer Daniel , Frempong-Boadu Anthony , Lau Darryl 
Published: August 2024

BACKGROUND AND OBJECTIVES:
Intraoperative red blood cell (RBC) salvage is frequently used in contemporary spine surgery, despite clinical concern in its efficacy as a surrogate for blood-banked allogeneic packed RBCs (pRBCs). During spine surgery, salvaged RBCs (sRBCs) are exposed to injurious high-heat electrocautery, prolonged stasis, and abrasive pharmaceuticals, potentially making sRBCs a poor blood substitute. We therefore sought to scientifically and objectively define the quality of sRBCs in the context of complex spine surgery.

METHODS:
This is a single-center, prospective, nonrandomized controlled trial of patients undergoing posterior-based multilevel thoracolumbar instrumented fusion for spinal deformity with planned use of intraoperative RBC salvage between June 2022 and July 2023. Surgeries were performed by fellowship-trained spinal neurosurgeons and orthopedic surgeons. The participants were split based on transfusion of sRBCs (given sufficient yield) vs no sRBC transfusion. Primary outcomes were RBC electrolyte composition, indices, deformability, and integrity, which were evaluated in comparison blood samples: Baseline, pRBC, and sRBC. Secondary outcomes were related to clinical effects of sRBC transfusion. Morphological assessment used Stimulated Raman Histology and machine learning. Deformability was assessed using ektacytometry.

RESULTS:
A total of 174 patients were included. The mean age was 50.2years ±25.4, 58.6% was female, the mean level fused was 10.0 ± 3.9, and 58.0% received sRBCs (median 207.0 mL). sRBCs differed significantly on standard laboratory measures, had a high proportion (30.7%) of shrunken and irregularly spiculated morphologies, and demonstrated abnormal deformability and relaxation kinetics. The hemolysis index was significantly elevated in sRBCs (2.9 ± 1.8) compared with Baseline samples and pRBCs (P < .01). Transfusion of sRBCs was associated with suboptimal resuscitation and provided no practical clinical benefit.

CONCLUSION:
RBCs salvaged during posterior thoracolumbar spine surgery are irreversibly injured, with hemolysis index exceeding Food and Drug Administration and Council of Europe transfusion standards in all samples, questioning their efficacy and safety as a blood substitute.
Resting Energy Expenditure, Metabolic and Sex Hormones in Two Phases of the Menstrual and Hormonal Contraceptive Cycles
Authors: LÖFBERG IDA E. , KARPPINEN JARI E. , LAATIKAINEN-RAUSSI VESA , LEHTI MAARIT , HACKNEY ANTHONY C. , IHALAINEN JOHANNA K. , MIKKONEN RITVA S. 
Published: August 2024

ABSTRACT

Introduction
Resting energy expenditure (REE) may fluctuate during the menstrual cycle (MC), due to the physiological effects of estradiol (E2) and progesterone. This study examined changes in REE and metabolic hormones (leptin, ghrelin, thyroid hormones), and dietary intake in two hormonally distinct groups, naturally menstruating women (NoOC) and women using monophasic combined oral contraceptives (COC).

Methods
Measurements included REE by indirect calorimetry, body composition by bioimpedance, and blood samples for hormone analysis in the early follicular and midluteal phases of the MC in the NoOC group (n = 38) or the active and inactive phases of the COC cycle (COC; n = 19). Participants recorded their food intake for 3 d after measurements. A secondary analysis was completed for the NoOC group without REE outliers (difference between measurements >1.5 × interquartile range, n = 4).

Results
In the NoOC group, luteal phase REE was 40 kcal higher than follicular phase REE (95% confidence interval (CI), −2 to 82 kcal·d−1, d = 0.20, P = 0.061). Leptin (d = 0.35, P < 0.001), triiodothyronine (T3; d = 0.26, P = 0.05), and fat intake (d = 0.48, P = 0.027) were higher, and thyroxine (d = 0.21, P = 0.041) was lower in the luteal phase. After excluding outliers, REE was 44 kcal higher in the luteal phase than in the follicular phase (95% CI, 12–76 kcal·d−1, d = 0.22, P = 0.007). In the COC group, the mean difference in REE was −2 kcal (95% CI, −82 to 79 kcal·d−1) between active and inactive phases, whereas T3 was higher in the inactive phase (d = 0.01, P = 0.037).

Conclusions
REE increases only slightly from the follicular to the luteal phase but remains unchanged between COC phases. Increases in T3, leptin, and fat intake during the luteal phase might echo metabolic fluctuations that parallel female sex hormones during the MC.
Characterization of a Diamond, SiC and Si Detector Response to Neutron Beams at the NCSR “Demokritos”
Authors: Kaperoni Kalliopi , Diakaki Maria , Kokkoris Mike , Weiss Christina , Griesmayer Erich , Melbinger Julian , Axiotis Michail , Chasapoglou Sotiris , Vlastou Roza , Fragner Theodor 
Published: August 2024

Detecting low energy neutrons (below 6 MeV) can be a challenge mostly due to the high γ-ray contamination and the low efficiency of the detectors. Over the last years semiconductor neutron detectors have been developed and due to their unique characteristics, they have been proven useful in numerous applications. Diamond, SiC and Si are the most popular materials for constructing resilient semiconductor detectors. Diamond exhibits excellent physical and electrical properties and it is the material of choice when high energy resolution, irradiation resistance and hardness is required. Silicon (Si) is the most commonly used material for semiconductor detectors, used in microelectronics as well as in various radiation applications. In addition, SiC shows increased radiation resistance and over the last decades it is used for applications in harsh environments, including extreme temperatures and intense radiation conditions. There is also a great interest in studying SiC based semiconductors, since it is a new and promising material, currently not available in the market and the substrate thicknesses produced are very limited. In this work, a study was made with a Diamond a Si and a SiC detector to detect four low neutron energies: 2.45 MeV, 2.95 MeV, 3.45 MeV and 3.95 MeV, with quasi-monogenetic neutron beams at the NCSR “Demokritos”. The experimental spectra were extracted, the calibration of the detectors used was performed and the elastic scattering spectrum was compared with the angular distribution.
DiffCRNN: A Novel Approach for Detecting Sound Events in Smart Home Systems Using Diffusion-based Convolutional Recurrent Neural Network
Authors: Al Dabel Maryam M. 
Published: August 2024

This paper presents a latent diffusion model and convolutional recurrent neural network for detecting sound event, fusing advantages of different networks together to advance security applications and smart home systems. The proposed approach underwent initial training using extensive datasets and subsequently applied transfer learning to adapt to the desired task to effectively mitigate the challenge of limited data availability. It employs the latent diffusion model to get a discrete representation that is compressed from the mel-spectrogram of audio. Subsequently a convolutional neural network (CNN) is linked as the front-end of recurrent neural network (RNN) which produces a feature map. After that, an attention module predicts attention maps in temporal-spectral dimensions level, from the feature map. The input spectrogram is subsequently multiplied with the generated attention maps for adaptive feature refinement. Finally, trainable scalar weights aggregate the fine-tuned features from the back-end RNN. The experimental findings show that the proposed method performs better compared to the state-of-art using three datasets: the DCASE2016-SED, DCASE2017-SED and URBAN-SED. In experiments on the first dataset, DCASE2016-SED, the performance of the approach reached a peak in F1 of 66.2% and ER of 0.42. Using the second dataset, DCASE2017-SED, the results indicate that the F1 and ER achieved 68.1% and 0.40, respectively. Further investigation with the third dataset, URBAN-SED, demonstrates that our proposed approach significantly outperforms existing alternatives as 74.3% and 0.44 for the F1 and ER.