bluuebunny/crossref_metadata_2025_split huggingface dataset:
020 A fluey man – a reason for neurologists to remain vigilant
Authors: Singh Neena , Gimson Amy , Dobson Ruth 
Published: March 2023

CaseWe present a 64 year old gentleman with previous non-metastatic melanoma and newly diagnosed myeloma, for which he had received steroids but not chemotherapy. He developed fever followed by an ascending acute flaccid paralysis with brainstem involvement, requiring ventilatory support within hours of onset. MRI demonstrated an extensive enhancing longitudinal spinal cord lesion with signal change in thalami, temporal lobes and pons. CSF protein was >6 g, WCC 150 (90% neutrophils), no organisms and negative virology. Neurophysiology demonstrated a selective motor neuropathy/neuronopathy.H1N1-influenza A (‘swine flu’) RNA was detected on nasopharyngeal aspirate. He was treated with Zanamavir, antimicrobials, steroids, and plasma exchange. His clinical improvement remains slow, and he will require long-term care.DiscussionThis patient developed a rare, catastrophic neurological complication of pandemic FluA, in the context of untreated multiple myeloma. Whilst not a pure acute flaccid myelitis, this case highlights the need to be aware of uncommon neurological complications of viral infections.There has been a peak in 2018 of cases of acute flaccid myelitis across the UK, Europe, and America. Public Health England has declared a national incident in response to this. The cause remains unproven, and neurologists should report suspected cases to PHE.
024 Electronic intervention to improve acute neurology referral system
Authors: Routledge Emma , Ziff Oliver , Jarman Paul , Turner Chris , Chandratheva Arvind 
Published: March 2023

IntroductionThere is conflicting viewpoints regarding phone versus email referral systems within acute neurology.MethodsOur study evaluates the referrals system at University College London Hospital. We assessed how effective the pre-existing phone system was at managing referrals and compared this to a newly implemented email system. Over a month period the neurology phone call-log was interrogated. We recorded incoming and outgoing calls (missed and received), timing and call duration. After the email system was implemented, we assessed the email-logs over a month period.ResultsWith the phone system nighty nine incoming and 54 outgoing calls were recorded. Of these, 63% incoming calls were missed and 37% outgoing calls were not answered. Fridays were the busiest day of the week with 33% of the total calls (6% Mondays, 22% Tuesdays, 20% Wednesday, 19% Thursday). Most calls were received between 09:00 – 10:00 (25% of total) & 16:00 – 17:00 (22% of total). With the email system, 45 referrals were received electronically. Of these, all were responded to within 24 hours.ConclusionsThe phone referral system was not fit for purpose with 63% of incoming calls missed. The electronic system was associated with far-reaching improvements in managing referrals.
031 Managing rituximab delivery in a neurosciences centre
Authors: Dorsey R , Williams T , Singh-Curry V , Johnson M , Pritchard J , Muraro P , Nicholas R 
Published: March 2023

Rituximab has potential indications in neurology not as yet studied in RCTs making access difficult but also means that there is no coherent process to ensure useful outcome data is acquired. In addition alternatives such as immunoglobulins now have limited availability. We set up a multidisciplinary team (MDT) to establish appropriate indication for rituximab, and ensure consistency of administration and outcome data collection.Data from neurosciences in Imperial Healthcare NHS Trust was audited (6/2010–4/2018). After completing a systematic review a MDT was initiated with peripheral nerve, epilepsy, and neuroinflammatory experts. The MDT was then audited (4/2018–1/2019).79 subjects were assessed: mean age 49.7±15.4 years (range 19–80yrs). 42 (5.4 per year) were treated since 2010 and 29 since the MDT began (34.8 per year). The commonest diagnoses were limbic encephalitis (17) and vasculitis (12). Subjects had on average 2.8 immune therapies prior to treatment. 21/71 had PLEX and 23/71 had immunoglobulins. Prior to the MDT inception 65% of subject reported positive outcomes. After the MDT 8 (19%) were rejected and there was minimal use in those without a clear diagnosis.Subjects who receive rituximab often have a series of in-hospital complex expensive therapies prior to treatment. A rituximab MDT increases its use in appropriate groups.
043 A specialist cognitive clinic for the deaf community
Authors: Harris Matthew , Au Darica , Judd Katy , Atkinson Joanna , Mummery Catherine 
Published: March 2023

BackgroundEarly dementia diagnosis is crucial to ensure timely treatment and support. Approximately 100,000 people in the UK are Deaf and use British Sign Language as their first language. For this population access to healthcare can be difficult, clinical assessment challenging and misdiagnosis may occur.In August 2011, a specialist cognitive clinic for the Deaf community was established at the National Hospital for Neurology and Neurosurgery. We sought to evaluate this service to inform future provision of care.MethodsWe retrospectively analysed electronic patient records from August 2011 until December 2018.Results36 patients were reviewed aged 35–83 years (median 71.5). 83% of those referred did not have a prior diagnosis. 17% had previously been given a provisional diagnosis, however this was changed in 67% of cases following review in our clinic.All patients underwent neuropsychological assessment and in 92% cranial imaging was performed. 8% additionally underwent FDG-PET and 25% lumbar puncture. 47% were diagnosed with a neurodegenerative disorder (Alzheimer’s Disease in 77%), 6% mild cognitive impairment, 11% a pre-existing neurological disorder and 19% with subjective memory complaints without evidence of neurodegeneration.Donepezil was commenced in all patients diagnosed with Alzheimer’s disease. 9% experienced adverse effects and changed medication.ConclusionIn this evaluation, we found that Deaf patients had difficulties obtaining an accurate diagnosis prior to clinic and we observed a high proportion of neurodegenerative and neurological diagnoses (64%) compared to other cognitive clinics (reportedly 40–50%). We believe these results highlight the challenges Deaf patients have in accessing healthcare and this underscores the importance of this service in ensuring patients receive an accurate and timely diagnosis.
083 Facial twitching, breathlessness and fever: an unexpected and potentially lethal triad
Authors: Mbizvo Gashirai K , Lentell Isabel , Leen Clifford , Roddie Huw , Derry Chris , Duncan Susan , Rannikmäe Kristiina 
Published: March 2023

BackgroundWe describe a patient co-presenting with epilepsia partialis continua (EPC), disseminated tuberculosis (TB), and hemophagocytic lymphohistiocytosis (HLH).CaseA 54-year-old lady presented with facial twitching, breathlessness, and night sweats. Clinical examination revealed pyrexia and continuous, stereotyped, right-sided facial contractions. These worsened with speech and continued through sleep. A clinical diagnosis of EPC was made (video provided). CT imaging of the chest and serous fluid analyses were consistent with a diagnosis of disseminated Mycobacterium tuberculosis, with a left motor strip tuberculoma evident on post-contrast MRI brain. An additional diagnosis of HLH was made following the identification of pancytopenia and hyperferritinaemia on peripheral blood, with hemophagocytosis evident on bone marrow investigation (pathology slides provided). She was extremely unwell and hospitalised for six months, including two admissions to intensive care for invasive ventilation. She was treated successfully with high doses of antiepileptic drugs, 12 months of oral anti-TB therapy, and chemotherapy with eight weeks of etoposide and dexamethasone for HLH, followed by 12 months of ciclosporin and prednisolone.ConclusionsPresentation with this triad is rare – to our knowledge, this is the first documented case. A lack of evidence surrounding the co-expression of this triad may represent absolute rarity or, more likely, clinical failure to recognise the triad (resulting in early death from untreated TB/HLH). Therefore, the case helps improve education around how such a patient may present and be managed.
Cervicalgias
Authors: Teixeira Manoel Jacobsen , Barros Filho Tarcísio de , Yeng Lin Tchia , Hamani Clement , Teixeira William Gemio Jacobsen 
Published: March 2023

A cervicalgia pode ser decorrente de condições sistêmicas, ou de anormalidades viscerais, músculo-esqueléticas ou neurológicas envolvendo a região cervical. Muitas vezes, entretanto, os exames laboratoriais, eletrofisiológicos e de imagem não identificam precisamente sua origem. Além disto muitas anormalidades, especialmente evidenciadas nos exames de imagem, não são relacionadas às condições álgicas. A região cervical apresenta intensa mobilidade o que condiciona fadiga e degeneração de estruturas regionais ricamente inervadas. A cervicalgia músculo-esquelética pode ser aguda, auto-limitada, ou crônica e, freqüentemente, é associada à dor em outras regiões. O diagnóstico clínico mais que os exames complementares são de grande importância no diagnóstico das razões da ocorrência das cervicalgias.
Seasonality of Upper-Ocean Vertical Eddy Buoyancy Flux in the Kuroshio Extension
Authors: Zhang Xiangyu , Jing Zhao , Yang Peiran 
Published: March 2023

Abstract
Oceanic mesoscale and submesoscale eddies produce a pronounced vertical buoyancy flux, playing an important role in ocean restratification. This study used a 1-km ocean simulation to investigate the seasonality of the vertical eddy buoyancy flux (VEBF) in the Kuroshio Extension as well as its underlying dynamics. The simulated VEBF in the upper 200 m over the Kuroshio Extension has a pronounced seasonal cycle. The winter VEBF peaks in the mixed layer, whereas the summer VEBF has a much smaller magnitude but a more complicated vertical structure with a narrow peak in the shallow mixed layer and a broader and stronger peak in the seasonal thermocline. The baroclinic instability (BCI), frontogenesis, and turbulent thermal wind (TTW) balance all contribute to the VEBF seasonal cycle. In winter, large surface heat loss and intense winds destroy stratification and enhance turbulent vertical mixing in the upper ocean. These phenomena intensify VEBF by promoting its components induced by the frontogenesis and TTW balance and by triggering mixed layer instability (MLI). In summer, strong stratification associated with suppressed turbulent vertical mixing weakens the contributions of the frontogenesis and TTW balance to VEBF and shifts the dominant BCI type from the MLI to the surface Charney- and Philips-like types with greatly reduced growth rate compared with that of MLI in winter. The shallow peak of the VEBF in summer is mainly attributed to the TTW balance, whereas the BCI and frontogenesis account primarily for its deep peak.
B-LBConA: a medical entity disambiguation model based on Bio-LinkBERT and context-aware mechanism
Authors: Yang Siyu , Zhang Peiliang , Che Chao , Zhong Zhaoqian 
Published: March 2023

AbstractBackgroundThe main task of medical entity disambiguation is to link mentions, such as diseases, drugs, or complications, to standard entities in the target knowledge base. To our knowledge, models based on Bidirectional Encoder Representations from Transformers (BERT) have achieved good results in this task. Unfortunately, these models only consider text in the current document, fail to capture dependencies with other documents, and lack sufficient mining of hidden information in contextual texts.ResultsWe propose B-LBConA, which is based on Bio-LinkBERT and context-aware mechanism. Specifically, B-LBConA first utilizes Bio-LinkBERT, which is capable of learning cross-document dependencies, to obtain embedding representations of mentions and candidate entities. Then, cross-attention is used to capture the interaction information of mention-to-entity and entity-to-mention. Finally, B-LBConA incorporates disambiguation clues about the relevance between the mention context and candidate entities via the context-aware mechanism.ConclusionsExperiment results on three publicly available datasets, NCBI, ADR and ShARe/CLEF, show that B-LBConA achieves a signifcantly more accurate performance compared with existing models.
Decision-makers’ experiences with rapid evidence summaries to support real-time evidence informed decision-making in crises: a mixed methods study
Authors: Khalid Ahmad Firas , Grimshaw Jeremy M. , Parakh Nandana D. , Charide Rana , Rab Faiza , Sohani Salim 
Published: March 2023

Abstract
Background
There is a clear need for research evidence to drive policymaking and emergency responses so that lives are saved and resources are not wasted. The need for evidence support for health and humanitarian crisis is even more pertinent because of the time and practical constraints that decision-makers in these settings face. To improve the use of research evidence in policy and practice, it is important to provide evidence resources tailored to the target audience. This study aims to gain real-world insights from decision-makers about how they use evidence summaries to inform real-time decision-making in crisis-settings, and to use our findings to improve the format of evidence summaries.

Methods
This study used an explanatory sequential mixed method study design. First, we used a survey to identify the views and experiences of those who were directly involved in crisis response in different contexts, and who may or may not have used evidence summaries. Second, we used the insights generated from the survey to help inform qualitative interviews with decision-makers in crisis-settings to derive an in-depth understanding of how they use evidence summaries and their desired format for evidence summaries.

Results
We interviewed 26 decision-makers working in health and humanitarian emergencies. The study identified challenges decision-makers face when trying to find and use research evidence in crises, including insufficient time and increased burden of responsibilities during crises, limited access to reliable internet connection, large volume of data not translated into user friendly summaries, and little information available on preparedness and response measures. Decision-makers preferred the following components in evidence summaries: title, target audience, presentation of key findings in an actionable checklist or infographic format, implementation considerations, assessment of the quality of evidence presented, citation and hyperlink to the full review, funding sources, language of full review, and other sources of information on the topic. Our study developed an evidence summary template with accompanying training material to inform real-time decision-making in crisis-settings.

Conclusions
Our study provided a deeper understanding of the preferences of decision-makers working in health and humanitarian emergencies about the format of evidence summaries to enable real-time evidence informed decision-making.
Psychological Capital and Job Search: A Systematic Literature Review and Agenda for Future Research
Authors: Fernández-Valera María-Magdalena 
Published: March 2023

Purpose: There is consistent evidence that a positive mindset could foster the job search process. Psychological capital, defined as a tendency to hold cognitions and positive appraisals of one's ability, could highlight the importance of individual cognitive appraisal in the job search process. Nevertheless, psychological capital's impact on job seekers is still unclear. Methods: The purpose of the present study was to explore the role of psychological capital in the job search process. The author conducted a systematic review following the PRISMA-P guidelines. This systematic review sought answers to three questions: 1) What theories are applied to explain the relationship between psychological capital and the job search process? 2) How is the association between psychological capital and the job search process? 3) Did the psychological capital interventions positively influence the job search process? The review focused on quantitative studies carried out between 2007 and 2021 on job seekers. Finally, 11 studies fit the inclusion criteria. Results: Overall, the literature review supports the significant association between psychological capital and the job search process. On the one hand, the studies analyzed have shown the resonance of psychological capital on the job search outcomes and job seekers' well-being. On the other hand, the results showed insufficient evidence to make any firm conclusions concerning psychological capital interventions' effects on the job search process improvement. Conclusion: It is concluded that psychological capital may be a valuable advantage for helping job seekers engage in their job search process. The results presented in this study could have important implications for job seekers and public and private employment agencies. Even so, it is necessary to continue contributing to its development. Particularly, there is still considerable scope for improvement in the study of psychological capital and the job search process in terms of the study design we apply, the variables we study and their measure, and the theoretical background we use to explain the previous relationship.
Pathogenic BCS1L Mutation Resulting in Hypertrophic Cardiomyopathy: A Unique Presentation of Nuclear Mitochondrial Disease
Authors: Incognito Cameron , Hedley Jeffrey , Posadas Kristine T. , Wang Xiangling , Desai Milind 
Published: March 2023

Abstract
A 21-year-old man with sensorineural hearing loss and glaucoma presented with severely limited exercise capacity since childhood. He was found to have biventricular concentric hypertrophy with greatest wall thickening at the posterior and lateral walls of the left ventricle apex (1.7 cm) and the free wall of the right ventricle (1.1 cm). There was no inducible left ventricular outflow tract obstruction. Metabolic testing revealed marked lactic aciduria (1,650.1 μmol/mmol creatinine) and plasma lactate (3.9 mmol/L). A sarcomeric hypertrophic cardiomyopathy gene panel was unremarkable, but mitochondrial gene analysis revealed a homozygous c.385G>A (p.Gly129Arg) pathogenic mutation in the BCS1L gene. This gene is responsible for an assembly subunit of cytochrome complex III in the respiratory transport chain and is the rarest respiratory chain defect. This gene has not frequently been implicated in cardiomyopathy. Mitochondrial hypertrophic cardiomyopathy is more rare than hypertrophic cardiomyopathy resulting from sarcomeric mutations and is more likely to be symmetric, less frequently results in left ventricular outflow tract obstruction, and is more likely to progress to dilated cardiomyopathy. Evidence-based screening protocols have not been established; treatment follows guideline-directed medical therapy for congestive heart failure, including evaluation for heart transplantation. This report expands the phenotype of the BCS1L mutation and suggests that affected patients may need screening for underlying cardiomyopathy.
Covid-19 não é democrática: determinação social do processo saúde-doença numa análise de gênero-raça-classe-sexualidade
Authors: Vinicius Ribeiro Cruz Marcus , Clara Santana Silveira Maria , Julie Soares Resende Nathália , De Paula Gomes Sthefany 
Published: March 2023

A disseminação da COVID-19 no Brasil se estabeleceu em um cenário político de importantes retrocessos democráticos e de desmonte da seguridade social. A fim de investigar mais profundamente esse contexto, o campo da saúde possui, historicamente, formulações de modelos teóricos que buscam as compreensões de saúde e doença. Ademais, para explicar as condições de saúde da população através de uma noção mais completa, torna-se fundamental debater sobre o processo de saúde-doença e sua determinação social em uma episteme de gênero-raça-classe-sexualidade, visto que a saúde entendida como amplo desenvolvimento das potencialidades humanas em certo momento histórico, choca-se com as limitações estabelecidas pela estrutura para o alcance dessas capacidades através das desigualdades que marcam a realidade nacional. Os desdobramentos cotidianos e os impactos diretos na vida da população negra, nas mulheres, na população LGBTQIA+ e, de forma geral, na classe trabalhadora na pandemia, com maior número de mortes, afetando em maior grau a saúde mental, as relações de trabalho e familiares, validam de forma concreta a determinação social do processo de saúde-doença. Portanto, o projeto e concepção de saúde precisa se posicionar na disputa de percepção crítica da realidade, e de ação para construir uma sociedade emancipada.
The feasibility of nipple-sparing mastectomy in combined with abdominal free flap breast reconstruction without skin paddles for flap monitoring: a single-center experience
Authors: Zhu Liling , Chen Kai , Li Shunrong , Zhang Songliang , Zhang Xiaolan , Yan Jingwen , Wang Shuai , Tan Lunyuan , Rao Nanyan 
Published: March 2023

Abstract
Background

Nipple-sparing mastectomy in combination with buried abdominal free flap breast reconstruction without leaving any skin paddles for post-operative monitoring might be associated with better cosmetic outcomes. The feasibility of this approach remains unclear while a detailed and validated protocol of post-operative flap monitoring is lacking.

Materials and Methods

Eligible patients receiving abdominal free-flap breast reconstruction between 2015 and 2020 in our institution were included. Patients were categorized into the buried-flap cohort and the skin-paddle cohort based on whether a skin paddle remained for direct visual monitoring post-operatively. We reported the learning curve of this surgery and the determinants of operative and/or ischemic time. The oncological outcomes and surgical complications rates were also analyzed.

Results

This study included 147 eligible patients (buried-flap cohort: N = 18; skin-paddle cohort: N = 129). In early-stage patients with immediate breast reconstruction (N = 104), there were no observed relapse events with a median follow-up time of 18 months. The learning curve analysis showed significant reduction of the surgery time and the ischemic time with accumulation of surgical experience after 30 cases. The surgery time and ischemic time were significantly shorter in the buried flap cohort, when compared to that of the skin-paddle cohort. The take-back surgery rates, flap failure rates, and other complication rates were similar between two cohorts under the intra- and post-operative monitoring protocol.

Conclusion

This study supported the feasibility of autologous abdominal free-flap breast reconstruction using the buried flap approach, and we validated our intra- and post-operative monitoring protocol. A multicenter and prospective study is needed to validate this approach.
Trial registration：NCT05560633