bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stopping inappropriate medication of children with intellectual disability, autism or both: the STOMP–STAMP initiative
Authors: Swanepoel Annie , Lovell Mark 
Published: March 2023

SUMMARYChildren with intellectual disability are often prescribed psychotropic medication to manage behaviours that challenge. Unfortunately, many receive medication with potentially serious long-term side-effects that has been prescribed inappropriately or for longer than is necessary. NHS England launched STOMP (stopping the over-medication of people with intellectual disability, autism or both with psychotropic medicines) in 2016 to reduce the inappropriate prescribing in adults. This was broadened to include children in 2018 by the addition of STAMP (supporting treatment and appropriate medication in paediatrics). In this article we review the rationale for STOMP–STAMP, highlight the Royal College of Psychiatrists’ position statement on STOMP–STAMP and give clinical advice for psychiatrists who treat children with intellectual disability, autism and/or attention-deficit hyperactivity disorder (ADHD). Importantly, it is essential to consider that ADHD may have been missed and that by diagnosing and treating it, the need for inappropriate antipsychotic medication may be reduced.
Effect of Distance From Fertility Center on Utilization of Fertility Preservation Referral in Men
Authors: Pelzman Daniel , Dederer Gregory , Joolharzadeh Pouya , Morrill Christian , Orwig Kyle , Pulaski Hanna , Hwang Kathleen 
Published: March 2023

PURPOSE: Fertility preservation (FP) is underutilized in males with cancer or other diseases requiring gonadotoxic therapies. We sought to evaluate whether patient distance from FP center affected rates of providing a semen analysis after referral. MATERIALS AND METHODS: We performed a retrospective analysis of all males who were referred for FP at a single institution between 2013 and 2021. A multiple logistic regression model was conducted with semen sample submission as the variable of interest. Predictor variables were disease type, distance, and payment method. Secondary outcomes were number of semen samples submitted and number of vials collected. RESULTS: Records of 461 males referred to our center were analyzed. Of these patients, 326 (71%) provided a semen sample after referral and 135 (30%) did not. Further distance from our center was associated with lower odds of submitting a semen sample (OR, 0.85; 95% CI, 0.75 to 0.97; P < .05). For patients who submitted at least one sample, distance did not affect the total number of samples submitted but was associated with a small increase in total vials cryopreserved. CONCLUSION: Men referred for FP exhibit a high rate of sperm cryopreservation. Further distance from FP center was associated with decreased odds to provide semen sample after referral. Our model estimated a 15% decrease in odds of collection with every doubling of distance from our center. Efforts must be made to improve FP utilization for patients traveling far distances, but distance alone should not preclude referral.
Real-world Experience With Neurotrophic Tyrosine Receptor Kinase Fusion–positive Tumors and Tropomyosin Receptor Kinase Inhibitors in Veterans
Authors: Zhou Katherine I. , Vashistha Vishal , Guo Aixia , Ahmed Sara , Kelley Michael J. 
Published: March 2023

PURPOSE Neurotrophic tyrosine receptor kinase 1-3 ( NTRK1-3) gene fusions are found in a broad range of tumor types. Clinical trials demonstrated high response rates to tropomyosin receptor kinase (TRK) inhibitors in NTRK fusion–positive cancers, but few reports have described real-world experience with these targeted agents. We evaluated the prevalence of NTRK fusions and the outcomes with TRK inhibitor therapy in a real-world population of patients in the Veterans Health Administration. METHODS Patients with NTRK fusions or rearrangements were identified from the Veterans Affairs (VA) National Precision Oncology Program (NPOP), and patients who were prescribed TRK inhibitors were identified from the Corporate Data Warehouse. Baseline data and clinical outcomes were obtained by retrospective review of medical records. RESULTS A total of 33 patients with NTRK fusions or rearrangements were identified, including 25 patients comprising 0.12% of all patients with solid tumors sequenced through VA NPOP. Twelve patients with NTRK fusions or rearrangements were treated with TRK inhibitors, none of whom had objective responses. Eight patients experienced toxicities leading to drug interruption, dose reduction, or discontinuation. CONCLUSION In this retrospective study of VA patients, NTRK fusions and rearrangements were less common than in previous studies, and objective responses to TRK inhibitors were not observed. Real-world experience with TRK inhibitors differs markedly from clinical trial findings, possibly due to differences in patient demographics, tumor types, and sequencing methods. Our findings highlight the need to study TRK inhibitors in the real-world setting and in populations underrepresented in clinical trials.
Gauge symmetry of the chiral Schwinger model from an improved gauge unfixing formalism
Authors: Ambrósio Gabriella V. , Costa Cleber N. , Alves Paulo R. F. , Abreu Everton M. C. , Neto Jorge Ananias , Thibes Ronaldo 
Published: March 2023

Abstract
In this paper, the Hamiltonian structure of the bosonized chiral Schwinger model (BCSM) is analyzed. From the consistency condition of the constraints obtained from the Dirac method, we can observe that this model presents, for certain values of the α parameter, two second-class constraints, which means that this system does not possess gauge invariance. However, we know that it is possible to disclose gauge symmetries in such a system by converting the original second-class system into a first-class one. This procedure can be done through the gauge unfixing (GU) formalism by acting with a projection operator directly on the original second-class Hamiltonian, without adding any extra degrees of freedom in the phase space. One of the constraints becomes the gauge symmetry generator of the theory and the other one is disregarded. At the end, we have a first-class Hamiltonian satisfying a first-class algebra. Here, our goal is to apply a new scheme of embedding second-class constrained systems based on the GU formalism, named improved GU formalism, in the BCSM. The original second-class variables are directly converted into gauge invariant variables, called GU variables. We have verified that the Poisson brackets involving the GU variables are equal to the Dirac brackets between the original second-class variables. Finally, we have found that our improved GU variables coincide with those obtained from an improved BFT method after a particular choice for the Wess-Zumino terms.
114 Angiographic Evaluation and Treatment Outcomes in Suspected Cerebrovascular Causes of Pulsatile Tinnitus
Authors: Cummins Daniel Dighton , Caton Michael Travis , Hemphill Kafi , Narsinh Kazim , Tu-Chan Adelyn , Meisel Karl , Amans Matthew 
Published: March 2023

INTRODUCTION:
Pulsatile tinnitus (PT) can cause significant detriment to quality of life and may herald a life-threatening cerebrovascular etiology. Digital subtraction angiography (DSA) can both provide a definitive diagnostic etiology of PT and offer endovascular treatment, yet the distribution of causes for PT and treatment efficacies remain to be determined.

METHODS:
Patients suspected to have a cerebrovascular source of PT who were evaluated by endovascular techniques at one large-volume PT center were retrospectively assessed. Baseline clinical features and treatment results by final etiology of PT were compared.

RESULTS:
164 patients who underwent endovascular evaluation of PT were included. Mean age was 54.3 ± 14.1 (25–89 years); 111 patients (67.7%) identified as female; and duration of PT was a median 365 days at presentation (range 11–7665 days). Causes of PT were 75.6% cerebrovascular and 24.4% non-vascular. Arteriovenous shunting lesions caused 20.7% of cases; venous etiologies 48.2%; and arterial etiologies 6.7%. Of patients with a shunting lesion treated endovascularly, 96.9% had lasting significant improvement or resolution in PT. Endovascular treatment was also associated with significant improvement in PT due to venous etiologies (73.4% with endovascular treatment vs 17.2% without; p < 1E-5). Arterial PT (18.2%) and non-vascular etiologies (0%) had fewer patients treated endovascularly and less improvement in PT symptoms.

CONCLUSIONS:
PT with a suspected cerebrovascular cause is most often attributable to venous etiologies. Arteriovenous shunting is a less common etiology of PT, but is the most responsive to treatment, and has the best symptomatic outcomes.
116 Switching from System-Based to Problem-Based Charting Increases the Patient-Specific Expected Mortality Rate and Length of Stay on a Neurosurgery Service
Authors: Ali Rohaid , Hagan Matthew , Tang Oliver Young , Sastry Rahul , O'Brien Jill , Dean Roye G. , Toms Steven A. , Asaad Wael , Doberstein Curtis E. , Oyelese Adetokunbo , Gokaslan Ziya L. , Telfeian Albert Edward 
Published: March 2023

INTRODUCTION:
To date, limited research has focused on how charting styles can affect quality metrics in neurosurgery.

METHODS:
We performed a comparative interrupted time-series analysis at an urban, academic, level I trauma center. The intervention consisted of adjusting the charting style from system-based to problem-based charting on an inpatient neurosurgery service line and providing a one-hour educational session targeting improved documentation of three problems with high clinical relevance to neurosurgery.

RESULTS:
Among patients whose providers were exposed to the charting improvement intervention, there was a significant increase in the E-MR (p = 0.029). Average E-LOS also increased to a degree that approached significance (p = 0.085). In a multivariate model adjusting for elective status, length of stay, cost of admission, and hospital associated complications, the increases in both E-MR (p = 0.029) and E-LOS (p = 0.091) persisted. The switch from SBC to PBC resulted in noninferior rates of documentation (p>0.05) for the six most common complications not targeted as documentation opportunities during the educational intervention. Among patients in the reference group, whose providers did not receive the charting intervention, there was no significant change in either the E-MR (p = 0.198) or the E-LOS (p = 0.341), both of which slightly decreased over the course of the study period.

CONCLUSIONS:
Switching from SBC to specialty-focused PBC on a neurosurgery service line at an urban, academic, level I trauma center led to a statistically significant increase in the average patient-specific E-MR and a trend toward significant increase in the average patient-specific E-LOS. The study illustrates the degree to which a low-cost intervention on documentation patterns can impact neurosurgical risk-adjusted quality metrics.
120 Blast-Related Traumatic Brain Injuries Secondary to Thermobaric Explosives: Implications for the War in Ukraine
Authors: Zhang Justin , Botterbush Kathleen , Bagdady Kazimir , Mercier Philippe , Mattei Tobias A. 
Published: March 2023

INTRODUCTION:
Advancements in modern weaponry have vastly increased the incidence and severity of craniospinal injuries. Specifically, thermobaric weapons can cause devastating blast-related traumatic brain injury (bTBI). With recent use of these weapons in the war in Ukraine, clinicians and laypersons alike may benefit from an improved understanding behind the dynamic interplay between explosive weaponry, its potential for bTBI, and the subsequent short and long-term consequences of these injuries.

METHODS:
A comprehensive review of thermobaric weapons and their use throughout history was performed. Mechanisms of action behind blast injuries and subsequent therapeutic advancements in neurosurgical management from pioneers of neurosurgery was conducted. We document long term neuropsychiatric sequela following bTBI and discuss its relevance in the current conflict in Ukraine. In addition, a quantitative analysis of the potential of thermobaric weapons to cause bTBI in a hypothetical scenario of its use in Ukrainian civilian zones was performed.

RESULTS:
A thermobaric weapon causes a prolonged blast pressure wave which can cause devastating injury through several mechanisms, including long-term neuropsychiatric sequela (notably PTSD). The origins of bTBI sequela date back to documentations in WWI of “shell-shock”, now widely known as PTSD. Trailblazers in neurosurgery, such as Harvey Cushing, and prominent psychologists, such as Charles Myers, were pivotal in identifying and treating early cases of bTBI. Our quantitative analysis demonstrates the significant potential of thermobaric weapons in causing bTBI. Construction of underground shelters may mitigate damage from the blast pressure wave.

CONCLUSIONS:
As humanitarian relief efforts set foot in Ukraine, results from our brief report may inform and assist the development of focused mitigation and rehabilitation strategies, especially in post-war reconstruction
121 Development and Validation of a Predictive Score for Lumbar Synovial Cyst Recurrence
Authors: Page Paul , Greeneway Garret , Ammanuel Simon G. , Resnick Daniel K. 
Published: March 2023

INTRODUCTION:
Lumbar Synovial Cysts represent a relatively rare clinical pathology that may result in radiculopathy or neurogenic claudication. Due to their potential for recurrence, some authors advocate for segmental fusion, as opposed to decompression alone, as a way to eliminate the risk for recurrence.

METHODS:
A retrospective review was conducted of all patients evaluated at a single center over 20 years who were found to have symptomatic lumbar synovial cysts requiring intervention. Only patients undergoing decompression without fusion were included in the analysis. Following this, baseline characteristics were obtained as well as radiographic information. A machine learning method (RiskSLIM) was then utilized to create a risk stratification score to identify patients at high risk for symptomatic cyst recurrence requiring repeat surgical intervention. Following this a 5-fold cross validation was completed.

RESULTS:
In total 89 patients were identified to have complete radiographic information. Of these, 11 patients developed cyst recurrence requiring reoperation. The Lumber Synovial Cyst Score (LSCS) was then created with an area under the curve of 0.83 with CAL error of 11.0%. Predicative factors were found to include facet inclination angle greater than 45 degrees, canal stenosis greater than 50%, T2 joint space hyperintensity, and presence of grade I spondylolisthesis. The probability of cyst recurrence ranged from < 5% for a score of 2 or less and > 88% for a score of 7.

CONCLUSIONS:
The LSCS model is a quick and accurate tool to assist in clinical decision making in treatment of lumbar synovial cysts.
136 Morphological Clusters of Chiari I Patients With Variable Response After Suboccipital Decompression
Authors: Nanda Pranav , Kons Zachary , Talati Pratik , Khanna Arjun , Shannon Elizabeth , Grannan Ben L. , Abulnaga Mazdak , Shnitzer Tal , Kahle Kristopher , Butler William 
Published: March 2023

INTRODUCTION:
Chiari malformation type I (CM-I) can cause debilitating neurologic symptoms, most notably distinctive headaches, and the only existing definitive treatment is suboccipital decompression. While CM-I is typically defined as ≥5 mm downward displacement of cerebellar tonsils, overall CM-I cerebellar morphology is highly heterogeneous, and it is uncertain if this variability represents distinct patient populations or influences clinical response to suboccipital decompression.

METHODS:
186 adult CM-I patients with high-resolution T1-MRIs were retrospectively identified. Each patient’s cerebellum was non-linearly and diffeomorphically transformed to template brain, with this transformation’s inverse representing cerebellar deformation. A similarity matrix was generated between patients’ deformations using the Pearson correlation coefficient of their inverse transformations’ log Jacobian determinants within each cerebellar lobule. Spectral clustering was performed on this similarity matrix to identify patient clusters. Headache freedom after suboccipital decompression was compared between clusters by Kaplan-Meier analysis.

RESULTS:
Three morphological clusters of CM-I patients were identified. Cluster A is characterized by posteroinferior cerebellar fullness and platybasia; B by midline anterior-posterior compression; C solely by tonsillar descent. After suboccipital decompression, headaches were found to recur more frequently and sooner in Cluster B (p < 0.01).

CONCLUSIONS:
These analyses suggest that CM-I encapsulates morphologically distinct subtypes, here identified as Cluster A and Cluster B, with Cluster C representing an intermediate phenotype. These clusters vary significantly in clinical response to suboccipital decompression, which may have implications for surgical patient selection or operative technique. Future research should involve independent validation of this cluster scheme and optimization of treatment for patients in Cluster B, which is found here to have poorer surgical outcomes.
153 Utilizing a 32-Channel System for Treatment of Complex Movement Disorders: Initial Case Series
Authors: Sherman Benjamin , Ahmed Mahad , Tov Lior Lev , Verhein Jessica , Hornbeck Traci , Halpern Casey H. , Katz Maya , Henderson Jaimie M. , Buch Vivek 
Published: March 2023

INTRODUCTION:
Complex, mixed movement disorders affecting multiple pathways (e.g., Holme’s Tremor (HT) or comorbid essential tremor (ET) with dystonia, among others) represent significant challenges for surgical treatment. These disease states are likely the result of combined or complex network pathologies, requiring multi-nodal targeting for DBS.

METHODS:
Multiple simultaneous deep targets were implanted using four 8-contact, directional leads placed through 2 burr-holes, which were connected to a 32-channel pulse generator. Targets were chosen based on disorders and comorbidities.

RESULTS:
Seven complex movement disorder patients were operated on at Stanford University using the approach described above. All seven patients in the series reported significant improvement in symptoms, and four patients also had objective metrics recorded demonstrating significant improvements. In these four patients, patient A presented with DBS-refractory Parkinsonian tremor and showed additional 17% reduction in UPDRS after addition of a third lead from an existing burr hole, utilizing the 32-channel system. Similarly patient C with HT and patients D and E with ET/dystonia all demonstrated significant improvement in TRS (p < 0.01) and dystonic symptoms after bilateral dual targeting of VIM and GPi through two burr-holes. Programming utilized tailored fractionation and stimulation parameters to achieve optimal results.

CONCLUSIONS:
We present the largest initial case series demonstrating the feasibility of a 32-channel multi-target DBS strategy for treating complex movement disorders. This approach warrants further investigation for treating complex, multi-circuit neuropsychiatric disorders.
169 Exome Sequencing Implicates Endothelial Ras Signaling Network in Vein of Galen Aneurysmal Malformation
Authors: Mekbib Kedous Y. , Zhao Shujuan , Nelson-Williams Carol , Prendergast Andrew , Zeng Xue , Rolle Myron , Shohfi John , Smith Hannah , Ocken Jack , Moyer Quentin , Piwowarczyk Paulina , Allington Garrett , Dong Weilai , van der Ent Martijn A. , Chen Di , Li Boyang , Duran Daniel , Mane Shrikant M. , Walcott Brian Patrick , Stapleton Christopher J. , Aagaard-Kienitz Beverly , Rodesch Georges , Jackson Eric M. , Smith Edward R. , Orbach Darren , Berenstein Alejandro , Bilguvar Kaya , Zhao Hongyu , Erson-Omay Zeynep , King Philip D. , Huttner Anita , Lifton Richard , Boggon Titus , Nicoli Stefania , Jin Sheng Chih , Kahle Kristopher 
Published: March 2023

INTRODUCTION:
Early neurovascular development is a complex and intricate process with devastating consequences when impaired. Vein of Galen Aneurysmal Malformations (VGAMs) are the most common and severe neonatal arteriovenous malformation and often present with high-output heart failure, hydrocephalus, neurodevelopmental delay, and brain hemorrhage. Despite their prevalence and severity, little is known regarding their genetic pathomechanism.

METHODS:
Genetic samples were collected from 114 VGAM probands, including 90 trios, from multiple sites. Collected specimens underwent whole exome sequencing, pathway analysis, and select ACVRL1 and EPHB4 mutations identified via sequencing were then studied in zebrafish models.

RESULTS:
Exome sequencing revealed a genome-wide significant burden of de novo mutations in Ras suppressor p120 Ras-GAP (RASA1) (enrichment = 324-fold; p = 4.8 x 10-7). Damaging transmitted variants were enriched in p120 Ras-GAP negative regulator Eph-B4 (EPHB4) (odds ratio = 27.4; p = 1.7 x 10-6). Eph-B4 missense variants caused loss of receptor tyrosine kinase activity constitutive Ras activation. Other probands had pathogenic variants in OMIM vascular disease genes PTNPN11, NOTCH1, and ACVRL1; the latter we found mutated in an ultra-rare multi-generational VGAM family. Pathway analysis identified enrichment of rare, damaging de novo and inherited variants in a network of interacting OMIM vascular disease genes involved in axon guidance (FDR = 2.3 x 10-5; enrichment = 3.65-fold). In zebrafish, the functional studies of ACVRL1 and EPHB4 confirmed severe vascular defects in mutant embryos.

CONCLUSIONS:
These results demonstrate that genetic regulation of a RASA1-centered Ras signaling hub is critical for cerebrovascular development and is impaired in VGAM pathogenesis. This finding has significant implications for the genetic counseling of patient families and the development of targeted therapeutics for VGAM neurovascular disorders.
172 Health Inequities in Access to Treatment for Unruptured Intracranial Aneurysms in the United States over 20 Years
Authors: Kandregula Sandeep , Savardekar Amey R. , Beyl Robbie , Caskey Joshua , Jee Elizabeth , Terrell Danielle , Adeeb Nimer , Whipple Garrett , Newman W. Christopher , Toms Jamie , Kosty Jennifer , Sharma Panjak , Cuellar Hugo , Guthikonda Bharat 
Published: March 2023

INTRODUCTION:
Literature suggests that minority racial and ethnic groups have lower treatment rates for unruptured intracranial aneurysms (UIA). It is uncertain how these disparities have changed across time.

METHODS:
The National Inpatient Sample (NIS) database was queried using diagnostic and procedural codes for adult patients who underwent open surgical or endovascular treatment for UIA. Aneurysmal SAH patients were used as a substitute control for patients with intracranial aneurysms that progressed to hemorrhage before intervention. A multivariable logistic regression model was constructed using patient factors and hospital factors to identify predictors of treatment.

RESULTS:
A total of 213,350 UIA patients and 173,375 aSAH patients from 2000-2019 were included in the final analysis. After adjusting for covariates, Black patients (0.715, 95% CI 0.699-0.730), Hispanic patients (0.734, 95% CI 0.717-0.751) and other racial/ethnic minority patients (0.633, 95% CI 0.617-0.651) had lower odds of intervention for UIA compared to White patients with UIA. Medicare patients had higher odds of treatment than private insurance patients while Medicaid and the uninsured patients had lower odds. Non-White/Hispanic females (0.697, 95% CI 0.646-0.752) and males (0.602, 95%CI 0.556-0.651) had lower treatment odds than their white counterparts, irrespective of insurance status. Multivariable regression analysis revealed that the treatment odds of Black patients improved over time, while other minority group patients had variable treatment odds over time.

CONCLUSIONS:
This analysis of NIS data from 2000 to 2019 demonstrates disparities in treatment for UIA across race, sex, insurance status, and hospital factors. The persistence of inequalities over time requires attention in order to target improvement.