bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Qualitative-Electroencephalogram (Q-EEG) Mapping to Aid the Selection of Suitable Areas to Target Repetitive Transcranial Magnetic Stimulation (rTMS) Treatment in a Case of Depression With Comorbid Obsessive Compulsive Disorder (OCD)
Authors: Eltagy Louay , O'Neill-Kerr Alex , Hristova Nadia 
Published: June 2022

AimsWe present the case of SN, a 25-year-old woman with diagnosis of anorexia nervosa, OCD, Generalized Anxiety Disorder (GAD) and depression. She has extensive history of contact with mental health services spanning more than 10 years. She has had 1 inpatient stay in an eating disorders unit lasting more than 6 months. Her treatment included various classes of medications, psychological therapy and social prescribing with little or no benefit. She has been referred to rTMS. The aims of the study are to determine the effect of rTMS in treatment of a patient with depression comorbid with OCD, understand the value of q-EEG in rTMS treatment and to treat OCD symptoms using rTMS guided by QEEG.MethodsSN had a total of 56 rTMS sessions targeting standard depression and anxiety areas; F3 (left sided excitatory) and F4 (right sided inhibitory). Following this her depression and anxiety improved but her OCD worsened. She then underwent a Q-EEG to be able to understand the physiological cause of her symptoms and suggest meaningful further neuromodulation that is tailored to her. This indicated dysregulation within the default mode network. Spindling beta waves were detected over the posterior electrode suggesting a tendency towards ruminations. There was clear hyperactivity in the supplementary motor area. SN had further 30 rTMS sessions targeting the OCD circuit (FC1 and FC2).ResultsRating scales showed a reduction in Patient Health Questionnaire-9 (PHQ-9) score from 22 to 14 (36%) in second course compared to an increase of PHQ-9 score from 9 to 15 (66.6%) in first course; indicating an overall 102% improvement in PHQ-9. It also showed reduction of Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in second course from 34 to 8. It was not done in the first course but there was a clinical increase in OCD symptoms following the end of the first course. These results were corroborated clinically.A repeat q-EEG showed that the areas previously highlighted in red at FC1 and FC2 had now all reverted to green, indicating normal neuronal connectivity.ConclusionrTMS can provide timely and adequate response to depression and anxiety especially one that has not responded adequately to medications and psychotherapy. Q-EEG is useful to direct the plan, create a personalized plan and achieve accurate results. The use of q-EEG, whilst useful, should be balanced with other considerations as financial constraints. It should be reserved to patients who have not responded favorably to standard rTMS treatment.
Natural Language Processing of Electronic Patient Records to Predict Psychiatric Inpatients at Risk of Early Readmission to Hospital Using Predictive Models Derived Through Machine Learning
Authors: Kapadi Tarif , Luz Saturnino 
Published: June 2022

AimsPsychiatric readmissions cause a burden on the healthcare system, incur a monetary cost and cause additional distress to acutely unwell patients. This project explores the use of the free-text of electronic patient records to predict inpatients in psychiatric hospitals at risk of readmission using predictive models generated by machine learning.MethodsFree-text was extracted from the electronic patient records of patients admitted to hospitals in Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) during the five years 2015–2019 inclusive. The anonymised records were obtained via the CRIS (Clinical Record Interactive Search) database. A total of 17208 records were extracted.The free-text entered by clinicians during an admission was extracted and processed using techniques of natural language processing to generate input vectors suitable to be used with machine learning algorithms. tf-idf (term frequency-inverse document frequency) vectors were used.A selection of algorithms were used to train predictive models. Two-thirds of the records were used as training data with the remainder as test data. Baseline model performance was assessed and then best-performing candidates underwent hyperparameter optimisation using five-fold cross-validation to improve performance. Bayesian optimisation was used to automate hyperparameter tuning during cross-validation. Hyperparameters were optimised on the log loss function. As the dataset was imbalanced with negative instances outnumbering positive instances to a significant degree, various techniques such as random undersampling of negative instances in the training data were used to deal with class imbalance throughout this process. Following cross-validation, the best-performing models underwent performance analysis.Models were used to make predictions on the test data. Performance was assessed using F1-measures, precision-recall curves and the average precision metric (equivalent to area under the precision-recall curve). These metrics were chosen due to their suitability in assessing models trained on imbalanced datasets.ResultsThe best F1 score obtained was 0.233 using a Random Forest model trained using unigram tf-idf vectors of 500 token dimension.The best average precision obtained was 0.157 using a Support Vector Machine trained using unigram tf-idf vectors of 2000 token dimension.Both the above results required the use of random oversampling of positive instances to improve performance on the imbalanced dataset.ConclusionThe performance indicates that the models generated are unlikely to have significant practical utility. Nevertheless, this exploratory project has produced a processed dataset with knowledge about its characteristics. This could be used for the further development of models using more complex techniques such as language modelling using neural networks.
Physical Health Screening in a Mental Health Setting
Authors: Middleton Laura , Ashcroft Katherine , Mather Alex , Gargan Georgina , Older Abby , Mitchell Andrew , Shaw Elizabeth 
Published: June 2022

AimsResearch demonstrates greater mortality and physical health morbidity in those with mental illness, as compared to the general population. National Health Service (NHS) England has introduced policies to reflect this and promote improvements in physical healthcare for mental health patients. Inpatient admission provides a valuable opportunity to action such recommendations and offer a detailed health review, guided by local frameworks. A new annual audit commenced in Cheshire and Wirral Partnership NHS Foundation Trust (CWP) assesses admission physical health screening on its adult acute inpatient wards.MethodsAudit standard was 100% compliance to CWP's admission pathway (Policy CP35). Parameters included doctor's review, medical history, physical examination, drug history, medication chart, allergy status, venous thromboembolic risk, blood tests, electrocardiogram (ECG), physiological observations, smoking history, body mass index (BMI) and falls risk. Data were collected retrospectively for all patients admitted or transferred to Juniper Ward, an acute adult inpatient unit in Bowmere Hospital in Chester, during October 2020 (cycle 1) and September 2021 (cycle 2). Different months were assessed due to senior staff changes in October 2021.Results30 patients were identified in 2020 and 37 in 2021. In 2020 the most consistently achieved parameters were, in order, medication chart/drug history, doctor's review and past medical history. In 2021 the most consistently achieved parameters were medication chart/drug history, smoking status and past medical history. Across both years completion of the cardiometabolic tool was lowest, although this improved from 6.7% to 16.2%. In 2020 there were 5 parameters achieving <50% compliance (cardiometabolic, physiological observations, smoking status, BMI and falls risk). In 2021 this reduced to 3 parameters (doctor's review, cardiometabolic tool, falls risk). Local policy was updated following the 2020 results, amending the criteria for doctor's review from commenced within 6 hours, to completed within 12 hours. Improvement was seen in all other areas in 2021, with medication chart/drug history documentation achieved in 100% of admissions.ConclusionGeneralised improvement was seen following the 2020 audit, although only one parameter reached 100% compliance and most remained under 75%. The first cycle led to a policy change with respect to the doctor's review timeframe, although this limited direct comparison between years. A flow chart will be trialled on Juniper Ward, highlighting required tasks and assigning ownership to specific team members. The local Medical Education team were also made aware of the results to inform junior doctor induction. The audit will be repeated in Autumn 2022.
The Impact of COVID-19 Outbreak (2nd Wave) on Mental Health of the Healthcare Community in the NHS: A Web-Based Questionnaire Study
Authors: Nasim Omer , Hayat Muhammad Khizar , Hussain Zeinab , Afridi Malghalara , Khan Raza Ali 
Published: June 2022

AimsTo determine the mental impact the second wave of COVID-19 has had on health care professionals working in the National Health Services (NHS), United Kingdom.MethodsA cross-sectional descriptive web-based survey was conducted among the staff of National Health Services (NHS) in Poole, United Kingdom. Two tertiary care hospitals staff were part of this study. The study was spanned over a duration of 6 months, October 2020 to April 2021. A standard GAD-7 and PHQ-9 questionnaire along with demographic information was uploaded on google docs for data collection. All healthcare staff working in the hospitals were included. Any person that did not fill the questionnaire completely was excluded. Data collected were analysed using SPSS for descriptive statistics and the chi-squared test was done keeping p < 0.05 as significant.ResultsA total of 160 health care professionals took part in the survey, with a mean age of 37.36 (SD = 11.51) years, predominantly females (58.8%). The majority of participants were not depressed (78.1%, p = 0.004) nor were they anxious (85%, p = 0.008). A significant difference (p = 0.050) was seen in participant's anxiousness regarding the source of information. All other demographic parameters were not significant for differences in depression or anxiety (p > 0.05). 33.6% of the respondents agreed and 9.6% totally agreed to being terrified of contracting the coronavirus. 40.4% disagreed while 16% did not have an opinion. A similar trend was seen for the other statements. More than half (56.3% and 56.9%) of the participants answered in the affirmative that they were worried about contracting the disease and getting their living place contaminated, a staggering 91.3% were anxious about affecting their families.ConclusionThe second wave of COVID-19 has had minimal effect on the mental health of health care workers in the NHS.
An Audit and Quality Improvement Project Regarding the Management of Patients With Eating Disorders Within the West Glasgow CAMHS Team
Authors: Singh Sukhmeet , Roberts Maryjane , Clark Alexandra , Boyle Christabel 
Published: June 2022

AimsThere has been a significant increase in presentations of people with eating disorders (ED) within CAMHS in relation to the pandemic with a significant pressure on services to continue to provide evidence-based treatments for an expanding number of severely unwell patients. The first aim was to assess the quality of referrals received for patients with suspected ED and to then implement an intervention regarding the way that referrals are handled. The second aim was to establish a process for handling and monitoring patients already open to the service.MethodsAn initial and repeat survey was sent to staff within the team. The survey included the Mental Health Professional Stress Scale (MHPSS). An audit was conducted to establish the quality of referrals from GPs based on the Junior Marsipan guidelines. Data were collected on physical measures and the written content of referrals for March 2020–21 and March 2021–22.Duty clinicians were asked to screen referrals and prompt GPs to submit recordings of physical parameters for the referrals to be triaged. In addition, a weekly meeting in a “board round” format was implemented to discuss new referrals and 40–50 existing patients each week depending on risk. We developed a physical health monitoring clinic once per week.ResultsMHPSS scores remained high between initial and follow-up surveys, with slightly increased mean scores for workload, organisational structure and processes, and lack of resources. Referrals from 2020–2021 (N = 26) and those from 2021–2022 (N = 39) were screened. The majority had a diagnosis of anorexia nervosa. Most referrals had records of height and weight (73.1 to 82.1%). 53.8% of referrals in the re-audit period required prompting for physical recordings to be submitted. There was no change in the written content of referrals at re-audit, with only 46.2% recording risk, 51.3% recording estimated onset and 56.4% documenting body image.There was a slight reduction in the mean time between referral and diagnosis from 44.1 to 34.2 days. The weekly board round received positive feedback (N = 10) with 70–100% answering agree/strongly agree to statements such as manage patients’ care safely, obtaining urgent advice and physical monitoring.ConclusionThe processes summarised above have been successful in improving the efficiency surrounding the management of patients with ED. Unfortunately, there has been no improvement in the stress levels of staff; we hope to conduct a focus group to better understand this. A referral proforma should be developed by the wider service for GPs to complete.
Morning Pseudoneutropenia in a Patient With Borderline Personality Disorder Treated With Clozapine
Authors: Tungaraza Tongeji 
Published: June 2022

AimsNeutropenia associated with clozapine affects up to 3% of patients. For the purpose of clozapine treatment, absolute neutrophil count (ANC) between 1.5–2.0 × 109/L is considered as amber result; requiring twice-weekly blood sampling until when it returns to normal. Interestingly, some patients on clozapine may develop transient neutropenia also known as Morning Pseudoneutropenia (MPN), or pseudoneutropenia. It is a phenomenon where normal diurnal variation of circulating white blood cells (WBC) and in particular ANC become more accentuated. In these patients, blood samples taken in the morning would tend to have amber results, while blood samples taken on the same day in the afternoon will have normal ANC. A case is reported where a patient with severe emotionally unstable personality disorder (EUPD) developed MPN 38 days after clozapine initiation.MethodsAA is a 19-year-old white lady with a diagnosis of severe EUPD. Prior to starting clozapine, AA had tried several oral and depot antipsychotics, antidepressants and lithium without success. AA was started on clozapine. Her initial pre-clozapine blood count taken in the morning was WBC-5.8 x109/L and her ANC was 2.7 x109/L. AA improved quickly on clozapine. However, five weeks later, her first amber report was received. AA went on to have another six amber results before MPN was suspected. AA blood sampling was moved to the afternoon. There were no more amber results thereafter.ResultsTo my knowledge, this is the first published case of a patient with EUPD treated with clozapine who went on to develop MPN. Recurrent amber results with samples taken before mid-day should alert clinicians of this phenomenon. Of course, other causes of neutropenia need to be excluded.It is noteworthy that most reported cases in literature though few, involves patients with treatment resistant schizophrenia. Being aware of this phenomenon may raise our suspicion index and hopefully reduce the need for frequent repeated blood tests and the need to stop clozapine given the risk of relapse and its implications.Few cases have also been reported in patients with physical health problems such as Grave's disease, systemic lupus erythematosus, and lymphangioleiomyomatosis. Medications that have been implicated to potentiate ANC diurnal variation including clozapine, risperidone, prednisolone, methimazole, and sirolimus.ConclusionMorning pseudoneutropenia is an accentuated normal diurnal variation of WBC. Early detection by collecting samples in the afternoon when there are recurring amber results can reduce unnecessary repeated blood tests and can prevent premature discontinuation of clozapine.
A Randomized Trial Evaluating Patient Experience and Preference Between Octreotide Long-Acting Release and Lanreotide for Treatment of Well-Differentiated Neuroendocrine Tumors
Authors: Raj Nitya , Cruz Elizabeth , O'Shaughnessy Sarah , Calderon Claudia , Chou Joanne F. , Capanu Marinela , Heffernan Olivia , DeMore April , Punn Sippy , Le Tiffany , Hauser Haley , Saltz Leonard , Reidy-Lagunes Diane 
Published: June 2022

PURPOSE: Somatostatin analogs octreotide long-acting release (octLAR) and lanreotide are equally acceptable in National Comprehensive Cancer Network guidelines for neuroendocrine tumors (NETs). Lanreotide is more expensive and given by deep subcutaneous injection, whereas octLAR is given intramuscularly. We evaluated patient preference between these agents in terms of injection site pain. MATERIALS AND METHODS: Randomized, single-blinded study. Patients with NETs received injections every 4 weeks. Arm 1: octLAR × 3, then lanreotide × 3; arm 2: reverse order. Self-reported injection site pain scores (range, 0-10) were obtained after each of the first three injections. Primary end point was comparison of mean pain scores over the first three injections. Secondary end points included patient-reported preference. RESULTS: Fifty-one patients enrolled (26 in arm 1 and 25 arm 2), all evaluable for primary end point. No significant difference was identified in the mean pain score over the first three injections (2.4 ± 1.9 v 1.9 ± 1.5, P = .5). Thirty-four of 51 (67%) patients (15 in arm 1 and 19 in arm 2) completed post-therapy questionnaires and were evaluable for secondary end points. Seven patients (47%) in arm 1 and eight patients (42%) in arm 2 indicated no drug preference at the end of treatment. In the other 19 patients, more patients indicated mild or strong preference for octLAR over lanreotide. CONCLUSION: We found minimal pain with octLAR and lanreotide and no significant pain score differences between the two. Patients indicating a drug preference trended toward favoring octLAR.
A lattice hydrodynamic model integrating the velocity limit effect under V2X environment
Authors: Jin Can , Li Xiaoqin , Peng Guanghan 
Published: June 2022

Abstract
The velocity limit signal often occurs because of bad traffic road infrastructure. Therefore, a novel lattice hydrodynamics model is provided by combining the velocity limit effect under V2X environment. The linear stability analysis reveals that the stability conditions are closely related to the velocity limit effect. Moreover, the evolution of density and hysteresis loop have been deeply explored in this paper via simulation. Interestingly, it is valuable to correctly consider the impact of velocity limit on traffic flow, which can play a positive role on traffic stability.
Female meiosis II and pronuclear fusion require the microtubule transport factor Bicaudal D
Authors: Vazquez-Pianzola Paula , Beuchle Dirk , Saro Gabriella , Hernández Greco , Maldonado Giovanna , Brunßen Dominique , Meister Peter , Suter Beat 
Published: June 2022

ABSTRACT
Bicaudal D (BicD) is a dynein adaptor that transports different cargoes along microtubules. Reducing the activity of BicD specifically in freshly laid Drosophila eggs by acute protein degradation revealed that BicD is needed to produce normal female meiosis II products, to prevent female meiotic products from re-entering the cell cycle, and for pronuclear fusion. Given that BicD is required to localize the spindle assembly checkpoint (SAC) components Mad2 and BubR1 to the female meiotic products, it appears that BicD functions to localize these components to control metaphase arrest of polar bodies. BicD interacts with Clathrin heavy chain (Chc), and both proteins localize to centrosomes, mitotic spindles and the tandem spindles during female meiosis II. Furthermore, BicD is required to localize clathrin and the microtubule-stabilizing factors transforming acidic coiled-coil protein (D-TACC/Tacc) and Mini spindles (Msps) correctly to the meiosis II spindles, suggesting that failure to localize these proteins may perturb SAC function. Furthermore, immediately after the establishment of the female pronucleus, D-TACC and Caenorhabditis elegans BicD, tacc and Chc are also needed for pronuclear fusion, suggesting that the underlying mechanism might be more widely used across species.
A terrain treadmill to study animal locomotion through large obstacles
Authors: Othayoth Ratan , Strebel Blake , Han Yuanfeng , Francois Evains , Li Chen 
Published: June 2022

ABSTRACT
A challenge to understanding locomotion in complex three-dimensional terrain with large obstacles is to create tools for controlled, systematic experiments. Recent terrain arenas allow observations at small spatiotemporal scales (∼10 body lengths or cycles). Here, we created a terrain treadmill to enable high-resolution observation of animal locomotion through large obstacles over large spatiotemporal scales. An animal moves through modular obstacles on an inner sphere, while a rigidly attached, concentric, transparent outer sphere rotates with the opposite velocity via closed-loop feedback to keep the animal on top. During sustained locomotion, a discoid cockroach moved through pillar obstacles for up to 25 min (2500 cycles) over 67 m (1500 body lengths). Over 12 trials totaling ∼1 h, the animal was maintained within a radius of 1 body length (4.5 cm) on top of the sphere 90% of the time. The high-resolution observation enables the study of diverse locomotor behaviors and quantification of animal–obstacle interaction.