bluuebunny/crossref_metadata_2025 huggingface dataset:
190 Nusinersen treatment in adults with spinal-muscular-atrophy with complex-spinal anatomy at St. George’s Hospital, London
Authors: Ambawatte Sathyajith Buddhika , Chhabda Sahil , Johnson Declan , Weidner Derek , Chatfield Sherryl , Appleton Pamela , Matthews Emma , Nirmalananthan Niranjanan , Galtrey Clare
Published: August 2022

We describe nusinersen, the only licensed treatment for adults with SMA in the UK, administra- tion with Single-Plane-Fluoroscopic-Guided(SPFG), Bi-Plane-Fluoroscopic-Guided(BPFG), or Computerised-Tomography-guided(CTG).

We treated three patients with type-2-SMA (two with Severe-Scoliosis[SS], one with Posterior-Spinal- Fusion[PSF]) and four with type-3-SMA (two ambulant, one with Normal-Spine[NS] and one Mild-Lumbar- Spinal-Deformities[MLSD] and two non-ambulant; one each with PSF and MLSD) aged 17 to 57-years. All had homozygous exon-7 and 8 deletions. One had two copies, four had three copies, and the remainder had four copies of SMN-2-gene.

At baseline, forced-vital-capacity was between 38% to 153%. Ambulant patients were assessed with HFMSE(score 37-60), RHS(scores 31-67) and, 6MTM(range 43-492m), and non-ambulant patients were assessed with CHOP-ATTEND(score 17-38), RUL(2-33), 9-hole-peg-test and dynamometer as appropriate.

In type-2, patients with SS had a total of 6(20.7%) BPFG-injections. Only one had severe hypokalemia requiring ITU and treatment cessation. In one with PSF, BPFG-injection was unsuccessful.

In type-3, SPFG-injections were successful in all 19 attempts with MLSD or NS. One each was complicated by transient low-pressure symptoms and radicular pain. Three CTG-injections on a patient with PSF were uncomplicated. All with successful LPs(96.5%) did not drop out.

We found that nusinersen could be administered regardless of the spinal anatomy with interventional radiology.
196 Clinical and molecular characterisation of a Scottish Charcot-Marie-Tooth disease cohort
Authors: Watson-Fargie Taylor , Boyd Marcus , Mahjoub Aisha , Brennan Kathryn
Published: August 2022

Charcot-Marie-Tooth (CMT) disease is the commonest inhereted neuropathy with previous studies charac- terising cohorts in Europe and USA. This Scottish single-centre retrospective cross-sectional study aimed to report frequency of CMT subtypes and characterise clinical, genetic, and electrophysiological features.

Electronic medical record data were collected from patients attending a specialist clinic. Data included patient demographics, neurological examination, family history, pain, and reports from allied health pro- fessionals, genetics, and neurophysiology. Data were analysed using descriptive statistics.

150 molecularly characterised and 39 uncharacterised patients were included comprising 78 patients with CMT1A (78), 5 with CMT1B, 5 with CMT1E, 25 with CMT1X, 17 with CMT2, 3 with CMT4 and 14 with Hereditary Neuropathy with Liability to Pressure Palsies (HNPP). There were similarities in generic neuropathy features, however, differences were observed. In this cohort, CMT1A patients had a lower prevalence of distal muscle wasting; CMT1B patients had an earlier mean presentation age and greater scoliosis prevalence; CMT1E patients had a later mean presentation age; CMT1X patients had greater tremor prevalence; HNPP patients showed lower morbidity.

This study provides the first Scottish data on CMT subtypes and their associated characteristics. It is anticipated this provides a representative baseline that will support investigation, management, and research of CMT.
T-cell response following COVID booster vaccination in seronegative people with multiple sclerosis
Authors: Tallantyre Emma , Vickaryous Nicola , Richards Aidan , Rios Francesca , George Katila , Scurr Martin , Godkin Andrew , Loveless Samantha , Dobson Ruth ,   et al,   on behalf of UK COVID-MS study group
Published: August 2022

Background

Attenuated vaccine response is a concern in people receiving immunosuppression. It is unclear whether booster vaccinations improve immunity in this context.

Methods

T-cell and antibody responses to Sars-COV-2 RBD (spike protein) were measured following third COVID-19 vaccine (v3) in people with MS who were IgG seronegative after vaccines 1&2.

Results

41 people with MS (30:11 female:male; mean age 45.6 years) were included; 28 receiving ocreli- zumab and 6 fingolimod, the remainder were on other immunosuppressants. Samples were taken 4-8 weeks following v3. Anti-RBD seroconversion after v3 occurred in 10/28 (36%) on ocrelizumab and 5/6 (83%) on fingolimod. T-cell responses were detected in 24/28 (86%) treated with ocrelizumab and 0/6 (0%) treated with fingolimod. All those with T-cell responses had seroconverted. There was an association between evidence of previous infection and seroconversion (p=0.0025), but not T-cell response to vaccination following v3 (Fisher’s exact p=0.2). Four patients (all on ocrelizumab) had experienced confirmed COVID since March 2020; 2 were admitted to hospital.

Conclusions

Seroconversion occurs in a proportion of seronegative people following COVID-19 vaccine dose 3. T-cell response is frequently seen despite the lack of humoral immunity. The clinical correlates of antibody and T cell responses to COVID-19 remain to be established.
Single-cell profiling of MS CSF B cells highlights roles for TNFα and mTORC1 signalling
Authors: Jacobs Benjamin , Ban Maria , Baker Amie , Al-Najjar Raghda , Else Jonathan , Sawcer Stephen
Published: August 2022

The presence of oligoclonal immunoglobulin bands in the cerebrospinal fluid (CSF) has long been rec- ognised as a characteristic manifestation of the immune dysregulation underlying multiple sclerosis (MS). However, it remains unclear how or why these bands develop, and little is known about the nature of the aberrantly expanded B cell clones that produce these immunoglobulins. To explore these questions we have performed single-cell RNA sequencing in CSF (108,219 cells) and PBMCs (232,587 cells) obtained from 104 individuals; 66 with multiple sclerosis, 25 with Non-Inflammatory Neurological Conditions (NINCs) and 13 with other Inflammatory Neurological Conditions (INCs).

We found that MS CSF harbours an 8-fold higher proportion of plasma cells than control CSF. Plasma cells in the MS CSF up-regulate diverse pathways implicated in pro-inflammatory signalling and antibody synthesis, including TNFα and mTORC1 signalling, compared with their peripheral counterparts.We identified a large number of clonally-expanded cells in the MS CSF which are largely IgG+ plasma cells with evidence of intrathecal antigen experience. These clonally-expanded cells display clonal connections to the periphery.

Our findings elucidate the phenotype of a critical cell population in MS biology – clonally-expanded CSF plasma cells. These insights have potential diagnostic and therapeutic implications, and may lead to more general insights into B cell autoimmunity.
Case presentation competition|5 Back to basics
Authors: Sim Nicholas Keyi , Foo Eng Chuan , Lwin Khine , Tun Shwe Zin , Dafalla Badr
Published: August 2022

Serotonin syndrome associated with clozapine withdrawal and concurrent selective serotonin reuptake inhibitor (SSRI) use has previously been reported.

A 56-year-old female with schizophrenia was admitted for pyrexia, rigidity, and altered mental state after her second dose of clozapine restart. She had discontinued her long-term clozapine 2 weeks prior. She developed ventilatory failure, reduced consciousness, eye deviation, and worsening rigidity, requiring ICU support. Examination showed a right upper motor neurone syndrome with absent ankle reflexes.

She had raised inflammatory markers and creatine kinase. Serum neuropathy, encephalitis screen, and COVID PCR were negative. Respiratory investigations were unfruitful. MRI head and spine did not show brain or cord signal change to correlate to signs. Lumbar puncture showed a quiet CSF, negative culture, viral PCR, and encephalitis antibodies. EEG showed bihemispheric background slowing.

Despite clinical improvement, repeat examination showed persistent signs. She was diagnosed with serotonin syndrome after developing a bilateral tremor. Treatment with cyproheptadine correlated with an improvement in her signs, cognitive state, and EEG.

Serotonin syndrome can present with reversible neuromuscular signs. With clozapine withdrawal, it can require a prolonged time course of recovery in contrast with classical serotonin syndrome. Cyprohepta- dine can cause agranulocytosis and this delays clozapine restart.
001 An unusual cause of lymphocytic meningitis
Authors: Alexandratou Anna , Ashjaei Shayan , Coutinho Ester , Stanton Biba
Published: August 2022

A 36-year-old Spanish man, with a background of ketamine use, presented with a 10-day history of severe headache, photophobia, nausea, unsteadiness and slurring of speech. His CT head was normal. CSF white cell count was 151 (lymphocytes), protein 0.7, glucose 2.3 (serum 3.6). He was treated with IV acyclovir for two weeks with no clinical improvement.

On examination he remained distressed by headache and photophobic with severe dysarthria, bidirec- tional nystagmus and ataxia.

Blood tests were normal or negative including HIV, serology for syphilis, mycoplasma, lyme and brucella, ANA, ENA, dsDNA, ANCA, ACE, LGI1 and NMDA antibodies, anti-Hu, Ri and Yo. IGRA was positive. MRI brain scan was normal. Serial lumbar punctures showed a variable CSF white cell count, with a negative extended virology panel, TB PCR, bacterial cultures, cytology and immunophenotyping.

There was no improvement with pulsed steroids or antimicrobial cover for listeria. After 5 plasma exchanges there was some improvement in his CSF white cell count and headache, but he remained very ataxic.

An extended paraneoplastic panel revealed positive anti-Tr antibodies. This is a well recognised cause of paraneoplastic cerebellar degeneration, normally associated with Hodgkin’s lymphoma. There have been no previous reported cases of anti-Tr antibodies associated with meningitic symptoms.
An audit of pregnancy and outcomes in the congenital myasthenic syndromes
Authors: Rooney Tatiana , O’Connell Karen , Alabaf Setareh , Ramdas Sithara , Beeson David , Palace Jacqueline
Published: August 2022

Background

The congenital myasthenic syndromes(CMS) are a heterogenous group of genetic disorders leading to disordered neuromuscular junction transmission. Due to their rarity, data on pregnancy outcomes is limited.

Methods

All CMS women with documented pregnancy were invited to complete a pregnancy and outcomes audit questionnaire.

Results

Amongst 16 women with CMS there were 27 pregnancies recorded: 26 single and 1 twin pregnancy. CMS related symptom worsening was reported in 63%, (AChR deficiency in 2/6, slow channel syndrome in 2/3, DOK7 in 8/9, RAPSYN in 3/6 and glycosylation {DPAGT1 and GFPT1} in 2/3), improvement was only reported in 2 (both RAPSYN). Recovery to baseline function was seen in all but one patient.

Miscarriage and caesarean section occurred in 31% and 33% of women. Over half of patients continued their medication during pregnancy which included: pyridostigmine (10), 3,4-DAP (9), ephedrine (3), salbutamol (3) and quinine (1). No foetal malformations were recorded.

Discussion

We report pregnancy outcomes in a relatively large CMS cohort. Whilst clinical worsening is common, it was usually reversible, and rates of miscarriage and caesarean section appeared similar to the background population.1Foetal outcomes appeared good and no safety signal was generated in relation to medication use during pregnancy.

Reference

1. Child and Maternal Health. 3/11/2020]; Available from: https://fingertips.phe.org.uk/profile/ child-health-profiles/data#page/1/gid/1938133222
012 Neurological signs in a general neurology face to face clinic during the Covid-19 pandemic
Authors: Wieshmann Udo
Published: August 2022

During the Covid-19 pandemic attempts have been made to manage patients with neurological symptoms remotely without a neurological examination.

To determine the prevalence of neurological signs we prospectively assessed 101 consecutive patients who were a referred to a general neurology clinic.

Three patients did not attend, leaving 98 patients (58 female, 40 male, mean age 51.0 years, standard deviation 19.9 years.

37 patients had neurological signs. (Cognitive impairment n=3, spastic tetraparesis n=1, spastic hemipa- resis n=2, hemianopia n=1, ataxia n=1, gait apraxia n=1, postural tremor n=2, bradykinesia and rigidity n=9, functional tremor n=4, anosmia n=1, combined upper and lower motor neuron signs, n=2, radicular distribution numbness n=1, distal symmetrical weakness and hypoaesthesia n=5, peripheral nerve hypo- aesthesia n=2, fatigability and lid lag n=2.)

Our data showed that a large proportion of general neurology patients had neurological signs.
016 The evolution of neurological admissions preceding and during the Covid-19 pandemic
Authors: Singh Prisca , Hassan-Smith Ghaniah
Published: August 2022

The novel SARS-CoV-2 virus has affected healthcare services across the world, with the impact on neurology services being no exception to the global disruption. There is variable reporting of neurological conditions during the pandemic. This work explores the patterns of admission to neurology wards in a large tertiary centre within the UK, providing insight into the real-world experience of neurologists at the forefront of the pandemic.

Comparing data from the period March 2019-March 2020, with March 2020-March 2021, we wished to identify and quantify specific alterations in caseload. Patient length of stay decreased by an average of 5 days during the pandemic, but the total number of admissions increased by 27%. Specifically, general medical admissions increased by 233% during the pandemic compared to the preceding year, highlight- ing the shift in workload away from neurology-specific cases. The types of diagnoses also shifted, with lower percentages of admissions for multiple sclerosis, epilepsy and functional cases, compared to rising numbers of cerebrovascular and CNS infection cases. While the impact of this changing caseload is yet to be fully appreciated, this early data allows further exploration of the pattern of neurological presenta- tions following the medicalisation of neurology wards.
019 The national headache management system: a route to ensuring nationwide evidence-based and equitable care
Authors: Gordon Alex , Lashley Daniel , Weatherby Stuart
Published: August 2022

Headache disorders are one of the three most common reasons for presentations to neurology services. Despite this, quality of headache care is known to be highly variable. Over 50% of patients have never received prophylactic medication despite eligibility, and patient concordance with treatment is poor.

The national headache management system, a freely available resource via headache.org.uk, is an addition to the British Association for the Study of Headache (BASH) 2019 guidelines. It allows both patients and clinicians to view material on diagnostic and treatment strategies in a systematic and logical way.

The system can benefit patient care by (1) improving likelihood of response to treatment due to evidence based recommendation, (2) increasing headache service efficiency through the potential for greater multidisciplinary professional use in the running of services, and (3) improving patient confidence, and therefore concordance with, treatment through a uniform approach to headache.

The headache management system thus represents an easy-to-use tool which has the potential to bring about huge improvements to headache care on a nationwide scale. Further iterations of this system include development of an app patients can use to track their care, with any problems signposting them to the appropriate advice via the website.
023 Impact of pandemic on neurologists and neurology practice
Authors: Kipps Christopher , Mummery Catherine
Published: August 2022

Background

Prior to the pandemic, a significant number of neurologists were experiencing levels of burnout in one or more factors as measured using the Maaslich Burnout Inventory (emotional exhaustion, depersonalisation, lack of personal accomplishment). Early in the pandemic, repeat assessment showed marked improvement in Maaslich scores (Spring 2020). We aimed to identify the impact of changes to neurology work practice on neurologists in the prolonged pandemic period.

Methods

Working ABN members were surveyed in Autumn 2021 using the Maaslich inventory and questions on work practice.

Results

We received 360 responses (n=296 Maaslich). Endorsement of burnout factors had returned to pre-pandemic levels (Spring 2020 less than pre-pandemic/Autumn 2021 t=5.426, P<0.001). Emotional Exhaustion correlated with service waiting times and individual fatigue, and inversely to QoL. Deperson- alisation correlated with fatigue and perceived reduction in service quality (inpatients). Most neurologists felt that inpatient (57%) and outpatient (77%) care quality had declined. Capacity in services remained constrained – less than 75% pre-pandemic capacity for MRI (23.3%), CSF sampling (32.8%) and neurophysi- ology (34.5%). Ability to attend educational events correlated with perceived service quality levels. Satis- faction and confidence in remote assessments was consistently lower than for face-to-face interaction.

Conclusion

The pandemic has had a marked effect on neurologists, their QoL and their practice. Levels of burnout correlate with personal fatigue and clinical service quality. Interestingly recent burnout scores are similar to those seen prior to the pandemic.
031 Pelvic autonomic dysfunction is common in patients with pure autonomic failure
Authors: Vichayanrat Ekawat , Hentzen Claire , Simeoni Sara , Pakzad Mahreen , Iodice Valeria , Panicker Jalesh
Published: August 2022

Introduction

Cardiovascular autonomic failure is the hallmark finding in Pure autonomic failure (PAF) however other autonomic functions are likely to be affected. This study aims to characterise genitourinary dysfunction in PAF patients and explore their relationship with cardiovascular autonomic dysfunction.

Methods

PAF patients who underwent cardiovascular autonomic testing completed self-administered questionnaires evaluating urinary and sexual symptoms and a 3-day bladder diary measuring fluid intake and urine output. Demographic, clinical features, disease duration and related medical comorbidities were assessed.

Results

25 PAF patients (10 males) were recruited (mean age 71+8 years; disease duration 13+8 years). 96% (24/25) reported lower urinary tract symptoms, most commonly overactive bladder symptoms (92%) followed by low stream (80%) and stress incontinence (52%). 4(16%) patients required catheterisation. 19/22 (86%) had nocturnal polyuria (NP), defined as NP index >0.3 (nocturnal urine volume/24-hour urine volume), mean NP index 0.45 (range, 0.20-0.73). There were no significant correlations between BP drops on head-up tilt, supine hypertension, respiratory sinus arrhythmia, Valsalva ratio or disease duration with the degree of nocturnal polyuria and need for catheterisation (p>0.05).

Conclusions

NP and genitourinary symptoms are common in PAF. The pathophysiology of NP in PAF is likely to be multifactorial and may not only be explained by cardiovascular autonomic failure.
041 Cognitive and neuropsychiatric effects of noradrenergic treatment in Alzheimer’s disease: systematic review and meta-analysis
Authors: David Michael , Giovane Martina Del , Liu Kathy , Gostick Benjamin , Oboh Imafidon , Howard Robert , Malhotra Paresh
Published: August 2022

Background

Dysfunction of the locus coeruleus-noradrenergic system occurs early in Alzheimer’s disease. This results in a low-noradrenergic state in some patients, which contributes to cognitive and neuropsychi- atric symptoms. We aimed to assess the efficacy of noradrenergic drugs for improving these symptoms.

Methods

The MEDLINE, Embase, and ClinicalTrials.gov databases were searched from 1980 to December 2021. We generated pooled estimates using random effects meta-analyses.

Results

19 randomised controlled trials, of which six studies were of ‘good’ quality, with seven ‘fair’ and six ‘poor’, included 1811 patients. Meta-analysis of 10 studies showed a small, significant positive effect of noradrenergic drugs on patients’ global cognition, as measured using the MMSE or ADAS-Cog compared to placebo (SMD:0.14, 95%CI:0.03 to 0.25, p=0.01; I2=0%). No significant effect was seen on measures of attention (SMD:0.01, 95%CI:-0.17 to 0.19, p=0.91; I2=0). The apathy meta-analysis included eight trials and detected a large positive effect of noradrenergic drugs (SMD:0.45, 95%CI:0.16 to 0.73, p=0.002; I2=58%), although results were limited by potentially substantial heterogeneity.

Discussion

Drug repurposing with established noradrenergic drugs, may offer safe and effective treatment in Alzheimer’s disease, for both cognition and apathy. However, there are number of factors that should be considered before the design of much needed future clinical trials. Including, targeting the correct patient sub-groups and using the correct medications, at the optimal dose, possibly in combination with other treatments, in order to maximise therapeutic effect.
042 Longitudinal assessment of sleep/wake behaviour in dementia patients living at home
Authors: Soreq Eyal , Kolanko Magdalena , Guruswamy Ravindran Kiran Kumar , Monica Ciro Della , Revell Victoria , Lai Helen , Barnaghi Payam , Malhotra Paresh , Dijk Deerk-Jan , Sharp David
Published: August 2022

Introduction

Disturbances of sleep/wake behaviour are amongst the most disabling symptoms of dementia, leading to increased carers’ burden and institutionalisation. The lack of unobtrusive, low- burden technologies validated to monitor sleep in patients living with dementia (PLWD) has prevented longitudinal studies of nocturnal disturbances and their correlates.

Aims

To examine the effect of medication changes and clinical status on the intraindividual variation in sleep/wake behaviour in PLWD.

Methods

Using under-mattress pressure-sensing mat in 46 PLWD, we monitored sleep/wake behavioural metrics for 13,711 nights between 2019-2021. Machine learning and >3.6million nightly summaries from 13,671 individuals from the general population were used to detect abnormalities in PLWD’s nightly sleep/wake metrics and convert them to risk scores. Additionally, GP records were reviewed for each patient to determine whether medication changes and clinical events affected sleep parameters.

Results

PLWD’s went to bed earlier and rose later than sex- and age-matched controls. They had more nocturnal awakenings with longer out-of-bed durations. Notably, at the individual patient level, increased metric-specific risk scores were temporally related to changes in antipsychotics and antidepressants, and acute illness, including UTI, cardiac events, and depressive episodes.

Conclusions

Passive monitoring of sleep/wake behaviours is a promising way to identify novel markers of disease progression and evaluate the effectiveness of pharmaceutical interventions in patients with dementia.
043 Depression is associated with increased dementia risk and reduced grey matter in a fronto-insular-cerebellar network
Authors: Paris Alvar , Amirthalingam Guru , Karania Tasvee , Dey Sumit , Foote Isabelle , Bothongo Phazha , Dobson Ruth , Noyce Alastair , Marshall Charles , Waters Sheena
Published: August 2022

Background

Depression may be a potentially modifiable risk factor for dementia, but it is not clear whether this is due to a causal effect, or whether depressive symptoms are an early prodromal feature of Alzheimer’s disease.

Objectives

To investigate whether depressive symptoms are associated with an increased risk of dementia. To establish associations between depressive symptoms and structural neuroanatomy.

Methods

A total of 491,603 adults from the UK Biobank study were included. Depression and dementia diagnoses were determined using linked medical records and self-report; depression symptomatology was based on questionnaire data. Brain MRI image-derived phenotypes in 42,471 participants were used to measure regional brain volumes.

Results

The risk for incident all-cause dementia was increased in participants with depressive symptoms or a recorded depression diagnosis (all OR>2, p<0.01). After excluding those with incident dementia, depressive symptoms were associated with volume reduction in a fronto-insular-cerebellar network.

Conclusion

Depression is associated with an increased risk of incident dementia. The neuroanatomical correlates of depressive symptoms do not relate to the default mode network degeneration found in prodromal Alzheimer’s disease, suggesting that increased dementia risk in depression may be due to poor brain health and diminished neural reserve more broadly.
Parallel Session 2: Neurodegeneration| Wed 18 May, 1115 – 1230|4 Novel complex motor behaviours in LGI1-autoantibody encephalitis
Authors: Michael Sophia , Ramanathan Sudarshini , Binks Sophie , Leite Maria Isabel , Sen Arjune , Irani Sarosh
Published: August 2022

Background

Pathognomonic clinical signs are increasingly well recognised across the autoim- mune encephalitides. Faciobrachial dystonic seizures (FBDS) are exclusively present in patients with LGI1-autoantibodies. Owing to their recent description and rarity, however, the wider clinical phenotypes remain less well-defined.

Aims

To describe novel clinical features in a large cohort of patients with LGI1-autoantibodies.

Methods

Patients were recruited for clinical research following either direct referral to the Oxford Autoim- mune Neurology Service, or via notification to the national Association of British Neurologists Rare Disease Ascertainment and Recruitment (RaDaR) Surveillance Unit. Novel clinical signs were identified through clinical assessment of 107 LGI1-autoantibody patients. We use video footage to present the phenotypes.

Results

5/104* (5%) of patients with LGI1-autoantibodies displayed highly unusual manual stereotypies which we have termed ‘complex motor behaviours’. These behaviours consisted of the patients acting out intricate manual behaviours using imaginary objects, for example drinking from a cup, writing, and imitation of winding a piece of string around the fingers. They typically occurred during sleep or periods of relaxed wakefulness, were of short duration (30-60 seconds), and were associated with loss of awareness. All patients had multiple seizure semiologies (3-5) and associated visual hallucinations and sleep disorder.

Conclusions

Complex motor behaviours were observed in 5% of patients with LGI1-autoantibodies and may represent either a novel seizure semiology or the sleep disorder agrypnia excitata. These findings expand the clinical phenotypes of LGI1-autoantibody encephalitis.
051 Stakeholder opinions of telematics as an alternative assessment for MCI drivers; a thematic analysis
Authors: Douglass April , Sproson Lise , Lnagranchi Vita , Chapman Sam , Blackburn Daniel
Published: August 2022

Background

Patients diagnosed with Mild Cognitive Impairment (MCI) are recommended to have their driving ability assessed to ensure they are not at risk to themselves or other drivers. Current, on-road driving assessments lack ecological validity, being unrepresentative of fluctuations in ability, and lack longitudinal data to assess changes in driving behaviour over time. GPS devices provide an unobtrusive, objective, and continuous form of assessment. This technology has not yet been marketed towards older drivers.

Methods

Four workshops were conducted with the stakeholders of this project, including older drivers with experience of MCI, clinicians and DVLA representatives. Thematic analysis was conducted on tran- scripts from the workshops to investigate these stakeholders’ opinions of the technology as a potential alternative driving assessment.

Results

Stakeholders stressed the importance of driving (independence, convenience, sense of freedom), described the issues surrounding the current methods of assessment and discussed the promising nature of telematics technology for older drivers.

Discussion

Outcomes suggest that with increased awareness and education around telematics, the older public may accept this technology as an advantageous alternative that could improve road safety as a whole.
Medium-term impact of the SARS-CoV-2 mRNA vaccine against disease activity in patients with systemic lupus erythematosus
Authors: Yoshida Tsuneyasu , Tsuji Hideaki , Onishi Akira , Takase Yudai , Shirakashi Mirei , Onizawa Hideo , Hiwa Ryosuke , Kitagori Koji , Akizuki Shuji , Nakashima Ran , Tanaka Masao , Yoshifuji Hajime , Morinobu Akio
Published: August 2022

Objectives

Numerous case reports have referred to new onset or flare of SLE after SARS-CoV-2 messenger RNA (mRNA) vaccines. Several observational studies showed that the short-term flare rate of SLE after SARS-CoV-2 vaccination is low. However, well-controlled clinical surveys are unavailable and the medium-term impact of the SARS-CoV-2 mRNA vaccines against the flare of SLE is uncertain. Therefore, we aimed to analyse the association between vaccination and medium-term subjective and objective disease activities of SLE and flares using matched pair methods.

Methods

Altogether, 150 patients with SLE from the Kyoto Lupus Cohort were included. Patients who received two doses of the SARS-CoV-2 mRNA vaccines were 1:1 matched with unvaccinated patients based on the first vaccination date. The outcome measures were the SLE Disease Activity Index-2000 (SLEDAI-2K), the Japanese version of the SLE Symptom Checklist Questionnaire (SSC-J) and the Safety of Estrogens in Lupus Erythematosus National Assessment-SLEDAI flare index at 30, 60 and 90 days after vaccination.

Results

SLEDAI-2K levels were not significantly different in vaccinated and unvaccinated patients with SLE at 30, 60 and 90 days after the second vaccination (adjusted estimate (95% CI): 30 days: −0.46 (−1.48 to 0.56), p=0.39; 60 days: 0.38 (−0.64 to 1.40), p=0.47; 90 days: 0.40 (−0.54 to 1.34), p=0.41). Similar results were observed in the SSC-J score (adjusted estimate (95% CI), 30 days: 0.05 (−1.46 to 1.56), p=0.95; 60 days: −0.63 (−2.08 to 0.82), p=0.40; 90 days: 0.27 (−1.04 to 1.58), p=0.69) and flare index (adjusted OR (95% CI), 30 days: 0.81 (0.36 to 1.85), p=0.62; 60 days: 1.13 (0.50 to 2.54), p=0.77; 90 days: 0.85 (0.32 to 2.26), p=0.74).

Conclusion

SARS-CoV-2 vaccination did not significantly influence the medium-term subjective and objective disease activities or flares of SLE until 90 days after the second vaccination.
Inter-arm blood pressure difference as a tool for predicting coronary artery disease severity
Authors: Das Somen , Iktidar Mohammad Azmain , Das Joyanti , Chowdhury Faisal , Roy Simanta
Published: August 2022

Background

Patients with severe atherosclerosis have been found to exhibit considerable changes in blood pressure (BP) between arms. The objective of our study was to investigate the predictive value of interarm blood pressure difference (IABPD) for coronary artery disease (CAD) severity.

Methods

It was a cross-sectional study conducted in the Department of Cardiology, Chittagong Medical College Hospital, Chattogram from May 2020 to November 2020. The study conveniently selected 110 individuals who visited the department for a coronary angiography during the study period. The BP of both arms were synchronously measured 1–2 days before the coronary angiography and IABPD were calculated. After coronary angiography, two blinded interventional cardiologists visually estimated the amount of coronary artery obstruction and determined the Gensini score.

Results

Among the participants, more than three-fourths of the patients were above 50 years of age (64.66%), and the majority were male (86.67%). 14.7% of participants had no occlusion in their coronary artery, 38.0% of participants had insignificant occlusion, 26.7% participants had mild occlusion, 10.3% participants had moderate occlusion, 3.3% participants had significant occlusion and 6.0% participants had total occlusion. Corrected pulse IABPD (cIABPDpulse) showed the greatest area under the receiver operating characteristic curve (0.73) for predicting a high Gensini score (>median). Multiple regression analysis revealed a significant relationship between corrected systolic IABPD (cIABPDsys) and the Gensini score (B=0.057, p<0.001).

Conclusion

The differences in BP between the arms were found to be having a strong positive correlation with CAD severity.
Computational simulation as a decision-making support tool for prefabricated pillars production
Authors: Ruiz Phelipe Viana , Gomes Carlos Eduardo Marmorato , Fontanini Patricia Stella Pucharelli
Published: August 2022

Competitive industrialization pressures the construction sector to move activities away from the construction site, contemplating the prefabricated elements use. Companies willing to remain in the competitive market must seek new positions and developments in their production and management chains. To support the managers' decision-making about the prefabricated concrete elements production line, this article presents a computer simulation model for prefabricated pillars production line productivity scenarios creation. The data used for this model development were collected through a case study in the production line of prefabricated pillars. A simulation software modelled the production line with a dashboard that enables multiple-scenario generation. The adopted approach works with stochastic data, allowing nonprogrammer users to: manipulate and control scenarios and layout settings, analyze results through a dashboard and provide management and decision-makers with a comprehensive view of possible solutions.
A method for determining the transition energies of $$^{\mathrm {83m}}$$Kr at the KATRIN experiment
Authors: Rodenbeck C.
Published: August 2022

The neutrino mass experiment KATRIN uses conversion electrons from the 32.2-keV transition of the nuclear isomer $$^{\mathrm {83m}}$$

83
m

Kr for calibration. Comparing the measured energies to the appropriate literature values allows for an independent evaluation of the energy scale, but the uncertainties in some of the literature values obtained by gamma spectroscopy are a limiting factor. Building upon the already excellent linearity of KATRIN’s energy scale, this paper proposes a novel method for determining the $$^{\mathrm {83m}}$$

83
m

Kr transition energies via high-precision electron spectroscopy. Notably, the method makes use of conversion electrons from the 41.6-keV direct transition of $$^{\mathrm {83m}}$$

83
m

Kr to its ground state in addition to conversion electrons from the much more frequent cascade of a 32.2-keV and a 9.4-keV transition. By implementing this method, KATRIN may be able to deliver order-of-magnitude improvements in precision over current $$^{\mathrm {83m}}$$

83
m

Kr transition energy literature values. Although concretely described here in the context of the KATRIN experiment and with $$^{\mathrm {83m}}$$

83
m

Kr, the method’s underlying principles are general enough for it to likely be a useful tool in various other nuclear spectroscopy settings.
The rho meson timelike electromagnetic form factors in kT factorization approach
Authors: Zhang Ya-Lan , Liu Xue-Chun , Shao Shan-Shan , Fan Yuan-Yuan , Wang Chao
Published: August 2022

In this paper, we calculate the [Formula: see text]-meson timelike electromagnetic form factors by employing the [Formula: see text] factorization approach. The theoretical ratio for the moduli of three helicity amplitudes and total cross-section for the annihilation/production process [Formula: see text] are analyzed at [Formula: see text], where the BaBar experiment was done. The results for the moduli of the three helicity amplitudes [Formula: see text] are predicted between [Formula: see text] and [Formula: see text], and the three form factors [Formula: see text] of rho meson are considered.
Modeling and Prediction of NOx Emission of a Coal-Fired Boiler by a Learning-Based KNN Mechanism
Authors: Song Xin , Zhu Liang , Liu Haibo , Wei Yonggang
Published: August 2022

The production of nitrogen oxides (NOx) in coal-fired boiler combustion has been found as a significant source of environmental pollution. Flue gas denitrification is a standard NOx control technology for small- and medium-sized coal-fired boilers. Achieving steady-state control in flue gas denitrification can be challenging since coal-fired boiler systems have complexity and significant delay. A model based on a learning-based K-nearest neighbor (KNN) query mechanism created for NOx output soft prediction is proposed in this study. First, a knowledge base in the proposed model is established through spatial division in accordance with the previous combustion parameters. Moreover, the clusters are established based on the output NOx values. Next, the domain of values of combustion parameters for the respective cluster is obtained. Second, the optimal cluster is selected using the knowledge base for an input vector q with new combustion parameters ([Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text]. Lastly, the K tuples in the cluster the closest to the values of the input vector q are adopted to predict the output NOx value of q. The predicted NOx value can serve as a feedforward signal to control the output of the reductant for accurate denitrification. As revealed by the experimental results, the proposed practical model, capable of conducting the prediction in a sub-second time, is highly competitive with existing techniques. Furthermore, a deep learning algorithm (DLA) is designed, whereas it underperforms the KNN model.
Intelligent Optimization Approaches for a Secured Dynamic Partial Reconfigurable Architecture-Based Health Monitoring System
Authors: Ram R. Saravana , Prabhaker M. Lordwin Cecil
Published: August 2022

In this work, an intelligent multi-objective optimization technique is proposed to optimize various parameters such as power consumption ([Formula: see text]), computation time ([Formula: see text]) and area ([Formula: see text]) for a health monitoring system designed using the Secured Dynamic Partial Reconfiguration (SDPR) architecture. The cost-efficient Dynamic Partial Reconfiguration (DPR)-based field-programmable gate array (FPGA) is very useful for analyzing many applications such as automation and data processing. The novelty of this paper is to design a new intelligent SDPR (i-SDPR) module in order to achieve better performance in a health monitoring system by considering various performance parameters. The SDPR architecture is incorporated with two reconfigurable modules such as Encrypt and Authenticate, which results in an increase in the core power consumption ([Formula: see text]), computation time ([Formula: see text]) and area ([Formula: see text]). So, to improve the performance of the SDPR-based health monitoring system, there is a necessity to optimize the performance parameters and it is achieved through intelligent multi-objective evolutionary (MOEA) techniques. The intelligent multi-objective evolutionary techniques such as Niched-Pareto Genetic Algorithm (NPGA), Pareto Archived Evolution Strategy (PAES) and Pareto Envelope-based Selection Algorithm (PESA) have been considered for better optimization in the performance parameters. For the study, the free-to-use MIMIC-III dataset is taken, which contains critically admitted various intensive care unit patient data. The dataset is processed through any one of the multi-objective evolutionary operators till satisfying the conditions and then forwarded to implementation. The proposed architecture has been implemented and tested using Cyclone[Formula: see text] V SX SoC Development Kit. The comparative analysis of various performance parameters was done for the proposed i-SDPR with the existing techniques such as the DPR and SDPR approach to show the improvement. The results declare that the proposed techniques obtain better performance compared to the existing techniques.
DEEP CRYOGENIC TREATED HIGH CARBON STEEL BLADES: TRIBOLOGICAL, MORPHOLOGICAL, AND ECONOMIC ANALYSIS
Authors: JAKHAR CHANDER , SAROHA ANIL , ANTIL PARVESH , AHLAWAT VISHAL , RANI ASHA , BUDDHI DHARAM , KUMAR VINAY
Published: August 2022

Straw combines are intended to process the remaining harvested straw. When cut at high temperatures and in abrasive conditions, the cutting blade of straw combines undergoes substantial surface deterioration. This deterioration shortens the blade’s lifespan and increases the cutting cost of the machine. In recent decades, cryogenic treatments have played a significant role in enhancing material properties. In this paper, cryogenic treatment is utilized to boost the wear resistance of straw combine blades in the current investigation. The performance of cryogenic treatment was tested in the laboratory using the pin-on-disc wear tester with sample type, load, sliding velocity, and time serving as process factors and wear loss as the response parameter. The smoothness of the cryogenically-treated sample’s surface is certified through morphological examination. Specific wear rate and field emission scanning electron microscope (FE-SEM) indicated that cryogenic treatment enhances the grain structure and intermolecular interaction of the specimen, resulting in an increase in wear resistance. As opposed to the untreated specimen, the wear on the treated surface is uniform over the entire surface, as demonstrated by FE-SEM analysis. The grain structure and intermolecular bonding of the specimen were improved as a result of the cryogenic treatment. The cryogenic treatment increased the cost of the cutter bar and chopping cylinder blades by 9.38% and 13.61%, respectively, compared to untreated blades, but the increased cost was fully offset by the longer blade life.
A PRACTICAL ALGORITHM TO DETECT SUPEREXPONENTIAL BEHAVIOR IN FINANCIAL ASSET PRICE RETURNS
Authors: LYNCH CHRISTOPHER , MESTEL BENJAMIN
Published: August 2022

To assist with the detection of bubbles and negative bubbles in financial markets, a criterion is introduced to indicate whether a market is likely to be in a superexponential regime (where growth in such a regime would correspond to an asset price bubble and decline to an negative bubble) as opposed to “normal” exponential behavior typified by a constant rate of growth or decline. The criterion is founded on the Johansen–Ledoit–Sornette model of asset dynamics in a bubble and is derived from a linear fit to observed data with a nonlinear time transformation with parameters distributed uniformly in their permitted ranges. Making use of expected values rather than the underlying distribution, the criterion is straightforward and efficient to compute and can in principle be applied in real time to intra-day markets as well as longer timescales. In some circumstances, the criterion is shown to have certain predictive qualities when applied to a portfolio of stocks, and could be used as input into algorithmic trading strategies. A simple strategy is described which is based on market reversion predictions of a portfolio of stocks and which in back-testing generates notable returns.
Sequential Auctions with Multiple Synergies
Authors: Chandrakar Pranjal , Bhalla Manaswini , Das Shubhabrata
Published: August 2022

We examine the sequential auctions of nonidentical and synergistically related (complementary/substitutable) objects. The objects are divided into categories, which are collections of substitutable items. Inter-category objects are complements. Bidders demand one unit from each category and aim to create a bundle of inter-category objects. We solve for all equilibria of the game with an exogenous order of sale. We establish that the sequential auction mechanism can achieve efficient outcomes subject to the order in which objects are presented during the auction. Specifically, we show that an efficient outcome is achieved if, in each category, the object that is valued more by both bidders (if any) is auctioned first. We show that the sequential auction mechanism suffers from the exposure problem in the presence of multiple synergies. We establish that the order in which the categories are presented during the auction may affect objects’ selling prices. Specifically, a decreasing trend in selling prices is observed in some of the outcomes.
General eccentric distance sum of graphs with given diameter
Authors: Vetrík Tomáš
Published: August 2022

For [Formula: see text], the general eccentric distance sum of a connected graph [Formula: see text] is defined as [Formula: see text], where [Formula: see text] is the vertex set of [Formula: see text], [Formula: see text] is the eccentricity of [Formula: see text], [Formula: see text] and [Formula: see text] is the distance between vertices [Formula: see text] and [Formula: see text] in [Formula: see text]. For [Formula: see text] and [Formula: see text], we present the graphs having the smallest general eccentric distance sum among graphs with given order and diameter, and among bipartite graphs with given order and odd diameter. The extremal graphs for the classical eccentric distance sum are corollaries of our results on the general eccentric distance sum.
On the double-critical graph conjecture
Authors: Dharmarajan R. , Ramachandran D.
Published: August 2022

A connected graph [Formula: see text] is double-critical if the chromatic number of [Formula: see text] is two less than that of [Formula: see text] whenever [Formula: see text] and [Formula: see text] are two adjacent vertices of [Formula: see text]. The double-critical graph conjecture states that the complete graphs are the only double-critical graphs. We give a proof of this conjecture for any double-critical graph that contains at least one universal vertex. Using this result we prove the conjecture for all double-critical graphs.
Crystal structure, microstructure, electrophysical properties, and thermally induced aging of PZT-CdNb2O6ceramics
Authors: Konstantin Andryushin , Alexey Pavelko , Sushrisangita Sahoo , Lidiya Shilkina , Alxandr Nagaenko , Inna Andryushina , Maksim Moysa , Larisa Reznichenko
Published: August 2022

Solid solution samples of the three-component system (1 − [Formula: see text])Pb(Ti[Formula: see text]Zr[Formula: see text])O[Formula: see text]CdNb2O6 with [Formula: see text] = 0.0125–0.0500, [Formula: see text][Formula: see text] = 0.0125 were obtained by solid phase synthesis followed by sintering using conventional ceramic technology. The crystal structure, microstructure, electrophysical, and thermophysical properties of these ceramics have been studied. It is shown that all studied solid solutions can be divided into two groups (with [Formula: see text] = 0.0125 and with [Formula: see text] 0.0125), characterized by different characteristics of the change in properties with variations in external influences. This is probably due to the transition from a perovskite-type structure with a tetragonal (T) unit cell to inhomogeneous solid solutions consisting of a series of T-phases with similar cell parameters. A conclusion is made about the expediency of using the data obtained in the development of similar materials for devices based on them.