bluuebunny/crossref_metadata_2025 huggingface dataset:
SARS-CoV-2 variants are associated with different clinical courses in children with MIS-C
Authors: Moreno Rojas Andres F. , Bainto Emelia , Harvey Helen , Tremoulet Adriana H. , Burns Jane C. , Dummer Kirsten B.
Published: December 2023

Background

Recent infection with SARS‑CoV‑2 in children has been associated with multisystem inflammatory syndrome in children (MIS-C). SARS‑CoV‑2 has undergone different mutations. Few publications exist about specific variants and their correlation with the severity of MIS-C.

Methods

This was a single-center, retrospective study including all patients admitted with MIS-C at Rady Children’s Hospital-San Diego between May 2020 and March 2022. Local epidemiologic data, including viral genomic information, were obtained from public records. Demographics, clinical presentation, laboratory values, and outcomes were obtained from electronic medical records.

Results

The analysis included 104 pediatric patients. Four MIS-C waves were identified. Circulating variants in San Diego during the first wave included clades 20A to C. During the second wave, there were variants from clades 20A to C, 20G, 21C (Epsilon), 20I (Alpha), and 20J (Gamma). The third wave had Delta strains (clades 21A, 21I, and 21J), and the fourth had Omicron variants (clades 21K, 21L, and 22C). MIS-C presented with similar symptoms and laboratory findings across all waves. More patients were admitted to the pediatric intensive care unit (PICU) (74%) and required inotropic support (63%) during the second wave. None of the patients required mechanical circulatory support, and only two required invasive ventilatory support. There was no mortality.

Conclusions

The various strains of SARS-CoV-2 triggered MIS-C with differing severities, with the second wave having a more severe clinical course. Whether the differences in disease severity across variants were due to changes in the virus or other factors remains unknown.
Effectiveness of embedded discontinuities technique in capturing geomechanical behavior in naturally fractured reservoirs
Authors: Maciel Bruno , Alvarez Leidy Laura , Belfort Nayara Torres , do Nascimento Guimarães Leonardo José , de Sá Beserra Leila Brunet
Published: December 2023

This paper highlights the efficacy of the finite element method with embedded strong discontinuities in modeling discontinuities in porous media, specifically in the geomechanical behavior of Naturally Fractured Reservoirs (NFRs). The approach considers hydromechanical coupling and offers low computational cost. NFRs account for a significant portion of global reserves, representing approximately 60% of global oil reserves and 40% of gas reserves. Given that flow in NFRs is more complex than in conventional reservoirs due to the presence of multiple fractures, it's crucial to understand how pressure variations or effective stress during operations impact fracture closure and permeability of these reservoirs. To analyze this behavior, numerical simulation results using the proposed method were compared, under different liquid pressure depletion values, with the approach proposed by Oda, which is commonly used in commercial software for calculating fracture permeability tensors. This approach was enriched with Barton's fracture closure formulation and updates on rock matrix porosity and permeability. Four simulations were conducted: Firstly, a hypothetical scenario consistent with Oda's assumptions, where fractures are interconnected and span the entire grid cell, to validate the numerical hydromechanical model; subsequently, three representative sections of a Brazilian pre-salt carbonate reservoir were selected. The study confirms the efficacy of the technique of embedded strong discontinuities in calculating equivalent permeabilities in NFRs, considering geomechanical effects, especially in cells with high fracture frequencies and intensities. Furthermore, the relevance of analyzing the geomechanical behavior in NFRs is emphasized.
Impact of stainless steel nano-alloys on biogas production rate: safe catalysts
Authors: El-Ansary Sara , Sliem Mahmoud A. , Badr Yehia , Soliman Wafaa
Published: December 2023

The feasibility of using nontoxic stainless steel colloidal solutions, synthesized by laser ablation in distilled water, for the production of biogas is examined in this paper. Given that their biodigesters are treated concurrently while taking into account the same experimental and environmental circumstances, certain results are compared with earlier work on NiFe2O4. As a result, the cumulative gas volume after the 50-days incubation period increased to 172 and 207% for NiFe2O4 and stainless steel nano-alloys, respectively. Additionally, the biogas flame and the information at hand are used to interpret the biological effect. The free Cr stainless steel colloidal solution yields an unexpected biogas volume of 207% of control, according to a recent discovery. However, the inhibition of Cr-based stainless steel digesters is attributed to the heat shock mechanism–based NIR resonance fluorescence property.

Novelty statement

Enhancement of biogas production rate from cow dung by 207%, in comparison to control, using nontoxic stainless steel nano-alloys free of Cr element synthesized by laser ablation of commercial targets in water. However, nano-alloys based on Cr element exhibit an inhibition effect due to a heat shock mechanism. Accordingly, stainless steel nano-alloys synthesized by laser ablation in water are eco-friendly and safe catalysts for applicants and users.

Graphical abstract
Navigating Interoperability in Disaster Management: Insights of Current Trends and Challenges in Saudi Arabia
Authors: Mani Zakaria Ahmed , Sultan Mohammed Ali Salem , Plummer Virginia , Goniewicz Krzysztof
Published: December 2023

In this rapid review, we critically scrutinize the disaster management infrastructure in Saudi Arabia, illuminating pivotal issues of interoperability, global cooperation, established procedures, community readiness, and the integration of cutting-edge technologies. Our exploration uncovers a significant convergence with international benchmarks, while pinpointing areas primed for enhancement. We recognize that continual commitments to infrastructural progression and technology adoption are indispensable. Moreover, we underscore the value of robust community involvement and cross-border collaborations as key factors in bolstering disaster response capabilities. Importantly, we spotlight the transformative influence of emerging technologies, such as artificial intelligence and the Internet of Things, in elevating the effectiveness of disaster management strategies. Our review champions in all-encompassing approach to disaster management, which entails harnessing innovative technologies, nurturing resilient communities, and promoting comprehensive disaster management strategies, encapsulating planning, preparedness, response, and recovery. As a result of our analysis, we provide actionable recommendations to advance Saudi Arabia’s disaster management framework. Our insights are timely and crucial, considering the escalating global focus on disaster response in the face of increasing disaster and humanitarian events.
SARS-CoV-2 nucleocapsid protein, rather than spike protein, triggers a cytokine storm originating from lung epithelial cells in patients with COVID-19
Authors: Wang Ying‑Chuan , Tsai Chih-Hsuan , Wang Yung-Chih , Yen Li-Chen , Chang Yao-Wen , Sun Jun-Ren , Lin Te-Yu , Chiu Chun-Hsiang , Chao Yu-Chan , Chang Feng-Yee
Published: December 2023

Purpose

The aim of this study was to elucidate the factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that may initiate cytokine cascades and correlate the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with their serum cytokine profiles.

Methods

Recombinant baculoviruses displaying SARS-CoV-2 spike or nucleocapsid protein were constructed and transfected into A549 cells and THP-1-derived macrophages, to determine which protein initiate cytokine release. SARS-CoV-2-specific antibody titers and cytokine profiles of patients with COVID-19 were determined, and the results were associated with their clinical characteristics, such as development of pneumonia or length of hospital stay.

Results

The SARS-CoV-2 nucleocapsid protein, rather than the spike protein, triggers lung epithelial A549 cells to express IP-10, RANTES, IL-16, MIP-1α, basic FGF, eotaxin, IL-15, PDGF-BB, TRAIL, VEGF-A, and IL-5. Additionally, serum CTACK, basic FGF, GRO-α, IL-1α, IL-1RA, IL-2Rα, IL-9, IL-15, IL-16, IL-18, IP-10, M-CSF, MIF, MIG, RANTES, SCGF-β, SDF-1α, TNF-α, TNF-β, VEGF, PDGF-BB, TRAIL, β-NGF, eotaxin, GM-CSF, IFN-α2, INF-γ, and MCP-1 levels were considerably increased in patients with COVID-19. Among them, patients with pneumonia had higher serum IP-10 and M-CSF levels than patients without. Patients requiring less than 3 weeks to show negative COVID-19 tests after contracting COVID-19 had higher serum IP-10 levels than the remaining patients.

Conclusion

Our study revealed that nucleocapsid protein, lung epithelial cells, and IP-10 may be potential targets for the development of new strategies to prevent, or control, severe COVID-19.
Extensive Study of Modern Approaches Used in Identifying the Buckingham Potential
Authors: Surulere S. A. , Shatalov M. Y. , Olayiwola F. E.
Published: December 2023

This paper presents two mathematical approaches of estimating unknown parameters of the Buckingham potential. Two functional forms of the potential was investigated owing to the complexities and difficulties arising from the original Buckingham potential. These complexities are due to the combination of both powers and an exponent in mathematical representation of the potential. Hence, we decided to consider approximating the parameters of the simpler form, widely known as the modified Buckingham potential. The method of least squares (differential and integral methods) were used to estimate the potential parameters and the calculation of the optimized values of the constructed goal function were included in the paper. The calculated estimates showed reasonable agreement with experimental datasets of copper atoms over a large vicinity of the interatomic potential distance. This conclusion was reached through the graphical analysis of potential energy curves and through the error between the respective curves. Optimized goal function values were used to compare the efficiency of the methods.
Information geometry of dynamics on graphs and hypergraphs
Authors: Kobayashi Tetsuya J. , Loutchko Dimitri , Kamimura Atsushi , Horiguchi Shuhei A. , Sughiyama Yuki
Published: December 2023

We introduce a new information-geometric structure associated with the dynamics on discrete objects such as graphs and hypergraphs. The presented setup consists of two dually flat structures built on the vertex and edge spaces, respectively. The former is the conventional duality between density and potential, e.g., the probability density and its logarithmic form induced by a convex thermodynamic function. The latter is the duality between flux and force induced by a convex and symmetric dissipation function, which drives the dynamics of the density. These two are connected topologically by the homological algebraic relation induced by the underlying discrete objects. The generalized gradient flow in this doubly dual flat structure is an extension of the gradient flows on Riemannian manifolds, which include Markov jump processes and nonlinear chemical reaction dynamics as well as the natural gradient. The information-geometric projections on this doubly dual flat structure lead to information-geometric extensions of the Helmholtz–Hodge decomposition and the Otto structure in $$L^{2}$$

L
2

-Wasserstein geometry. The structure can be extended to non-gradient nonequilibrium flows, from which we also obtain the induced dually flat structure on cycle spaces. This abstract but general framework can broaden the applicability of information geometry to various problems of linear and nonlinear dynamics.
The Economics of Music
Authors: Tschmuck Peter
Published: December 2023

The music industry is one of the most dynamic and fascinating business sectors. Its business model has had to evolve and adapt to continually changing technologies that impact at every level from distribution to artist management. Its latest challenge has been the closure of live music venues during the Covid-19 pandemic.

The second edition of this much used introduction to the economic workings of the music business has been updated to include analysis of the impact of the pandemic as well as new trends in the industry, such as the increasing dominance of tech companies and big data and the growing importance of collective management organizations as market players, which has impacted on new business contracts. At a time when live performance outstrips music sales as the primary source of income for today's musicians, this new edition also examines how different stakeholder positions have shifted.

The book remains a rigorous presentation of the industry's business model, the core sectors of publishing, recording and live music, and the complex myriad of licensing and copyright arrangements that underpin the industry. The revenue streams of recording companies are analysed alongside the income stream of artists to show how changing formats and distribution platforms impact both industry profit margins and artists' earnings.
Histories of artificial intelligence: a genealogy of power
Authors: Ali Syed Mustafa , Dick Stephanie , Dillon Sarah , Jones Matthew L. , Penn Jonnie , Staley Richard
Published: December 2023

Like the polar bear beleaguered by global warming, artificial intelligence (AI) serves as the charismatic megafauna of an entangled set of local and global histories of science, technology and economics. This Themes issue develops a new perspective on AI that moves beyond conventional origin myths – AI was invented at Dartmouth in the summer of 1956, or by Alan Turing in 1950 – and reframes contemporary critique by establishing plural genealogies that situate AI within deeper histories and broader geographies. ChatGPT and art produced by AI are described as generative but are better understood as forms of pastiche based upon the use of existing infrastructures, often in ways that reflect stereotypes. The power of these tools is predicated on the fact that the Internet was first imagined and framed as a ‘commons’ when actually it has created a stockpile for centralized control over (or the extraction and exploitation of) recursive, iterative and creative work. As with most computer technologies, the ‘freedom’ and ‘flexibility’ that these tools promise also depends on a loss of agency, control and freedom for many, in this case the artists, writers and researchers who have made their work accessible in this way. Thus, rather than fixate on the latest promissory technology or focus on a relatively small set of elite academic pursuits born out of a marriage between logic, statistics and modern digital computing, we explore AI as a diffuse set of technologies and systems of epistemic and political power that participate in broader historical trajectories than are traditionally offered, expanding the scope of what ‘history of AI’ is a history of.
A true crime story: The role of space, time, and identity in narrating criminal authority
Authors: Rossi Norma
Published: December 2023

This article presents a theoretical and methodological argument for employing a narrative-based approach to explore criminal organisations’ (COs) claims to political authority, accompanied by an empirical example. International Relations scholarship is increasingly interested in the role narratives play in political meaning-making processes, with violent non-state actors (VNSAs) beginning to occupy a central space in such investigations. This work has contributed important insights into how VNSAs, such as terrorists and insurgents, mobilise narratives to challenge state authority. However, this literature still needs to take stock of groups that do not directly challenge the state but rather live within it. Drawing on Mikhail Bakhtin’s literary theory and using the Sicilian Mafia as a case study, I show that COs exercise and construct their narratives of political authority by reappropriating the state’s key constitutive narratives of space, time, and identity. By reflecting the same form of (statist) political imagination via alternative spatial, temporal, and identity configurations, these groups simultaneously reject and reproduce modern articulations of political authority in their spatio-temporal and identity dimensions.
Replacing the standard bearer: Theorising leadership transition in insurgencies
Authors: Youngman Mark , Moore Cerwyn
Published: December 2023

The transition from one leader to the next represents a critical moment in the life cycle of insurgencies: it is a period of heightened uncertainty and vulnerability when roles and relationships are in flux. However, remarkably little scholarly attention has been paid to understanding this process. Building our case around the insurgency in Russia’s North Caucasus, we address this gap by developing a typology of key tasks that new leaders must perform in order to navigate the transition period. We argue that, within insurgencies that are weakly institutionalised, leadership can most usefully be conceived of as a negotiated relationship in which both leaders and followers have agency. Successful performance of these tasks helps ensure the maintenance of this relationship and, through this, movement continuity. Therefore, this paper contributes to both the empirical literature on insurgency and our understanding of leadership and transition within rebel movements.
Granting Immigrants the Right to Vote in National Elections: Empirical Evidence from Swedish Administrative Data
Authors: Aggeborn Linuz , Andersson Henrik , Dehdari Sirus H. , Lindgren Karl-Oskar
Published: December 2023

Faced with rising levels of cross-border migration, many countries have extended local voting rights to non-citizen residents. However, empirical evidence indicates that voter turnout among non-naturalized immigrants is lower when compared to citizens. This raises the question of how to explain this difference. A common answer is that the low turnout rates of non-citizen residents are primarily due to the socio-economic composition of this group and the challenges involved in adapting to a new political system. An alternative but less discussed possibility is that the low turnout concerns the nature of the elections. Hence, we examine whether the turnout of non-citizens is hampered because they are only allowed to partake in local elections. Based on a regression discontinuity design (RDD) using Swedish administrative data, we find that turnout could increase by 10–20 percentage points if the voting rights of non-citizens were extended to the national level.
Distant metastasis at the time of presentation of head and neck squamous cell carcinoma: a retrospective chart review from a tertiary cancer care centre
Authors: Majitha CS , Nayak Dipak Ranjan , Shetty Shama , Devaraja K , Basheer Juhi Irfana
Published: December 2023

Objective

To evaluate the rates and patterns of distant metastasis in head and neck SCC at the time of presentation and to study the association between distant metastasis with pre-treatment, clinical, and pathological predictors of outcomes.

Method

This is a retrospective study conducted in a tertiary care hospital. All patients with primary head and neck squamous cell carcinoma that had been evaluated at our institute between October 2018 and December 2020 were included in the study. Various clinical data were analysed and pattern of metastasis was studied.

Result

Ten per cent (50 cases) of 501 studied patients had distant metastasis. The most common site of distant metastasis was lung. The rate of distant metastasis was high in patients with poorly differentiated cancers. By Kaplan–Meier analysis, the median survival duration after diagnosis of metastasis was four months.

Conclusion

The rate of distant metastasis was 10 per cent in the study. Patients with poorly differentiated tumours, locally advanced primary lesions, higher nodal stage, particularly with extra nodal extension, and hypopharyngeal primary, tend to exhibit increased risk for distant metastasis at the time of presentation.
The Entangled Nature of Work: Histories of Humans and Nonhuman Labor
Authors: Fleischman Thomas
Published: December 2023

A survey of recent works of labor and environment reveal the centrality of hybridity to analyses of human and nonhuman natures. These are most apparent in analyses of labor, technology, and nature. While ways of knowing nature amongst the powerful have been oriented toward the ever-greater domination of workers and nonhuman nature, interspecies entanglements and solidarity erupt through the marginal, overlooked spaces. Taken together, the books included in this review suggest a way toward finding alternative, more just futures for living alongside nonhuman nature.
A transformable wheel-spoke-paddle hybrid amphibious robot
Authors: Ge Yikai , Gao Feng , Chen Weixing
Published: December 2023

The intricate water-land intermingled nature of wild environments necessitates robots to exhibit multimodal cross-domain mobility capabilities. This paper introduces a novel wheel-spoke-paddle hybrid amphibious robot (WSP-bot) that can operate on flat and rough terrains, water surfaces, and water-land transitional zones. The proposed robot relies on a propulsion mechanism called transformable wheel-spoke-paddle (WSP), which combines the stability of wheeled robots with the obstacle-climbing capability of legged robots, while also providing additional aquatic mobility. The utilization of a crank-slider-based transformation mechanism enables seamless switching between multiple motion modes. An analysis of mode transition and ground motion in spoke mode was conducted, along with an investigation of its obstacle-crossing capability. Simulations were performed for mode transition, ground locomotion, and obstacle-crossing, as well as propulsion of a single WSP module on water. Based on the above work, a prototype robot was manufactured. Prototype tests, including mode transition and mobility tests on land and water surfaces under multimodal states, confirmed the effectiveness of the proposed WSP-bot.
Making space for singing in the 21st century classroom – A focus group interview study with primary school music teachers in Sweden
Authors: Bojner Horwitz Eva , Thorarinn Johnson David , Lyberg-Åhlander Viveka , Sahlén Birgitta , Laukka Petri , Bygdéus Pia
Published: December 2023

The present study aimed to increase understanding of how singing activities may be initiated in primary school, and what support and assistance teachers require to conduct singing activities as an integrated part of the school day. Five music teachers participated in a focus group interview. The following main themes were identified: 1) pedagogical and methodological flexibility, 2) the role of routines and familiarity, 3) the embodied and multimodal dimensions of singing, 4) the importance of accompaniment and instruments, 5) the experience of insecurity and obstacles and 6) the perceived synergies between singing and other learning activities. This knowledge may be important to integrate within music teacher education in order to secure singing’s place in schools.
Manipulation without Resistance: Consensus Elections in Rural China
Authors: Liu Jingping
Published: December 2023

The Chinese Communist Party has been increasing its control over village elections since the early 2010s, yet this move has not triggered any widespread popular resistance. Drawing on ethnographic evidence from village elections held in 2017 in a county in Hunan province, I conceptualize a form of electoral manipulation I term “consensus elections,” in which the Party engineers a pre-electoral consensus with ordinary villagers on whom to select while deterring challenges from village elites. Consensus elections are rooted in the Chinese political elites’ ideal that favours electoral participation over competition. While participation increases regime legitimacy, competition threatens regime authority. Propaganda promoting this electoral ideal shapes the views of ordinary villagers, laying a basis of legitimacy on consensus elections. The villagers embraced voting as being oriented by a unitary common interest and developed a cynicism whereby campaigning was equated with corruption. Comparison of the processes involved in engineering consensus elections in five villages suggests popular support for such elections. Whereas popular resistance was mounted against the lack of participation, popular complicity helps the Party to deter challenges from village elites. Consensus elections have facilitated the fall of Chinese village elections without undermining the Party's legitimacy, but consensus elections will also encourage more political challenges from village elites through non-institutionalized channels.
Relational values shape people’s connectedness to nature in a former military protected area of Ecuador
Authors: Asanza-Reyes Christian Oswaldo , Castro Antonio J , Requena-Mullor Juan Miguel , López-Rodríguez María Dolores , Quintas-Soriano Cristina
Published: December 2023

Relational values are a way of recognizing and valuing the complex and interconnected relationships between people and nature, such as caregiving, place attachment and spiritual meaning, as well as the social and cultural impacts of degradation and environmental and conservation efforts. However, the implications of these values for the management and conservation of protected areas are little known. We explored the role of relational values in shaping local communities’ connectedness to a protected area of Ecuador that had been used by the military in the past and the implications of the values for well-being. Four hundred individual face-to-face surveys in the surroundings of Arenillas Ecological Reserve (south-west Ecuador) indicated high levels of connectedness towards this natural reserve amongst local communities through multiple values of nature. However, relational values were identified as the most prominent value explaining the strength of connectedness to nature, followed by intrinsic and instrumental values. We also showed that combinations of different natural values (instrumental, intrinsic and relational) might explain the support for specific well-being components. Our findings offer understanding of human behaviour towards protected areas with a military past and represent a first step in Ecuador towards comprehending how relational values shape the connectedness of local communities to nature.
Chylothorax related to acute SARS-CoV-2 infection in a patient with Noonan syndrome with prior uncomplicated cardiac surgeries
Authors: Ehsan Lubaina , Thoe Jessica A. , Parent John J. , Fakhoury Joseph D.
Published: December 2023

SARS-CoV-2 is a novel coronavirus that has rarely been associated with chylothorax. Patients with Noonan syndrome are at risk for developing chylothorax, especially after cardiothoracic interventions. We present the case of SARS-CoV-2 infection triggering the underlying tendency of a patient with Noonan syndrome to develop chylothorax who did not develop it even after prior cardiothoracic interventions. Patient presented in respiratory distress without hypoxia and was found, on imaging, to have a large right-sided pleural effusion, which was eventually classified as chylothorax. The patient was then started on a low-fat diet. Chest tube drainage substantially reduced the effusion in size, and it remained stable. Our report highlights that SARS-CoV-2 infection can cause the development of a chylothorax or a chylous effusion in patients with Noonan syndrome or among populations with a similar predisposition. A high index of suspicion in vulnerable patients or those not responding to traditional therapy should exist with providers, thus leading to the testing of the fluid to confirm the diagnosis.
54 Age-Related Differences in the Associations Between Cannabis Use and Cognition in People Living with HIV (PLWH)
Authors: DeFelice Jason S , Cook Robert L , Cohen Ronald A , Porges Eric C
Published: December 2023

Objective:

PLWH report using cannabis for both recreational reasons and HIV symptom management (e.g., nausea, pain, depression/anxiety). Recent literature suggests that cannabis may attenuate HIV symptoms and neuroinflammation, which are strongly related to neurocognition. Additionally, older adults who are particularly vulnerable to cognitive impairment experience a decline in the endogenous cannabinoid system with age. Therefore, the aims of the present study were 1) to determine if cannabis use is associated with cognitive performance in PLWH, 2) to determine if age moderates the relationship between cannabis use and cognition in PLWH, and 3) to determine if there are differences in cognition in cannabis non-users, occasional users, and daily users among PLWH.

Participants and Methods:

The sample included 225 PLWH (78% undetectable; 51% female, Mean age=49.10) who were classified as non-users (n=52), occasional users (n=53), or daily users (n=120). Cannabis use was measured via the Timeline Follow-back (TLFB). Cognition was examined using the NIH Toolbox Cognition Battery, which included measures of attention, working memory, executive function, processing speed, and episodic memory, as well as a fluid cognition composite score.

Results:

Increased frequency of cannabis use was weakly positively associated with episodic memory performance, r(224) = 0.15, p<0.05. Results of the multiple regression indicate that frequency of cannabis use was not significantly associated with any of the six cognitive domains. However, there was a significant interaction between age and cannabis use in the domains of attention (ß= 0.13, p < 0.05), working memory (ß= 0.12, p < 0.05), and episodic memory (ß= 0.15, p < 0.05), suggesting worse cognitive performance in older adults who use cannabis as compared to younger adults in this sample. When participants were grouped based on use status, there were no significant main effects of group.

Conclusions:

After controlling for the effects of demographic factors and HIV disease severity, no significant negative associations between cannabis use and cognition were observed, suggesting that cannabis use is not related to cognitive impairment in PLWH. However, results were clarified by a significant interaction, indicating that older adults who use cannabis perform worse in the domains of attention, working memory, and episodic memory compared to younger adults, suggesting synergistic cognitive effects of age and cannabis use. We additionally found preliminary evidence for a potential positive effect of cannabis use on episodic memory in the overall sample. Future studies examining biological and behavioral mechanisms of improvement will be necessary to better examine this relationship.
1 Significant Psychiatric Burden Exists in Women Veterans with Drug-Resistant Epilepsy
Authors: Sullivan-Baca Erin , Rehman Rizwana , Miller Brian I , Haneef Zulfi
Published: December 2023

Objective:

Epilepsy, and specifically drug-resistant epilepsy (DRE), is associated with an increased risk of psychiatric dysfunction, likely due to a combination of physiological mechanisms, emotional reactions to disease burden, and bi-directional influences. Women with epilepsy warrant special consideration due to many factors, including hormonal influences on seizure susceptibility, reproductive health considerations, and unique psychiatric and clinical profiles. However, there is yet to be large-scale research characterizing women with DRE. The present study characterized psychiatric conditions, treatment, and hospitalization data in a Veterans Health Administration (VHA)-wide sample of women Veterans and then compared results to a male Veteran sample to explore sex differences.

Participants and Methods:

Data from 52,579 Veterans enrolled in VHA care between FY2014 and 2nd Quarter FY2020 were gathered from the VHA Corporate Data Warehouse administrative data. The sample was comprised of 5,983 women (11.4%) and 46,596 men (88.6%). Demographics, psychiatric diagnoses, psychiatric medications, ER visits, and hospitalizations were characterized. Chi-square analyses were used to examine group differences between men and women.

Results:

The vast majority of the women Veteran sample had at least one psychiatric diagnosis (86.1%), with over half of the sample diagnosed with depression (68.3%), PTSD (54.1%), and/or anxiety disorders (57.7%). When compared to men, women Veterans were more likely to have a psychiatric diagnosis (86.1% vs. 68.1%), evidenced a higher number of co-morbid psychiatric conditions (2.4 vs. 1.6), and were prescribed more psychiatric medications (3.4 vs. 2.3; all significant at p<0.001). All individual psychiatric diagnoses were more prevalent in women than men and, notably, suicidality was also higher in women (13.5% vs. 10.0%; p < 0.001). Women Veterans also had a higher number of ER visits (6.9 vs. 5.5; p < 0.001) and psychiatric hospitalizations than men (.4 vs. .3, p < 0.001).

Conclusions:

The present study represents the largest known investigation to date of women with DRE and is also the largest study of women Veterans with any form of epilepsy. It highlights a vast psychiatric burden in this subset of women Veterans, with high rates of psychiatric comorbidity, lending to downstream effects on psychiatric medication burden and risk for emergency care usage and psychiatric hospitalization. Comparisons to men emphasize that women are differentially impacted by the psychiatric toll of DRE and warrant special consideration. The markedly higher rates of depressive disorders and suicidality in women Veterans with DRE is especially notable when considering risk of harm and mortality. Overall, the present work adds to the paucity of literature of women Veterans with seizures and gaps in the broader DRE research base, with implications for specialized screening and maximizing treatment interventions in this population.
17 Value-Consistent Rehabilitation is Related to Long-Term Quality of Life and Psychological Adjustment After Traumatic Brain Injury
Authors: Miller Luke R
Published: December 2023

Objective:

Modern perspectives of rehabilitation after traumatic brain injury (TBI) emphasize the importance of individualized holistic approaches (i.e., physical and psychological adjustment) and collaboration toward goals (e.g., among the survivor, rehabilitation professionals, family/friends, etc.). Recent research has sought to employ a holistic, value-based approach (via the Valued Living Questionnaire) to measuring goals and whether those with TBI are acting in accordance with them, and quality of life outcomes. However, no research has examined whether rehabilitation practices are consistent with survivor values using this framework. The aim of the current study was to investigate the impact of value-consistent rehabilitation practices on quality of life and psychological adjustment outcomes in those with TBI.

Participants and Methods:

The current study included a sample of 73 adults with a history of TBI (M years since injury = 7.6, SD = 9.7) between the ages of 18 and 72 (Mage = 44.0 years, SD = 13.1; 73% female, 90.4% white) who had participated in outpatient rehabilitation. Individuals were recruited from brain injury support groups on Facebook and completed a series of surveys measuring TBI severity [Ohio State University Traumatic Brain Injury Identification Method-Short Form (OSU-TBI-ID)], value-consistent rehabilitation practices [modified Valued Living Questionnaire (VLQ)], life satisfaction [Life Satisfaction Questionnaire-9 (LiSat-9)], and psychological flexibility [Acceptance & Action Questionnaire - Acquired Brain Injury (AAQ-ABI)]. Discrepancy scores were calculated to compare perceived importance of and how helpful rehabilitation was for each VLQ domain. Bivariate Pearson correlations were conducted to investigate the relationships between value-consistent rehabilitation, life satisfaction, and psychological flexibility.

Results:

The VLQ domains with the greatest discrepancies were spirituality (-2.26), marriage/intimate relations (-2.06), and family relations (-2.02) such that rehabilitation helped less in these domains despite their importance. Greater levels of value-consistent rehabilitation were related to higher levels of life satisfaction overall (r = 0.40, p < 0.001) and lower levels of reactive avoidance of emotions related to one’s brain injury (r = -0.26, p = 0.03). In terms of specific domains of life satisfaction, greater value-consistent rehabilitation was related to higher levels of vocational (r= 0.44, p < .001), physical self-care (r = 0.28, p = 0.018), and friendship satisfaction (r= 0.41, p < .001).

Conclusions:

Our findings suggest rehabilitation practices may not be acting proportionately with TBI survivor values. Moreover, our results suggest value-consistent rehabilitation is important for long term quality of life and psychological adjustment outcomes. Future work should seek to identify factors that optimize opportunity for individualized treatment.
24 Poststroke Depression in Patients with Infratentorial Stroke Undergoing Acute Inpatient Stroke Rehabilitation
Authors: Waldman Rachel , Jaywant Abhishek
Published: December 2023

Objective:

Poststroke depression is common in those with stroke and is associated with worse functional outcomes, recurrence of stroke, and increased mortality. Poststroke depression has been most commonly associated with lesions of the frontal lobe and anterior regions of the brain, in addition to lesions in subcortical structures. Yet, there is also evidence that indicates the presence of depressive symptoms in those with infratentorial (including brainstem, pontine, and cerebellar) stroke, which may be mediated by alternative pathophysiologic mechanisms. Patients undergoing acute inpatient stroke rehabilitation may present with depressive symptoms that go unassessed or untreated throughout their recovery, including those with infratentorial stroke. The current objective was to evaluate the degree of depressive symptoms in patients with infratentorial stroke compared to those with supratentorial stroke.

Participants and Methods:

Participants were admitted to an acute inpatient rehabilitation unit for stroke rehabilitation. Participants were enrolled in an ongoing clinical trial. Participants with recent infratentorial stroke (N = 7; 4 female; Median age = 69 years; Median education = 16 years) were administered the Patient Health Questionnaire-9 (PHQ-9) to assess symptoms of depression. Severity of depressive symptoms (PHQ-9 total score) in participants with infratentorial stroke was compared to those with supratentorial stroke (N = 19; 10 female; Median age = 69 years; Median education = 15 years) through Mann-Whitney U tests.

Results:

Participants with infratentorial stroke endorsed similar levels of depression to those with supratentorial stroke. Participants with infratentorial stroke endorsed overall mild depressive symptoms (Mean PHQ-9 score = 7.29; Median = 7), similar to those with supratentorial stroke (Mean PHQ-9 score = 7.11; Median = 6). Significant differences in depressive symptoms were not observed between participants with infratentorial and supratentorial stroke (p = .785).

Conclusions:

Patients with infratentorial and supratentorial stroke may experience a similar degree of poststroke depression. Despite differences in suspected pathophysiologic mechanisms, infratentorial and supratentorial stroke appear to influence depressive symptoms to a similar extent. While future analyses with larger sample sizes are indicated, the current study indicates that patients with infratentorial and supratentorial stroke should be evaluated for depressive symptoms during the acute phases of recovery to inform treatment and potentially improve outcomes.
41 Predictors of Cognitive Symptoms Following Adult Civilian Mild Traumatic Brain Injury
Authors: Levy Arielle M. , Saling Michael M. , Anderson Jacqueline F. I.
Published: December 2023

Objective:

Mild traumatic brain injury (mTBI) is an important public health problem, due to its high incidence and the failure of at least 20% of patients to successfully recover from injury. Cognitive symptoms, in particular, are an important area of research in mTBI, due to their association with return to work and referral to neuropsychological services. Understanding the predictors of cognitive symptoms may help to improve outcomes after mTBI. This study explored female sex, psychological distress, coping style and illness perceptions as potential predictors of cognitive symptoms following adult civilian mTBI.

Participants and Methods:

Sixty-nine premorbidly healthy adults with mTBI (mean age = 36.7, SD = 14.7, range = 18-60; 15 females) were recruited from trauma wards at two public hospitals in Australia and assessed 6-12 weeks following injury. Cognitive complaint was measured using a comprehensive 30-item scale (CCAMCHI) assessing mTBI-specific symptoms in the domains of processing speed, attention, memory and executive function. Participants additionally completed the following measures: Brief-COPE, Illness Perceptions Questionnaire-Revised, Inventory of Depressive Symptomatology, Beck Anxiety Inventory, and PTSD Checklist for DSM-5. The latter three measures were combined to create an index of psychological distress.

Results:

Bivariate nonparametric correlational analyses indicated that female sex (r[67] = .26, 95% CI [.14, .55], p = .03) and psychological distress (r[66] = .54, 95% CI [.40, .72], p < .001) were each significantly associated with cognitive symptom reporting following mTBI. Additionally, while none of the three coping style factors were associated with cognitive symptom reporting, seven of the eight dimensions of illness perceptions were associated with symptom reporting (|r| = .25 - .58, p < 0.05). In a linear regression model assessing the combined effects of each variable, female sex, greater psychological distress, and overall negative illness perceptions were each significant independent predictors of increased cognitive complaint (adj. R2 = .47, F[4,63] = 15.59, p < .001).

Conclusions:

These findings implicate female sex, psychological distress, and illness perceptions as key factors associated with cognitive symptom reporting after mTBI. This research suggests that these factors may be useful in clinical practice when considering early identification of individuals at risk of poor recovery. Specifically, this research implicates females, individuals with high psychological distress, and individuals with negative illness perceptions as important to subgroups to consider for potential intervention after mTBI. Additionally, as psychological distress and illness perceptions are both potentially modifiable, this research suggests that these factors may be useful targets for intervention.
49 Longitudinal White Matter Changes in First Time Mild Traumatic Brain Injury in Relationship with Cognitive Performance: A Diffusion Tensor Imaging Study
Authors: Voelbel Gerald , Wu Zijin , Lazar Mariana , Azmi Hooman , Ogedegbe Chinwe
Published: December 2023

Objective:

The objective of the study was to examine longitudinal changes in the white matter tracts with diffusion tensor imaging (DTI), neuropsychological performance, and the associate between the two in adults with a mild traumatic brain injury (mTBI).

Participants and Methods:

Sixteen adult patients (age = 38.5(12.8); 75% female) seeking medical care at an emergency department for their first mTBI and 15 healthy adults (age = 30.5(11.3); 33% female) from the community were recruited. DTI and the neuropsychological evaluation were performed at 7 days and 4-months post-injury. The neuropsychological evaluation consisted of the CNS Vital Signs computerized neurocognitive test battery and 2 trials of the Paced Auditory Serial-Addition Test.

Results:

Results showed a significant decrease in fractional anisotropy (FA) and an increase in radial diffusivity (RD) of the right uncinate fasciculus as well as a significant decrease in FA and axial diffusivity (AD) of the right inferior fronto-occipital fasciculus over the 4-month follow-up period in the mTBI group compared to the Control group.

The FA of multiple white matter tracts at baseline were positively associated with working memory, sustained attention, and complex attention at baseline in the mTBI group but not the Control group. The global mean cerebral diffusivity for FA at baseline was positively associated with working memory and sustained attention at 4-months post-injury.

Conclusions:

The current findings of abnormal white matter suggest an oxidative stress reaction as a result of mTBI altering the diffusivity of some white matter tracts. Furthermore, the disruption of the white matter tracts at baseline may serve as a biomarker for identifying mTBI and those who may have prolonged cognitive difficulties in working memory and attention as a result of the mTBI.
Plenary C: Developing Tools for Global Neuropsychological Assessment
Authors: Schretlen David J.
Published: December 2023

Abstract & Learning Objectives:

During the 20th century, neuropsychology emerged as a research and clinical specialty, predominantly—though not exclusively—in Western Europe and North America. Formation of the International Neuropsychological Society has done much to foster globalization of the discipline, though we have yet to develop neuropsychological assessment instruments that are suitable for worldwide use. Test publishers have few financial incentives to undertake the development, standardization, and normative data collection required to create cognitive tests for worldwide use. And health-related funding organizations typically prioritize disease-focused etiologic, mechanistic, and treatment research in their resource allocation. Thus, developing such tools will likely require clinical data and other contributions from the entire international community of neuropsychologists. In this address, I will focus on two approaches to developing tests and norms that are suitable to global use, along with ongoing efforts and progress to date in each. I will also appeal to every member of the international community of neuropsychologists to help turn this vision into a reality now.

Upon conclusion of this course, learners will be able to:

1.

Describe two fundamental approaches to developing neuropsychological tests that are appropriate for international use.

2.

Explain at least one strength and limitation of each approach to global test and regression-based norms development.

3.

Assess how to personally engage in a project that aims to provide contributors with free access to a global neuropsychological test battery that is suitable for use worldwide in multiple languages.