bluuebunny/crossref_metadata_2025 huggingface dataset:
Massive transfusions and severe hypocalcemia: An opportunity for monitoring and supplementation guidelines
Authors: Hall Chad , Nagengast Andrea K. , Knapp Chris , Behrens Brandon , Dewey Elizabeth N. , Goodman Andrew , Bommiasamy Aravind , Schreiber Martin
Published: July 2021

Background

Massive transfusion protocols (MTPs) are associated with severe hypocalcemia, contributing to coagulopathy and mortality in severely injured patients. Severity of hypocalcemia following massive transfusion activation and appropriate treatment strategies remain undefined.

Study design and methods

This was a retrospective study of all MTP activations in adult trauma patients at a Level 1 trauma center between August 2016 and September 2017. Units of blood products transfused, ionized calcium levels, and amount of calcium supplementation administered were recorded. Primary outcomes were ionized calcium levels and the incidence of severe ionized hypocalcemia (iCa ≤1.0 mmol/L) in relation to the volume of blood products transfused.

Results

Seventy‐one patients had an MTP activated during the study period. The median amount of packed red blood cells (PRBCs) transfused was 10 units (range 1–52). A total of 42 (59.1%) patients had periods of severe hypocalcemia. Patients receiving 13 or more units of PRBC had a greater prevalence of hypocalcemia with 83.3% having at least one measured ionized calcium ≤1.0 mmoL/L (p = .001). The number of ionized calcium levels checked and the amount of supplemental calcium given in patients who experienced hypocalcemia varied considerably.

Discussion

Severe hypocalcemia commonly occurs during MTP activations and correlates with the number of packed red blood cells transfused. Monitoring of ionized calcium and amount of calcium supplementation administered is widely variable. Standardized protocols for recognition and management of severe hypocalcemia during massive transfusions may improve outcomes.
Hemorrhagic shock and hemostatic resuscitation in canine trauma
Authors: Edwards Thomas H. , Rizzo Julie A. , Pusateri Anthony E.
Published: July 2021

Hemorrhage is a significant cause of death among military working dogs and in civilian canine trauma. While research specifically aimed at canine trauma is limited, many principles from human trauma resuscitation apply. Trauma with significant hemorrhage results in shock and inadequate oxygen delivery to tissues. This leads to aberrations in cellular metabolism, including anaerobic metabolism, decreased energy production, acidosis, cell swelling, and eventual cell death. Considering blood and endothelium as a single organ system, blood failure is a syndrome of endotheliopathy, coagulopathy, and platelet dysfunction. In severe cases following injury, blood failure develops and is induced by inadequate oxygen delivery in the presence of hemorrhage, tissue injury, and acute stress from trauma. Severe hemorrhagic shock is best treated with hemostatic resuscitation, wherein blood products are used to restore effective circulating volume and increase oxygen delivery to tissues without exacerbating blood failure. The principles of hemostatic resuscitation have been demonstrated in severely injured people and the authors propose an algorithm for applying this to canine patients. The use of plasma and whole blood to resuscitate severely injured canines while minimizing the use of crystalloids and colloids could prove instrumental in improving both mortality and morbidity. More work is needed to understand the canine patient that would benefit from hemostatic resuscitation, as well as to determine the optimal resuscitation strategy for these patients.
Preoperative anemia management program reduces blood transfusion in elective cardiac surgical patients, improving outcomes and decreasing hospital length of stay
Authors: Cahill Christine M. , Alhasson Bassam , Blumberg Neil , Melvin Amber , Knight Peter , Gloff Marjorie , Robinson Renee , Akwaa Frank , Refaai Majed A.
Published: July 2021

Background

Anemia is an independent risk factor for hospitalization, readmission, prolonged length of stay (LOS), diminished quality of life, and mortality. A multidisciplinary program was implemented to manage anemia preoperatively as a patient blood management (PBM) initiative.

Methods and Materials

From March 2016 to August 2018, 240 patients were screened for anemia during their preoperative cardiovascular visit. About 52/240 (22%) were found to be anemic and met out inclusion criteria. Also, 45/52 (87%) had iron deficiency anemia and 7 (13%) had anemia without iron deficiency. A similar historical cohort of patients undergoing elective cardiovascular surgery with hemoglobin (Hb) < 12 g/dl from September 2014 to February /2016 (n = 52) served as control group. The primary outcome was perioperative red blood cell (RBC) transfusion. Secondary outcomes were date‐of‐surgery Hb, intensive care unit (ICU) and hospital LOS, complication rates, and transfusion cost.

Results

The two most common treatments were IV iron ± folate (n = 36/45; 80%) and oral iron (n = 9/45; 20%). As compared to historical patients, study patients had significantly higher day‐of‐surgery Hb (10.6 ± 1.4 vs. 9.8 ± 1.3 g/dl, p < .001), lower utilization of RBC transfusion (0.86 ± 1.4 vs. 2.78 ± 2.4, p < .001), fewer days in the ICU (2.1 ± 2.0 vs. 4.0 ± 3.5, p = .002), and shorter total LOS (6.9 ± 4.8 vs. 12.9 ± 6.8, p < .0001). Study patients also showed lower overall complication rates (p < .0001). Analysis of RBC acquisition cost and transfusion cost also showed significant saving of 69% ($293 vs. $945 and $656 vs. $2116, respectively).

Conclusion

When corrected for type of procedures and surgeon, our pilot anemia program in elective cardiovascular surgeries showed higher day‐of‐surgery Hb and significant reduction in RBC transfusion rates, ICU and hospital LOS, and overall complication rates.
New driving force for China’s import growth: Assessing the role of cross‐border e‐commerce
Authors: Ma Shuzhong , Guo Xueyao , Zhang Hongsheng
Published: July 2021

This paper investigates the role of cross‐border e‐commerce on China's import growth, using the promulgation of cross‐border e‐commerce‐related policies since 2012 as a quasi‐natural experiment and using the ‘Cross‐border E‐commerce Retail Import Commodity List’ to identify cross‐border e‐commerce industries. Our difference‐in‐difference results show that cross‐border e‐commerce has significantly boosted China's import growth. Dynamic effects show that while China's imports were low prior to 2012, cross‐border e‐commerce has increased China's imports significantly since 2012, verifying the validity of our baseline results. Placebo tests and a series of robustness checks further confirm the validity and robustness of the baseline results. Further analysis reveals that cross‐border e‐commerce has mainly promoted imports from developed countries, and primarily facilitated imports of clothing, food and daily necessities. Mechanism analysis shows that cross‐border e‐commerce not only stimulated both the intensive and extensive margins in import growth, but also reduced cultural distances and increased China's imports from countries with larger cultural distances substantially. However, geographical and institutional distances still matter and exhibit significantly negative effects on China's cross‐border e‐commerce imports.
Comparison of venous hemoglobin saturation measurements obtained by in vivo oximetry and calculated from blood gas analysis in critically ill dogs
Authors: Walton Rebecca A. L. , Hansen Bernie
Published: July 2021

Objective

To compare in vivo central venous hemoglobin saturation measurement (ScvO2) using a fiber optic catheter with saturation calculated from blood gas analysis in critically ill dogs.

Design

Prospective observational study.

Setting

University veterinary teaching hospital intensive care unit.

Animals

A convenience sample of 20 dogs with severe illness.

Interventions

Dogs were instrumented with either a central venous catheter with an integrated fiber optic cable or a conventional catheter with a fiber optic probe inserted through its distal port. Baseline saturation was measured with the fiber optic system (FSO2), then monitored continuously. Central venous blood was collected for analysis and FSO2 was recorded by the principal investigator (PI) or nursing staff participating in data collection (staff) at baseline and at 1, 2, 3, and 6 hours. Hemoglobin oxygen saturation (SO2) values calculated using human Bohr coefficients were taken directly from the analyzer (GPSO2), and were also calculated using temperature‐correction and canine Bohr coefficients (RSO2).

Measurements and Main Results

Ninety‐seven paired measurements from 20 dogs were analyzed. FSO2 obtained by the PI (n = 41) had better agreement with both GPSO2 (concordance correlation coefficient ρc = 0.926 vs 0.5562) and RSO2 (ρc = 0.75 for PI vs 0.54) than did staff (n = 56). RSO2 values were always smaller than GPSO2. FSO2 ‐ GPSO2 differences were smaller when measurements were collected by the PI versus Staff (mean difference 0.21 vs −6.6, respectively, P < 0.02). Thirty‐six of 41 FSO2 values obtained by PI were within 5% of GPSO2.

Conclusions

Concordance between FSO2 and either calculation method was low, but was better when performed by PI. The larger difference between methods when using RSO2 suggests a positive bias by FSO2. Difficulty obtaining stable measurements may have contributed to the poor concordance between methods within Staff.
Treatment and outcome of eight horses with limb cellulitis and septic tendonitis or desmitis
Authors: Cooper Hannah E. , Davidson Elizabeth J. , Slack Joann , Ortved Kyla F.
Published: July 2021

Objective

To report the clinical features, treatment, and outcome in horses with cellulitis and concurrent septic tendonitis and/or desmitis.

Study Design

Short case series.

Methods

Medical records from 2000 to 2019 were reviewed, identifying horses with cellulitis and concurrent septic tendonitis and/or desmitis based on sonographic examination and positive bacterial culture. Signalment, ultrasonographic results, bacterial culture, treatment, duration of hospitalization, and complications were recorded. Long‐term outcome data were obtained from follow‐up examinations and/or telephone interviews. Successful outcome was defined as return to intended use.

Results

Eight horses met the inclusion criteria. All infections occurred in hindlimbs, with septic suspensory ligament in six of eight horses, and septic superficial digital flexor tendon in one of eight horses. Surgical debridement was performed in six of eight horses. All horses were treated with systemic and regional intravenous antimicrobials and were discharged from the hospital. Long‐term follow‐up was available in seven of eight horses. Of these, four horses returned to their intended athletic function, two horses returned to their intended function as a broodmare or pasture pet, and one horse is still rehabilitating.

Conclusion

Septic tendonitis or desmitis is a rare but possible sequela of limb cellulitis. Based on the findings in this study, prognosis for return to athletic function is fair to good for horses diagnosed with cellulitis and concurrent septic tendonitis or desmitis.
Decay Heat Characterization for the European Sodium Fast Reactor
Authors: Jiménez-Carrascosa Antonio , García-Herranz Nuria , Krepel Jiri , Margulis Marat , Baker Una , Shwageraus Eugene , Fridman Emil , Gregg Robert
Published: July 2021

In this work, a detailed assessment of the decay heat power for the commercial-size European sodium-cooled fast reactor (ESFR) at the end of its equilibrium cycle has been performed. The summation method has been used to compute very accurate spatial- and time-dependent decay heat by employing state-of-the-art coupled transport-depletion computational codes and nuclear data. This detailed map provides basic information for subsequent transient calculations of the ESFR. A comprehensive analysis of the decay heat has been carried out and interdependencies between decay heat and different parameters characterizing the core state prior to shutdowns, such as discharge burnup or type of fuel material, have been identified. That analysis has served as a basis to develop analytic functions to reconstruct the spatial-dependent decay heat power for the ESFR for cooling times within the first day after shutdown.
A Three-Dimensional Finite Element Damage Mechanics Model to Simulate Fretting Wear of Hertzian Line and Circular Contacts in Partial Slip Regime
Authors: Ahmadi Arman , Sadeghi Farshid
Published: July 2021

In this investigation, a three-dimensional (3D) finite element model (FEM) was developed to study fretting wear of Hertzian circular and line contacts. The wear law incorporated in this model is based on the accumulated dissipated energy (ADE). A stress-based damage mechanics finite element model using the ADE was developed to determine wear of non-conformal bodies in contact. Voronoi tessellation was used to simulate the microstructure of the materials during the fretting process. In order to simulate the wear area in fretting contacts, a material removal approach was developed and implemented in the model. The FEM was used to investigate partial slip regimes under various operating conditions. The normal and shear surface tractions for the circular and line contacts were applied to the domain in order to improve the computational efficiency. The calculated wear volume rate using the FE model is in good agreement with the wear coefficient available in the open literature. The influence of modulus of elasticity, hardness, and coefficient of friction on the partial slip fretting phenomenon were studied. In order to verify the model, several fretting wear tests were conducted using AISI 8620 steel and AISI 1566 steel in a partial slip regime of circular contact configuration. The properties for each material such as the modulus of elasticity, hardness, and the grain size were measured experimentally and compared with the model. For the defined load and displacement amplitude of the experimental fretting tests, both materials have shown a partial slip behavior in the initial cycles and then transition to a gross slip regime. The numerical model predicted the worn surface and wear-rate in partial slip regime which corroborated well with these experimental test results.
On the Evolution of Passive Magnetic Bearings
Authors: Samanta P. , Hirani H.
Published: July 2021

The present work portrays the latest review of the progressive advances in passive magnetic bearing (PMB) technology. PMB is an old technology with many encouraging properties. However, there are a number of inherent issues with design, analysis, and performance characterization that must be considered for reliable operation. Finally, it examines in detail the geometrical configurations, load-bearing capacity, dynamic behavior, and stability connected with stiffness and damping.
Supplemental Material: Detrital zircon geothermochronology reveals pre-Alleghanian exhumation of regional Mississippian sediment sources in the southern Appalachian Valley and Ridge Province
Authors: McKay M. , al. et
Published: July 2021

U-Pb zircon data, U-Th/He data, and HeFTy models.
Temporal changes in blood pressure following prehospital rapid sequence intubation
Authors: Fouche Pieter Francsois , Meadley Ben , StClair Toby , Winnall Alison , Stein Christopher , Jennings Paul Andrew , Bernard Stephen , Smith Karen
Published: July 2021

Background

Rapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the changes in systolic blood pressure in a large cohort of paramedic-led RSI cases over the whole prehospital timespan.

Methods

Intensive Care Paramedics in Victoria, Australia, are authorised to use RSI in medical or trauma patients with a Glasgow Coma Scale <10. This retrospective cohort study analysed data from patientcare records for patients aged 12 years and above that had received RSI, from 1 January 2008 to 31 December 2019. This study quantifies the systolic blood pressure changes using regression with fractional polynomial terms. The analysis is further stratified by high versus Low Shock Index (LSI). The shock index is calculated by dividing pulse rate by systolic blood pressure.

Results

During the study period RSI was used in 8613 patients. The median number of blood pressure measurements was 5 (IQR 3–8). Systolic blood pressure rose significantly by 3.4 mm Hg (p<0.001) and then returned to baseline in the first 5 min after intubation for LSI cases. No initial rise in blood pressure is apparent in High Shock Index (HSI) cases. Across the whole cohort, systolic blood pressure decreased by 7.1 mm Hg (95% CI 7.9 to 6.3 mm Hg; p<0.001) from the first to the last blood pressure measured.

Conclusions

Our study shows that in RSI patients a small transient elevation in systolic blood pressure in the immediate postintubation period is found in LSI, but this elevation is not apparent in HSI. Blood pressure decreased over the prehospital phase in RSI patients with LSI, but increased for HSI cases.
#3112 Acquired aphantasia in 88 cases: a preliminary report
Authors: Knowles Laurence , Jones Kealan , Zeman Adam
Published: July 2021

Aims

For most of us, visual imagery is a fundamental feature of day-to-day subjective experience. It is thought to play multiple cognitive roles.1 However, there is widespread variation in the subjective intensity of visual imagery, ranging from extreme vividness to complete absence. The term aphantasia was coined recently to describe the latter, which is usually lifelong. While rarer, cases of acquired aphantasia can provide mechanistic insight. Isolated cases have long been reported,2 with some attempts at theoretical synthesis.3 4 We give a preliminary description of 88 such cases identified from among ~14,000 people contacting us in the wake of publicity surrounding Aphantasia.

Methods

Cases were selected from individuals contacting us spontaneously reporting reduced or absent intensity of visual imagery. Contacts were asked to complete two measures of visual imagery, the Vividness of Visual Imagery Questionnaire (VVIQ) and Imagery Questionnaire (IQ).5

Results

Cases were divided into those in with a strong probability of a neurological cause (n=39), a psychological cause (n=20) and those about which we cannot yet be confident (n=29). Functional aphantasia appears likely to account for some of the cases in the third category. The commonest precipitating events were head injury (n=19), affective disorder (n=17) and stroke (n=13). Other causes included surgery (postoperative) (n=7), drugs (n=6), infectious or inflammatory disease (n=3), neurodegenerative disease (n=3), and seizure disorders (n=2). For subjects completing the VVIQ (n=29), the mean score was 20.1/80 (range 16-32,) indicating marked reduction of imagery vividness. Localizable lesions were predominantly right sided (n=6) and occurred in posterior cortical areas, particularly occipital and parietal, as well as two cases associated with damage to temporal cortex. Some cases reported other impairments, including impaired memory (n=12), prosopagnosia (n=5) and navigational difficulties (n=2). Of cases who reported on their dreams (n=28), around half had lost visual dreaming, a third had preserved visual dreaming and the remainder had visual dreaming of reduced intensity.

Conclusions

To our knowledge, this is the largest reported case series of acquired loss of visual imagery. Both neurological and psychological disorders can be responsible for acquired aphantasia. Our series includes cases of probable functional aphantasia. Further detailed analysis of these cases is required.

References

Pearson. Nat. Rev. Neurosci. 2019;20:624634.

Zago, et al. Cognit. Neuropsychiatry 2011;16:481504.

Farah. Cognition 1984;18:245272.

Bartolomeo. Cortex 2002;38:357378.

Zeman, et al. Cortex 2020;130:426440.
#3029 HIV-associated neurocognitive disorder: an investigation using structural neuroimaging in a c-ART treated tanzanian cohort
Authors: McDonald Lucy , Koipapi Sengua , Howlett William , Dekker Marieke , Urasa Sarah , Kalaria Rajesh , Walker Richard , Firbank Michael , Paddick Stella-Maria
Published: July 2021

Background

There is a newly emergent ageing population of people living with HIV (PLWH) in Africa. However, there is little research into HIV-associated neurocognitive disorder (HAND) in this population. Existing research suggests HAND is prevalent however the aetiology remains unclear. This study aims to determine whether HAND is truly prevalent and explore potential causes in PLWH on c-ART using objective structural measures.

Aims

Explore whether substantial atrophy and/or white matter hyperintensities (WMH) is present on the clinical magnetic resonance imaging (MRI) reports and quantitative analysis of people with optimally managed HIV in Northern Tanzania.

Explore the aetiology of HAND by assessing whether cerebral atrophy and/or WMH is associated with demographic risk factors, HIV–related factors and/or comorbidities.

Investigate whether structural damage is related to objectively measured cognitive impairment, and whether this is a subcortical or cortical impairment.

Explore which neurocognitive test is the best predictor of structural damage and therefore most valid diagnostic test for HAND.

Methods

A systematic sample of PLWH aged ≥ 50 were recruited from a HIV clinic in Kilimanjaro, Tanzania. Demographic data and comorbidities were self-reported. HIV-disease management data were obtained. Viral load and CD4 count were measured. A neurocognitive battery and informant history of functional impairment identified HAND. Cerebral atrophy (brain and ventricle volume) and WMH were measured using quantitative analysis of 1.5T MRI.

Preliminary results

This cohort (n=91) had well-managed HIV (75.9% suppressed viral load, median CD4 507 cells/ul). The significant independent predictor (IP) of decreased brain volume was older age at HIV diagnosis (p=.001), and of increased ventricle volume was increased age (p<.0001), male gender (p<.0001) and increased frailty (p<.0001). The significant IPs of increased WMH volume were increased age (p<.0001) and smoking (p=.021). Only memory impairment independently predicted all structural measures.

Conclusions

This is the first MRI study of older c-ART treated PLWH in Africa. Despite c-ART and good disease management, HAND was objectively prevalent and unrelated to measures of HIV. Cerebral atrophy and WMH were associated with factors of neurodegeneration. Cerebral atrophy was associated with male gender and age at diagnosis (legacy effect).
#3090 Different measures of behavioural involvement in amyotrophic lateral sclerosis yield varying rates of behavioural change
Authors: Didcote Lyndsay , Vitoratou Silia , Al-Chalabi Ammar , Goldstein Laura H
Published: July 2021

Objectives/Aims

Amyotrophic Lateral Sclerosis (ALS), also known as Motor Neuron Disease (MND), is a progressive and life-limiting neurodegenerative disease which can involve behavioural change. There are five commonly reported disease-specific screening tools of behavioural change but it is not clear how they differ in applicability. This study therefore set out to investigate the extent to which these measures similarly identify impairment by examining i) intercorrelations between scores on the measures completed about the same people with ALS, and ii) the percentage of people with ALS characterised as impaired on each measure.

Methods

The behavioural component of the ALS-Cognitive Behavioural Screen (ALS-CBS-b), behavioural component of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS-b), ALS-Frontotemporal Dementia Questionnaire (ALS-FTD-Q), Beaumont Behavioural Inventory (BBI), and MND Behavioural Instrument (MiND-B) were all completed by 35 carers of people with ALS. Total scores for each measure underwent Spearman correlation analysis. Classifications of impairment (for behavioural impairment or ALS-FTD) were determined using published cut-offs and agreement between measures was determined by calculating Cohens kappa coefficients.

Results

The behavioural measures were significantly intercorrelated (p<0.05 in all cases) but with differing strengths of association. The association between the ALS-CBS-b and ALS-FTD-Q was weak to moderate (r=0.41) while other associations between the ALS-FTD-Q, MiND-B, BBI, and ALS-CBS-b were moderate to strong (0.53-0.75). While the ECAS-b was moderately associated with the BBI (r=0.53), the ECAS-b was only weakly to moderately associated with the ALS-CBS-b, MiND-B and ALS-FTD-Q (0.36-0.48). The association between ALS-CBS-b and ALS-FTD-Q scores (r=0.41) was similarly in the weak to moderate range. The ECAS-b and ALS-CBS-b had the weakest intercorrelation (r=0.36). Percentages of the sample classified with behavioural involvement by the measures ranged between 20.0% (ALS-FTD-Q) and 74.3% (MiND-B). Percentages of the sample classified with ALS-FTD by the measures ranged between 2.9% (ECAS-b) and 20% (ALS-CBS-b). Agreement of classification between measures (Cohens kappa) was mostly fair to moderate (0.21-0.57) although generally better for classifications of ALS-FTD than for milder behavioural involvement. Between the ECAS-b and BBI there was complete agreement on the classification of ALS-FTD (k = 1.0).

Conclusions

Existing measures of behavioural change in people with ALS may yield very differing conclusions and cannot be assumed to be interchangeable. Variability in the detection of impairment between measures may result from differing item content, behaviours sampled or cut-off scores for impairment. This inconsistency between measures may lead to inappropriate healthcare provision and discrepancies in research conclusions.

Funding

MND Association
#3106 Limb weakness in the emergency department: a focus on unexplained aetiology presentations
Authors: Wang Qiying , Udom Arina , Wang Yanxin , Kusnierz-Was Paulina , Castro Megan , Butler Matthew , Posporelis Sotirios
Published: July 2021

Background

Functional neurological disorder (FND) is a common and potentially disabling neuropsychiatric condition. While its presentation can be extremely diverse, from aphonia to seizure activity, one of the most common symptoms is weakness of one or more limbs. Despite functional weakness being one of the most common presentations seen in neurological practice, little is known about its prevalence in an Emergency Department (ED) setting. Hereby, we aim to describe the demographic and clinical characteristics of patients attending the ED with limb weakness of an unknown and potentially functional aetiology.

Methods

We carried out a retrospective electronic records review of all ED attendances with limb weakness as the presenting complaint, at Kings College Hospital. Patients admitted to the hospital were followed up until the point of discharge. The following clinical and demographic data were analyzed: age, gender, mode of arrival, psychiatric history and clinical diagnosis on discharge. Results: During the 15-month study period, 1340 patients presented with leg weakness at the ED, nearly half of these (47.54%) arrived by ambulance. 4.55% had unexplained weakness with no definite diagnosis on discharge. A significant proportion (62.31%) were admitted for further investigations; 6.35% of these were diagnosed with FND, while a further 25 patients (2.99%) were discharged with suspected FND. Patients with an FND diagnosis had a median age of 45 years; 62.96% were females, and they were significantly younger than male patients with FND (P=0.003). Less than half (44%) of the FND patients had one or more psychiatric diagnoses.

Discussion

A diagnosis of functional leg weakness was given to 3.95% (53/1340) of patients presenting with leg weakness in the ED. It is striking that none of these patients were given a diagnosis of FND in the ED, but only after admission to a ward. 6.4% (86/1340) were discharged from the hospital with an unclear diagnosis, 14% of which a functional overlay was suspected. Main limitations of the study: it is retrospective and single-centre.

Conclusion

This study highlights difficulties and obstacles in recognising and diagnosing functional presentations of limb weakness in the ED. There is a clear need for optimisation of the classification and coding system of the Emergency Department. Increased awareness and education around FND has the potential to raise diagnostic confidence and significantly improve patient experience and care.
#3123 Assessing international alcohol and internet use patterns during COVID-19 isolation using an online survey: highlighting distinct stressors conferring risk to compulsive behaviours
Authors: Sallie Samantha N , Ritou Valentin JE , Bowden-Jones Henrietta , Voon Valerie
Published: July 2021

Objectives and Aims

The Coronavirus (COVID-19) pandemic has required drastic safety measures to contain virus spread, including an extended self-isolation period. Those with greater perceived or actual life stress are vulnerable to develop or reinstate problematic behaviours characterised by addiction and compulsive mechanisms. Thus, we assessed how the COVID-19 pandemic and isolation measures affected alcohol consumption and internet use in the general population.

Methods

We developed an online international survey, entitled Habit Tracker (HabiT), completed by 1,346 adults (≥18 years), which measured changes in amount and severity of alcohol consumption (Alcohol Use Disorders Identification Test; AUDIT),online gaming (Internet Gaming Disorder Scale-Short Form; IGDS9-SF), and pornography viewing (Cyber Pornography Addiction Test; CYPAT) before (post-hoc recall)and during the COVID-19 pandemic and consequent lockdown. These measures were related to ten COVID-19-specific stress factors. Lastly, we assessed psychiatric factors widely recognized to be associated with problematic alcohol and internet use such as anxiety, depression (Hospital Anxiety and Depression Scale; HADS), and impulsivity (Short Impulsive-Behavior Scale; SUPPS-P).

Results

Of the sample, we observed an overall increase in online gaming and a decrease alcohol consumption and pornography viewing. Those who increased their amount and severity of alcohol use (36%) during lockdown reported stress associated with the pandemic itself, such as being an essential worker directly caring for those with or having a loved one become severely ill from COVID-19. Further, those residing in the United Kingdom- as opposed the United States or Canada- increased their weekly amount of alcohol consumption. Alternatively, those who increased online gaming (64%) and pornography viewing (43%)reported low frequency or poor quality social interactions resultant of lockdown measures. All three groups displayed higher levels of depression, anxiety, and urgency impulsivity.

Conclusions

Our findings underscore the theoretical mechanism of negative emotionality underlying forms of compulsive behaviour driven by stress, depression, and anxiety; while highlighting distinct avenues by which these behaviours can manifest. Limitations include subjects being within varying phases of lockdown during the time of testing and a large degree of study dropout (n=1,515). We emphasise the relevance of identifying those in need of greater support services to mitigate negative health outcomes associated with problematic alcohol consumption and internet usage in the context of COVID-19 isolation.
6 PTSD and war photo journalists
Authors: Feinstein Anthony
Published: July 2021

War journalism is becoming increasingly dangerous. Journalists who define their careers by longevity in war zones have a lifetime prevalence of PTSD similar to frontline combat veterans. Local journalists can also confront grave danger, but unlike foreign correspondents, they work and live in dangerous places. They too have rates of PTSD and depression that well exceed that seen in the general population. Local journalists whose families are targeted are particularly vulnerable in this regard. Journalists who chose these dangerous career paths differ cognitively from their colleagues who have chosen less adventurous careers, most notably when it comes to decisions that entail risk. The ability to manage anxiety and fear in extreme situations may to a degree be modulated by epigenetic factors.
7 Covid-19 and neuropsychiatry
Authors: Michael Benedict D
Published: July 2021

As the clinical features and potential complications of COVID-19 emerged last year it became clear that neurological, neuropsychiatric and psychiatric disorders were potentially significant. There were also reasons to expect this from past viral outbreaks, including other severe coronaviruses. The CoroNerve study, led by Ben Michael and colleagues, was rapidly set up to as a UK-wide surveillance system for clinicians to initially briefly notify cases and later provide full clinical details. A psychiatry reporting system, led by the RCPsych neuropsychiatry faculty, was added and the first 153 notifications were published last June. The full clinical details of the first 267 cases completed were published as a preprint in January.

The has been a rapid growth in the number and quality of publications regarding the neuropsychiatry of COVID-19 and this has been collated on the JNNP Neurology & Neuropsychiatry of COVID-19 blog which we set up to respond to the need for rapid capture and synthesis of a fast moving field with weekly updates and publications from a growing international team, including a recently published preprint systematic review and meta-analysis of the neurology and neuropsychiatry of COVID-19. We will jointly review the CoroNerve data and its context in the emerging wider evidence base regarding the neuropsychiatry of COVID-19, highlighting exciting new research areas such as long COVID and projects such as the recently started COVID-CNS study funded by UKRI.

We would like to thank those who have already submitted cases to CoroNerve and encourage others to do the same, including those associated with COVID-19 vaccination, and to flag up that notifying a case and providing data results in pubmed searchable collaborator status on resulting publications.
Peripheral blood leucocyte telomere length is associated with progression of interstitial lung disease in systemic sclerosis
Authors: Liu Shuo , Chung Melody P , Ley Brett , French Sarah , Elicker Brett M , Fiorentino David F , Chung Lorinda S , Boin Francesco , Wolters Paul J
Published: July 2021

Background

Peripheral blood leucocyte telomere length (PBL-TL) is associated with outcomes in patients with idiopathic pulmonary fibrosis. Whether PBL-TL is associated with progression of systemic sclerosis-associated interstitial lung disease (SSc-ILD) is unknown.

Methods

A retrospective observational cohort study was performed using prospectively collected data from 213 patients with SSc followed at the University of California San Francisco (UCSF) Scleroderma Center. PBL-TL was measured by quantitative PCR of DNA isolated from peripheral blood. Associations between PBL-TL and pulmonary function test trends in patients with SSc-ILD were assessed by longitudinal analysis using Generalised Linear Mixed Models. Findings were validated in a cohort of 61 patients with SSc-ILD enrolled in the Stanford University Scleroderma Center database.

Results

Patients with UCSF SSc with ILD were found to have shorter PBL-TL compared with those without ILD (6554±671 base pairs (bp) vs 6782±698 bp, p=0.01). Shorter PBL-TL was associated with the presence of ILD (adjusted OR 2.1 per 1000 bp TL decrease, 95% CI [1.25 to 3.70], p=0.006). PBL-TL was shorter in patients with SSc-ILD lacking SSc-specific autoantibodies compared with seropositive subjects (6237±647 bp vs 6651±653 bp, p=0.004). Shorter PBL-TL was associated with increased risk for lung function deterioration with an average of 67 mL greater loss in per year for every 1000 bp decrease in PBL-TL in the combined SSc-ILD cohorts (longitudinal analysis, adjusted model: 95% CI −104 mL to −33 mL, p<0.001).

Conclusions

These findings suggest that telomere dysfunction may be associated with SSc-ILD progression and that PBL-TL measurement may be useful for stratifying risk for SSc-ILD progression.
Prospective nationwide multicentre cohort study of the clinical significance of autoimmune features in idiopathic interstitial pneumonias
Authors: Enomoto Noriyuki , Homma Sakae , Inase Naohiko , Kondoh Yasuhiro , Saraya Takeshi , Takizawa Hajime , Inoue Yoshikazu , Ishii Hiroshi , Taguchi Yoshio , Izumi Shinyu , Yamano Yasuhiko , Tanino Yoshinori , Nishioka Yasuhiko , Toyoshima Mikio , Yokomura Koshi , Imokawa Shiro , Koshimizu Naoki , Sano Takehisa , Akamatsu Taisuke , Mukae Hiroshi , Kato Motoyasu , Hamada Naoki , Chiba Hirofumi , Akagawa Shinobu , Muro Shigeo , Uruga Hironori , Matsuda Hiroyuki , Kaida Yusuke , Kanai Miho , Mori Kazutaka , Masuda Masafumi , Hozumi Hironao , Fujisawa Tomoyuki , Nakamura Yutaro , Ogawa Noriyoshi , Suda Takafumi
Published: July 2021

Background

Some patients with idiopathic interstitial pneumonia (IIP) show autoimmune features. Interstitial pneumonia with autoimmune features (IPAF) was recently proposed as a research concept in these patients. However, retrospective studies reported conflicting results of its prognosis. Therefore, this study was conducted to prospectively evaluate the clinical significance of autoimmune features in patients with IIP.

Methods

This nationwide multicentre study prospectively enrolled consecutive patients with IIP. At the diagnosis, we systematically evaluated 63 features suggestive of connective tissue diseases using a checklist including symptoms/signs and autoantibodies, which contained most items of the IPAF criteria and followed up with the patients. Clinical phenotypes were included in a cluster analysis.

Results

In 376 patients with IIP enrolled, 70 patients (18.6%) met the IPAF criteria. The proportion of patients with IPAF was significantly lower in idiopathic pulmonary fibrosis (IPF) than in non-IPF (6.0% vs 24.3%, respectively). During a median observation period of 35 months, patients with IPAF more frequently developed systemic autoimmune diseases and had less frequent acute exacerbation of IIPs than patients with non-IPAF. IPAF diagnosis was significantly associated with better survival and was an independent positive prognostic factor in total and patients with non-IPF. Cluster analysis by similarity of clinical phenotypes identified a cluster in which there was a higher number of women, and patients had more autoimmune features and a better prognosis than other clusters.

Interpretation

These observations suggest that some patients with IIP show autoimmune features with distinct characteristics and favourable prognosis. However, we were not able to determine the appropriate therapies for these patients.
Variations in growth and architecture in the range limit of Salix humboldtiana, the willow native to South America
Authors: Salgado Mariana , Gallo Leonardo Ariel , Torres Cristian Daniel , Stecconi Marina , Puntieri Javier Guido
Published: July 2021

The conditions faced by edge populations of a tree species may affect the architecture of individual trees. The latitudinally broad range of Salix humboldtiana Willd. encompasses tropical to cold-temperate climatic regions, with its southernmost population in central Patagonia. We expected S. humboldtiana trees from the southern-edge population to develop smaller shoots and a lower level of axis differentiation than trees of this species from a more northern population, and we expected edge trees to outperform non-edge trees when growing in a common garden at an intermediate latitude. For juvenile individuals of S. humboldtiana from edge and non-edge natural populations, the trunk diameter, height, branching angle, as well as the length, number of nodes, diameter, leaf area, and specific leaf area of the main branch and the trunk annual shoots were measured. The size and extension rates of shoots developed by trees of both origins in a common garden were also evaluated. In natural populations, the shoot leaf area and the specific leaf area were higher for the edge population than for the non-edge population. In a common garden, the shoot extension period and the length were higher for non-edge plants than for edge plants. The growth-period differences between populations in a common garden may support the hypothesis of stress adaptation in the southernmost S. humboldtiana trees.
An anisotropic charged fluids with Chaplygin equation of state
Authors: Estevez-Delgado Joaquin , Maya Noel Enrique Rodríguez , Peña José Martínez , Cleary-Balderas Arthur , Paulin-Fuentes Jorge Mauricio
Published: July 2021

A stellar model with an electrically charged anisotropic fluid as a source of matter is presented. The radial pressure is described by a Chaplygin state equation, [Formula: see text], while the anisotropy [Formula: see text] is annulled in the center of the star [Formula: see text] is regular and [Formula: see text], the electric field, is also annulled in the center. The density pressures and the tangential speed of sound are regular, while the radial speed of sound is monotonically increasing. The model is physically acceptable and meets the stability criteria of Harrison–Zeldovich–Novikov and in respect of the cracking concept the solution is unstable in the region of the center and potentially stable near the surface. A graphic description is presented for the case of an object with a compactness rate [Formula: see text], mass [Formula: see text] and radius [Formula: see text] km that matches the star Vela X-1. Also, the interval of the central density [Formula: see text], which is consistent with the expected magnitudes for this type of stars, which shows that the behavior is accurate for describing compact objects.
Two-dimensional new coherent structures of lump-soliton solutions for the Mel’nikov equation
Authors: Liu Wei , Meng Yuan , Qiao Xiaoyan
Published: July 2021

Under investigation in this paper are new novel coherent structures of two-dimensional lump-soliton for the Mel’nikov equation. The Hirota bilinear method and Kadomtsev–Petviashvili hierarchy reduction method are applied to construct a particular family of determinant semi-rational solutions exhibiting various coherent waves to the Mel’nikov equation. We first investigate some novel coherent waves, [Formula: see text]th-order lumps first appear from the [Formula: see text] dark line solitons and finally disappear into those [Formula: see text] dark line solitons after living on the constant background for a very short period. In contrast to the usual lump, those lumps in the coherent structures of lump-soliton are not only localized in two-dimensional space and but also localized in time.
An 8-bit Hybrid TDC/Single-Slope ADC with an Improved Continuous-Time Comparator
Authors: Naghieh Pedram , Rahiminejad Ehsan
Published: July 2021

Single-slope analog-to-digital converter (SS ADC) and time-to-digital converter (TDC) architectures in their high-speed or high-resolution status tend to either have high-power consumption or occupy large area. However, using the hybrid structure of these two, although synchronizing them might be a limiting factor, can solve the area and power consumption issues. In this paper, a 4-bit SS ADC is combined with a 4-bit TDC. Moreover, a new low-powered continuous-time comparator architecture is designed to adjust its current based on not only the inputs amplitude but also their proximity near the flip point. In addition, a novel delay correction technique is utilized to resolve its nonlinear propagation delay. The presented technique reduces 90% nonlinearity of the comparator’s propagation delay and decreases its delay variation to 450[Formula: see text]ps. Using TSMC CMOS 130[Formula: see text]nm technology with a sampling frequency of 5.88[Formula: see text]MHz, the simulation result illustrates 788[Formula: see text][Formula: see text]W power consumption with the master clock frequency of 100[Formula: see text]MHz while an integral nonlinearity (INL) of [Formula: see text]1.41–+0.76[Formula: see text]LSB and a differential nonlinearity (DNL) of [Formula: see text]1.05–+0.05[Formula: see text]LSB is achieved in 625[Formula: see text]ps resolution. Finally, figure-of-merit (FoM) depicts 31.2[Formula: see text]fJ/conv. step. The presented converter can be used in CMOS image sensors and multi-resolution applications.
Storage and Proximity Management for Centralized Personal Health Records Using an IPFS-Based Optimization Algorithm
Authors: Mubashar Amna , Asghar Kalsoom , Javed Abdul Rehman , Rizwan Muhammad , Srivastava Gautam , Gadekallu Thippa Reddy , Wang Dong , Shabbir Maryam
Published: July 2021

Centralized Personal Health Records (PHR) are mutable with compromised security as it may lead to a single point of failure. Confidentiality, protection and security are the common issues in clinical record frameworks. Specific security and protection schemes are being used to secure clinical records. Accordingly, using the Interplanetary File System (IPFS), a decentralized PHR can be maintained to allow patients to access their records without delay. Moreover, a Kademlia-based distributed hash table provides fault tolerance and enables patients to keep track of their medical history. However, a significant issue in IPFS is data availability. It is only available on the web until users or hosts of the network request each peer, later it leads to a permanent loss of data. We propose an architecture that aims to provide faster retrieval and constant PHR availability using Blockchain and IPFS. The results show that an optimal node is selected in each iteration amongst all the available adjacent nodes.
The Application of Inorganic Optical Nanoprobes in Bacterial Infection
Authors: Ding Linyu , Jiang Lai , Liu Gang
Published: July 2021

Bacterial infection is an acute infection caused by pathogens or conditional pathogens, which leads to severe disease and even death. It has become a significant reason for diseases and deaths worldwide. Therefore, rapid and precise detection, diagnosis, and treatment in the early stage are the key to deal with bacterial infections. Over recent years, along with the advances in biomaterials and nanotechnology, numerous nanomaterial-based multifunctional probes have been extensively explored in the biomedical field. Because of their excellent optical properties, inorganic optical nanoprobes are used to rapidly detect bacterial infection in the early stage and show excellent antibacterial properties, which has a great application prospect in antibacterial therapy expected to reduce the risk of bacterial infection. In this mini-review, we generally overviewed and summarized recent progress on inorganic nanoparticle-based optical imaging techniques as a platform to construct functional theranostics for the efficient treatment of bacterial infections. The opportunities and challenges in the application of fluorescent optical nanoprobes are prospected.