bluuebunny/crossref_metadata_2025 huggingface dataset:
THUR 054 The heart holds answers the brain cannot to see
Authors: Owain Williams , Mo Hu , Deepthi Changaradil , Andrew Fry , Robert Powell
Published: October 2018

Neuronal ceroid lipofuscinosis (NCL) is a range of inherited lysosomal storage disorders. This case highlights the cardiac pathology associated with NCL and reports improved seizure control following correction of cardiac arrhythmias.

A 26-year-old woman presented with episodes of altered awareness with head and eye deviation on a background of a progressive neurodegenerative disorder. She initially presented at 7 years of age with progressive retinal dystrophy. As a teenager she developed seizures with prominent myoclonus, psychosis, cognitive impairment and immobility. Her epilepsy was refractory to treatment and seizures had increased in frequency prior to admission.

ECG demonstrated sinus bradycardia of 30bpm and episodes of 20 s sinus arrest. This was managed by the insertion of a pacemaker, resulting in a dramatic reduction in the frequency of her seizures. Investigation into the underlying disorder was revisited identifying vacuolated lymphocytes and homozygous CLN3 gene deletions. These findings are consistent with a diagnosis of juvenile NCL (Batten disease).

This case demonstrates the importance of cardiac monitoring in investigating a change in seizure pattern. We hypothesise that the patient presented with reflex hypoxic seizures secondary to asystolic episodes. It also highlights the value of securing a diagnosis to enable appropriate cardiac screening in NCL patients.
WED 097 Diagnostic lumbar punctures in IIH: what is the patient experience?
Authors: Scotton William J , Mollan Susan , Walters Thomas , Doughty Sandra , Nightingale Peter , Botfield Hannah , Markey Keira , Yiangou Andreas , Williamson Shelly , Sinclair Alexandra
Published: October 2018

Aims and methods

Patients with idiopathic intracranial hypertension (IIH) often report significant morbidity associated with lumbar punctures. We therefore aimed to assess the patient’s experience of diagnostic lumbar puncture (LP) in IIH using an online survey designed in collaboration with IIH: UK (a leading UK charity).

Results

463 patients responded to the survey, and were eligible for analysis, over a 2 month period in 2015. 40% of patients described severe pain during the LP (VRS≥8), and the median pain score during the LP was 7 (VRS, IQR 5–7). The majority of patients felt they received insufficient pain relief (85%). Levels of anxiety about future LP’s were high (median VRS 7, IQR 4–10), with 47% being extremely anxious (VRS≥8). LPs performed as an emergency were associated with significantly greater pain scores compared to elective procedures (median 7, IQR 5–7 vs 6, IQR 4–8, p=0.012). Higher LP pain scores (VRS) were significantly associated with poorly informed patients (Spearman correlation, r=−0.32, p<0.001).

Conclusions

This study has shown that a significant number of these patients are experiencing significant morbidity from pain and anxiety. This morbidity is associated with both inadequate pre-procedural information, as well as the setting the LP is performed in.
WED 112 Seeing invisible parkinsonian tremor with a smartphone camera
Authors: Paschal O’Gorman , Stefan Williams , Hui Fang , Rami Qahwaji , Parisa Patel , D Graham Christopher , Jane Alty
Published: October 2018

Arthur C Clarke’s ‘third law’ states that any sufficiently advanced technology is indistinguishable from magic. Computer vision is the processing of images or video by computer to extract useful information. A technique termed ‘Eulerian magnification’ involves amplification of tiny movements from video recordings, so that very small motions can become visible to the human eye. This has the potential to detect tremor that is of such small amplitude it cannot otherwise be seen. Crucially, the only hardware required is a camera and computer processor, items that are ubiquitous. There is only one previous report of Eulerian magnification applied to a simple video of a Parkinson’s patient, but Parkinsonian signs could clearly be seen in the pre-processing video, and no control video was shown. We present remarkable video in which no tremor is seen in either patient or control before processing, and yet a Parkinsonian tremor is revealed in patient but not control after amplification. Blinded clinician ratings detect a greater number of Parkinsonian tremors after computer processing. Furthermore, we report a method using an ‘optical flow’ computing technique that records pixel motion vectors, and enables the computer to measure the direction and relative amplitude of this amplified movement.
THUR 006 A case of GABA-B antibody mediated encephalopathy
Authors: Omar Abdel-Mannan , Seeedharan Harikrishnan , Khaled Abdel-Aziz
Published: October 2018

A previously well 17 year old female presented with a self-limiting episode of derealisation and depersonalisation lasting 24 hours. Initial MRI demonstrated new left peri-trigonal white matter hyperintensity. Initial bloods were normal and serum was negative for white cell enzymes, VLCFA and broad autoimmune screen but positive for GABA-b antibodies (Ab).

Six months later, an acute cognitive decline, intermittent upper limb tremor and emotional lability led to readmission. On examination she had an ACE-R of 88/100 and mildly slowed saccades. Repeat MRI was stable and EEG was diffusely slow, particularly the right temporal lobe. She had a mild CSF lymphocytosis (8 cells). An underlying malignancy was excluded with CT chest, abdomen, pelvis and PET CT. She was treated with PLEX and pulsed intravenous methylprednisolone, which led to an improvement of her symptoms and cognitive status. She was discharged on oral steroid taper. One month later she had a milder relapse and was retreated with PLEX and started on mycophenolate. She has now been in remission for 18 months.

Conclusions

Our case highlights that neurologists should consider GABA-b Ab mediated encephalitis as a differential in patients presenting with derealisation and depersonalisation, in addition to previously described presentations of seizures and ataxia.
WED 127 Update on the questionnaire for brain donors at queen square brain bank
Authors: Katie Yoganathan , Pedro Barbosa , Alastair Noyce , Eduardo Fernandez , Karen Shaw , Helen Ling , Daniela Hansen , Tom Warner , Andrew Lees
Published: October 2018

The Queen Square Brain Bank (QSBB) is recognised as a world leading neuropathological resource for brain tissue for study into Parkinson’s disease (PD) and Parkinson-plus syndromes. At recruitment to the donor register, a self-assessment form is given to every donor and used for administrative and research purposes. Due to the recent increase in donations from individuals with Parkinsonian syndromes and the latest advances on risk factors and symptomatology of PD, a new questionnaire is needed. This study is a literature review of existing self-report questionnaires used in PD, Parkinson-plus syndromes, hyperkinetic disorders and cognitive impairment, to assess their suitability for inclusion in the new questionnaire for QSBB brain donors. This is the first systematic review of our knowledge to include all five domains of Parkinsonian symptoms. Subsequently, the modified Delphi method was used to reach a consensus of the domains from an expert panel. This information was cross-referenced with the Clinical Data Interchange Standards Consortium. Through the creation of this new questionnaire, we hope to improve the quality of the data collected from brain donors, which hopefully will ultimately help improve our understanding and management of these disorders.
WED 129 Improving community exercise provision in parkinson’s
Authors: Palin Madeleine , Rideout Jane , Carroll Camille , Evans Valerie
Published: October 2018

Objective

To improve community-based exercise provision for people with Parkinson’s (PwP).

Background

Regular exercise of moderate-high intensity is beneficial to PwP, significantly reducing impact of symptoms and improving quality of life.

Aim

To increase exercise opportunity for PwP by:

Development, delivery and evaluation of a programme to increase community exercise providers’ knowledge and understanding of Parkinson’s disease (PD).

Development of a ‘tool kit’ to facilitate national dissemination of the course.

Methods

Funding was achieved from Active Devon and Parkinson’s UK. Course content and evaluation methodology were developed by the PenPEN training co-ordinator (VE), and project team. The 3 hour pilot course was delivered in November 2017. A pre- and post-course questionnaire was administered to participants.

Results

25 Delegates attended the course, representing a range of activities including dance, swimming and football. 100% completed questionnaires. Evaluation demonstrated significant improvement in comfort communicating with PwP (p=0.002), understanding of PD and the benefits of exercise, and suggesting exercise to PwP (p<0.001).

Conclusions

We have developed a means of increasing community exercise provision for PwP. Details of trained exercise providers are disseminated via clinics and Parkinson’s UK branches. An Exercise Provider Training Toolkit will be made available via the Parkinson’s Excellence Network.
THUR 007 A garden variety neuropathy
Authors: Sumangala Salini , Simpson Ben , George Jithin
Published: October 2018

A 47 year old with subacute onset of walking difficulties, asymmetric lower limb and facial weakness and areflexia was admitted as a suspected case of Guillain-Barre syndrome. Clinical examination revealed left lower motor neuron facial weakness, right upper limb and lower limb weakness and a suspended area of pain and allodynia at T7. Structural imaging of the brain and spine was normal. CSF protein was elevated with pleocytosis. Nerve conduction studies was suggestive of proximal demyelinating polyradicular neuropathy. The clinical suspicion of neuroborreliosis was confirmed in CSF with Borrelia VlsE antigen positivity and serum Borrelia Burgdorferi IgG EIA positivity. The patient had no recollection of tick exposure but did recall a presumed horsefly bite on the forearm two weeks earlier of uncertain significance. This is a case of Bannwarth syndrome - meningoradiculoneuritis due to neuroborreliosis endemic in Northern Europe. Our patient was treated with Ceftriaxone with rapid improvement of symptoms. This case highlights the importance of careful history taking including ascertainment of travel to Borrelia endemic areas and recognition of this eminently treatable meningoradiculoneuropathy.
THUR 153 Antibodies against the voltage-gated potassium channel complex
Authors: Das Joyutpal , Chauhan Vanisha , Keh Ryan , Mills Daniel , Nicholas Johal , Matthews Rachael , Lilleker James , Gosal David , Sharaf Nazar
Published: October 2018

Voltage-gated potassium channel (VGKC) complex antibodies have been associated with a spectrum of presentations including peripheral nerve hyperexcitability (PNH), Morvan’s syndrome, autoimmune encephalopathy, epilepsy and recently psychosis.

We retrospectively reviewed the medical records of 70 patients from the Greater Manchester Neuroscience Centre, who had tested positive for VGKC-complex antibodies between 2012 and 2015 to identify the clinical relevance of positive results.

The majority were diagnosed with autoimmune encephalopathy(19) followed by epilepsy(14), psychosis(10) and PNH(6). The remaining fifteen had other neurological presentations and six had no primary neurological disorder. 39/70 patients who had antibody titres>400 pM, were diagnosed with autoimmune encephalopathy(19), epilepsy(9), psychosis(4), PNH(3) and other disorders(4). 24/39 patients, who received treatment with one or a combination of corticosteroids, intravenous immunoglobulins, cyclophosphamide, plasma exchange, azathioprine or rituximab, had a diagnosis of autoimmune encephalopathy(18), epilepsy(2), psychosis(2) and malignancy(2). 16/24 were treatment responsive. 3/31 patients with lower titres were also treated, but only one with the classic phenotype (PNH) responded to treatment.

The classic phenotype often had a titre >400 pM. PNH may have a titre ≤400 pM. The patients without classic presentations typically had titres≤400 pM. Consistent with previous studies, clinical phenotyping and antibody titre helped to determine the relevance of VGKC-complex antibodies.
THUR 155 Autonomic function testing in autoimmune autonomic ganglionopathies
Authors: Vinojini Vivekanandam , Ekawat Vichayanrat , Ian Skeavington , Nadine Almeida , Valeria Iodice , Merete Hagen Ellen , Gorgon Ingle
Published: October 2018

Introduction

Autoimmune autonomic ganglionopathies (AAG) are an increasingly diagnosed cause of autonomic failure. In 50% of patients, nicotinic ganglionic acetylcholine receptor (α3-AchR) antibodies are found. The presentation includes orthostatic hypotension, gastrointestinal and bladder dysfunction, abnormal pupillary responses and sicca symptoms. Physiological changes are documented with serial autonomic function testing. Gold standard therapy is not well established; however treatment with repeated plasma exchange appears to alter disease course.

We provide the first description of consecutive autonomic function tests of one patient with seronegative AAG versus one patient with seropositive AAG both treated with serial plasma exchanges.

Methods

We compare ten parameters – time tolerated in head up tilt (HUT), lowest tilt heart rate (HR), systolic and diastolic blood pressures (BP), HR Valsalva phase 2 and 4, Valsalva ratio, change in catecholamines, HR response to deep breathing and antibody titre.

Results

HUT time, Valsalva ratio and the lowest tilt diastolic BP correlate best with clinical course over time. The α3-AchR titre also correlates with clinical improvement in the seropositive AAG patient.

Conclusions

We propose that repeated HUT time, Valsalva ratio and lowest tilt diastolic BP should be recorded in patients with AAG to determine treatment response and to assist in deciding treatment continuation.
WED 011 Subacute combined degeneration of the cord: laugh until you are weak
Authors: Anna Francis , Maz Matar
Published: October 2018

A 33 year old lady presented to her GP with a 2 week history of numbness affecting her thighs. Routine blood tests revealed normal haemoglobin and folate levels with a borderline B12 concentration of 103 ng/L. Over the subsequent 2 weeks the numbness spread to involve her feet and her hands. Despite commencing cobalamin injections her symptoms continued to progress. She was admitted to hospital 4 weeks after the onset of symptoms with disabling sensory ataxia.

All reflexes were either absent or elicited only with reinforcement. Plantars were downgoing. There was impairment of all sensory modalities in a glove-and-stocking distribution, with proprioception accurate at the ankle on the right and the knee on the left. Her gait was broad-based. The remainder of the neurological examination was unremarkable.

A full peripheral neuropathy screen revealed no abnormality. An MRI spine showed longitudinally extensive myelitis mainly affecting the dorsal cord extending from C4 to T3. MRI brain and lumbar puncture were pristine.

Guided by the MRI findings direct questioning elicited a long history of frequent recreational nitrous oxide use. We review the accumulating literature regarding nitrous oxide-induced subacute combined degeneration of the cord and explore the pathophysiological mechanisms underlying it.
THUR 159 Radiological findings in two patients with autoimmune GFAP astrocytopathy
Authors: Daniel White , Markand Patel , Wasim Muhammad , Tom Hayton , Satheesh Ramalingam , Vijay Sawlani , Saiju Jacob
Published: October 2018

Background

Autoimmune Glial Fibrillary Acidic Protein (GFAP) Astrocytopathy is a relatively new category of immune-mediated disease involving the central nervous system that demonstrates a widely variable spectrum of clinical presentations, ranging from the relatively mild or subacute onset of cognitive impairment, seizures, encephalopathy, meningeal symptoms to more complex forms of encephalomyelitis.

Materials and Methods

We present a radiological review of two cases which were recently diagnosed in our institution. They presented with fever, meningoencephalitis and bilateral papilloedema. CSF antibody analysis (GFAPα-IgG) from Mayo Clinic confirmed the diagnosis of GFAP in both cases.

Results

The typical radiological findings in both of the cases were a radial pattern of enhancement in brain and longitudinally extensive myelitic lesions in the spinal cord. The first patient improved with immunosupression treatment. The second patient had a significantly more severe clinical presentation with drug-refractory progression, who later died.

Conclusion

Patients presenting with subacute onset of cognitive impairment, meningoencephalomyelitis and papilloedema should raise the suspicion of autoimmune GFAP astrocytopathy. Though it is a relatively new disease entity, the radial pattern of enhancement and long spinal cord lesions on imaging are striking and CSF and serum antibodies are highly specific.
WED 167 Socioeconomic status and progression of disability in ms
Authors: Harding Katharine , Kingwell Elaine , Wardle Mark , Zhu Feng , Robertson Neil , Tremlett Helen
Published: October 2018

There is evidence that socioeconomic status (SES) is associated with multiple sclerosis (MS) incidence; however it is less clear whether there is also an association with long-term prognosis.

3113 patients were selected from the MS registries of British Columbia, Canada (n=2069), and Cardiff, Wales (n=1044). SES, based on neighbourhood-level average income, was measured at onset of MS. Cox proportional hazards regression was used to analyse the association of SES with time to sustained and confirmed EDSS 6.0 and EDSS 4.0. The association between SES and EDSS scores was assessed longitudinally by a linear regression model fitted using generalised estimating equations (GEE) with an exchangeable working correlation structure. All models were adjusted for age at onset, sex, year of onset, initial course and DMT. The cohorts were analysed individually and results combined using meta-analysis.

SES was associated with hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR]=0.90, 95% CI 0.89–0.91), and 4.0 (aHR=0.93, 0.88–0.98). GEE modelling confirmed association of SES with EDSS (β=−0.13, [−0.18- −0.08], p<0.001). We found evidence that lower SES is associated with poorer outcomes. Reasons for this are complex but may include lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.
THUR 178 Infections during grade 3/4 lymphopenia with cladribine tablets
Authors: Cook Stuart , Leist Thomas , Comi Giancarlo , Montalban Xavier , Sylvester Elke , Hicking Christine , Dangond Fernando
Published: October 2018

Background

In CLARITY, cladribine tablets 3.5 mg/kg (CT3.5) demonstrated efficacy in relapsing MS patients. The most common AE was lymphopenia, reflecting cladribine’s mode of action. Integrated safety analysis showed infection incidence was not higher in patients receiving CT3.5 vs placebo, bar a small increase of herpes zoster (HZV).

Objective

Post-hoc analysis examined infectious AEs occurring concurrently with Grade 3/4 lymphopenia (G3/4) in CT3.5 treated patients.

Methods

The AE profile for CT3.5 during the periods of G3/4 was analysed. Adjusted-AE incidences per 100 patient years (Adj-AE/100PY) were calculated in a cohort of patients receiving CT3.5 monotherapy in clinical trials.

Results

Data are presented as Adj-AE/100PY: G3/4 vs without G3/4. Adj-AE/100PY for any infections/infestations was 57.53 vs 24.50. Infections were similar between periods. ≥50% cases with G3/4 were easily-treatable upper- respiratory-tract infections (nasopharyngitis: 13.48 vs 5.24; upper-respiratory-tract infection: 9.67 vs 3.41; pharyngitis: 4.51 vs 0.73). HZV occurred in 4 patients with G3/4 (4.50 vs 0.73); cases were dermatomal and mild-to- moderate in severity. Single occurrences were reported for most infectious AEs. Opportunistic infections were single occurrences, not severe, serious or difficult-to-treat.

Conclusions

G3/4 increased frequency of infections but did not affect the type of infectious AEs in CT3.5 treated patients. HZV profile was uncomplicated, consistent with findings of previous analyses.

Disclaimer

http://medpub-poster.merckgroup.com/ABN2018DISC_Grade34.pdf
WED 182 Cladribine tablets effects on lymphocytes in ms patients
Authors: Soelberg-Sorensen Per , Dangond Fernando , Hicking Christine , Giovannoni Gavin
Published: October 2018

Background

Lymphopenia is expected from the mechanism of action of cladribine tablets 3.5 mg/kg (CT3.5)

Objective

Investigate absolute lymphocyte counts (ALC; 312 weeks) and subsets (240 weeks) in RRMS patients receiving 2 annual courses of CT3.5.

Methods

Pooled data from patients randomised to CT3.5 over 2 years in CLARITY/CLARITY-Extension inclusive of the PREMIERE registry (n=685).

Results

Baseline: median ALC=1.86 × 109/L. Year-1: ALC reached nadir at 9 weeks post-treatment with CT3.5 (1.00 × 109/L). Year-2: ALC reached nadir at Week-55 (0.81 × 109/L), then recovered to the normal range (≥1.00 × 109/L; Week-96). ALC was in normal range in 75% of patients by Week-144. Baseline median CD4+ were 851 cells/µL. Nadirs occurred at Week-16 (385 cells/µL) in Year-1 and at Week-60 (292 cells/µL) in Year-2; values increased after nadirs and regained threshold (350 cells/µL, ~Week-120). Baseline median CD8+ were 378 cells/µL. Nadirs occurred at Week-16 (239 cells/µL; Year 1) and Week-72 (232 cells/µL; Year 2). CD8+ recovered quickly after treatment and remained above 200 cells/µL at all times. Baseline median CD19+ were 205 cells/µL. Nadirs occurred at Week-9 (18 cells/µL; Year-1) and Week-52 (31 cells/µL; Year-2). CD19+ then reached threshold of 100 cells/µL by the end of Year-2.

Conclusion

Lymphocyte recovery begins soon after CT3.5. ALC, CD19+ B and CD4+ T cells; reached threshold by 7.5, 12 and 18 months. CD8+ cells remained above threshold.

Disclaimer

http://medpub-poster.merckgroup.com/ABN2018DISC_LongLymph.pdf
WED 014 Oct minimises unnecessary investigation for suspected papilloedema
Authors: Thomas Coysh , David Whiteside , Sarah Williamson , Louwai Muhammed , Vinod Metta , Fatemeh Geranmayeh , Barry Seemungal , Carolyn Gabriel , Joanna Ball , Richard Nicholas
Published: October 2018

Background

Optical coherence tomography (OCT) is a rapid and painless way to provide a record of the optic disc structure. Though not specific, it can identify swollen optic discs. We determined the impact of OCT prior to referral on the pathway for managing suspected papilloedema.

Methods

Audit of adults referred from the Western Eye Hospital to St Mary’s Hospital with suspected papilloedema was performed between 1/1/17 and 16/5/17. A follow-up re-audit was performed from 1/6/17 to 31/8/17 following implementation of OCT prior to referral.

Results

The initial audit identified 50 patients over 136 days and the re-audit 26 patients over 92 days. In the initial audit 6/50 had OCT and 17/50 (34%) were admitted. 6/50 patients were subsequently found not to have papilloedema on fundoscopy, none of whom had OCT. 4/6 underwent unnecessary neuroimaging and lumbar puncture. 3 were admitted, equating to 18% of all admissions, for an average of 2.3 days. In the re-audit all had OCT, 6/26 (23%) were admitted and none were subsequently found not to have papilloedema.

Conclusion

Use of OCT prior to referral for suspected papilloedema helps to reduce unnecessary investigations.
THUR 196 Pregnancy outcomes in alemtuzumab-treated rrms patients
Authors: David Rog , Jiwon Oh , Christina Chambers , Kerstin Hellwig , Pamela McCombe , Luke Chung , Nadia Daizadeh , S Compston D Alastair
Published: October 2018

Murine studies show no alemtuzumab-related teratogenicity, but no controlled human clinical studies of alemtuzumab in pregnancy exist. In phase 2 (CAMMS223 [NCT00050778]) and phase 3 (CARE-MS I [NCT00530348], CARE-MS II [NCT00548405]) studies, patients received 2 annual alemtuzumab courses. Two extension studies provided longer-term evaluation (NCT00930553; TOPAZ [NCT02255656]). Pregnant/lactating patients were ineligible for further treatment but were followed up for safety. As of 1 April 2017, 248 pregnancies occurred in 156/972 alemtuzumab-treated female patients (mean [SD] age at conception, 32.5 [4.4] years; mean [SD] time from last alemtuzumab dose to conception, 33.5 [22.6] months; 16 within 4 months of dosing), with 218 completed, 14 ongoing, and 16 with unknown outcomes. Of completed pregnancies with known outcomes, 147 (67%) were live births with no congenital abnormalities or birth defects. There were 48 (22%) spontaneous abortions, 22 (10%) elective abortions, and 1 (0.5%) stillbirth. To date, there has been no signal for teratogenicity. Incidence of spontaneous abortions was comparable with treatment-naive MS patients (5%–21%) and the general population (17%–22%). Real-world data are currently collected by the International Lemtrada Pregnancy Exposure Registry, a prospective, non-interventional, observational safety study enrolling patients in ≥19 countries who become pregnant within 4 months of alemtuzumab exposure.

Study Support: Sanofi.
Comparing short versions of the Alcohol Use Disorders Identification Test (AUDIT) in a military cohort
Authors: Watterson Jason , Gabbe B , Dietze P , Bowring A , Rosenfeld J V
Published: October 2018

Background

The Alcohol Use Disorders Identification Test (AUDIT) is widely used for monitoring harmful alcohol consumption among high-risk populations. A number of short versions of AUDIT have been developed for use in time-constrained settings. In military populations, a range of AUDIT variations have been used, but the optimal combination of AUDIT items has not been determined.

Methods

A total of 952 participants (80% male), recruited as part of a wider study, completed the AUDIT-10. We systematically assessed all possible combinations of three or four AUDIT items and established AUDIT variations using the following statistics: Cronbach’s alpha (internal consistency), variance explained (R2) and Pearson’s correlation coefficient (concurrent validity).

Results

Median AUDIT-10 score was 7 for males and 6 for females, and 380 (40%) participants were classified as having a score indicative of harmful or hazardous alcohol use (≥8) according to WHO classifications.

A novel four-item AUDIT variation (3, 4, 8 and 9) performed consistently higher than established variations across statistical measures; it explained 85% of variance in AUDIT-10, had a Pearson’s correlation of 0.92 and Cronbach’s alpha was 0.63. The FAST, an established shortened AUDIT variant, together with several other four-item novel variants of AUDIT-10 performed similarly. The AUDIT-C performed consistently low on all measures, but with a satisfactory level of internal consistency (75%).

Conclusion

Shortened AUDIT variations may be suitable alternatives to the full AUDIT for screening hazardous alcohol consumption in military populations. Four-item AUDIT variations focused on short-term risky drinking and its consequences performed better than three item versions.

Trial registration number

ACTRN12614001332617.
Systemic sclerosis: state of the art on clinical practice guidelines
Authors: Smith Vanessa , Scirè Carlo Alberto , Talarico Rosaria , Airo Paolo , Alexander Tobias , Allanore Yannick , Bruni Cosimo , Codullo Veronica , Dalm Virgil , De Vries-Bouwstra Jeska , Della Rossa Alessandra , Distler Oliver , Galetti Ilaria , Launay David , Lepri Gemma , Mathian Alexis , Mouthon Luc , Ruaro Barbara , Sulli Alberto , Tincani Angela , Vandecasteele Els , Vanhaecke Amber , Vanthuyne Marie , Van den Hoogen Frank , Van Vollenhoven Ronald , Voskuyl Alexandre E , Zanatta Elisabetta , Bombardieri Stefano , Burmester Gerd , Fonseca João Eurico , Frank Charissa , Hachulla Eric , Houssiau Frederic , Mueller-Ladner Ulf , Schneider Matthias , van Laar Jacob M , Vieira Ana , Cutolo Maurizio , Mosca Marta , Matucci-Cerinic Marco
Published: October 2018

Systemic sclerosis (SSc) is an orphan disease characterised by autoimmunity, fibrosis of the skin and internal organs, and vasculopathy. SSc may be associated with high morbidity and mortality. In this narrative review we summarise the results of a systematic literature research, which was performed as part of the European Reference Network on Rare and Complex Connective Tissue and Musculoskeletal Diseases project, aimed at evaluating existing clinical practice guidelines or recommendations. Only in the domains ‘Vascular & Ulcers’ (ie, non-pharmacological approach to digital ulcer), ‘PAH’ (ie, screening and treatment), ‘Treatment’ and ‘Juveniles’ (ie, evaluation of juveniles with Raynaud’s phenomenon) evidence-based and consensus-based guidelines could be included. Hence there is a preponderance of unmet needs in SSc referring to the diagnosis and (non-)pharmacological treatment of several SSc-specific complications. Patients with SSc experience significant uncertainty concerning SSc-related taxonomy, management (both pharmacological and non-pharmacological) and education. Day-to-day impact of the disease (loss of self-esteem, fatigue, sexual dysfunction, and occupational, nutritional and relational problems) is underestimated and needs evaluation.
Relapsing polychondritis: state of the art on clinical practice guidelines
Authors: Rednic Simona , Damian Laura , Talarico Rosaria , Scirè Carlo Alberto , Tobias Alexander , Costedoat-Chalumeau Nathalie , Launay David , Mathian Alexis , Matthews Lisa , Ponte Cristina , Toniati Paola , Bombardieri Stefano , Frank Charissa , Schneider Matthias , Smith Vanessa , Cutolo Maurizio , Mosca Marta , Arnaud Laurent
Published: October 2018

Due to the rarity of relapsing polychondritis (RP), many unmet needs remain in the management of RP. Here, we present a systematic review of clinical practice guidelines (CPGs) published for RP, as well as a list of the most striking unmet needs for this rare disease. We carried out a systematic search in PubMed and Embase based on controlled terms (medical subject headings and Emtree) and keywords of the disease and publication type (CPGs). The systematic literature review identified 20 citations, among which no CPGs could be identified. We identified 11 main areas with unmet needs in the field of RP: the diagnosis strategy for RP; the therapeutic management of RP; the management of pregnancy in RP; the management of the disease in specific age groups (for instance in paediatric-onset RP); the evaluation of adherence to treatment; the follow-up of patients with RP, including the frequency of screening for the potential complications and the optimal imaging tools for each involved region; perioperative and anaesthetic management (due to tracheal involvement); risk of neoplasms in RP, including haematological malignancies; the prevention and management of infections; tools for assessment of disease activity and damage; and patient-reported outcomes and quality of life indicators. Patients and physicians should work together within the frame of the ReCONNET network to derive valuable evidence for obtaining literature-informed CPGs.
Analysis of carbohydrate-active enzymes in Thermogemmatispora sp. strain T81 reveals carbohydrate degradation ability
Authors: Tomazini Atilio , Lal Sadhana , Munir Riffat , Stott Matthew , Henrissat Bernard , Polikarpov Igor , Sparling Richard , Levin David B.
Published: October 2018

The phylum Chloroflexi is phylogenetically diverse and is a deeply branching lineage of bacteria that express a broad spectrum of physiological and metabolic capabilities. Members of the order Ktedonobacteriales, including the families Ktedonobacteriaceae, Thermosporotrichaceae, and Thermogemmatisporaceae, all have flexible aerobic metabolisms capable of utilizing a wide range of carbohydrates. A number of species within these families are considered cellulolytic and are capable of using cellulose as a sole carbon and energy source. In contrast, Ktedonobacter racemifer, the type strain of the order, does not appear to possess this cellulolytic phenotype. In this study, we confirmed the ability of Thermogemmatispora sp. strain T81 to hydrolyze cellulose, determined the whole-genome sequence of Thermogemmatispora sp. T81, and using comparative bioinformatics analyses, identified genes encoding putative carbohydrate-active enzymes (CAZymes) in the Thermogemmatispora sp. T81, Thermogemmatispora onikobensis, and Ktedonobacter racemifer genomes. Analyses of the Thermogemmatispora sp. T81 genome identified 64 CAZyme gene sequences belonging to 57 glycoside hydrolase families. The genome of Thermogemmatispora sp. T81 encodes 19 genes for putative extracellular CAZymes, similar to the number of putative extracellular CAZymes identified in T. onikobensis (17) and K. racemifer (17), despite K. racemifer not possessing a cellulolytic phenotype. These results suggest that these members of the order Ktedonobacteriales may use a broader range of carbohydrate polymers than currently described.
Applications of modified mathematical method on some nonlinear water wave dynamical models
Authors: Seadawy Aly R. , Ali Asghar , Lu Dianchen
Published: October 2018

The extended simple equation method is applied to construct solitary wave solutions of (3 + 1)-dimensional Kadomtsev–Petviashvili-Benjamin–Bona–Mahony (KP-BBM), Korteweg–de Vries Benjamin–Bona–Mahony (KdV-BBM), Breaking soliton (BS) and (2 + 1) Maccari system waves system of equations. These models have prevalent usage in modern science. This technique can also be functional to solve different kinds of nonlinear evolution problems in contemporary areas of research. It is an effective and powerful mathematical tool in finding solitary wave solutions of nonlinear evolution equations (NLEEs) in mathematical physics.
Sum rules for strong decays of 10 and 27 dibaryon multiplets in broken SU(3) symmetry
Authors: Sánchez-Colón G. , Polanco-Euán E. N. , López-Fortín C. E.
Published: October 2018

10 and 27 SU(3) multiplets of hexaquarks states with baryon number [Formula: see text], known as dibaryons, are considered. Previous analyses are complemented and sum rules for strong decay amplitudes with SU(3) symmetry violation up to the first order are determined for the 10 and 27 dibaryon multiplets into a baryon octet plus a baryon decuplet and for the dibaryon 27 into two baryon octets.
Some diameter notions of Fibonacci cubes
Authors: Savitha K. S. , Vijayakumar A.
Published: October 2018

In any network, the diameter is often taken as a measure of efficiency, as it measures the maximum communication delay. The fact that addition or deletion of edges changes the diameter gives rise to the concept of diameter variability. Its study becomes important as it determines the communication efficiency when an addition or deletion of a link occurs in a network. Two other important graph parameters considered as a measure of reliability and efficiency of networks are wide diameter and fault diameter. In this paper, we study these diameter notions of the Fibonacci cubes.
Urban Trees and Water Use in Arid Climates: Insights from an Integrated Bioeconomic-Health Model
Authors: Jones Benjamin A. , Fleck John
Published: October 2018

Managing outdoor water use while maintaining urban tree cover is a key challenge for water managers in arid climates. Urban trees generate flows of ecosystem services in arid areas, but also require significant amounts of irrigation. In this paper, a bioeconomic-health model of trees and water use is developed to investigate management of an urban forest canopy when irrigation is costly, water has economic value, and trees provide ecosystem services. The optimal tree irrigation decision is illustrated for Albuquerque, New Mexico, an arid Southwest US city. Using a range of monetary values for water, we find that the tree irrigation decision is sensitive to the value selected. Urban deforestation is optimal when the value of water is sufficiently high, or alternatively starts low, but grows to cross a specific threshold. If, however, the value of water is sufficiently low or if the value of tree cover rises over time, then deforestation is not optimal. The threshold value of water where the switch is made between zero and partial deforestation is well within previously identified ranges on actual water values. This model can be applied generally to study the tradeoffs between urban trees and water use in arid environments.
1.5°C Hotspots: Climate Hazards, Vulnerabilities, and Impacts
Authors: Schleussner Carl-Friedrich , Deryng Delphine , D'haen Sarah , Hare William , Lissner Tabea , Ly Mouhamed , Nauels Alexander , Noblet Melinda , Pfleiderer Peter , Pringle Patrick , Rokitzki Martin , Saeed Fahad , Schaeffer Michiel , Serdeczny Olivia , Thomas Adelle
Published: October 2018

Differentiating the impacts of climate change between 1.5°C and 2°C requires a regional and sector-specific perspective. Whereas for some regions and sectors the difference in climate variables might be indistinguishable from natural variability, other areas especially in the tropics and subtropics will experience significant shifts. In addition to region-specific changes in climatic conditions, vulnerability and exposure also differ substantially across the world. Even small differences in climate hazards can translate into sizeable impact differences for particularly vulnerable regions or sectors. Here, we review scientific evidence of regional differences in climate hazards at 1.5°C and 2°C and provide an assessment of selected hotspots of climate change, including small islands as well as rural, urban, and coastal areas in sub-Saharan Africa and South Asia, that are particularly affected by the additional 0.5°C global mean temperature increase. We interlink these with a review of the vulnerability and exposure literature related to these hotspots to provide an integrated perspective on the differences in climate impacts between 1.5°C and 2°C.
The Construction of ATLAS and CMS
Authors: Della Negra Michel , Jenni Peter , Virdee Tejinder S.
Published: October 2018

The article describes the early years of the two large general-purpose experiments, ATLAS and CMS, at CERN's Large Hadron Collider (LHC). It covers the early conception of the detector designs to achieve the physics goals, the subsequent building of the worldwide collaborations, the evolution of the designs incorporating advances in technology and other considerations, and the painstaking global construction efforts. A detailed technical description of the detectors is beyond the scope of this review. This article also describes the development and deployment of the software and computing systems, by both the collaborations and the LHC Worldwide Computing Grid, in order to extract the physics results.
Space Occupancy through BLE Dynamic Broadcasting
Authors: Borić Miran , Díaz Redondo Rebeca P. , Fernández Vilas Ana
Published: October 2018

Internet of Things (IoT) merges different technologies to provide the needed infrastructure for an adequate inter‐device connection and data exchange, with Bluetooth Low Energy (BLE) being one of the latest acquisitions. The use of BLE beacons offers a straightforward approach to broadcast information to any device being in the coverage zone and able to process such signal. Instead of this static solution, in this paper, we face an alternative approach that, combining both Wi‐Fi and BLE beacon technologies, is able to dynamically adapt the information being broadcast depending on the particular devices in the coverage area. Taking advantage of the beacon device communications, we propose to monitor the space occupancy throughout the study area (typically inside a building) by following the beacon device data exchange. This information would be later used to improve space analysis. As a proof of concept, we have conducted an experiment inside a faculty to check the potentiality of the proposal, obtaining promising results.
A Multistage Solution Approach for Dynamic Reactive Power Optimization Based on Interval Uncertainty
Authors: Shen Xiaodong , Liu Yang , Liu Yan
Published: October 2018

In order to solve the uncertainty and randomness of the output of the renewable energy resources and the load fluctuations in the reactive power optimization, this paper presents a novel approach focusing on dealing with the issues aforementioned in dynamic reactive power optimization (DRPO). The DRPO with large amounts of renewable resources can be presented by two determinate large-scale mixed integer nonlinear nonconvex programming problems using the theory of direct interval matching and the selection of the extreme value intervals. However, it has been admitted that the large-scale mixed integer nonlinear nonconvex programming is quite difficult to solve. Therefore, in order to simplify the solution, the heuristic search and variable correction approaches are employed to relax the nonconvex power flow equations to obtain a mixed integer quadratic programming model which can be solved using software packages such as CPLEX and GUROBI. The ultimate solution and the performance of the presented approach are compared to the traditional methods based on the evaluations using IEEE 14-, 118-, and 300-bus systems. The experimental results show the effectiveness of the presented approach, which potentially can be a significant tool in DRPO research.
Strength and Cost Analysis of New Steel Sets as Roadway Support Project in Coal Mines
Authors: Li Qinghai , Yang Renshu , Li Jingkai , Wang He , Wen Zhijie
Published: October 2018

Roadway support in swelling soft rocks in coal mines has become a critical challenge in recent years. For deformation control in swelling soft rocks, high strength sets are preferred in sites. But high strength always means high costs. Therefore, higher strength sets with not too much cost will be more welcomed in situ. Based on this, three new sets, including a floor beam set, a roof + floor beams set, and a roof + floor beams + braces set, have been developed in the present research. Strength comparisons and costs comparisons have been conducted in this research. Results illustrate that compared with the original set, in the floor beam set, the relative strength of bottom corners reaches 2.964, while the relative cost reaches 1.294; compared with the original set, in the roof + floor beams set, the relative strength of the top arch reaches 2.345, while the relative strength of bottom corners reaches 2.964, and the relative cost reaches 1.568; and compared with the original set, in the roof + floor beams + braces set, the relative strength of the top arch reaches 2.635, and the relative strength of bottom corners reaches 5.905, but the relative cost reaches 1.930. Floor beam set and roof + floor beams set illustrate higher strength and not too higher costs than the original set. Although the roof + floor beams + braces set exhibit much higher strength, they also demonstrate much higher costs than the original set. These new sets can be chosen according to different geological conditions in situ.
Prevalence of Temporomandibular Disorder Symptoms among Orthognathic Patients in Southern Germany: Retrospective Study
Authors: AlWarawreh Amjad M. , AlTamimi Zaid H. , Khraisat Hazem M. , Kretschmer Winfried
Published: October 2018

This study investigated the prevalence of temporomandibular disorder (TMD) among patients before and after orthognathic surgery and assessed the effect of orthognathic surgery on each of the TMD symptoms (clicking, pain, crepitus, and MRI findings). A sample of 100 consecutive patients undergoing bimaxillary surgery for correction of craniofacial deformities (31 male and 69 female), with ages ranging between 17 and 58 years (mean age: 27.7 ± 9.3 years), were interviewed and examined regarding signs and symptoms of TMD. Clinical examination and X-ray and magnetic resonance imaging of the temporomandibular junction were performed at the time of surgery and 1 year thereafter. The prevalence of TMD preoperatively and postoperatively was 35% and 27%, respectively. A high frequency of relief was found in the patients with TMD symptoms (74.3%; 19 (70.3%) of patients had reduced clicking, 7 (87.5%) patients had reduced pain, 4 (100%) patients had reduced crepitus, and 4 (57.1%) patients showed changes in MRI findings), 12 patients who were asymptomatic before surgery developed clicking in TMJ after surgery, 3 developed pain, and 3 developed crepitus. TMD problems can occur in a variety of patients, including those who have facial deformities, and require orthognathic surgery. However, orthognathic surgery may not predictably treat or reduce the symptoms of TMD.
Enhancing Countries’ Fitness with Recommender Systems on the International Trade Network
Authors: Liao Hao , Huang Xiao-Min , Wu Xing-Tong , Liu Ming-Kai , Vidmer Alexandre , Zhou Ming-Yang , Zhang Yi-Cheng
Published: October 2018

Prediction is one of the major challenges in complex systems. The prediction methods have shown to be effective predictors of the evolution of networks. These methods can help policy makers to solve practical problems successfully and make better strategy for the future. In this work, we focus on exporting countries’ data of the International Trade Network. A recommendation system is then used to identify the products that correspond to the production capacity of each individual country but are somehow overlooked by the country. Then, we simulate the evolution of the country’s fitness if it would have followed the recommendations. The result of this work is the combination of these two methods to provide insights to countries on how to enhance the diversification of their exported products in a scientific way and improve national competitiveness significantly, especially for developing countries.
Modelling and Estimation for Uncertain Systems with Transmission Delays, Packet Dropouts, and Out‐of‐Order Packets
Authors: Liu Li , Yang Aolei , Zhou Wenju , Naeem Wasif , Wang Gang , Wang Hua
Published: October 2018

The study focuses on the modelling and estimation of a class of discrete‐time uncertain systems, including network‐induced random delays, packet dropouts, and out‐of‐order packets during the data transmission from the plant to the estimator. In order to improve system performance, event‐triggered signal selection method is used to establish the system model. Based on this model, a distributed measurement and centralized fusion estimation scheme is designed using a robust finite horizon Kalman‐type filter. Since the phenomena caused by the network‐induced deteriorate estimation accuracy, a time‐based reorganization measurement is employed to design a linear delay compensation strategy based on estimation. Moreover, in order to obtain the optimal linear estimation, weighted fusion estimation approach is used to perform information collaboration through the error cross‐covariance matrix. Simulation results demonstrate that the proposed method has higher estimation performance than the existing methods in this study.
Assessment of Ruthenium Dye N719 Adsorption Kinetics in Mesoporous TiO2 Films of Dye-Sensitized Solar Cells via Nanoplasmonic Sensing
Authors: Rajab Fahd M.
Published: October 2018

A dye monolayer formation on a semiconductor surface is critical for efficient dye-sensitized solar cells. The role of dye is to absorb light and convert it to photoelectrons, which are injected into the semiconductor conduction band as device current. We measured dye N719 adsorption via optical techniques including indirect nanoplasmonic sensing. The adsorption rate constant of dye N719 in mimic TiO2 photoelectrodes is determined as ka = 983 M−1 s−1. Dye adsorption for ruthenium dyes N3, N749, and Z907, coated onto TiO2 photoelectrodes of varying thicknesses ranging from 3 μm to 10 μm, was conducted and related to fabricated dye-sensitized solar cell efficiency. Analytical studies included scanning electron microscopy and ellipsometry, X-ray diffraction, and UV-Vis spectroscopy, as well as quantum efficiency and current-voltage device characterizations. The results show greatest enhancement of device performance for dye N719 in spite of multilayer formation, which often is underestimated when addressing the dynamic competing factors that reverse thick-film device performance.