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The heterogeneity of chronic post-COVID neuropsychiatric symptoms (PCNPS), especially after infection by the Omicron strain, has not been adequately explored.
Aims
To explore the clustering pattern of chronic PCNPS in a cohort of patients having their first COVID infection during the ‘Omicron wave’ and discover phenotypes of patients based on their symptoms’ patterns using a pre-registered protocol.
Method
We assessed 1205 eligible subjects in Hong Kong using app-based questionnaires and cognitive tasks.
Results
Partial network analysis of chronic PCNPS in this cohort produced two major symptom clusters (cognitive complaint–fatigue and anxiety–depression) and a minor headache–dizziness cluster, like our pre-Omicron cohort. Participants with high numbers of symptoms could be further grouped into two distinct phenotypes: a cognitive complaint–fatigue predominant phenotype and another with symptoms across multiple clusters. Multiple logistic regression showed that both phenotypes were predicted by the level of pre-infection deprivation (adjusted P-values of 0.025 and 0.0054, respectively). The severity of acute COVID (adjusted P = 0.023) and the number of pre-existing medical conditions predicted only the cognitive complaint–fatigue predominant phenotype (adjusted P = 0.003), and past suicidal ideas predicted only the symptoms across multiple clusters phenotype (adjusted P < 0.001). Pre-infection vaccination status did not predict either phenotype.
Conclusions
Our findings suggest that we should pursue a phenotype-driven approach with holistic biopsychosocial perspectives in disentangling the heterogeneity under the umbrella of chronic PCNPS. Management of patients complaining of chronic PCNPS should be stratified according to their phenotypes. Clinicians should recognise that depression and anxiety cannot explain all chronic post-COVID cognitive symptoms.
Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.
Methods
T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).
Results
PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).
Conclusions
PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.
Increasing penetration of variable and intermittent renewable energy resources on the energy grid poses a challenge for reliable and efficient grid operation, necessitating the development of algorithms that are robust to this uncertainty. However, standard algorithms incorporating uncertainty for generation dispatch are computationally intractable when costs are nonconvex, and machine learning-based approaches lack worst-case guarantees on their performance. In this work, we propose a learning-augmented algorithm, RobustML, that exploits the good average-case performance of a machine-learned algorithm for minimizing dispatch and ramping costs of dispatchable generation resources while providing provable worst-case guarantees on cost. We evaluate the algorithm on a realistic model of a combined cycle cogeneration plant, where it exhibits robustness to distribution shift while enabling improved efficiency as renewables penetration increases.
Objectives/Goals: Transmission-blocking vaccines hold promise for malaria elimination by reducing community transmission. But a major challenge that limits the development of efficacious vaccines is the vast parasite’s genetic diversity. This work aims to assess the genetic diversity of the Pfs25 vaccine candidate in complex infections across African countries. Methods/Study Population: We employed next-generation amplicon deep sequencing to identify nonsynonymous single nucleotide polymorphisms (SNPs) in 194 Plasmodium falciparum samples from four endemic African countries: Senegal, Tanzania, Ghana, and Burkina Faso. The individuals aged between 1 and 74 years, but most of them ranged from 1 to 19 years, and all presented symptomatic P. falciparum infection. The genome amplicon sequencing was analyzed using Geneious software and P. falciparum 3D7 as a reference. The SPNs were called with a minimum coverage of 500bp, and for this work, we used a very sensitive threshold of 1% variant frequency to determine the frequency of SNPs. The identified SNPs were threaded to the crystal structure of the Pfs25 protein, which allowed us to predict the impact of the novel SNP in the protein or antibody binding. Results/Anticipated Results: We identified 26 SNPs including 24 novel variants, and assessed their population prevalence and variant frequency in complex infections. Notably, five variants were detected in multiple samples (L63V, V143I, S39G, L63P, and E59G), while the remaining 21 were rare variants found in individual samples. Analysis of country-specific prevalence showed varying proportions of mutant alleles, with Ghana exhibiting the highest prevalence (44.6%), followed by Tanzania (12%), Senegal (11.8%), and Burkina Faso (2.7%). Moreover, we categorized SNPs based on their frequency, identifying dominant variants (>25%), and rare variants (Discussion/Significance of Impact: We identified additional SNPs in the Pfs25 gene beyond those previously reported. However, the majority of these newly discovered display low variant frequency and population prevalence. Further research exploring the functional implications of these variations will be important to elucidate their role in malaria transmission.
The cumulative effects of long-term exposure to pandemic-related stressors and the severity of social restrictions may have been important determinants of mental distress in the time of COVID-19.
Aim
This study aimed to investigate mental health among a cohort of Chinese university students over a 28-month period, focusing on the effects of lockdown type.
Methods
Depression, anxiety, stress and fear of COVID-19 infection were measured ten times among 188 Chinese students (females 77.7%, meanage = 19.8, s.d.age = 0.97), every 3 months: from prior to the emergence of COVID-19 in November 2019 (T1) to March 2022 (T10).
Results
Initially depression, anxiety and stress dipped from T1 to T2, followed by a sudden increase at T3 and a slow upward rise over the remainder of the study period (T3 to T10). When locked down at university, participants showed greater mental distress compared with both home lockdown (d = 0.35–0.48) and a no-lockdown comparison period (d = 0.28–0.40). Conversely, home lockdown was associated with less anxiety and stress (d = 0.19 and 0.21, respectively), but not with depression (d = 0.13) compared with a no-lockdown period.
Conclusions
This study highlights the cumulative effects of exposure to COVID-19 stressors over time. It also suggests that the way in which a lockdown is carried out can impact the well-being of those involved. Some forms of lockdown appear to pose a greater threat to mental health than others.
This research explores a phenomenon that we see nearly every day and has implications for how we view people in other nations: Different media outlets may report the same international events either in terms of the nation (e.g., “Russia invades Ukraine”) or in terms of the leader (e.g., “Putin invades Ukraine”). Five studies, conducted during the 2022 Russia-Ukraine Conflict and involving both field and experimental data, find that readers of nation-framed news about the conflict had worse impressions of the people in the associated nation (Russians) than readers of the corresponding leader-framed version. We explain the psychology behind this framing effect and identify its moderators. Our research underscores the importance of responsible media practices in shaping global perceptions.
Prior to the No Surprises Act (NSA), numerous states passed laws protecting patients from surprise medical bills from out-of-network (OON) hospital-based physicians supporting elective treatment in in-network hospitals. Even in non-emergency situations, patients have little ability to choose physicians such as anaesthesiologists, pathologists or radiologists. Using a comprehensive, multi-payer claims database, we estimated the effect of these laws on hospital-based physician reimbursement, charges, network participation and potential surprise billing episodes. Overall, the state laws were associated with a reduction in anaesthesiology prices and charges, but an increase in pathology and radiology prices. The price effects for each state exhibit substantial heterogeneity. California and New Jersey experienced increases in network participation by anaesthesiologists and pathologists and reductions in potential surprise billing episodes, but, overall, we find little evidence of changes in network participation across all of the states implementing surprise billing laws. Our results suggest that the effects of the NSA may vary across states.
Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital heart surgery database worldwide but does not provide information beyond primary episode of care. Linkage to hospital electronic health records would capture complications and comorbidities along with long-term outcomes for patients with CHD surgeries. The current study explores linkage success between Society of Thoracic Surgeons Congenital Heart Surgery Database and electronic health record data in North Carolina and Georgia.
Methods:
The Society of Thoracic Surgeons Congenital Heart Surgery Database was linked to hospital electronic health records from four North Carolina congenital heart surgery using indirect identifiers like date of birth, sex, admission, and discharge dates, from 2008 to 2013. Indirect linkage was performed at the admissions level and compared to two other linkages using a “direct identifier,” medical record number: (1) linkage between Society of Thoracic Surgeons Congenital Heart Surgery Database and electronic health records from a subset of patients from one North Carolina institution and (2) linkage between Society of Thoracic Surgeons data from two Georgia facilities and Georgia’s CHD repository, which also uses direct identifiers for linkage.
Results:
Indirect identifiers successfully linked 79% (3692/4685) of Society of Thoracic Surgeons Congenital Heart Surgery Database admissions across four North Carolina hospitals. Direct linkage techniques successfully matched Society of Thoracic Surgeons Congenital Heart Surgery Database to 90.2% of electronic health records from the North Carolina subsample. Linkage between Society of Thoracic Surgeons and Georgia’s CHD repository was 99.5% (7,544/7,585).
Conclusions:
Linkage methodology was successfully demonstrated between surgical data and hospital-based electronic health records in North Carolina and Georgia, uniting granular procedural details with clinical, developmental, and economic data. Indirect identifiers linked most patients, consistent with similar linkages in adult populations. Future directions include applying these linkage techniques with other data sources and exploring long-term outcomes in linked populations.
Cells of magnetotactic bacteria are used as model systems for studying the magnetic properties of ferrimagnetic nanocrystals. Each individual bacterial strain produces magnetosomes (membrane-bounded magnetic crystals) that have distinct sizes, shapes, crystallographic orientations and spatial arrangements, thereby providing nanoparticle systems whose unique magnetic properties are unmatched by synthetic chemically-produced crystals. Here, we use off-axis electron holography in the transmission electron microscope to study the magnetic properties of isolated and closely-spaced bullet-shaped magnetite (Fe3O4) magnetosomes biomineralized by the following magnetotactic bacterial strains: the cultured Desulfovibrio magneticus RS-1 and the uncultured strains LO-1 and HSMV-1. These bacteria biomineralize magnetite crystals whose crystallographic axes of elongation are parallel to <100> (RS-1 and LO-1) or <110> (HSMV-1). We show that the individual magnetosome crystals are single magnetic domains and measure their projected in-plane magnetization distributions and magnetic dipole moments. We use analytical modelling to assess the interplay between shape anisotropy and the magnetically preferred <111> magneto-crystalline easy axis of magnetite.
This study documents several correlations observed during the first run of the plasma wakefield acceleration experiment E300 conducted at FACET-II, using a single drive electron bunch. The established correlations include those between the measured maximum energy loss of the drive electron beam and the integrated betatron X-ray signal, the calculated total beam energy deposited in the plasma and the integrated X-ray signal, among three visible light emission measuring cameras and between the visible plasma light and X-ray signal. The integrated X-ray signal correlates almost linearly with both the maximum energy loss of the drive beam and the energy deposited into the plasma, demonstrating its usability as a measure of energy transfer from the drive beam to the plasma. Visible plasma light is found to be a useful indicator of the presence of a wake at three locations that overall are two metres apart. Despite the complex dynamics and vastly different time scales, the X-ray radiation from the drive bunch and visible light emission from the plasma may prove to be effective non-invasive diagnostics for monitoring the energy transfer from the beam to the plasma in future high-repetition-rate experiments.
This paper presents a comprehensive technical overview of the Linac Coherent Light Source II (LCLS-II) photoinjector laser system, its first and foremost component. The LCLS-II photoinjector laser system serves as an upgrade to the original LCLS at SLAC National Accelerator Laboratory. This advanced laser system generates high-quality laser beams for the LCLS-II, contributing to the instrument’s unprecedented brightness, precision and flexibility. Our discussion extends to the various subsystems that comprise the photoinjector, including the photocathode laser, laser heater and beam transport systems. Lastly, we draw attention to the ongoing research and development infrastructure underway to enhance the functionality and efficiency of the LCLS-II, and similar X-ray free-electron laser facilities around the world, thereby contributing to the future of laser technology and its applications.
In Global Navigation Satellite Systems (GNSS)-denied environments, aiding a vehicle's inertial navigation system (INS) is crucial to reducing the accumulated navigation drift caused by sensor errors (e.g. bias and noise). One potential solution is to use measurements of gravity as an aiding source. The measurements are matched to a geo-referenced map of Earth's gravity to estimate the vehicle's position. In this paper, we propose a novel formulation of the map matching problem using a hidden Markov model (HMM). Specifically, we treat the spatial cells of the map as the hidden states of the HMM and present a Viterbi style algorithm to estimate the most likely sequence of states, i.e. most likely sequence of vehicle positions, that results in the sequence of observed gravity measurements. Using a realistic gravity map, we demonstrate the accuracy of our Viterbi map matching algorithm in a navigation scenario and illustrate its robustness compared with existing methods.
Dense suspensions of solid particles in viscous liquid are ubiquitous in both industry and nature, and there is a clear need for efficient numerical routines to simulate their rheology and microstructure. Particles of micron size present a particular challenge: at low shear rates, colloidal interactions control their dynamics while at high rates, granular-like contacts dominate. While there are established particle-based simulation schemes for large-scale non-Brownian suspensions using only pairwise lubrication and contact forces, common schemes for colloidal suspensions generally are more computationally costly and thus restricted to relatively small system sizes. Here, we present a minimal particle-based numerical model for dense colloidal suspensions that incorporates Brownian forces in pairwise form alongside contact and lubrication forces. We show that this scheme reproduces key features of dense suspension rheology near the colloidal-to-granular transition, including both shear thinning due to entropic forces at low rates and shear thickening at high rates due to contact formation. This scheme is implemented in LAMMPS, a widely used open source code for parallelised particle-based simulations, with a runtime that scales linearly with the number of particles, making it amenable for large-scale simulations.
This study investigates the impact of primary care utilisation of a symptom-based head and neck cancer risk calculator (Head and Neck Cancer Risk Calculator version 2) in the post-coronavirus disease 2019 period on the number of primary care referrals and cancer diagnoses.
Methods
The number of referrals from April 2019 to August 2019 and from April 2020 to July 2020 (pre-calculator) was compared with the number from the period January 2021 to August 2022 (post-calculator) using the chi-square test. The patients’ characteristics, referral urgency, triage outcome, Head and Neck Cancer Risk Calculator version 2 score and cancer diagnosis were recorded.
Results
In total, 1110 referrals from the pre-calculator period were compared with 1559 from the post-calculator period. Patient characteristics were comparable for both cohorts. More patients were referred on the cancer pathway in the post-calculator cohort (pre-calculator patients 51.1 per cent vs post-calculator 64.0 per cent). The cancer diagnosis rate increased from 2.7 per cent in the pre-calculator cohort to 3.3 per cent in the post-calculator cohort. A lower rate of cancer diagnosis in the non-cancer pathway occurred in the cohort managed using the Head and Neck Cancer Risk Calculator version 2 (10 per cent vs 23 per cent, p = 0.10).
Conclusion
Head and Neck Cancer Risk Calculator version 2 demonstrated high sensitivity in cancer diagnosis. Further studies are required to improve the predictive strength of the calculator.
Research articles in the clinical and translational science literature commonly use quantitative data to inform evaluation of interventions, learn about the etiology of disease, or develop methods for diagnostic testing or risk prediction of future events. The peer review process must evaluate the methodology used therein, including use of quantitative statistical methods. In this manuscript, we provide guidance for peer reviewers tasked with assessing quantitative methodology, intended to complement guidelines and recommendations that exist for manuscript authors. We describe components of clinical and translational science research manuscripts that require assessment including study design and hypothesis evaluation, sampling and data acquisition, interventions (for studies that include an intervention), measurement of data, statistical analysis methods, presentation of the study results, and interpretation of the study results. For each component, we describe what reviewers should look for and assess; how reviewers should provide helpful comments for fixable errors or omissions; and how reviewers should communicate uncorrectable and irreparable errors. We then discuss the critical concepts of transparency and acceptance/revision guidelines when communicating with responsible journal editors.
Sleep problems associated with poor mental health and academic outcomes may have been exacerbated by the COVID-19 pandemic.
Aims
To describe sleep in undergraduate students during the COVID-19 pandemic.
Method
This longitudinal analysis included data from 9523 students over 4 years (2018–2022), associated with different pandemic phases. Students completed a biannual survey assessing risk factors, mental health symptoms and lifestyle, using validated measures. Sleep was assessed with the Sleep Condition Indicator (SCI-8). Propensity weights and multivariable log-binomial regressions were used to compare sleep in four successive first-year cohorts. Linear mixed-effects models were used to examine changes in sleep over academic semesters and years.
Results
There was an overall decrease in average SCI-8 scores, indicating worsening sleep across academic years (average change −0.42 per year; P-trend < 0.001), and an increase in probable insomnia at university entry (range 18.1–29.7%; P-trend < 0.001) before and up to the peak of the pandemic. Sleep improved somewhat in autumn 2021, when restrictions loosened. Students commonly reported daytime sleep problems, including mood, energy, relationships (36–48%) and concentration, productivity, and daytime sleepiness (54–66%). There was a consistent pattern of worsening sleep over the academic year. Probable insomnia was associated with increased cannabis use and passive screen time, and reduced recreation and exercise.
Conclusions
Sleep difficulties are common and persistent in students, were amplified by the pandemic and worsen over the academic year. Given the importance of sleep for well-being and academic success, a preventive focus on sleep hygiene, healthy lifestyle and low-intensity sleep interventions seems justified.
The early use of Robust Design (RD) supports the development of product concepts with low sensitivity to variation, which offers advantages for reducing the risk of costly iterations. Due to the lack of approaches for early evaluation of product robustness, the embodiment-function-relation and tolerance (EFRT-) model was developed, which combines the contact and channel approach and tolerance graphs. The information exchange of both approaches offers a high potential for reliable robustness evaluation results. However, that potential currently relies unused, since the link between applicable robustness criteria and the extended information is missing. To solve this problem, four research steps were determined: (1) understanding of robustness, (2) collection of RD principles, (3) identification of EFRT-model information and (4) mapping of RD principles and information. The results show nine adapted RD principles, the identified model information for the robustness evaluation, the evaluation criteria as well as their mapping. Utilizing the mapping and the proposed criteria in this contribution, a more comprehensive robustness evaluation in early stages is enabled.
A regional block, also known as a localized block, is a type of anesthetic that blocks nerve transmission to prevent or alleviate pain. Regional anesthesia is the process of injecting an anesthetic substance into a peripheral nerve and inhibiting transmission to avoid or treat pain. It is distinct from general anesthesia in that it does not alter the patient’s level of awareness to alleviate pain. There are numerous advantages of regional anesthesia over general anesthesia, including avoidance of airway manipulation, lower dosages, fewer systemic medication adverse effects, shorter recovery period, and considerably less discomfort following surgery.
This paper used data from the Apathy in Dementia Methylphenidate Trial 2 (NCT02346201) to conduct a planned cost consequence analysis to investigate whether treatment of apathy with methylphenidate is economically attractive.
Methods:
A total of 167 patients with clinically significant apathy randomized to either methylphenidate or placebo were included. The Resource Utilization in Dementia Lite instrument assessed resource utilization for the past 30 days and the EuroQol five dimension five level questionnaire assessed health utility at baseline, 3 months, and 6 months. Resources were converted to costs using standard sources and reported in 2021 USD. A repeated measures analysis of variance compared change in costs and utility over time between the treatment and placebo groups. A binary logistic regression was used to assess cost predictors.
Results:
Costs were not significantly different between groups whether the cost of methylphenidate was excluded (F(2,330) = 0.626, ηp2 = 0.004, p = 0.535) or included (F(2,330) = 0.629, ηp2 = 0.004, p = 0.534). Utility improved with methylphenidate treatment as there was a group by time interaction (F(2,330) = 7.525, ηp2 = 0.044, p < 0.001).
Discussion:
Results from this study indicated that there was no evidence for a difference in resource utilization costs between methylphenidate and placebo treatment. However, utility improved significantly over the 6-month follow-up period. These results can aid in decision-making to improve quality of life in patients with Alzheimer’s disease while considering the burden on the healthcare system.
This paper uses vector autoregression model analysis to identify monetary policy shocks on UK data using surprise changes in the policy rate as external instruments and imposing block exogeneity restrictions on domestic variables to estimate parameters from the viewpoint of the domestic economy. The results show large and persistent effects of monetary policy shocks on the domestic economy and point to the critical role of exchange rates and term premia. The analysis resolves important empirical puzzles of traditional recursive identification methods.