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Background: Neck vessel imaging is often performed in hyperacute stroke to allow neurointerventionalists to estimate access complexity. This study aimed to assess clinician agreement on catheterization strategies based on imaging in these scenarios. Methods: An electronic portfolio of 60 patients with acute ischemic stroke was sent to 53 clinicians. Respondents were asked: (1) the difficulty of catheterization through femoral access with a regular Vertebral catheter, (2) whether to use a Simmons or reverse-curve catheter initially, and (3) whether to consider an alternative access site. Agreement was assessed using Fleiss’ Kappa statistics. Results: Twenty-two respondents (7 neurologists, 15 neuroradiologists) completed the survey. Overall there was slight interrater agreement (κ=0.17, 95% CI: 0.10–0.25). Clinicians with >50 cases annually had better agreement (κ=0.22) for all questions than those with fewer cases (κ=0.07). Agreement did not significantly differ by imaging modality: CTA (κ=0.18) and MRA (κ=0.14). In 40/59 cases (67.80%), at least 25% of clinicians disagreed on whether to use a Simmons or reverse-curve catheter initially. Conclusions: Agreement on catheterization strategies remains fair at best. Our results suggest that visual assessment of pre-procedural vessels imaging is not reliable for the estimation of endovascular access complexity.
Severe fatigue following COVID-19 is a debilitating symptom in adolescents for which no treatment exists currently.
Aims:
The aim of this study was to determine the effectiveness and feasibility of cognitive behavioural therapy (CBT) for severe fatigue following COVID-19 in adolescents.
Method:
A serial single-case observational design was used. Eligible patients were ≥12 and <18 years old, severely fatigued and ≥6 months post-COVID-19. Five patients, consecutively referred by a paediatrician, were included. The primary outcome was a change in fatigue severity, assessed with the fatigue severity subscale of the Checklist Individual Strength, 12 weeks after the start of CBT, tested with a permutation distancing two-phase A-B test. Secondary outcomes were the presence of severe fatigue, difficulty concentrating and impaired physical functioning directly post-CBT as determined with questionnaires using validated cut-off scores. Also, the frequency of post-exertional malaise (PEM) and absence from school directly post-CBT determined with self-report items were evaluated.
Results:
All five included patients completed CBT. Twelve weeks after starting CBT for severe post-COVID-19 fatigue, three out of five patients showed a significant reduction in fatigue severity. After CBT, all five patients were no longer severely fatigued. Also, four out of five patients were no longer physically impaired and improved regarding PEM following CBT. All five patients reported no school absence post-CBT and no difficulties concentrating.
Conclusion:
This study provides a first indication for the effectiveness and feasibility of CBT among adolescents with post-COVID-19 fatigue.
The allosauroid theropod dinosaurs of the clade Carcharodontosauridae were the apex predators in terrestrial ecosystems of the Early Cretaceous but were replaced in this ecological niche by Tyrannnosauridae in the Late Cretaceous. Details of this turnover are poorly known because only two transitional ecosystems, containing both carcharodontosaurids and tyrannosauroids, had been recognized to date (Cenomanian Cedar Mountain Formation of Utah, USA, and Turonian Bissekty Formation of Uzbekistan). Moreover, the presence of carcharodontosaurids in the Bissekty Formation, based on a maxilla fragment identified as Ulughbegsaurus uzbekistanensis Tanaka et al., 2021, has been recently questioned. Here we report on the third ecosystem containing both clades of apex predators, the Cenomanian Khodzhakul Formation in Uzbekistan. This new occurrence of Carcharodontosauridae is based on a newly identified maxilla that closely resembles the holotype maxilla of U. uzbekistanensis and is identified as Ulughbegsaurus sp. The revised morphological characters of both specimens support attribution of Ulughbegsaurus to Carcharodontosauridae. We report a novel neurovascular feature of the theropod maxilla—a medial alveolar canal that supplied the alveoli medially and contained tributaries of the palatine vessels in Ulughbegsaurus.
Item response theory (IRT) model applications extend well beyond cognitive ability testing, and various patient-reported outcomes (PRO) measures are among the more prominent examples. PRO (and like) constructs differ from cognitive ability constructs in many ways, and these differences have model fitting implications. With a few notable exceptions, however, most IRT applications to PRO constructs rely on traditional IRT models, such as the graded response model. We review some notable differences between cognitive and PRO constructs and how these differences can present challenges for traditional IRT model applications. We then apply two models (the traditional graded response model and an alternative log-logistic model) to depression measure data drawn from the Patient-Reported Outcomes Measurement Information System project. We do not claim that one model is “a better fit” or more “valid” than the other; rather, we show that the log-logistic model may be more consistent with the construct of depression as a unipolar phenomenon. Clearly, the graded response and log-logistic models can lead to different conclusions about the psychometrics of an instrument and the scaling of individual differences. We underscore, too, that, in general, explorations of which model may be more appropriate cannot be decided only by fit index comparisons; these decisions may require the integration of psychometrics with theory and research findings on the construct of interest.
The challenging tracking control issue for a space manipulator subject to parametric uncertainty and unknown disturbance is addressed in this paper. An observer-based fixed-time terminal sliding mode control methodology is put forward. Firstly, a nonlinear disturbance observer is introduced for exactly reconstructing the lumped uncertainty without requiring any prior knowledge of the lumped uncertainty. Meanwhile, the estimation time’s upper bound is not only irrelevant to the initial estimation error but can be directly predicted in advance via a specific parameter in the observer. Invoking the estimated information, a fast fixed-time tracking controller with strong robustness is designed, where a novel sliding mode surface incorporated enables faster convergence. The globally fixed-time stability of the closed-loop tracking system is rigorously demonstrated through Lyapunov stability analysis. Finally, numerical simulations and comparisons verify the validity and superiority of the suggested controller.
Severe fatigue and cognitive complaints are frequently reported after SARS-CoV-2 infection and may be accompanied by depressive symptoms and/or limitations in physical functioning. The long-term sequelae of COVID-19 may be influenced by biomedical, psychological, and social factors, the interplay of which is largely understudied over time. We aimed to investigate how the interplay of these factors contribute to the persistence of symptoms after COVID-19.
Methods
RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled participants aged⩾16 years after SARS-CoV-2 diagnosis. We used a structural network analysis to assess relationships between biomedical (initial COVID-19 severity, inflammation markers), psychological (illness perceptions, coping, resilience), and social factors (loneliness, negative life events) and persistent symptoms 24 months after initial disease (severe fatigue, difficulty concentrating, depressive symptoms and limitations in physical functioning). Causal discovery, an explorative data-driven approach testing all possible associations and retaining the most likely model, was performed.
Results
Data from 235/303 participants (77.6%) who completed the month 24 study visit were analysed. The structural model revealed associations between the putative factors and outcomes. The outcomes clustered together with severe fatigue as its central point. Loneliness, fear avoidance in response to symptoms, and illness perceptions were directly linked to the outcomes. Biological (inflammatory markers) and clinical (severity of initial illness) variables were connected to the outcomes only via psychological or social variables.
Conclusions
Our findings support a model where biomedical, psychological, and social factors contribute to the development of long-term sequelae of SARS-CoV-2 infection.
Yellow and knotroot foxtail are two common weed species infesting turfgrass and pastures in the southeastern region of the United States. Yellow and knotroot foxtail share morphological similarities and are frequently misidentified by weed managers, thus leading to confusion in herbicide selection. Greenhouse research was conducted to evaluate the response of yellow and knotroot foxtail to several turfgrass herbicides: pinoxaden (35 and 70 g ai ha−1), sethoxydim (316 and 520 g ai ha−1), thiencarbazone + dicamba + iodosulfuron (230 g ai ha−1), nicosulfuron + rimsulfuron (562.8 g ai ha−1), metribuzin (395 g ha−1), sulfentrazone (330 g ai ha−1), sulfentrazone + imazethapyr (504 g ai ha−1), and imazaquin (550 g ai ha−1). All treatments controlled yellow foxtail >87% with more than 90% reduction of the biomass. By comparison, only sulfentrazone alone controlled knotroot foxtail 90% and completely reduced aboveground biomass. Sethoxydim (520 g ai ha−1), metribuzin, and imazaquin controlled knotroot foxtail >70% at 28 d after application. In a rate response evaluation, nonlinear regression showed that yellow foxtail was approximately 8 times more susceptible to pinoxaden and 2 times more susceptible to sethoxydim than knotroot foxtail based on log (WR50) values, which were 50% reduction in fresh weight. Our research indicates that knotroot foxtail is more difficult to control across a range of herbicides, making differentiation of these two species important before herbicides are applied.
Diagnostic criteria for major depressive disorder allow for heterogeneous symptom profiles but genetic analysis of major depressive symptoms has the potential to identify clinical and etiological subtypes. There are several challenges to integrating symptom data from genetically informative cohorts, such as sample size differences between clinical and community cohorts and various patterns of missing data.
Methods
We conducted genome-wide association studies of major depressive symptoms in three cohorts that were enriched for participants with a diagnosis of depression (Psychiatric Genomics Consortium, Australian Genetics of Depression Study, Generation Scotland) and three community cohorts who were not recruited on the basis of diagnosis (Avon Longitudinal Study of Parents and Children, Estonian Biobank, and UK Biobank). We fit a series of confirmatory factor models with factors that accounted for how symptom data was sampled and then compared alternative models with different symptom factors.
Results
The best fitting model had a distinct factor for Appetite/Weight symptoms and an additional measurement factor that accounted for the skip-structure in community cohorts (use of Depression and Anhedonia as gating symptoms).
Conclusion
The results show the importance of assessing the directionality of symptoms (such as hypersomnia versus insomnia) and of accounting for study and measurement design when meta-analyzing genetic association data.
‘Captorhinikos’ chozaensis Olson, 1954 is a captorhinid eureptile with multiple tooth rows from the lower Permian (Cisuralian: Kungurian) Clear Fork Group of north-central Texas and the Hennessey Formation of Oklahoma. It has five maxillary and four dentary tooth rows. We re-examined the available specimens referred to ‘Captorhinikos’ chozaensis to elucidate aspects of its skeletal structure and assess its phylogenetic relationships. Our parsimony analysis confirmed previous suggestions that this taxon is not referable to the same taxon as Captorhinikos valensis Olson, 1954 (type species of the genus) and ‘Captorhinikos’ parvus Olson, 1970 and thus is placed in its own new genus, Sumidadectes. It also recovered Sumidadectes chozaensis n. comb. as the earliest-diverging moradisaurine captorhinid.
This chapter takes a psychological perspective on tort law decision-making, drawing on psychological theory, empirical research, and legal practices in tort litigation to assess the state of knowledge about decision-making in tort cases. It examines how plaintiffs decide to bring a lawsuit, how defendants respond, and the process of dispute resolution in tort cases. Most tort cases do not go to trial, but trial decisions remain significant as a framework for negotiations. The chapter also draws on psychological theory and research to describe how the judge and the jury as decision-makers resolve legal issues and reach liability verdicts and damage awards in tort cases. Psychological heuristics, biases, and other psychological phenomena affect decision-making in intentional tort, negligence, and strict liability cases, and judgments about liability and damages. The chapter closes with suggestions for further investigations of understudied topics in tort law decision-making.
To describe cognitive impairment in out-of-hospital cardiac arrest (OHCA) survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.
Participants and Methods:
This was a prospective case control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. We administered an extensive neuropsychological assessment at approximately 7 months post-cardiac event, including a neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. Z-scores of individual tests were converted to neuropsychological composite scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions). Between-group differences on the neuropsychological composite scores were investigated with linear regression. Associations between anxiety, depression, fatigue, insomnia, hypertension, diabetes, and the neuropsychological composite scores among OHCA survivors were calculated with Spearman’s rho.
Results:
Of 184 eligible OHCA survivors, 108 were included (mean age = 62, 88% male), with 92 MI controls enrolled (mean age = 64, 89% male). Amongst OHCA survivors, 29% performed z <-1 indicating at least borderline-mild impairment in >2 cognitive domains, and 14% performed z <-2 exhibiting major impairment in >1 cognitive domain. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = -0.37, 95% confidence intervals [-0.61, -0.12]), verbal (MD = -0.34 [-0.62, -0.07]), and visual/constructive functions (MD = -0.26 [-0.47, -0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, processing speed (MD = -0.41 [-0.74, -0.09]) and executive functions (MD = -0.69 [-1.13, -0.24]) were also worse following OHCA. Depressive symptoms were associated with worse executive functions (rs = -0.37, p <0.001) and worse processing speed (rs = -0.27, p = 0.01) post-OHCA. Anxiety symptoms (rs = -0.21, p = 0.01) and general fatigue (rs = -0.24, p = 0.01) were associated with worse executive functions. Diabetes was associated with worse processing speed (rs = -0.20, p = 0.03), visual/constructive (rs = -0.29, p <0.001) and executive functions (rs = -0.25, p = 0.02), while hypertension and insomnia were not significantly associated with neuropsychological test performance.
Conclusions:
Cognitive impairment is generally mild following OHCA, but most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed worse than MI controls. We suggest that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.
In this brief communication, we discuss the current landscape and unmet needs of pediatric to adult transition care in neurology. Optimizing transition care is a priority for patients, families, and providers with growing discussion in neurology. We also introduce the activities of the University of Toronto Pediatric-Adult Transition Working Group – a collaborative interdivisional and inter-subspeciality group of faculty, advanced-practice providers, trainees, and patient-family advisors pursuing collaboration with patients, families, and universities from across Canada. We envision that these efforts will result in a national neurology transition strategy that will inform designation of health authority attention and funding.
This paper investigates the issue of tracking control for a free-floating space manipulator with prescribed performance constraints, considering the inertia uncertainties, internal disturbances and input saturation. An inherently continuous adaptive controller is proposed by incorporating non-singular fixed-time sliding mode control, prescribed performance control (PPC), and auxiliary compensation. First, a modified non-singular fast fixed-time terminal sliding surface is constructed, which has a shorten convergence time than the conventional fixed-time sliding surface. Unlike the existing complicated PPCs, a simple structure controller is developed to satisfy prescribed performance constraints through a unique tangent-type PPC technique. The input saturation is then compensated adaptively by an auxiliary mechanism. The Lyapunov theory thoroughly validates the stability and fixed-time convergence of the closed-loop tracking system. With the suggested control scheme, the system states can converge quickly to a small neighbourhood around the origin within a preassigned time, while the position tracking error can be confined within a prescribed performance bounds even in the presence of input saturation. Compared to the existing tracking methods, the suggested control approach has the advantages of faster transient convergence, higher steady-state tracking precision, and stronger robustness. Simulation comparisons demonstrate the effectiveness and superiority of the proposed controller.
The Community Research Advisory Council (C-RAC) of the Johns Hopkins Institute for Clinical and Translational Research was established in 2009 to provide community-engaged research consultation services. In 2016–2017, C-RAC members and researchers were surveyed on their consultation experiences. Survey results and a 2019 stakeholder meeting proceeding helped redesign the consultation services. Transitioning to virtual consultations during COVID-19, the redesigning involved increasing visibility, providing consultation materials in advance, expanding member training, and effective communications. An increase in consultations from 28 (2009–2017) to 114 (2020–2022) was observed. Implementing stakeholder-researcher inputs is critical to holistic and sustained community-engaged research.
Homeless shelter residents and staff may be at higher risk of SARS-CoV-2 infection. However, SARS-CoV-2 infection estimates in this population have been reliant on cross-sectional or outbreak investigation data. We conducted routine surveillance and outbreak testing in 23 homeless shelters in King County, Washington, to estimate the occurrence of laboratory-confirmed SARS-CoV-2 infection and risk factors during 1 January 2020–31 May 2021. Symptom surveys and nasal swabs were collected for SARS-CoV-2 testing by RT-PCR for residents aged ≥3 months and staff. We collected 12,915 specimens from 2,930 unique participants. We identified 4.74 (95% CI 4.00–5.58) SARS-CoV-2 infections per 100 individuals (residents: 4.96, 95% CI 4.12–5.91; staff: 3.86, 95% CI 2.43–5.79). Most infections were asymptomatic at the time of detection (74%) and detected during routine surveillance (73%). Outbreak testing yielded higher test positivity than routine surveillance (2.7% versus 0.9%). Among those infected, residents were less likely to report symptoms than staff. Participants who were vaccinated against seasonal influenza and were current smokers had lower odds of having an infection detected. Active surveillance that includes SARS-CoV-2 testing of all persons is essential in ascertaining the true burden of SARS-CoV-2 infections among residents and staff of congregate settings.
Meat quality is not only influenced by breed but also rearing environment. The aim of this study was to evaluate the influence of different housing environments on growth performance, carcase traits, meat quality, physiological response pre-slaughter and fatty acid composition in two pig breeds. A total of 120 growing pigs at 60-70 days of age were arranged in a 2 × 2 factorial design with the breeds (Duroc × Landrace × Large White [D × L × LW] and Duroc × Landrace × Min pig [D × L × M]) and environmental enrichment (barren concrete floor or enriched with straw bedding) as factors. Each treatment was performed in triplicate with ten pigs per replicate. The pigs housed in the enriched environment exhibited a higher average daily gain, average daily feed intake, saturated fatty acid percentage and backfat depth than the pigs reared in the barren environment. Plasma cortisol levels were lower and growth hormone higher in enriched compared to barren pens. The D × L × M pigs showed lower cooking loss compared with the D × L × LW pigs. Moreover, the D × L × M pigs exhibited poor growth performance but had a better water-holding capacity. Only carcase traits and meat quality interaction effects were observed. We concluded that an enriched environment can reduce preslaughter stress and improve the growth performance of pigs and modulate the fatty acid composition of pork products.
Doyle’s (2013) theoretical survey of discount functions criticizes two parametric families abbreviated as CRDI and CADI families. We show that Doyle’s criticisms are based on a mathematical mistake and are incorrect.
This volume, which combines the experience of local governance in different countries, a qualitative study of local governance in action in one region of India, and a unique forty-year national panel study of rural India, provides a sober assessment of both the remarkable achievements of India’s experiment with the Panchayati Raj and the ways in which this experiment has fallen short of its promise. It is essential reading not only for those looking for ways to make rural governance work better but also for academic social scientists looking for fresh ideas about how to model and analyze the process of rural governance.
We describe severe acute respiratory coronavirus virus 2 (SARS-CoV-2) IgG seroprevalence and antigenemia among patients at a medical center in January–March 2021 using residual clinical blood samples. The overall seroprevalences were 17% by infection and 16% by vaccination. Spent or residual samples are a feasible alternative for rapidly estimating seroprevalence or monitoring trends in infection and vaccination.