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We assessed the impact of the coronavirus disease 19 (COVID-19) pandemic on code stroke activations in the emergency department, stroke unit admissions, and referrals to the stroke prevention clinic at London’s regional stroke center, serving a population of 1.8 million in Ontario, Canada. We found a 20% drop in the number of code strokes in 2020 compared to 2019, immediately after the first cases of COVID-19 were officially confirmed. There were no changes in the number of stroke admissions and there was a 22% decrease in the number of clinic referrals, only after the provincial lockdown. Our findings suggest that the decrease in code strokes was mainly driven by patient-related factors such as fear to be exposed to the SARS-CoV-2, while the reduction in clinic referrals was largely explained by hospital policies and the Government lockdown.
There are few approved therapies for adults with attention-deficit/hyperactivity disorder (ADHD) in Europe. Lisdexamfetamine (LDX) is an effective treatment for ADHD; however, no clinical trials examining the efficacy of LDX specifically in European adults have been conducted. Therefore, to estimate the efficacy of LDX in European adults we performed a meta-regression of existing clinical data.
A systematic review identified US- and Europe-based randomized efficacy trials of LDX, atomoxetine (ATX), or osmotic-release oral system methylphenidate (OROS-MPH) in children/adolescents and adults. A meta-regression model was then fitted to the published/calculated effect sizes (Cohen's d) using medication, geographical location, and age group as predictors. The LDX effect size in European adults was extrapolated from the fitted model. Sensitivity analyses performed included using adult-only studies and adding studies with placebo designs other than a standard pill-placebo design.
Twenty-two of 2832 identified articles met inclusion criteria. The model-estimated effect size of LDX for European adults was 1.070 (95% confidence interval: 0.738, 1.401), larger than the 0.8 threshold for large effect sizes. The overall model fit was adequate (80%) and stable in the sensitivity analyses.
This model predicts that LDX may have a large treatment effect size in European adults with ADHD.
To document patient characteristics and treatment patterns in a real-world population diagnosed with attention-deficit/hyperactivity disorder (ADHD).
This was a retrospective chart review of children/adolescents (6–17 years) diagnosed with ADHD in the UK, Germany and Netherlands who initiated stimulant monotherapy (SM), non-stimulant (atomoxetine) monotherapy (NSM) or polypharmacy (SM/NSM ± SM/NSM or other psychotropics) on/after 1-1-2012. To facilitate descriptive comparisons, cohort quotas were imposed: ∼50% SM; ∼25% NSM; ∼25% polypharmacy. Index date was first SM, NSM or polypharmacy treatment on/after 1-1-2012. Patients were required to have ≥ 6 months’ pre-index (baseline) history and ≥ 12 months’ post-index follow-up. Analyses were descriptive.
In total, 497 patients were included (mean [SD] age: 10.8 [2.9] years; 77% male); 65% (SM), 63% (NSM) and 83% (polypharmacy) had at least marked baseline ADHD severity based on Clinical Global Impressions scale (P < 0.05 SM/NSM vs polypharmacy). Ninety percent (SM), 75% (NSM) and 73% (polypharmacy) were pharmacotherapy naïve at index (all P < 0.10); 61% (SM), 65% (NSM) and 72% (polypharmacy) received previous behavioural therapy. In SM patients, methylphenidate was predominant (most frequent brands: Concerta® [29%], Medikinet® [28%]); in polypharmacy patients, methylphenidate plus atomoxetine (22%) or other psychotropic (19%) was most common. Index therapy switch was common, particularly in polypharmacy patients (25%) (P < 0.05 vs SM [14%] and NSM [13%]). Switches were precipitated by poor response in 75% of cases overall.
Polypharmacy patients generally presented a more complicated history (including higher ADHD severity) and treatment pathway versus monotherapy patients. Index therapy switches were commonplace and more frequent in polypharmacy patients, often due to poor response.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
This research paper addresses the hypothesis that intensive cooling management during the summer improves the secretion of metabolic hormones in dairy cows. To test this hypothesis, we characterized the effect of different cooling managements on the different ghrelin isoforms and leptin secretion of 20 Israeli-Holstein dairy cows during 5 weeks during heat stress. The cows were divided into two groups: one was exposed to 5 cooling sessions per day (5 CS) and the other to 8 cooling sessions per day (8 CS). Blood was collected and leptin and ghrelin isoforms level were radioimmunoassayed. Analysis of the interaction between coolings and the week of the experiment showed that the 8 CS group consumed more food and produced more milk, although neither difference was statistically significant. In addition, the 8 CS group exhibited higher blood levels of acyl-ghrelin and leptin as compared to the 5 CS group. Conversely, the blood levels of total ghrelin were lower in the cows exposed to 8 CS as compared to cows from the 5 CS treatment. Furthermore, a significant correlation was found only between total ghrelin levels and the weeks, but not with other parameters examined. We further compared digestibility as well as stress parameters between the groups. We found that the 8 CS group cows ruminated and lay down more hours during a day and simultaneously had better activity time. No significant difference was detected between groups in milk yield and digestibility parameters. Our results suggest that intensive cooling management during the hot season influences the levels of metabolic hormones in the circulation and helps to mitigate the detrimental effect of heat stress on dairy cow welfare and production.
Lieder and Griffiths rightly urge that computational cognitive models be constrained by resource usage, but they should go further. The brain's primary function is to regulate resource usage. As a consequence, resource usage should not simply select among algorithmic models of “aspects of cognition.” Rather, “aspects of cognition” should be understood as existing in the service of resource management.
Research identifies highly variable prevalence estimates for autism spectrum disorder (ASD) in children and adolescents with attention deficit hyperactivity disorder (ADHD), particularly between community and clinical samples, warranting quantitative meta-analyses to investigate the true prevalence of ASD in children and adolescents with ADHD.
Studies were identified through a systematic literature search of PsycINFO, MEDLINE and Web of Science through January 2018. Twenty-two publications met inclusion criteria (total N = 61 985). Two random effects meta-analyses were conducted: (1) to identify the proportion of children and adolescents with ADHD that met criteria for ASD; and (2) to compare the severity of dimensionally-measured ASD symptomology in children and adolescents with and without ADHD.
The overall pooled effect for children and adolescents with ADHD who met threshold for ASD was 21%. There was no significant difference between community samples (19%) and clinical samples (24%) or between US studies v. those from other countries. Children and adolescents with ADHD had substantially more dimensionally-measured ASD traits compared with those who did not have ADHD (d = 1.23).
The findings provide further evidence that ADHD and ASD are associated in nature. Clinical and research implications are discussed.
Background: Strokes can cause a variety of cardiovascular complications. The underlying mechanisms are largely unknown but there is evidence that dysautonomia plays a role in stroke induced-heart injury (SIHI) and arrhythmias triggered by damage of specific brain regions involved in the autonomic regulation of cardiac functions. Understanding these mechanisms could aid in preventing these cardiovascular consequences. We hypothesize that compared to -patients with sinus rhythm (SR) or with cardiogenic atrial fibrillation known before the stroke (cKAF) or diagnosed after the stroke (cAFDAS), those with neurogenic AFDAS (nAFDAS) will show a specific pattern of autonomic functioning. Methods: We will prospectively evaluate 200 ischemic stroke patients at the London Health Sciences Center University Hospital. Participants will undergo continuous electrocardiographic monitoring during 14 days. Based on pre-specified criteria, patients with AFDAS will be classified into presumably neurogenic vs cardiogenic. We will assess autonomic function within 14 days after stroke onset by using the Autonomic Reflex Screening. We will compare markers of cardiac dysfunction with autonomic changes, as well as specific stroke topographies for SR, cKAF, cAFDAS, and nAFDAS. Results: We are currently performing an interim analysis. Conclusions: Characterizing the autonomic changes that occur after ischemic stroke and their relationship with heart injury will help to advance knowledge on the pathophysiology of SIHI.
In this report we present a possible scheme of short-term CME detection forecasting developed on the basis of statistical analysis of solar radio emission regularities prior to “isolated” solar Coronal Mass Ejections registered in 1998, 2003, 2009-2013.
We investigate numerically the transitions and oscillatory regimes in two-layer quasigeostrophic hetons and tripoles composed of patches of uniform potential vorticity (PV). The contour-surgery algorithms are employed, in which either some symmetries are preserved, or asymmetric evolution of the vortex structures is allowed, induced by generally asymmetric numerical noise. The fluid layers are assumed equally thick. First, the evolution of hetons is considered. A heton, a steadily translating pair of vortices residing in different layers, is antisymmetric in the sense that the two PV patches are opposite in sign and symmetric in shape about the axis of translation. A feebly stable heton, when exposed to weak antisymmetric perturbations, responds by developing an oscillation, which culminates in a transition to a new, substantially robust oscillating heton. The results obtained reinforce our earlier findings regarding the modon-to-modon transition (Kizner et al., J. Fluid Mech., vol. 468, 2002, pp. 239–270; Kizner, Phys. Fluids, vol. 18 (5), 2006, 056601; Kizner, UTAM Symposium on Hamiltonian Dynamics, Vortex Structures, Turbulence (ed. Borisov et al.), IUTAM Bookseries, vol. 6, 2008, pp. 125–133. Springer) and clarify the transition mechanism. Asymmetric perturbations might cause a heton-to-tripole transition. Next we consider the transitions and oscillations in carousel tripoles exposed to weak, generally asymmetric perturbations. A carousel tripole is a steadily rotating centrally symmetric ensemble of three PV patches, with the central vortex being located in one layer and the two remaining, satellite vortices in the other layer. Depending on the tripoles’ size, hence also on the shape of the satellite vortices, three different types of transition are revealed, the transition to a ringed (shielded) monopole being one of them. Whereas the transition of a ringed monopole into a tripole is a known phenomenon, the reverse transition in baroclinic flows is detected for the first time.
Rates of psychiatric disorders are highly prevalent among prison inmates, and recent evidence confirms over-representation of youths and adults with attention deficit hyperactivity disorder (ADHD). The risk for psychiatric co-morbidity may be greater among offenders with ADHD. We undertook a systematic review and meta-analysis of reported rates of co-existing psychiatric morbidity with ADHD in prison samples.
Studies published from 1980 to 2015 were identified using five bibliographic indexes, review articles and reference lists. Included studies had a defined ADHD group and provided additional prevalence on at least one of the following: conduct disorder, substance use disorder, mood disorder, anxiety disorder, or personality disorder. We performed meta-analytical estimates of the prevalence of each co-morbid disorder within ADHD, and estimated the risk for co-existing disorders among prisoners with ADHD by pooling odds ratios (OR) with 95% confidence intervals.
Eighteen studies with data for 1615 with ADHD and 3128 without ADHD were included. The risk (OR) of all psychiatric morbidity is increased among adult inmates with ADHD. Associations in youths with ADHD were restricted to mood disorder (OR 1.89, 95% confidence interval 1.09–3.28).
This study quantifies the extent of co-morbidity presented by offenders with ADHD, especially adults. The differences between risk estimates for youths and adults indicate an incremental effect in both frequency and severity for the development of further co-morbid pathology through adulthood. The findings have implications for clinical intervention and for criminal justice policy.
Studies report the variable prevalence of attention deficit hyperactivity disorder (ADHD) in incarcerated populations. The aim of this meta-analysis was to determine the prevalence of ADHD in these populations.
Primary research studies reporting the prevalence (lifetime/current) of ADHD in incarcerated populations were identified. The meta-analysis used a mixed log-binomial model, including fixed effects for each covariate and a random study effect, to estimate the significance of various risk factors.
Forty-two studies were included in the analysis. ADHD prevalence was higher with screening diagnoses versus diagnostic interview (and with retrospective youth diagnoses versus current diagnoses). Using diagnostic interview data, the estimated prevalence was 25.5% and there were no significant differences for gender and age. Significant country differences were noted.
Compared with published general population prevalence, there is a fivefold increase in prevalence of ADHD in youth prison populations (30.1%) and a 10-fold increase in adult prison populations (26.2%).
M. Laroussi, Old Dominion University, Virginia,M. G. Kong, Loughborough University,G. Morfill, Max-Planck-Institut für Plasmaphysik, Garching, Germany,W. Stolz, Ludwig-Maximilians-Universität Munchen
M. Laroussi, Old Dominion University, Virginia,M. G. Kong, Loughborough University,G. Morfill, Max-Planck-Institut für Plasmaphysik, Garching, Germany,W. Stolz, Ludwig-Maximilians-Universität Munchen
We develop a plasma processing technique for modifying the surface properties of micro- and nanostructured materials for biomedical applications. We also investigate the physical and chemical roles of the plasma in modifying the surfaces of micro- and nanostructured materials such as magnetic nanoparticles (MNPs), carbon nanotubes (CNTs), nanophosphors, and biomolecules for various biomedical applications. We introduced amino groups onto the surfaces of graphite-encapsulated iron compound nanoparticles using a low-pressure Ar plasma pre-treatment and ammonia plasma post-treatment followed by immobilization of biomolecules, such as dextran and N-acetyllactosamine (LacNAc). The present technique was also used to introduce amino groups onto CNT dot arrays grown on Si substrates for use in biochip sensors.
We have investigated the nonthermal bioplasma sources and their characteristics as well as their interactions with biological cells. The electron temperature and plasma density are measured to be about 1.5 eV and 3×1012 cm-3 , respectively, for the direct palsma jet under Ar gas flow. The hydroxyl radical density has also been investigated and measured to be maximum value of about 3 ×1015 cm-3 and 8 ×1014 cm-3 in the direct plasma jet and dielectric barrier discharge bioplasma, respectively, by the ultraviolet optical absorption spectroscopy. Herein, we have investigated the basic interactions of these nonthermal bioplasma with the living organisms in morphological and biomolecular aspects. We found that the secondary electron emision coefficient of the biological surface has been drastically increased by atmospheric bioplasma, which indicates the biological surface to be oxidized especially by the hydroxyl (OH) radical species. In order to elucidate the basic mechanisms for the cell shrinking and apoptosis leading to a cell death by the nonthermal bioplasma, the cell membrane potential has been estimated based on the ROS density as well as cell capacitances. It is also found that the molecular electron energy band structure in the biological cells have been shifted closer toward the vacuum surface and accordingly their central energy of molecular band becomes small by the nonthermal bioplasma due to cell oxidation caused by OH radicals.
Two independent ovarian cancer cell lines and fibroblast controls were treated with nonequilibrium atmospheric pressure plasma (NEAPP). Most ovarian cancer cells were detached from the culture dish by continuous plasma treatment to a single spot on the dish. Next, the plasma source was applied over the whole dish using a robot arm. In vitro cell proliferation assays showed that plasma treatments significantly decreased proliferation rates of ovarian cancer cells compared to fibroblast cells. FACS and Western blot analysis showed that plasma treatment of ovarian cancer cells induced apoptosis. NEAPP could be a promising tool for therapy for ovarian cancers.
We report the kinetic analysis of radicals on fungal spores of Penicillium digitatum interacted with charged-neutral oxygen species (O*) generated plasma discharge using real time in situ electron spin resonance (ESR) measurements. The ESR signal from the spores was observed at a g-value of around 2.004 with a line width of approximately 5G. We have successfully obtained information regarding the reaction mechanism with free radicals and realtime in situ ESR has proven to be a useful method to elucidate plasma-induced surface reactions on biological specimens
Atmospheric microplasma has been intensively studied for various application fields, since this technology has features shown here: generated around only 1 kV under atmospheric pressure,discharge gap of only 10 to 100mm,dielectric barrier discharge. Low discharge voltage atmospheric plasma processis an economical and effective solution forvarious applications such as indoor air control including sterilization, odor removal, surface treatment, and would be suitable for plasma-life science field such as medical application.
In thispaper, the basic study for plasma-life science will be presented. One life science application of microplasma is “sterilization”. The sterilization process was carried out with active species generated between themicroplasmaelectrodes.The active species were observed by emission spectrometry. The spectra showed the existence of active species, and the microplasma had typical characteristics of non-thermal plasma. Sterilization of E. coli was confirmed after microplasma treatment with Ar gas. The bacteria shape was changed after the microplasma process. The other application is “Surface treatment” by long life active species of materials which used for the medical field. The targets are glass, polymer film and others could be also possible.
The process is known as remote microplasma sterilization method. Microplasma generated by both air and Ar are effective for sterilization. Observation by the SEM images shows the E. coli had a shrunked shape after the microplasma treatment.
The contact angle of a water droplet on the polymer surface was measured to estimate its hydrophilicity. The relation between the contact angle and treatment time was investigated. Contact angle decreased from 75.6° to 45.6° after 10 s of treatment.