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Encephalitis due to anti-N-methyl-D-aspartate receptor antibodies (ANMDARE) is the most frequent immune-mediated encephalitis. It is distinguished by the subacute onset of neuropsychiatric symptoms.
To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with ANMDARE.
This was a prospective, longitudinal study in patients with a diagnostic suspicion of ANMDARE that presented to the National Institute of Neurology from March 2018 to February 2019. A comparative analysis of two groups (positive N-methyl-D-aspartate receptor [NMDAR] vs. negative NMDAR antibodies in cerebrospinal fluid [CSF]) was done on admission and at discharge. Neuropsychiatric systematic assessments included the Neuropsychiatric Inventory Questionnaire, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method Severity, the Montreal Cognitive Assessment, and the Overt Agitation Severity Scale.
24 individuals were analysed: 14 had positive NMDAR antibodies, and 10 had negative NMDAR antibodies in CSF. On admission, agitation/aggression, euphoria/exaltation, and disinhibition were more common in patients with positive antibodies. Excited catatonia and delirium were diagnosed more frequently in patients with positive antibodies. At discharge, there was an important decrease in neuropsychiatric symptoms, but substantial cognitive impairment remained. The mean hospitalisation length was 41.71 (SD 39.33) days for patients with definitive ANMDARE (p 0.259).
Neuropsychiatric symptoms profile in ANMDARE was associated with the early onset of euphoria/exaltation and disinhibition, accompanied by marked psychomotor agitation. When ANMDARE was suspected, the presence of excited-type catatonia and delirium showed a tendency to predict definitive ANMDARE. At discharged, most patients recovered from catatonia, delirium, and psychosis, but marked cognitive symptoms, anxiety, and depression persisted at discharge.
The purpose of this article is to describe the process of developing and implementing a transdisciplinary community-based research center, the Center for Health Equity Research (CHER) Chicago, to offer a model for designing and implementing research centers that aim to address structural causes of health inequality.
Scholars from diverse backgrounds and disciplines formed a multidisciplinary team for the Center and adopted the structural violence framework as the organizing conceptual model. All Center activities were based on community partnership. The Center activities were organized within three cores: administrative, investigator development, and community engagement and dissemination cores. The key activities during the first year were to develop a pilot grant program for early-stage investigators (ESIs) and to establish community partnership mechanisms.
CHER provided more than 60 consultations for ESIs, which resulted in 31 pilot applications over the three application cycles. Over 200 academic and community partners attended the community symposium and discussed community priority. Some challenges encountered were to improve communication among investigators, to clarify roles and responsibilities of the three cores, and to build consensus on the definition and operationalization of the concept of structural violence.
There is an increasing need for local hubs to facilitate transdisciplinary collaboration and community engagement to effectively address health inequity. Building consensus around a shared vision among partners is a difficult and yet important step toward achieving equity.
Parasites inflict many costs on their hosts. Understanding host–parasite relationship eco-evolutionary dynamics needs appreciation of how parasites affect individual fitness, survival and reproductive potential, and how they combine to influence population demography, dynamics and viability; also, how these processes drive microevolutionary processes that define natural and sexual selection. We synthesise work on the relationship between the red grouse and its main parasite, a gastrointestinal nematode. At individual level, we show how parasites impose a physiological cost, measured by immunosuppression and increased oxidative stress, and how their impact varies depending on contexts. We describe how parasite infection constrains expression of sexually selected traits and summarise how relationships between parasite, host and environment shape host population demography and dynamics. Genetic analyses in red grouse suggest nematode burden is moderately heritable, underpinned by a potentially large array of genes involved in the immune system, energy balance and broader homeostatic processes. There is no clear association between allele frequencies among populations and differences in nematode burdens. Possibly, beneficial alleles for parasite resistance cannot spread through the population due to the strong diversifying e?ects of gene ?ow and genetic drift.
Lifestyles are involved in the pathogenesis of depression and many of these factors can be modified for the potential prevention of depression. Our aim was to assess the association between a healthy-lifestyle score, that includes some less-studied lifestyle indicators, and the risk of depression.
We followed 14,908 participants initially free of any history of depression in the “Seguimiento Universidad de Navarra” (SUN) cohort. Information was collected biennially from 1999 to December 2016. We calculated a healthy-lifestyle score (0–10 points), previously associated with cardioprotection, by giving one point to each of the following components: never smoking, physical activity (> 20 METs-h/week), Mediterranean diet adherence (≥ 4 points), healthy body mass index (≤ 22 kg/m2), moderate alcohol consumption (women 0.1–5 g/d; men 0.1–10 g/d of ethanol), avoidance of binge drinking (never more than 5 alcoholic drinks in a row), low television exposure (≤ 2 h/d), short afternoon nap (≤ 30 min/day), time spent with friends (>1 h/d) and working at least 40 h/week.
During a median follow-up of 10.4 years, we observed 774 new cases of major depression among participants initially free of depression. The highest category (8–10 factors) showed a significant inverse association with a 32% relative risk reduction for depression compared to the lowest category (0–3 factors) (multivariable-adjusted hazard ratio: 0.68; 95% CI:0.49-0.95) (p for trend = 0.010).
Adopting a healthy-lifestyle was associated with a lower risk of incident depression in the SUN cohort. This index, including ten simple healthy lifestyle habits, may be useful for a more integrative approach to depression prevention.
Transcatheter implantation of pulmonary balloon-expandable stent-valves requires pre-stenting of the right ventricular outflow tract with large calibre stents. To increase awareness of the associated risks of this part of transcatheter pulmonary valve replacement therapy, we report potential fatal complications during the implantation of AndraStents® in the right ventricular outflow tract in six cases from five different European institutions and their management.
Method and result:
We present a retrospective case series analysis looking at the time period from 2013 to 2018. Of 127 AndraStents® implanted in the right ventricular outflow tract, in six patients, age from 13 to 71 years, a misconfiguration of the AndraStent® occurred forming a “diabolo”-configuration. During inflation of the balloon, the stent showed extreme “dog-boning”, an expansion of the stent at both ends with the middle part remaining unexpanded. This led to rupture of the balloon and loss of manoeuvrability in four patients. Out of the total six cases, in four patients the stent was eventually expanded with high-pressure balloons, and in one case the stent was surgically retrieved. In one patient, in whom a percutaneous retrieval of the embolised stent was attempted, a fatal bleeding occurred.
Pre-stenting of the right ventricular outflow tract by AndraStents® can lead to misconfiguration of the stent with potentially fatal complications. Rescue strategies of misconfigured stents include stent inflation and placement with high pressure non-compliant balloons or surgical backup. Interventional retrieval measures of AndraStents® cannot be advised.
The aim of this study is to investigate the impact of anatomical changes in prostate cancer patients on the target coverage when using 6 MV beams-VMAT therapy and to propose strategies that allow us to evaluate the dose or correct it by normalization without having to perform a new simulation.
Methods and materials:
Ten patients of high-risk prostate cancer were chosen for the study. All test plans were delivered using the same isocenter and monitor units as the original plan and compared against the original unedited plan. The expansion and contraction of body contours due to size changes was mimicked by increasing and decreasing the body contour with depths of −2, −1·5, …, 1·5, 2 cm, in the anterior, and both lateral directions of the patient. A total of 90 plans were evaluated, 9 for each patient. Dose-volume histogram statistics were extracted from each plan and normalized to prescription dose.
Weight changes resulted in considerable dose modifications to the target and critical structures. Plans were found to be varied with 2·9% ± 0·3% per cm SSD change for VMAT treatment with a correlation index close to one. Therefore, doses variations were linear to the changes of depth. Gamma index evaluation was performed for the 10 renormalized plans. All of them passed criteria of 3%/3 mm in at least 98.2% of points. Eight of them passed criteria in 99% points. Gamma index 4%/4 mm passed 100% points in all patients for the chosen region of interest.
The dosimetry estimation presented in this study shows important data for the radiation oncology staff to justify whether a CT rescan is necessary or not when a patient experiences weight changes during treatment. Based on the results of our study, discrepancies between real dose and planned dose were >5% for 1·7 cm of difference in external contour in the anterior and both lateral directions of the patient.
Widely distributed species such as Arbacia stellata adjust patterns of their life history according to local conditions. In the present study the reproductive cycle of this species was analysed throughout a sampling year. Gonadal development cycle, sex ratio, actual fecundity and oocyte size distribution were characterized and the relationship of these reproductive characteristics with environmental variables such as sea surface temperature, photoperiod, chlorophyll a and net primary production evaluated. Our results showed that A. stellata is a gonochoric sea urchin. Gametogenesis was classified into six stages for both sexes (immature, growth, pre-maturity I, pre-maturity II, mature and spawning) and no synchrony was observed for the gonads between individuals. The female to male ratio was close to 1:1 in most months. The gonadosomatic index (GSI) showed significant differences between sexes or months; however, the highest values were observed during spring, with positive correlation with chlorophyll a. No significant differences were observed in the maturity index (MI) between sexes, with a positive correlation with temperature but negative with chlorophyll. Actual fecundity showed wide variations throughout the year and correlation with chlorophyll a and temperature. Oocyte size distribution was unimodal and the predominant frequency was that of mature oocytes. The reproductive cycle of A. stellata has a semi-continuous pattern for both sexes and partial spawning throughout the year in the sampling site. We observed nutrient assimilation in the gonads during spring and a larger reproductive activity from late summer to early winter.
A 6–18 GHz high-power amplifier (HPA) design in GaN on SiC technology is presented. This power amplifier consists of a two-stage corporate amplifier with two and four transistors, respectively. It has been fabricated on UMS using their 0.25 µm gate length process, GH25. A study of the suitable attachment method and measurement on wafer and on jig are detailed. This HPA exhibits an averaged output power of 39.2 dBm with a mean gain of 11 dB in saturation and a 24.5% maximum power added efficiency in pulse mode operation with a duty cycle of 10% with a 25 µs pulse width.
Preliminary evidence suggests that hoarding disorder (HD) and obsessive-compulsive disorder (OCD) may show distinct patterns of brain activation during executive performance, although results have been inconclusive regarding the specific neural correlates of their differential executive dysfunction. In the current study, we aim to evaluate differences in brain activation between patients with HD, OCD and healthy controls (HCs) during response inhibition, response switching and error processing.
We assessed 17 patients with HD, 18 patients with OCD and 19 HCs. Executive processing was assessed inside a magnetic resonance scanner by means of two variants of a cognitive control protocol (i.e. stop- and switch-signal tasks), which allowed for the assessment of the aforementioned executive domains.
OCD patients performed similar to the HCs, differing only in the number of successful go trials in the switch-signal task. However, they showed an anomalous hyperactivation of the right rostral anterior cingulate cortex during error processing in the switch-signal task. Conversely, HD patients performed worse than OCD and HC participants in both tasks, showing an impulsive-like pattern of response (i.e. shorter reaction time and more commission errors). They also exhibited hyperactivation of the right lateral orbitofrontal cortex during successful response switching and abnormal deactivation of frontal regions during error processing in both tasks.
Our results support that patients with HD and OCD present dissimilar cognitive profiles, supported by distinct neural mechanisms. Specifically, while alterations in HD resemble an impulsive pattern of response, patients with OCD present increased error processing during response conflict protocols.
OBJECTIVES/SPECIFIC AIMS: This project presents the implementation of research tracks instructional design using a learning management system (LMS). METHODS/STUDY POPULATION: On January 2018, a Novel Methodologies in Health Disparities Research Symposium was held, with participation of local and national collaborators. The purpose was to identify the most important areas of knowledge, essential skills, available online resources and conferences associated with each research track. The recommendations provided contributed to the instructional design of novel methodologies research tracks aiming to improve health disparity research. The LMS includes general documents, instructional materials and assessment instruments, among others. Scholars are required to comply with 30 contact hours. The content and strategies utilized will be evaluated. RESULTS/ANTICIPATED RESULTS: Active scholar participation through the LMS is expected. Evaluation results will reflect the strengths and challenges of the implementation of instructional design. DISCUSSION/SIGNIFICANCE OF IMPACT: This strategy will engage scholars in an active learning experience enhancing their career development as independent researchers to eliminate health disparities.
Over the centuries, Spanish historiography has attached great importance to the wars that Octavian launched at the start of the last third of the 1st c. B.C. against the population in the north of the Iberian peninsula. In this way he intended to bring an end to the long conquest of Iberia that had begun two centuries earlier in the hegemonic struggle with Carthage. Although the wars previously attracted the attention of European scholars, today they play little part in the historiography of the Early Roman Empire and even less in the biographies of Augustus, who suffered some of his worst military fortunes in this war, putting his very life in danger (Suet., Aug. 29.3 and 81.1; Hor., Carm. 3.14; Dio 53.25.5-7; Oros. 6.21.4). Even Departments of Ancient History in Spanish universities have failed to progress beyond well-worn exegesis of the written sources. This is because until just two decades ago all the information came from two historical sources: Florus and Orosius, on the one hand, and Dio Cassius, on the other (the relevant books of Livy being lost). Although they stress the importance of the conflict, these sources are excessively laconic; they have also been subjected to erudite speculations about place-names that have turned the military campaigns into a series of historiographic fictions.1
The potential of a mass asteroid impact on Earth to disturb the chemosynthetic communities at global scale is discussed. Special emphasis is made on the potential influence on anammox communities and their implications in the nitrogen biogeochemical cycle. According to our preliminary estimates, anammox communities could be seriously affected as a consequence of global cooling and the large process of acidification usually associated with the occurrence of this kind of event. The scale of affectations could vary in a scenario like the Chicxulub as a function of the amount of soot, depth of the water column and the deposition rate for sulphates assumed in each case. The most severe affectations take place where the amount of soot and sulphates produced during the event is higher and the scale of time of settlements for sulphates is short, of the order of 10 h. In this extreme case, the activity of anammox is considerably reduced, a condition that may persist for several years after the impact. Furthermore, the impact of high levels of other chemical compounds like sulphates and nitrates associated with the occurrence of this kind of event are also discussed.
Archaeological investigations at Monte Bernorio (northern Spain) and its surroundings are yielding exciting new evidence for the destruction of the Iron Age oppidum by the Roman military and the subsequent Roman occupation of the area.
The Latino population in the United States is rapidly growing and faces profound health disparities; however, engagement of Latinos in biomedical research remains low. Our community-based participatory research partnership has recruited 2083 Spanish-speaking Latinos into 21 studies over 15 years. We sought to identify and describe the strategies we have used to successfully recruit and retain Spanish-speaking Latinos in research.
We abstracted and analyzed data from archived study notes, progress reports, team meeting minutes, and in-depth interviews conducted annually from community-based participatory research partnership members. We used a nominal group process to refine and prioritize strategies.
Overall, 13 recruitment strategies and 12 retention strategies emerged. These strategies relied on the creativity and perseverance of the study team and partners.
It is essential that we develop and disseminate effective recruitment and retention strategies that engage Latinos in biomedical research to reduce health disparities and promote health equity.
Magnetic fields pervade the universe and play an important role in many astrophysical processes. However, they require specialised observational tools, and are challenging to model and understand. This volume provides a unified view of magnetic fields across astrophysical and cosmological contexts, drawing together disparate topics that are rarely covered together. Written by the lecturers of the XXV Canary Islands Winter School, it offers a self-contained introduction to cosmic magnetic fields on a range of scales. The connections between the behaviours of magnetic fields in these varying contexts are particularly emphasised, from the relatively small and close ranges of the Sun, planets and stars, to galaxies and clusters of galaxies, as well as on cosmological scales. Aimed at young researchers and graduate students, this up-to-date review uniquely brings together a subject often tackled by disconnected communities, conveying the latest advances as well as highlighting the limits of our current understanding.
Magnetic fields play an important role in many astrophysical processes. They are difficult to detect and characterize because often their properties have to be inferred through interpreting the polarization of the light. Magnetic fields are also challenging to model and understand. Magnetized plasmas behave following highly non-linear differential equations having no general solution, so that every astrophysical problem represents a special case to be studied independently. Hence, magnetic fields are often an inconvenient subject that is overlooked or simply neglected (the elephant in the room, as they are dubbed on posters in the XXV Canary Islands Winter School of Astrophysics). Such a difficulty burdens the research on magnetic fields, which has evolved to become a very technical subject, with many small disconnected communities studying specific aspects and details. The school tried to amend the situation by providing a unifying view of the subject. The students had a chance to understand the behavior of magnetic fields in all astrophysical contexts, from cosmology to the Sun, and from starbursts to AGNs. The school was planned to present a balanced yet complete review of our knowledge, with excursions into the unknown to point out present and future lines of research.
The subject of Cosmic Magnetic Fields was split into seven different topics: cosmic magnetic field essentials, solar magnetic fields, stellar magnetic fields, the role of magnetic fields on AGN feedback, magnetic fields in galaxies, magnetic fields in galaxy clusters and at larger scales, and primordial magnetic fields and magnetic fields in the early Universe. The corresponding lectures were delivered by seven well known and experienced scientists that have played key roles in the major advances of the field during the last years: F. Cattaneo, P. Judge, O. Kochukhov, R. Keppens, R. Beck, K. Dolag, and F. Finelli. Their lectures were recorded and are freely available at the IAC website: http://iactalks.iac.es/talks/serie/19. Together with the reviews included in the present volume, they form a unique resource for both students and professional researchers. They provide a global view of this very compartmentalized, yet fundamental, field of research.