The varied clinical and radiological manifestations of contrast-induced encephalopathy following coronary angiography

Contrast-induced encephalopathy (CIE) is a rare complication of imaging using ionidated contrast media. Its pathogenesis remains unknown, and its clinical presentation is variable. We present two cases of CIE following coronary angiography (CAG) that underscore the multitude of clinical manifestations and imaging findings associated with the disorder. In patients 1, CIE manifested during the CAG with agitation and decreased consciousness, followed by left hemiparesis and visual neglect. Native computed tomography (CT) of the head was unremarkable but CT perfusion (CTP) showed extensive hypoperfusion of the right hemisphere with corresponding slow-wave activity in the electroencephalogram (EEG). These findings were more pronounced the next day. Magnetic Resonance Imaging (MRI) revealed multiple small dot-like ischemic lesions across the brain. By day six she had fully recovered. Patient 2 developed transient expressive aphasia during the CAG followed by migraineous symptoms. Native head CT showed a large area of parenchymal edema, sulcal effacement and variable subarachnoid hyperdensity in the right hemisphere. He developed mild left side hemiparesis, spontaneous gaze deviation and inattention. Brain MRI showed small dot-like acute ischemic lesions across the brain. The next morning, he had a generalized tonic-clonic seizure (GTCS) after which native head CT was normal, but the EEG showed a post-ictal finding covering the right hemisphere. His hemiparesis resolved within two months. The diversity in clinical and radiographic presentations suggest that CIE involve many pathophysiological processes.

Cyber-Physical Systems for High-Performance Machining of Difficult to Cut Materials in I5.0 Era-A Review

The fifth Industrial revolution (I5.0) prioritizes resilience and sustainability, integrating cognitive cyber-physical systems and advanced technologies to enhance machining processes. Numerous research studies have been conducted to optimize machining operations by identifying and reducing sources of uncertainty and estimating the optimal cutting parameters. Virtual modeling and Tool Condition Monitoring (TCM) methodologies have been developed to assess the cutting states during machining processes. With a precise estimation of cutting states, the safety margin necessary to deal with uncertainties can be reduced, resulting in improved process productivity. This paper reviews the recent advances in high-performance machining systems, with a focus on cyber-physical models developed for the cutting operation of difficult-to-cut materials using cemented carbide tools. An overview of the literature and background on the advances in offline and online process optimization approaches are presented. Process optimization objectives such as tool life utilization, dynamic stability, enhanced productivity, improved machined part quality, reduced energy consumption, and carbon emissions are independently investigated for these offline and online optimization methods. Addressing the critical objectives and constraints prevalent in industrial applications, this paper explores the challenges and opportunities inherent to developing a robust cyber-physical optimization system.

Informing the pandemic response: the role of the WHO's COVID-19 Weekly Epidemiological Update

On 31 December 2019, the Municipal Health Commission of Wuhan, China, reported a cluster of atypical pneumonia cases. On 5 January 2020, the WHO publicly released a Disease Outbreak News (DON) report, providing information about the pneumonia cases, implemented response interventions, and WHO's risk assessment and advice on public health and social measures. Following 9 additional DON reports and 209 daily situation reports, on 17 August 2020, WHO published the first edition of the COVID-19 Weekly Epidemiological Update (WEU). On 1 September 2023, the 158th edition of the WEU was published on WHO's website, marking its final issue. Since then, the WEU has been replaced by comprehensive global epidemiological updates on COVID-19 released every 4 weeks. During the span of its publication, the webpage that hosts the WEU and the COVID-19 Operational Updates was accessed annually over 1.4 million times on average, with visits originating from more than 100 countries. This article provides an in-depth analysis of the WEU process, from data collection to publication, focusing on the scope, technical details, main features, underlying methods, impact and limitations. We also discuss WHO's experience in disseminating epidemiological information on the COVID-19 pandemic at the global level and provide recommendations for enhancing collaboration and information sharing to support future health emergency responses.

Electrophysiological signatures of anxiety in Parkinson's disease

Anxiety is a common non-motor symptom in Parkinson's disease (PD) occurring in up to 31% of the patients and affecting their quality of life. Despite the high prevalence, anxiety symptoms in PD are often underdiagnosed and, therefore, undertreated. To date, functional and structural neuroimaging studies have contributed to our understanding of the motor and cognitive symptomatology of PD. Yet, the underlying pathophysiology of anxiety symptoms in PD remains largely unknown and studies on their neural correlates are missing. Here, we used resting-state electroencephalography (RS-EEG) of 68 non-demented PD patients with or without clinically-defined anxiety and 25 healthy controls (HC) to assess spectral and functional connectivity fingerprints characterizing the PD-related anxiety. When comparing the brain activity of the PD anxious group (PD-A, N = 18) to both PD non-anxious (PD-NA, N = 50) and HC groups (N = 25) at baseline, our results showed increased fronto-parietal delta power and decreased frontal beta power depicting the PD-A group. Results also revealed hyper-connectivity networks predominating in delta, theta and gamma bands against prominent hypo-connectivity networks in alpha and beta bands as network signatures of anxiety in PD where the frontal, temporal, limbic and insular lobes exhibited the majority of significant connections. Moreover, the revealed EEG-based electrophysiological signatures were strongly associated with the clinical scores of anxiety and followed their progression trend over the course of the disease. We believe that the identification of the electrophysiological correlates of anxiety in PD using EEG is conducive toward more accurate prognosis and can ultimately support personalized psychiatric follow-up and the development of new therapeutic strategies.

Legal framework in aid of biological diversity and statutory deficiencies in Pakistan

Abstract The traditional perception of mutual rights and obligations in the developing world was practically confined to human beings only. Fortunately, this conventional understanding is growing to include all living beings in the scope of certain basic rights. It is also addressing those creatures which are co-existing with human societies naturally or are associated for their subsistence and interdependence. It means that there should be prescribed body of rules and regulations to regulate human conduct in the society. In Pakistan social awakening for animal rights supported by international campaigns have urged state institutions to make adequate body of rules and regulations for protection of animal rights. Purpose of developing required understanding, at the first place is to clarify what is a right and what is an obligation? Secondly what should be the nature of these rights and obligations. Should these be only specific to human beings or there are other beings who also possess certain rights? If other living beings, species have rights, how these rights are to be conferred and regulated? Who is under obligation to provide these rights? Who is liable and responsible to ensure observance of such obligations? It is becoming clearer that like human beings’ animals do have certain rights as living beings. All most all religions of the world have prescribed certain rights to them which are encrypted in their holy books. Most of the people are aware of basic concept of observing mild and kind behavior towards pet animals only. Today we scientifically know that humanity and animals have co-existing inevitability. By observing mutual behavior and sensation, the world has provided special rights to the animals by making laws and Acts. Implementation of those rights can only be made through mutual understanding of the citizens under the supervision of law enforcing agencies. It is the responsibility of state and citizens of the states jointly to protect the animals when their rights are being violated.

Economic valuation of selected ecosystem services in Islamabad Capital Territory (ICT), Pakistan

Abstract Payment for ecosystem services (PES) is a mechanism where a consumer is able and ready to pay for the protection of the precise ecosystem service and there must be a provider such as local societies receiving an economic resource, who in return, must have the ability to maintain that ecosystem service. Economic valuation provides basis for payment for ecosystem services. Therefore, objective of this study was to evaluate tourism and carbon stock services of the Islamabad Capital Territory (ICT), Pakistan. Two forest zones (Chirpine and Scrub) of Islamabad capital territory (ICT) were selected for estimation of carbon stock and their carbon credits and carbon worth, a questionnaire-based survey was conducted for tourism as a payment for ecosystem services. The method for carbon stock assessment was systematic sampling for Chirpine forest whereas random sampling was done for scrub forest. The size of sampling plot was 17.84 m radius, and a total of 93 plots (49 Scrub zone and 44 Chirpine zone) was taken in the study area. The carbon stock of both zones (Chirpine and Scrub zone) is 22556.75 ton/ha (Chirpine 20105.79, Scrub 2450.96) and total carbon dioxide sequestered by both zone is 82557.72 ton/ha (Chirpine 73587.2, Scrub 8970.52), total carbon credits of both zone is 302160.87 (Chirpine 269328.97, Scrub 32831.9) and the carbon worth of both Chirpine and scrub zone is 4532418.92 $ (Chirpine 4039937.09$, Scrub 492481.83$). Similarly, from tourism point of view, in Shakar Parian, 94% tourists were agreed for PES whereas 6% were disagreed for the PES (the 6% tourist were disagreed to contribute for PES, 40% were agreed for Rs.5 contribution and 54% for Rs.10.). moreover, in Lake view Park, 97% tourists were agreed and 3% are disagreed (In Lake View Park 5% tourists were disagreed for the PES contribution whereas 32% were agreed for Rs.5 and 63% were for Rs.10). In Damen e Koh, around 87% tourist were agreed and 13% were disagreed, (24% were agreed for the contribution of Rs.5 and 63% tourists were agreed for the contribution of Rs.10). In Marghazar Zoo, 93% tourists were agreed (22% were agreed for contribution of Rs.5 and 71% tourist were agreed for contribution of Rs.10) and 7% are disagreed for PES whereas 7% tourists were not agreed for contribution. PES may implement to compensate forest and parks manager to ensure better management of the forests and parks. Due to prime location and scenic beauty of the ICT, it has huge potential for implementation of PES mechanism for sustainable forest management and conservation. Therefore, it is recommended that Capital Development Authority (CDA) Islamabad should devise a plan for implementation of PES in forests and parks of ICT for its sustainable management of recreational and forest resources.

Impact of estradiol, testosterone and their ratio on left and right auricular myofilament function in male and female patients undergoing coronary artery bypass grafting

BACKGROUND

The impact of sex hormones on right and left auricular contractile apparatus function is largely unknown. We evaluated the impact of sex hormones on left and right heart contractility at the level of myocardial filaments harvested from left and right auricles during elective coronary artery bypass surgery.

METHODS

150 patients (132 male; 18 female) were enrolled. Preoperative testosterone and estradiol levels were measured with Immunoassay. Calcium induced force measurements were performed with left- and right auricular myofilaments in a skinned fiber model. Correlation analysis was used for comparison of force values and levels of sex hormones and their ratio.

RESULTS

Low testosterone was associated with higher top force values in right-sided myofilaments but not in left-sided myofilaments for both sexes (p = 0.000 in males, p = 0.001 in females). Low estradiol levels were associated with higher top force values in right-sided myofilaments (p 0.000) in females and only borderline significantly associated with higher top force values in males (p 0.056). In females, low estradiol levels correlated with higher top force values in left sided myofilaments (p 0.000). In males, higher Estradiol/Testosterone ratio (E/T ratio) was only associated with higher top force values from right auricular myofilaments (p 0.04) In contrast, in females higher E/T ratio was associated with lower right auricular myofilament top force values (p 0.03) and higher top force values in left-sided myofilaments (p 0.000).

CONCLUSIONS

This study shows that patients' comorbidities influence left and right sided contractility and may blur results concerning influence of sex hormones if not eliminated. A sex hormone dependent influence is obvious with different effects on the left and right ventricle. The E/T ratio and its impact on myofilament top force showed divergent results between genders, and may partially explain gender differences in patients with cardiovascular disease.

Association of Chest Pain with Rate Pressure Product and ST-segment Changes after Sub Arachnoid Block in Caesarean Section

When healthy women undergo caesarean section (CS) under sub arachnoid anaesthesia, transient electrocardiographic changes, such as ST-segment depression and T-wave abnormalities, are observed. During an elective caesarean section under sub arachnoid anaesthesia, about one-third of healthy parturient experience chest pain and ECG changes suggestive of myocardial ischemia. To assess the ST-segment and Rate Pressure Product changes with chest pain in patients with elective caesarean section under subarachnoid block. The Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh was the site of this prospective observational study. The study included 86 healthy women between the ages of 20 and 35 who needed an elective caesarean section under a single shot sub arachnoid block and who visited the Department of Anesthesia, Analgesia, and Intensive Care Medicine at BSMMU in Shahbagh, Dhaka from January 2019 to June 2019. In comparison to the no chest pain group, ST-segment changes among the chest pain group at delivery, 5 minute, 10 minute after delivery and at the end of the surgery were highly significant (p=0.001). Comparatively, Rate Pressure Product changes were found to be significantly higher in the group with chest pain than in the group without chest pain (p=0.001). It is concluded that there is a substantial association of chest pain with rate pressure product and ST-segment changes after subarachroid block in caesarean section.

Neuropsychiatric post-acute sequelae of COVID-19: prevalence, severity, and impact of vaccination

The potential long-term neuropsychiatric effects of COVID-19 are of global concern. This study aimed to determine the prevalence and predictors of neuropsychiatric post-acute sequelae of COVID-19 among Egyptian COVID-19 survivors and to study the impact of full vaccination before COVID-19 infection on the occurrence and severity of these manifestations. Three months after getting COVID-19 infection, 1638 COVID-19 survivors were screened by phone for possible neuropsychiatric sequelae. Subjects suspected to suffer from these sequelae were invited to a face-to-face interview for objective evaluation. They were requested to rate the severity of their symptoms using visual analogue scales (VAS). The mean age of participants was 38.28 ± 13 years. Only 18.6% were fully vaccinated before COVID-19 infection. Neuropsychiatric post-acute sequelae of COVID-19 were documented in 598 (36.5%) subjects, fatigue was the most frequent one (24.6%), followed by insomnia (16.4%), depression (15.3%), and anxiety (14.4%). Moderate and severe COVID-19 infection and non-vaccination increased the odds of developing post-COVID-19 neuropsychiatric manifestations by 2 times (OR 1.95, 95% CI = 1.415-2.683), 3.86 times (OR 3.86, 95% CI = 2.358-6.329), and 1.67 times (OR 1.67, 95% CI = 1.253-2.216), respectively. Fully vaccinated subjects before COVID-19 infection (n = 304) had significantly lesser severity of post-COVID-19 fatigue, ageusia/hypogeusia, dizziness, tinnitus, and insomnia (P value = 0.001, 0.008, < 0.001, 0.025, and 0.005, respectively) than non-vaccinated subjects. This report declared neuropsychiatric sequelae in 36.5% of Egyptian COVID-19 survivors, fatigue being the most prevalent. The effectiveness of COVID-19 vaccines in reducing the severity of some post-COVID-19 neuropsychiatric manifestations may improve general vaccine acceptance.

Protocolized screening and detection of occult alcohol use before and after liver transplant: Lessons learned from a quality improvement initiative

INTRODUCTION

Detection of alcohol (ETOH) use with biomarkers provides an opportunity to intervene and treat patients with alcohol use disorder before and after liver transplant (LT). We describe our center's experience using urine ethyl glucuronide (EtG) and serum phosphatidylethanol (PEth) in alcohol screening protocols.

METHODS

Single-center, retrospective review of patients presenting for LT evaluation, patients waitlisted for LT for alcohol-associated liver disease (ALD), and patients who received a LT for ALD over a 12-month period, from October 1, 2019 through September 30, 2020. Patients were followed from waitlisting to LT, or for up to 12 months post-LT. We monitored protocol adherence to screening for ETOH use- defined as completion of all possible tests over the follow-up period- at the initial LT visit, while on the LT waitlist and after LT.

RESULTS

During the study period, 227 patients were evaluated for LT (median age 57 years, 58% male, 78% white, 54.2% ALD). Thirty-one patients with ALD were placed on the waitlist, and 38 patients underwent LT for ALD during this time period. Protocolized adherence to screening for alcohol use was higher for PEth for all LT evaluation patients (191 [84.1%] vs. 146 [67%] eligible patients, p < .001), in patients with ALD waitlisted for LT (22 [71%] vs. 14 (48%] eligible patients, p = .04) and after LT for ALD, 20 (33 [86.8%] vs. 20 [52.6%] eligible patients, p < .01). Few patients with a positive test in any group completed chemical dependency treatment.

CONCLUSIONS

When screening for ETOH use in pre- and post-LT patients, protocol adherence is higher using PEth compared to EtG. While protocolized biomarker screening can detect recurrent ETOH use in this population, engagement of patients into chemical dependency treatment remains challenging.

Identification of Parkinson's Disease Subtypes from Resting-State Electroencephalography

BACKGROUND

Parkinson's disease (PD) patients present with a heterogeneous clinical phenotype, including motor, cognitive, sleep, and affective disruptions. However, this heterogeneity is often either ignored or assessed using only clinical assessments.

OBJECTIVES

We aimed to identify different PD sub-phenotypes in a longitudinal follow-up analysis and their electrophysiological profile based on resting-state electroencephalography (RS-EEG) and to assess their clinical significance over the course of the disease.

METHODS

Using electrophysiological features obtained from RS-EEG recordings and data-driven methods (similarity network fusion and source-space spectral analysis), we have performed a clustering analysis to identify disease sub-phenotypes and we examined whether their different patterns of disruption are predictive of disease outcome.

RESULTS

We showed that PD patients (n = 44) can be sub-grouped into three phenotypes with distinct electrophysiological profiles. These clusters are characterized by different levels of disruptions in the somatomotor network (Δ and β band), the frontotemporal network (α2 band) and the default mode network (α1 band), which consistently correlate with clinical profiles and disease courses. These clusters are classified into either moderate (only-motor) or mild-to-severe (diffuse) disease. We showed that EEG features can predict cognitive evolution of PD patients from baseline, when the cognitive clinical scores were overlapped.

CONCLUSIONS

The identification of novel PD subtypes based on electrical brain activity signatures may provide a more accurate prognosis in individual patients in clinical practice and help to stratify subgroups in clinical trials. Innovative profiling in PD can also support new therapeutic strategies that are brain-based and designed to modulate brain activity disruption. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

WHO Global Situational Alert System: a mixed methods multistage approach to identify country-level COVID-19 alerts

BACKGROUND

Globally, since 1 January 2020 and as of 24 January 2023, there have been over 664 million cases of COVID-19 and over 6.7 million deaths reported to WHO. WHO developed an evidence-based alert system, assessing public health risk on a weekly basis in 237 countries, territories and areas from May 2021 to June 2022. This aimed to facilitate the early identification of situations where healthcare capacity may become overstretched.

METHODS

The process involved a three-stage mixed methods approach. In the first stage, future deaths were predicted from the time series of reported cases and deaths to produce an initial alert level. In the second stage, this alert level was adjusted by incorporating a range of contextual indicators and accounting for the quality of information available using a Bayes classifier. In the third stage, countries with an alert level of 'High' or above were added to an operational watchlist and assistance was deployed as needed.

RESULTS

Since June 2021, the system has supported the release of more than US$27 million from WHO emergency funding, over 450 000 rapid antigen diagnostic testing kits and over 6000 oxygen concentrators. Retrospective evaluation indicated that the first two stages were needed to maximise sensitivity, where 44% (IQR 29%-67%) of weekly watchlist alerts would not have been identified using only reported cases and deaths. The alerts were timely and valid in most cases; however, this could only be assessed on a non-representative sample of countries with hospitalisation data available.

CONCLUSIONS

The system provided a standardised approach to monitor the pandemic at the country level by incorporating all available data on epidemiological analytics and contextual assessments. While this system was developed for COVID-19, a similar system could be used for future outbreaks and emergencies, with necessary adjustments to parameters and indicators.

Quantum dots decorated photoanodes in bioelectrochemical fuel cells: Enhanced electricity generation using green algae

The power performance of the bio-electrochemical fuel cells (BEFCs) depends mainly on the energy harvesting ability of the anode material. The anode materials with low bandgap energy and high electrochemical stability are highly desirable in the BEFCs. To address this issue, a novel anode is designed using indium tin oxide (ITO) modified by chromium oxide quantum dots (CQDs). The CQDs were synthesized using facile and advanced pulsed laser ablation in liquid (PLAL) technique. The combination of ITO and CQDs improved the optical properties of the photoanode by exhibiting a broad range of absorption in the visible to UV region. A systematic study has been performed to optimize the amount of CQDs and green Algae (Alg) film grown using the drop casting method. Chlorophyll (a, b, and total) content of algal cultures (with different concentrations) were optimized to investigate the power generation performance of each cell. The BEFC cell (ITO/Alg10/Cr3//Carbon) with optimized amounts of Alg and CQDs demonstrated enhanced photocurrent generation of 120 mA cm^-2 at a photo-generated potential of 24.6 V m^-2 . The same device exhibited a maximum power density of 7 W m^-2 under continuous light illumination. The device also maintained 98% of its initial performance after 30 repeated cycles of light on-off measurements.

A Real-Time Deep Machine Learning Approach for Sudden Tool Failure Prediction and Prevention in Machining Processes

Tool Condition Monitoring systems are essential to achieve the desired industrial competitive advantage in terms of reducing costs, increasing productivity, improving quality, and preventing machined part damage. A sudden tool failure is analytically unpredictable due to the high dynamics of the machining process in the industrial environment. Therefore, a system for detecting and preventing sudden tool failures was developed for real-time implementation. A discrete wavelet transform lifting scheme (DWT) was developed to extract a time-frequency representation of the AE_rms signals. A long short-term memory (LSTM) autoencoder was developed to compress and reconstruct the DWT features. The variations between the reconstructed and the original DWT representations due to the induced acoustic emissions (AE) waves during unstable crack propagation were used as a prefailure indicator. Based on the statistics of the LSTM autoencoder training process, a threshold was defined to detect tool prefailure regardless of the cutting conditions. Experimental validation results demonstrated the ability of the developed approach to accurately predict sudden tool failures before they occur and allow enough time to take corrective action to protect the machined part. The developed approach overcomes the limitations of the prefailure detection approach available in the literature in terms of defining a threshold function and sensitivity to chip adhesion-separation phenomenon during the machining of hard-to-cut materials.

Effect of channel density, inverse solutions and connectivity measures on EEG resting-state networks reconstruction: A simulation study

Along with the study of brain activity evoked by external stimuli, the past two decades witnessed an increased interest in characterizing the spontaneous brain activity occurring during resting conditions. The identification of connectivity patterns in this so-called "resting-state" has been the subject of a great number of electrophysiology-based studies, using the Electro/Magneto-Encephalography (EEG/MEG) source connectivity method. However, no consensus has been reached yet regarding a unified (if possible) analysis pipeline, and several involved parameters and methods require cautious tuning. This is particularly challenging when different analytical choices induce significant discrepancies in results and drawn conclusions, thereby hindering the reproducibility of neuroimaging research. Hence, our objective in this study was to shed light on the effect of analytical variability on outcome consistency by evaluating the implications of parameters involved in the EEG source connectivity analysis on the accuracy of resting-state networks (RSNs) reconstruction. We simulated, using neural mass models, EEG data corresponding to two RSNs, namely the default mode network (DMN) and dorsal attentional network (DAN). We investigated the impact of five channel densities (19, 32, 64, 128, 256), three inverse solutions (weighted minimum norm estimate (wMNE), exact low-resolution brain electromagnetic tomography (eLORETA), and linearly constrained minimum variance (LCMV) beamforming) and four functional connectivity measures (phase-locking value (PLV), phase-lag index (PLI), and amplitude envelope correlation (AEC) with and without source leakage correction), on the correspondence between reconstructed and reference networks. We showed that, with different analytical choices related to the number of electrodes, source reconstruction algorithm, and functional connectivity measure, high variability is present in the results. More specifically, our results show that a higher number of EEG channels significantly increased the accuracy of the reconstructed networks. Additionally, our results showed significant variability in the performance of the tested inverse solutions and connectivity measures. Such methodological variability and absence of analysis standardization represent a critical issue for neuroimaging studies that should be prioritized. We believe that this work could be useful for the field of electrophysiology connectomics, by increasing awareness regarding the challenge of variability in methodological approaches and its implications on reported results.

Brain network dynamics in the alpha band during a complex postural control task

Objective &#xD;To decipher brain network dynamic remodeling from&#xD;electroencephalography (EEG) during a complex postural control task combining&#xD;virtual reality and a moving platform. &#xD;Approach &#xD;EEG (64 electrodes) data from&#xD;158 healthy subjects were acquired. The experiment is divided into several phases,&#xD;and visual and motor stimulation is applied progressively. We combined advanced&#xD;source-space EEG networks with clustering algorithms to decipher the brain networks&#xD;states (BNS) that occurred during the task. &#xD;Main results&#xD;The results show that BNS distribution describes the different phases of the experiment with specific transitions&#xD;between visual, motor, salience, and default mode networks coherently. We also showed&#xD;that age is a key factor that affects the dynamic transition of BNSs in a healthy&#xD;cohort. &#xD;Significance &#xD;This study validates an innovative approach, based on a robust methodology and a consequent cohort, to quantify the brain networks dynamics in the BioVRSea paradigm. This work is an important step towards a quantitative evaluation&#xD;of brain activities during PC and could lay the foundation for developing brain-based&#xD;biomarkers of PC-related disorders.

Role of vanadium ions substitution on spinel MnCo2O4 towards enhanced electrocatalytic activity for hydrogen generation

Improving efficient electrocatalysts (ECs) for hydrogen generation through water splitting is of significant interest in tackling the upcoming energy crisis. Sustainable hydrogen generation is the primary prerequisite to realizing the future hydrogen economy. This work examines the electrocatalytic activity of hydrothermally prepared vanadium doped MnCo spinel oxide microspheres (MC), MnV_xCo_2-xO₄ (V_x-MnCo MC, where x ≤ 0.4) in the HER (hydrogen evolution reaction) process. Magnetization measurements demonstrated a paramagnetic (at high temperatures) to a ferrimagnetic (at low temperatures) transition below the Curie temperature (Tc) in all the samples. The magnetization is found to intensify with the rising vanadium content of MCs. The optimized catalyst V_x-MnCo MCs (x = 0.3) outperformed other prepared ECs with a Tafel slope of 84 mV/dec, a low onset potential of 78.9 mV, and a low overpotential of 85.9 mV at a current density of 10 mA/cm², respectively. The significantly improved HER performance of hydrothermally synthesized V_x-MnCo MCs (x = 0.3) is principally attributable to many exposed active sites, accelerated electron transport at the EC/electrolyte interface, and remarkable electron spectroscopy for chemical analysis (ECSA) value was found ~ 11.4 cm². Moreover, the V_x-MnCo MCs (x = 0.3) electrode exhibited outstanding electrocatalytic stability after exposure to 1000 cyclic voltametric cycles and 36 h of chronoamperometric testing. Our results suggest a feasible route for developing earth-abundant transition metal oxide-based EC as a superior electrode for future water electrolysis applications.

Analysis of task-related MEG functional brain networks using dynamic mode decomposition

Objective.Functional connectivity networks explain the different brain states during the diverse motor, cognitive, and sensory functions. Extracting connectivity network configurations and their temporal evolution is crucial for understanding brain function during diverse behavioral tasks.Approach.In this study, we introduce the use of dynamic mode decomposition (DMD) to extract the dynamics of brain networks. We compared DMD with principal component analysis (PCA) using real magnetoencephalography data during motor and memory tasks.Main results.The framework generates dominant connectivity brain networks and their time dynamics during simple tasks, such as button press and left-hand movement, as well as more complex tasks, such as picture naming and memory tasks. Our findings show that the proposed methodology with both the PCA-based and DMD-based approaches extracts similar dominant connectivity networks and their corresponding temporal dynamics.Significance.We believe that the proposed methodology with both the PCA and the DMD approaches has a very high potential for deciphering the spatiotemporal dynamics of electrophysiological brain network states during tasks.

A new One Health Framework in Qatar for future emerging and re-emerging zoonotic diseases preparedness and response

One Health is increasingly recognized as an optimal approach to address the global risk of health threats originating at the human, animal, and ecosystem interface, and their impact. Qatar has successfully practiced One Health approach for investigation and surveillance of zoonotic diseases such as MERS-CoV, and other health threats. However, the current gaps at institution and policy level hinder the sustainment of One Health. In this paper, we have assessed the potential for implementation of One Health Framework to reinforce and sustain One Health capacities in Qatar for 2022-2027. To implement One Health Framework in the country, Qatar Joint External Evaluation (JEE) report, lessons learnt during One Health experiences on zoonotic, vector-borne, and food borne diseases were used to present an outline for multisectoral coordination. In addition, technical capacities of One Health and factors that are required to operationalize it in the country were also assessed in series of meetings and workshops held at Ministry of Public Health on March 2022. Present health care infrastructure and resources were found to be conducive for effective management and response to shared health threats as evident during MERS-CoV, despite being more event based. Regardless, the need for more sustainable capacity development was unanimously emphasized. The consensus between all relevant stakeholders and partners was that there is a need for better communication channels, policies and protocols for data sharing, and the need to invest more resources for better sustainability. The proposed framework is expected to strengthen and facilitate multilateral coordination, enhanced laboratory capacity and network, improve active surveillance and response, risk communication, community engagement, maximize applied research, and build One Health technical work force. This would enable advancement and sustainment of One Health activities to prevent and control health threats shared between humans-animals-ecosystem interface.

Predicting postural control adaptation measuring EEG, EMG, and center of pressure changes: BioVRSea paradigm

Introduction: Postural control is a sensorimotor mechanism that can reveal neurophysiological disorder. The present work studies the quantitative response to a complex postural control task. Methods: We measure electroencephalography (EEG), electromyography (EMG), and center of pressure (CoP) signals during a virtual reality (VR) experience called BioVRSea with the aim of classifying different postural control responses. The BioVRSea paradigm is based on six different phases where motion and visual stimulation are modulated throughout the experiment, inducing subjects to a different adaptive postural control strategy. The goal of the study is to assess the predictability of those responses. During the experiment, brain activity was recorded from a 64-channel EEG, muscle activity was determined with six wireless EMG sensors placed on lower leg muscles, and individual movement measured by the CoP. One-hundred and seventy-two healthy individuals underwent the BioVRSea paradigm and 318 features were extracted from each phase of the experiment. Machine learning techniques were employed to: (1) classify the phases of the experiment; (2) assess the most notable features; and (3) identify a quantitative pattern for healthy responses. Results: The results show that the EEG features are not sufficient to predict the distinct phases of the experiment, but they can distinguish visual and motion onset stimulation. EMG features and CoP features, when used jointly, can predict five out of six phases with a mean accuracy of 74.4% (±8%) and an AUC of 0.92. The most important feature to identify the different adaptive strategies is the Squared Root Mean Distance of points on Medio-Lateral axis (RDIST_ML). Discussion: This work shows the importance and the feasibility of a quantitative evaluation in a complex postural control task and demonstrates the potential of EEG, CoP, and EMG for assessing pathological conditions. These predictive systems pave the way for developing an objective assessment of pathological behavior PC responses. This will be a first step in identifying individual disorders and treatment options.

Role of anti-Giardia recombinant cyst wall protein IgG polyclonal antibodies in diagnosis and protection

Giardia duodenalis (G. duodenalis) is an infectious protozoan that has a global distribution especially in the hot climate. Around 200 million people are infected worldwide annually by Giardia, but infection is not always accompanied by symptoms, especially in endemic countries. Using traditional microscopy techniques in diagnosis, both in stool and water samples were less sensitive when compared to immunological methods; and the need for new diagnostic methods was necessary. Also, protection from infection is required in endemic areas. Therefore, the study aimed to produce anti- G. duodenalis IgG polyclonal antibodies (pAbs) by immunizing rabbit by G. duodenalis cyst recombinant protein. The produced antibodies were evaluated in the detection of G. duodenalis antigens in patients' stool and water samples from endemic areas across River Nile; where pAbs were used as a coating and a peroxidase conjugate antibody in sandwich ELISA. Moreover, pAbs were tested for the protection of mice from giardiasis. Sandwich ELISA using pAb has succeeded in the detection of G. duodenalis coproantigens in stool samples by a sensitivity of 97% and a specificity of 92.72%. Moreover, G. duodenalis cyst was detected in only seven water samples by ordinary microscopy; while sandwich ELISA revealed nineteen positive results. IgG pAb (1/200 µg/ml) protected mice from giardiasis; which was evident from the reduction in cysts and trophozoites numbers. We recommended the use of sandwich ELISA to monitor water quality, investigate environmental contamination and diagnosis in patients' stools. The pAbs can be prepared in large amount and used in field diagnosis and protection. This will help in the early diagnosis of G. duodenalis in water, which in turn can control outbreaks in rural areas.

Dynamic rewiring of electrophysiological brain networks during learning

Human learning is an active and complex process. However, the brain mechanisms underlying human skill learning and the effect of learning on the communication between brain regions, at different frequency bands, are still largely unknown. Here, we tracked changes in large-scale electrophysiological networks over a 6-week training period during which participants practiced a series of motor sequences during 30 home training sessions. Our findings showed that brain networks become more flexible with learning in all the frequency bands from theta to gamma ranges. We found consistent increase of flexibility in the prefrontal and limbic areas in the theta and alpha band, and over somatomotor and visual areas in the alpha band. Specific to the beta rhythm, we revealed that higher flexibility of prefrontal regions during the early stage of learning strongly correlated with better performance measured during home training sessions. Our findings provide novel evidence that prolonged motor skill practice results in higher, frequency-specific, temporal variability in brain network structure.

A Challenging Case of Atypical Papillary Proliferation of Nipple with Loss of Myoepithelial Layer Cells; a Diagnostic Dilemma

Introduction/Objective

Papillary breast lesions are comprised of a broad spectrum of entities ranging from benign conditions like intraductal papilloma to invasive carcinoma. These lesions account for less than 3% percent of breast tumors and less than 2% of breast malignancies. The wide range and overlap in the clinical, imaging, and histologic characteristics of these lesions can often make them difficult to classify. Here we present a case of a challenging neoplastic nipple papillary lesion with a differential diagnosis ranging from nipple adenoma with atypia to papillary carcinoma.

Methods/Case Report

48-year-old female with history of left nipple mass for 6 months, presented to the emergency department with mild bleeding from the left nipple for two hours. Breast ultrasound showed a group of fine pleomorphic calcifications within a mass arising from the left nipple, highly concerning for Paget's disease. Histopathology revealed papillary proliferation of well-formed round structures within a variably fibrous/hemorrhagic stroma. The nodules exhibited papillary fronds with epithelial hyperplasia of monotonous low-grade cells, and scattered mitoses, forming relatively rigid/luminal structures with polarization. No desmoplasia or conventional infiltrative pattern was seen. Immunohistochemical staining showed strong expression for estrogen receptor (ER). Cytokeratin 5/6, p63 and calponin did not highlight the myoepithelial layer in the papillary elements or around the round structures. A diagnosis of atypical papillary proliferation was rendered to warrant an excision. Subsequently, the patient underwent total mastectomy, which revealed conventional invasive ductal carcinoma with lymphovascular space invasion.

Results (if a Case Study enter NA)

NA

Conclusion

Atypical papillary lesions of the nipple are difficult to classify in a limited biopsy material. The loss of myoepithelial cell layer makes interpretation even more challenging. Extreme caution should be taken in assigning neoplastic nature to the lesions in biopsy which eventually guide the surgeon in making decision to preserve the nipple or not.

The development of an automated machine learning pipeline for the detection of Alzheimer's Disease

Although Alzheimer's disease is the most prevalent form of dementia, there are no treatments capable of slowing disease progression. A lack of reliable disease endpoints and/or biomarkers contributes in part to the absence of effective therapies. Using machine learning to analyze EEG offers a possible solution to overcome many of the limitations of current diagnostic modalities. Here we develop a logistic regression model with an accuracy of 81% that addresses many of the shortcomings of previous works. To our knowledge, no other study has been able to solve the following problems simultaneously: (1) a lack of automation and unbiased removal of artifacts, (2) a dependence on a high level of expertise in data pre-processing and ML for non-automated processes, (3) the need for very large sample sizes and accurate EEG source localization using high density systems, (4) and a reliance on black box ML approaches such as deep neural nets with unexplainable feature selection. This study presents a proof-of-concept for an automated and scalable technology that could potentially be used to diagnose AD in clinical settings as an adjunct to conventional neuropsychological testing, thus enhancing efficiency, reproducibility, and practicality of AD diagnosis.

Dynamic right ventricular structural and functional changes in acute decompensated heart failure, new insights from serum sST2 and speckle-tracking echocardiography imaging

Background

Right ventricular (RV) mechanics are affected by volume/pressure overload in acute decompensated heart failure (ADHF) which can be detected using biomarkers and echocardiography. ST2 (suppression of tumorigenicity 2) is a biomarker of myocardial fibrosis and remodeling, that has been studied in patients with ADHF. Although baseline serum soluble ST2 (sST2) values at ADHF admission have been proved to predict outcomes, serial measurements are even of greater value.

Purpose

To evaluate the right ventricular dynamic structural and functional changes in ADHF patients during hospitalization, using serum sST2 and speckle-tracking echocardiography imaging.

Methods

We prospectively enrolled 61 ADHF patients with LV ejection fraction less than 50% and serum NT-proBNP more than 900 pg/ml. All patients received intravenous diuretics and did not require inotropic support during hospital stay. Blood samples were collected to measure serum sST2 levels on hospital admission and discharge. All patients underwent serial conventional and speckle tracking echocardiography on admission, at 48 hours and on hospital discharge. RV speckle tracking echocardiography analysis was done using 2D Cardiac Performance Analysis version 4.6.

Results

Serum sST2 had significant strong positive correlation with serum NT-proBNP on admission (r=0.84, P&lt;0.0001) and showed significant reduction from 2.47 (1.27–4.05) ng/ml on admission to 1.86 (1.06–3.24) ng/dl at hospital discharge (P&lt;0.0001) denoting successful decongestion. There was significant decrease in inferior vena cava diameter (P&lt;0.0001) and estimated pulmonary artery systolic pressure (EPASP) (P=0.002) throughout hospital stay, however this was not associated with significant change in RV dimensions (P&gt;0.05) or contractility assessed by trans-annular plane systolic excursion (TAPSE) (P=0.09) and S-wave velocity at lateral tricuspid annulus (P=0.9). There was significant improvement in RV free wall strain (RVFWS) (P=0.005) assessed by speckle tracking echocardiography which was mainly noticed after the first 48 hours till discharge, but RV 4-chamber strain (RV4CS) did not change significantly (P=0.06).

Conclusions

RVFWS assessed by speckle tracking echocardiography can detect improvement in RV systolic function not detected by other conventional echocardiographic parameters in ADHF patients. Improvement in RVFWS together with decline in serum sST2 levels can be used as marker of improved cardiac mechanics and successful decongestion.

Funding Acknowledgement

Type of funding sources: None.

Assessing HD-EEG functional connectivity states using a human brain computational model

OBJECTIVE

Electro/Magnetoencephalography (EEG/MEG) source-space network analysis is increasingly recognized as a powerful tool for tracking fast electrophysiological brain dynamics. However, an objective and quantitative evaluation of pipeline steps is challenging due to the lack of realistic 'controlled' data. Here, our aim is two-folded: 1) provide a quantitative assessment of the advantages and limitations of the analyzed techniques and 2) introduce (and share) a complete framework that can be used to optimize the entire pipeline of EEG/MEG source connectivity.

APPROACH

We used a human brain computational model containing both physiologically based cellular GABAergic and Glutamatergic circuits coupled through Diffusion Tensor Imaging, to generate high-density EEG recordings. We designed a scenario of successive gamma-band oscillations in distinct cortical areas to emulate a virtual picture-naming task. We identified fast time-varying network states and quantified the performance of the key steps involved in the pipeline: 1) inverse models to reconstruct cortical-level sources, 2) functional connectivity measures to compute statistical interdependency between regional signals, and 3) dimensionality reduction methods to derive dominant brain network states (BNS).

MAIN RESULTS

Using a systematic evaluation of the different decomposition techniques, results show significant variability among tested algorithms in terms of spatial and temporal accuracy. We outlined the spatial precision, the temporal sensitivity, and the global accuracy of the extracted BNS relative to each method. Our findings suggest a good performance of wMNE/PLV combination to elucidate the appropriate functional networks and ICA techniques to derive relevant dynamic brain network states.

SIGNIFICANCE

We suggest using such brain models to go further in the evaluation of the different steps and parameters involved in the EEG/MEG source-space network analysis. This can reduce the empirical selection of inverse model, connectivity measure, and dimensionality reduction method as some of the methods can have a considerable impact on the results and interpretation.

Multisystem Inflammatory Syndrome in the Context of Paediatric COVID-19 infection in the Republic of Ireland April 2020 to April 2021

Aim

Our aim was to describe the epidemiology of multisystem inflammatory syndrome in children (MIS‐C) in the Republic of Ireland, in the context of all cases of COVID‐19 in children, during the first year of the SARS‐CoV‐2 pandemic.

Methods

Cases of MIS‐C were identified by prospective surveillance in Irish hospitals from April 2020 to April 2021. Paediatric COVID‐19 cases and outbreaks in schools or childcare facilities were notified to and routinely investigated by Public Health. Univariate and bivariate analyses were carried out in Excel, Stata and JMP statistical package.

Results

Fifty‐four MIS‐C cases (median age 7.58 years; males 57%) were identified over the study period. MIS‐C incidence was higher in certain ethnicities (‘black’ 21.3/100,000 [95% CI 4.3–38.4]; and ‘Irish Traveller’ 14.7/100,000 [95% CI −5.7‐35.1]) than those of ‘white’ ethnicity (3.4 /100,000). MIS‐C cases occurred in three temporal clusters, which followed three distinct waves of community COVID‐19 infection, irrespective of school closures. Formal contact tracing identified an epidemiological link with a COVID‐19‐infected family member in the majority of MIS‐C cases (77%). In contrast, investigation of COVID‐19 school outbreaks demonstrated no epidemiological link with MIS‐C cases during the study period.

Conclusion

Efforts at controlling SARS‐CoV‐2 transmission in the community may be a more effective means to reduce MIS‐C incidence than school closures. Establishing a mandatory reporting structure for MIS‐C will help delineate the role of risk factors such as ethnicity and obesity and the effect of vaccination on MIS‐C incidence.

998 Improving Accuracy of Tumour Site Identification During Colonoscopy; a Retrospective Analysis

Aim

Colonoscopy is essential for accurate pre-operative colorectal tumour localisation. Due to variable colonic length and lack of internal landmarks, tumour site identification can be difficult, posing risks of inappropriate operations being offered. To avoid this, we must correctly identify the tumour site on endoscopy in &gt;95% of patients as per BSG guidelines. In 2019, accuracy levels compared to radiology and histology fell significantly short of this standard. We therefore made improvements to our endoscopy database and displayed relevant guidelines in endoscopy rooms. Here, we evaluate improvement in accuracy of endoscopic tumour localisation after implementation of these initiatives.

Method

Retrospective study of results of all colonoscopies (214) showing suspicious lesions at our trust in 2020, compared to results of counterpart radiology and histology tests, and audited against the BSG standard of &gt;95% accurate identification of tumour position by colonic segment.

Results

Accuracy of endoscopic tumour localisation was 92.2% and 92.3% compared to histology and radiology respectively. Although this does not meet the national standard of &gt;95%, it is a significant improvement from the year prior - 80.2% and 78.8% compared to histology and radiology respectively. The greatest degree of error appears in the rectum, often being confused with recto-sigmoid and sigmoid.

Conclusions

Guideline reminders and database improvements were crucial to increased accuracy. However, clearer definition of colonic territories is required to avoid confusion when attributing localisation. We recommend following the American guidelines in which the term ‘recto-sigmoid’ is abolished in favour of a boundary 15cm from the anal verge that represents the division between rectum and sigmoid.

Post-COVID-19 neuropsychiatric manifestations among COVID-19 survivors suffering from migraine: a case-control study

BACKGROUND

The burden of post-coronavirus disease (COVID)-19 symptoms has been increasing and is of great concern in patients with pre-existing chronic medical conditions.This study aimed to delineate the post-COVID-19 neuropsychiatric symptoms among migraine patients compared to the non-migraine control group.

METHODS

Two groups, each of 204 COVID-19 survivors, were enrolled in the study after 3 months of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, one group fulfilling the episodic migraine criteria and the other serving as a matching control group. Subjects were evaluated through an in-person interview for post-COVID-19 neuropsychiatric symptoms, including detailed headache patterns and severity, using the visual analogue scale.

RESULTS

The Frequency of headache during the acute phase of COVID-19 was more frequent in migraine patients (OR = 1.60, 95%CI = 1.04-2.45, P-value = 0.031). The reported significant post-COVID-19 neuropsychiatric symptoms in migraine patients compared to controls were fatigue (OR = 1.662, 95%CI = 1.064-2.596, P-value = 0.025), anosmia/hyposmia (OR = 2.06, 95%CI = 1.164- 3.645, P-value = 0.012), cacosmia (OR = 2.663, 95%CI = 1.145-6.195, P-value = 0.019), depression (OR = 2.259, 95%CI = 1.284- 3.975, P-value = 0.004), anxiety (OR = 3.267, 95%CI = 1.747- 6.108, P-value ≤ 0.001), insomnia (OR = 2.203, 95%CI = 1.298- 3.739, P-value = 0.003), and headache (OR = 3.148, 95%CI = 1.616-6.136, P-value =  ≤ 0.001).While there was no statistically significant difference between migraine patients and controls regarding the post-COVID-19 functional status score (P-value = 0.102). The pattern of post-COVID-19 headache was reported as chronic headache transformation in 17.6% of the migraine group, with the median intensity rate being 5.5 and IQR (3-7). In the control group, 14% experienced chronic headache attributed to systemic viral infection with a median intensity rate of 2 and IQR (2-5), while 12% experienced a new daily persistent headache with a median intensity of 5 and IQR (1-6).

CONCLUSION

The study highlighted the importance of follow-up migraine patients upon recovery from COVID-19 infection, being more vulnerable to post-COVID-19 symptoms.

Methods Used to Estimate EEG Source-Space Networks: A Comparative Simulation-Based Study

Along with the study of the brain activity evoked by external stimuli, an important advance in current neuroscience involves understanding the spontaneous brain activity that occurs during resting conditions. Interestingly, the identification of the connectivity patterns in "resting-state" has been the subject of a great number of electrophysiology-based studies. In this context, the Electroencephalography (EEG) source connectivity method enables estimating resting-state cortical networks from scalp-EEG recordings. However, there is still no consensus over a unified pipeline adapted in all cases (e.g., type of task, a priori on studied networks) and numerous methodological questions remain unanswered. In order to address this problem, we simulated, using neural mass models, EEG data corresponding to the default mode network (DMN), the most widely studied resting-state network, and tested the effect of different channel densities, two inverse solutions and two functional connectivity measures on the correspondence between the reconstructed networks and the reference networks. Results showed that increasing the number of electrodes enhances the accuracy of the network reconstruction, and that eLORETA/PLV led to better accuracy than other inverse solution/connectivity measure combinations in terms of the correlation between reconstructed and reference connectivity matrices. This work has a wide range of implications in the field of electrophysiology connectomics, and is a step towards a convergence and standardization of approaches in this emerging field.

Genome-Wide Scan for Parent-of-Origin Effects in a sub-Saharan African Cohort With Nonsyndromic Cleft Lip and/or Cleft Palate (CL/P)

OBJECTIVE

Nonsyndromic cleft lip and/or cleft palate (NSCL/P) have multifactorial etiology where genetic factors, gene-environment interactions, stochastic factors, gene-gene interactions, and parent-of-origin effects (POEs) play cardinal roles. POEs arise when the parental origin of alleles differentially impacts the phenotype of the offspring. The aim of this study was to identify POEs that can increase risk for NSCL/P in humans using a genome-wide dataset.

METHODS

The samples (174 case-parent trios from Ghana, Ethiopia, and Nigeria) included in this study were from the African only genome wide association studies (GWAS) that was published in 2019. Genotyping of individual DNA using over 2 million multiethnic and African ancestry-specific single-nucleotide polymorphisms from the Illumina Multi-Ethnic Genotyping Array v2 15070954 A2 (genome build GRCh37/hg19) was done at the Center for Inherited Diseases Research. After quality control checks, PLINK was employed to carry out POE analysis employing the pooled subphenotypes of NSCL/P.

RESULTS

We observed possible hints of POEs at a cluster of genes at a 1 mega base pair window at the major histocompatibility complex class 1 locus on chromosome 6, as well as at other loci encompassing candidate genes such as ASB18, ANKEF1, AGAP1, GABRD, HHAT, CCT7, DNMT3A, EPHA7, FOXO3, lncRNAs, microRNA, antisense RNAs, ZNRD1, ZFAT, and ZBTB16.

CONCLUSION

Findings from our study suggest that some loci may increase the risk for NSCL/P through POEs. Additional studies are required to confirm these suggestive loci in NSCL/P etiology.