Environmentally Benign pSOFC for Emissions-Free Energy: Assessment of Nickel Network Resistance in Anodic Ni/BCY15 Nanocatalyst

Yttrium-doped barium cerate (BCY15) was used as ceramic matrix to obtain Ni/BCY15 anode cermet for application in proton-conducting solid oxide fuel cells (pSOFC). Ni/BCY15 cermets were prepared in two different types of medium, namely deionized water (W) and anhydrous ethylene glycol (EG) using wet chemical synthesis by hydrazine. An in-depth analysis of anodic nickel catalyst was made aiming to elucidate the effect of anode tablets' preparation by high temperature treatment on the resistance of metallic Ni in Ni/BCY15-W and Ni/BCY15-EG anode catalysts. On purpose reoxidation upon high-temperature treatment (1100 °C for 1 h) in air ambience was accomplished. Detailed characterization of reoxidized Ni/BCY15-W-1100 and Ni/BCY15-EG-1100 anode catalysts by means of surface and bulk analysis was performed. XPS, HRTEM, TPR, and impedance spectroscopy measurements experimentally confirmed the presence of residual metallic Ni in the anode catalyst prepared in ethylene glycol medium. These findings were evidence of strong metal Ni network resistance to oxidation in anodic Ni/BCY15-EG. Enhanced resistance of the metal Ni phase contributed to a new microstructure of the Ni/BCY15-EG-1100 anode cermet getting more stable to changes that cause degradation during operation.

Portable Diffuse Reflectance Spectroscopy of Potato Leaves for Pre-Symptomatic Detection of Late Blight Disease

We report on the use of leaf diffuse reflectance spectroscopy for plant disease detection. A smartphone-operated, compact diffused reflectance spectrophotometer is used for field collection of leaf diffuse reflectance spectra to enable pre-symptomatic detection of the progression of potato late blight disease post inoculation with oomycete pathogen Phytophthora infestans. Neural-network-based analysis predicts infection with >96% accuracy, only 24 h after inoculation with the pathogen, and nine days before visual late blight symptoms appear. Our study demonstrates the potential of using portable optical spectroscopy in tandem with machine learning analysis for early diagnosis of plant diseases.

To evaluate serum cortisol levels in patients with alcohol withdrawal delirium v/s patients with delirium due to any other disorder

Background

Delirium is an acute confusional state characterized by changes in the mental status, level of consciousness, impaired cognition, and inattention. It can develop within hours or days. Cortisol release from the hypothalamic-pituitary-adrenal axis (HPA) is vital for the host survival in stress. Biomarkers are used as an indicator of pathogenic processes or to assess the responses to a therapeutic intervention. To improve delirium recognition and care, investigators have identified possible biomarkers that may help in diagnosing individuals with delirium, assessing the severity of delirium. Cortisol has been suggested as biomarker for the diagnosis of delirium.

Aims and Objectives

To evaluate and compare levels of serum cortisol in patients with alcohol withdrawal delirium with delirium due to other disorders.

Materials and Methods

It was a cross-sectional prospective observational study. A total of 30 patients in Group A and 32 in Group B were included. The participants were evaluated based on delirium rating scale (DRS).

Results

It was seen that in alcohol withdrawal delirium group, there was significant positive correlation between DRS score and serum cortisol level, i.e., with increase in DRS score, there was increase in serum cortisol levels and vice versa.

Conclusion

Serum cortisol levels are associated and directly correlate with the occurrence and severity of delirium. Further studies are needed to elucidate the implications of this association for diagnosis and treatment.

Analysis of diffuse reflectance spectroscopy by means of Bayesian inference and separation of the parameters for scattering strength and spectral dependence of the scattering

For many applications in tissue optics, knowledge of the scattering coefficient or at least the reduced scattering coefficient is essential. In addition, its spectral dependence is also an important feature, as this provides information about scatterer sizes. While the characterization of the spectral dependence should be a simple fit, experimental results show strong fluctuations even for the same tissue type. For in-vivo measurements, this problem is even greater. Therefore, it is the aim of this study to analyze the instabilities of the scattering characterizations and find a solution for it by means of Bayesian inference. In this study, this behavior is investigated using the example of diffuse reflectance spectroscopy. It can be shown that the currently used fitting functions are unstable for the fitting as both parameters for characterizing the reduced scattering coefficient describe the spectral dependence as well as the scattering strength. However, by a simple coordinate transform, a stable mathematical description of the scattering is derived. By the fact that a posteriori probability of the reduced scattering coefficient narrows down significantly with the Bayesian inference, the new fitting function is verified.

Superior Rectus Transposition and Medial Rectus Recession for Treatment of Duane Retraction Syndrome and Sixth Nerve Palsy

Purpose: To evaluate the outcome of augmented superior rectus transposition (SRT) with medial rectus (MR) recession in patients with Duane Retraction Syndrome (DRS) and sixth nerve palsy.Methods: Twenty four patients (16 DRS and 8 sixth nerve palsy) that underwent the procedure were included. The superior rectus muscle was secured, detached, and re-attached to the sclera along the spiral of Tilaux, adjacent to lateral rectus insertion. A non-absorbable augmentation suture was passed through the sclera, 8 mm posterior to the insertion of the lateral rectus.Results: At the last follow-up, the effect of surgery in decreasing esotropia in both groups was significant (P = .001 for DRS group, P = .002 for sixth nerve palsy). In both groups, abduction deficit improved significantly (P < .001 for DRS and P = .008 for sixth nerve palsy). After the surgery, small, asymptomatic vertical deviation in primary position was induced in five patients (20.8%). Post-operatively, none of the patients complained of torsional diplopia. In the 6-month follow-up, compared with the first postoperative visit, an eso-drift at distance or near developed in 11 patients (45.8%). Of the 11 patients with eso-drift, overcorrection (exotropia of 3-14 PD) was present at the first post-operative visit in 5 cases. Four cases showed an exo-drift (2-5 PD) at distance or near over time.Conclusion: SRT with medial rectus recession improves esotropia and abduction limitation without inducing significant vertical deviations and torsional diplopia. Some of the cases that underwent SRT with MR recession may show an eso-drift. The eso-drift can correct initial exotropia in some cases.

Protocadherin-Mediated Cell Repulsion Controls the Central Topography and Efferent Projections of the Abducens Nucleus

Cranial motor nuclei in the brainstem innervate diverse types of head and neck muscles. Failure in establishing these neuromuscular connections causes congenital cranial dysinnervation disorders (CCDDs) characterized by abnormal craniofacial movements. However, mechanisms that link cranial motor nuclei to target muscles are poorly understood at the molecular level. Here, we report that protocadherin-mediated repulsion mediates neuromuscular connection in the ocular motor system in zebrafish. We identify pools of abducens motor neurons that are topographically arranged according to soma size and convergently innervate a single muscle. Disruptions of Duane retraction syndrome-associated transcription factors reveal that these neurons require Mafba/MAFB, but not Sall4/SALL4, for differentiation. Furthermore, genetic perturbations of Pcdh17/protocadherin-17 result in defective axon growth and soma clumping, thereby abolishing neuromuscular connectivity. Our results suggest that protocadherin-mediated repulsion forms the central topography and efferent projection pattern of the abducens nucleus following Mafba-dependent specification and imply potential involvement of protocadherins in CCDD etiology.

Quality and Feasibility of Automated Digital Retinal Imaging in the Emergency Department

BACKGROUND

Emergency physicians (EPs) frequently evaluate patients at risk for sight-threatening conditions but may have difficulty performing direct ophthalmoscopy effectively. Digital fundus photography offers a potential alternative.

OBJECTIVE

We sought to assess the performance of an automated digital retinal imaging platform in a real-world emergency department.

METHODS

We performed a prospective, observational study of emergency department patients who were at risk for acute, nontraumatic, posterior segment pathology. Photographs were obtained using an automated digital retinal camera and were subsequently reviewed by an ophthalmologist. We recorded the number of attempts required, total time required, patient comfort, and findings on EP-performed direct ophthalmoscopy, if performed.

RESULTS

Of 123 participants completing the study, 93 (75.6%) had ≥1 eye with a diagnostically useful image, while 29 (23.6%) had no photographs of diagnostic value. The mean number of attempts required to obtain images was 1.45 (range 1-3) and the mean elapsed time required to complete photography was 109.6 s. The mean patient comfort score was 4.6 on a 5-point scale, where 5 was the most comfortable. Direct ophthalmoscopy was performed by an emergency department provider for 19 (15.4%) patients. Acute findings were noted in 14 patients during expert review of fundus photographs, though in only 2 of these cases was direct ophthalmoscopy performed by an EP with only 1 finding ultimately identified correctly.

CONCLUSIONS

Automated digital imaging of the ocular fundus is rapidly performed, is well tolerated by patients, and can be used to obtain diagnostic quality images without the use of pharmacologic pupillary dilation in most emergency department patients who are at risk for acute posterior segment pathology.

Longitudinal Changes in Disability Rating Scale Scores: A Secondary Analysis Among Patients With Severe TBI Enrolled in the Epo Clinical Trial

OBJECTIVES

Long-term neurological response to treatment after a severe traumatic brain injury (sTBI) is a dynamic process. Failure to capture individual heterogeneity in recovery may impact findings from single endpoint sTBI randomized controlled trials (RCT). The present study re-examined the efficacy of erythropoietin (Epo) and transfusion thresholds through longitudinal modeling of sTBI recovery as measured by the Disability Rating Scale (DRS). This study complements the report of primary outcomes in the Epo sTBI RCT, which failed to detect significant effects of acute treatment at 6 months post-injury.

METHODS

We implemented mixed effects models to characterize the recovery time-course and to examine treatment efficacy as a function of time post-injury and injury severity.

RESULTS

The inter-quartile range (25th-75th percentile) of DRS scores was 20-28 at week1; 8-24 at week 4; and 3-17 at 6 months. TBI severity group was found to significantly interact with Epo randomization group on mean DRS recovery curves. No significant differences in DRS recovery were found in transfusion threshold groups.

CONCLUSIONS

This study demonstrated the value of taking a comprehensive view of recovery from sTBI in the Epo RCT as a temporally dynamic process that is shaped by both treatment and injury severity, and highlights the importance of the timing of primary outcome measurement. Effects of Epo treatment varied as a function of injury severity and time. Future studies are warranted to understand the possible moderating influence of injury severity on treatment effects pertaining to sTBI recovery. (JINS, 2019, 25, 293-301).

In vivo nerve identification in head and neck surgery using diffuse reflectance spectroscopy

Background

Careful identification of nerves during head and neck surgery is essential to prevent nerve damage. Currently, nerves are identified based on anatomy and appearance, optionally combined with electromyography (EMG). In challenging cases, nerve damage is reported in up to 50%. Recently, optical techniques, like diffuse reflectance spectroscopy (DRS) and fluorescence spectroscopy (FS) show potential to improve nerve identification.

Methods

212 intra‐operative DRS/FS measurements were performed. Small nerve branches (1–3 mm), on near‐nerve adipose tissue, muscle and subcutaneous fat were measured during 11 surgical procedures. Tissue identification was based on quantified concentrations of optical absorbers and scattering parameters.

Results

Clinically comprehensive parameters showed significant differences (<0.05) between the tissues. Classification using k‐Nearest Neighbor resulted in 100% sensitivity and a specificity of 83% (accuracy 91%), for the identification of nerve against surrounding tissues.

Conclusions

DRS/FS is a potentially useful intraoperative tool for identification of nerves from adjacent tissues.

Level of Evidence

Observational proof of principle study.

The influence of dissolved Si on Ni precipitate formation at the kaolinite water interface: Kinetics, DRS and EXAFS analysis

Unraveling the formation process of Ni precipitates at molecular scale is important for understanding the fate and mobility of Ni species in the real environment. Dissolved Si presents in the natural environment ubiquitously, which can alter Ni sorption as well as incorporation into neoformed precipitates. Batch experiments show that the dissolved Si leads to a rapid increase in the Ni sorption rate and interferes with the formation of Ni precipitates. The results of diffuse reflectance spectroscopy (DRS) and extended X-ray absorption fine structure (EXAFS) spectroscopy analyses suggest that the nucleation of a (Ni,Al) phyllosilicate phase involves a kaolinite-like local structure. Then, the substantial presence of Si affects the initial formation of Ni precipitate nucleation and the resulting crystal growth. Dioctahedral kaolinite may act as a nucleating surface for the heterogeneous formation of trioctahedral (Ni,Al) phyllosilicates under environmentally relevant conditions. This study provides experimental evidence on nucleation and epitaxial growth processes of Ni precipitate on kaolinite and provides insight on the relationship between substrates and precipitation, which is crucial for understanding the physicochemical behavior of Ni on mineral surfaces.

A disposable, flexible skin patch for clinical optical perfusion monitoring at multiple depths

Stable, relative localization of source and detection fibers is necessary for clinical implementation of quantitative optical perfusion monitoring methods such as diffuse correlation spectroscopy (DCS) and diffuse reflectance spectroscopy (DRS). A flexible and compact device design is presented as a platform for simultaneous monitoring of perfusion at a range of depths, enabled by precise location of optical fibers in a robust and secure adhesive patch. We will discuss preliminary data collected on human subjects in a lower body negative pressure model for hypovolemic shock. These data indicate that this method facilitates simple and stable simultaneous monitoring of perfusion at multiple depths and within multiple physiological compartments.

Characterization and photocatalytic performance evaluation of various metal ion-doped microstructured TiO2 under UV and visible light

Commercially available microcrystalline TiO2 was doped with silver, ferrous and ferric ion (1.0 mol %) using silver nitrate, ferrous sulfate and ferric nitrate solutions following the liquid impregnation technology. The catalysts prepared were characterised by FESEM, XRD, FTIR, DRS, particle size and micropore analysis. The photocatalytic activity of the prepared catalysts was tested on the degradation of two model dyes, methylene blue (3,7-bis (Dimethylamino)-phenothiazin-5-ium chloride, a cationic thiazine dye) and methyl blue (disodium;4-[4-[[4-(4-sulfonatoanilino)phenyl]-[4-(4-sulfonatophenyl)azaniumylidenecyclohexa-2,5-dien-1-ylidene]methyl]anilino]benzene sulfonate, an anionic triphenyl methane dye) under irradiation by UV and visible light in a batch reactor. The efficiency of the photocatalysts under UV and visible light was compared to ascertain the light range for effective utilization. The catalysts were found to have the anatase crystalline structure and their particle size is in a range of 140-250 nm. In the case of Fe(2+) doped TiO2 and Fe(3+) doped TiO2, there was a greater shift in the optical absorption towards the visible range. Under UV light, Ag(+) doped TiO2 was the most efficient catalyst and the corresponding decolorization was more than 99% for both the dyes. Under visible light, Fe(3+) doped TiO2 was the most efficient photocatalyst with more than 96% and 90% decolorization for methylene blue and methyl blue, respectively. The kinetics of the reaction under both UV and visible light was investigated using the Langmuir-Hinshelwood pseudo-first-order kinetic model. Kinetic measurements confirmed that, Ag(+) doped TiO2 was most efficient in the UV range, while Fe(3+) doped TiO2 was most efficient in the visible range.

Fabrication and characterization of ZnO@CdS core-shell nanostructure using acetate precursors: XRD, FESEM, DRS, FTIR studies and effects of cadmium ion concentration on band gap

ZnO@CdS core-shell nano-structure has been synthesized using zinc acetate dihydrate, and cadmium acetate dihydrate as simple precursors in a water-ethanol matrix without using any surfactant, ligand or chelating agents. The effect of different concentrations of cadmium acetate and sodium sulfide on optical and electronic properties of ZnO@CdS core-shell was investigated. The morphology and structure of the ZnO@CdS core-shell nano-structures have been confirmed by field-emission scanning electron microscopy (FESEM) and X-ray diffraction (XRD) measurements. The results showed that the ZnO@CdS core-shell nano-structure is mixed cubic and hexagonal structures. FESEM results showed the mono-dispersed and uniform size of 39nm. Optical properties were studied by UV-visible diffuse reflectance spectroscopy (DRS) technique and the results showed that band gaps of ZnO@CdS core-shell nanocomposites were red shifted by increasing the cadmium concentration. FTIR spectrum of ZnO@CdS core-shell nano-structure showed a band at 482cm(-1) correlated to ZnO bond and a band at 630cm(-1) due to the stretching frequency of CdS bond.

Mattis dementia rating scale (DRS) normative data for the brazilian middle-age and elderly populations

OBJECTIVE

To expand norms for the Mattis Dementia Rating Scale (DRS) for the Brazilian middle-age and elderly populations.

METHODS

The DRS was administered to 502 individuals without cognitive deficits, 312 women and 190 men, aged 50 years or over and with educational level ranging from 0 to 13 years or more. The sample was composed of subjects who participated in other studies, from Caeté (Minas Gerais state), Ribeirão Preto (São Paulo state) and São Paulo (São Paulo state). Participants were divided into four schooling groups (illiterate, 1 to 4 years, 5 to 12 years and 13 years or more). The subjects were divided into four groups according to age (50 to 60, 61 to 70, 71 to 80, and 80 years or over).

RESULTS

Normative data for DRS scores are expressed as percentile values. The group with lowest schooling and subjects older than 80 years had the worst scores.

CONCLUSION

As expected, age and education were strongly correlated with DRS scores. Illiterates and older old individuals performed worse than the other groups. These data might help to improve the accuracy of the diagnosis of cognitive impairment and dementia in Brazilian middle-age and elderly populations.

Structural elucidation and spectral characterizations of Co3O4 nanoflakes

A facile solvothermal process is successfully developed to prepare F-center cubic Co3O4 nanoflakes in ethylene-glycol-water solvent. Cobalt acetate [Co(Ac)2·4H2O] is directly used as precursor and ethylene glycol performs a reducer and modifying agent in the system. The as obtained products were characterized by XRD, FT-IR, UV-Vis-DRS, SEM, EDAX, XPS and HR-TEM. XRD studies indicate that the nanoflakes have the same crystal structure found in cubic form of Co3O4. The lattice parameter, X-ray density and the specific area of nanoflakes were also estimated from XRD pattern. The various functional groups present in Co3O4 nanoflakes were identified by FTIR analysis. The band gap energy of Co3O4 nanoflakes was calculated from UV-Vis-DRS spectral studies. SEM analyses ascertain that Co3O4 nanocrystals are nanoflakes in nature and the particle size in SEM is exactly consistent with XRD results. The elemental composition was determined using the energy dispersive X-ray spectroscopy was performed at several points in the region and averaged to obtain the representative results. The atomic composition of the Co3O4 was detected by X-ray photoelectron spectroscopy (XPS). The nanoscale structures were observed using high-resolution transmission electron microscopy.

[Dystocia risk score: a decision making tool to combat maternal mortality]

As a way to prevent maternal mortality and stillbirth, the dystocia risk score includes three components: a left column provides a list of eight characteristics to check for in the woman; an upper horizontal section provides a checklist of possible outcomes of the pregnancy itself: and a rectangular grid indicates the prognosis in three zones: a large red (dangerous), a medium-sized grey (doubtful) and a small blue (hopeful). The DRS is positive if there is at least one cross in the dangerous zone and/or two crosses in the doubtful zone (it indicates that the woman should be referred to a center specialized in obstetric emergency care); elsewhere, the DRS is negative. The validation test gives good results (sensitivity=83.61%, specificity=90.05%, positive predictive value=72.34%, and negative predictive value=94.04%). Its large-scale use would accelerate the identification of pregnant women with a high risk of dystocia. Their timely referral to specialized emergency obstetrics centers would increase the efficacy of care and reduce the levels of maternal mortality and stillbirth.

Long-term disability and survival in traumatic brain injury: results from the National Institute on Disability and Rehabilitation Research Model Systems

OBJECTIVES

To document long-term survival in 1-year survivors of traumatic brain injury (TBI); to compare the use of the Disability Rating Scale (DRS) and FIM as factors in the estimation of survival probabilities; and to investigate the effect of time since injury and secular trends in mortality.

DESIGN

Cohort study of 1-year survivors of TBI followed up to 20 years postinjury. Statistical methods include standardized mortality ratio, Kaplan-Meier survival curve, proportional hazards regression, and person-year logistic regression.

SETTING

Postdischarge from rehabilitation units.

PARTICIPANTS

Population-based sample of persons (N=7228) who were admitted to a TBI Model Systems facility and survived at least 1 year postinjury. These persons contributed 32,505 person-years, with 537 deaths, over the 1989 to 2011 study period.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Survival.

RESULTS

Survival was poorer than that of the general population (standardized mortality ratio=2.1; 95% confidence interval, 1.9-2.3). Age, sex, and functional disability were significant risk factors for mortality (P<.001). FIM- and DRS-based proportional hazards survival models had comparable predictive performance (C index: .80 vs .80; Akaike information criterion: 11,005 vs 11,015). Time since injury and current calendar year were not significant predictors of long-term survival (both P>.05).

CONCLUSIONS

Long-term survival prognosis in TBI depends on age, sex, and disability. FIM and DRS are useful prognostic measures with comparable statistical performance. Age- and disability-specific mortality rates in TBI have not declined over the last 20 years. A survival prognosis calculator is available online (http://www.LifeExpectancy.org/tbims.shtml).

Longitudinal description of the disability rating scale for individuals in the National Institute on Disability and Rehabilitation Research traumatic brain injury model systems national database

OBJECTIVE

To develop a detailed understanding of temporal change (ie, estimated trajectories) at the individual level as measured by the Disability Rating Scale (DRS).

DESIGN

Individual growth curve (IGC) analysis of retrospective data obtained from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury (TBI) Model Systems National Database.

SETTING

Multicenter longitudinal database study.

PARTICIPANTS

Individuals with TBI (N=8816) participating in the TBI Model Systems National Database project.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE DRS RESULTS

The negative exponential consisting of 3 growth parameters (pseudointercept, asymptote, rate) was successfully used to predict trajectory of recovery on the DRS qualified by the following covariates: race, sex, level of education and age at admission, rehabilitation length of stay, and cognitive and motor FIM scores at rehabilitation admission. Based on these results, an interactive tool was developed to allow prediction of the trajectory of recovery for individuals and subgroups with specified characteristics on the selected covariates.

CONCLUSIONS

With the use of IGC analysis, the longitudinal trajectory of recovery on the DRS for individuals sharing common characteristics and traits can be described. This methodology allows researchers and clinicians to predict numerous individual-level trajectories through use of a web-based computer automated interactive tool.

Do rehospitalization rates differ among injury severity levels in the NIDRR Traumatic Brain Injury Model Systems program?

OBJECTIVE

To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic brain injury (TBI) but without DOC at rehabilitation admission.

DESIGN

Prospective observational study.

SETTING

Inpatient rehabilitation within TBIMS with annual follow-up.

PARTICIPANTS

Of 9028 persons enrolled from 1988 to 2009 (N=9028), 366 from 20 centers met criteria for DOC at rehabilitation admission and follow-up data, and another 5132 individuals met criteria for moderate (n=769) or severe TBI (n=4363).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants and/or their family members completed follow-up data collection including questions about frequency and nature of rehospitalizations at 1 year postinjury. For the subset of participants with DOC, additional follow-up was conducted at 2 and 5 years postinjury.

RESULTS

The DOC group demonstrated an overall 2-fold increase in rehospitalization in the first year postinjury relative to those with moderate or severe TBI without DOC. Persons with DOC at rehabilitation admission have a higher rate of rehospitalization across several categories than persons with moderate or severe TBI.

CONCLUSIONS

Although the specific details of rehospitalization are unknown, greater injury severity resulting in DOC status on rehabilitation admission has long-term implications. Data highlight the need for a longitudinal approach to patient management.

Medical complications during inpatient rehabilitation among patients with traumatic disorders of consciousness

OBJECTIVE

To assess the incidence of medical complications in patients with recent traumatic disorders of consciousness (DOCs).

DESIGN

Data on adverse events in a placebo controlled trial of amantadine hydrochloride revealed no group difference, which allowed these events to be reanalyzed descriptively as medical complications experienced by the 2 groups collectively.

SETTING

Eleven clinical facilities in the United States, Denmark, and Germany with specialty rehabilitation programs for patients with DOCs.

PARTICIPANTS

Patients (N=184) with nonpenetrating traumatic brain injury enrolled from acute inpatient rehabilitation programs between 4 and 16 weeks postinjury.

INTERVENTIONS

Participants were randomized to receive 200 to 400mg of amantadine hydrochloride or placebo daily for 4 weeks, and followed for an additional 2 weeks. Adverse events were recorded and categorized with respect to their nature, timing, and severity.

MAIN OUTCOME MEASURE

Number, type, and severity of medical complications occurring during the 6-week study interval.

RESULTS

A total of 468 medical complications were documented among the patients (.40 events per week per patient). More than 80% of patients experienced at least 1 medical complication, and 41 of these were defined as serious adverse events. New medical complications declined over time in rehabilitation and were not dependent on time since injury. Hypertonia, agitation/aggression, urinary tract infection, and sleep disturbance were the most commonly reported problems. Hydrocephalus, pneumonia, gastrointestinal problems, and paroxysmal sympathetic hyperactivity were the most likely to be severe.

CONCLUSIONS

Patients with DOCs have a high rate of medical complications early after injury. Many of these complications require brain injury expertise for optimal management. Active medical management appears to contribute to the reduction in new complications. An optimal system of care for DOC patients must provide expert medical management in the early weeks after injury.

Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems

OBJECTIVE

To characterize the 5-year outcomes of patients with traumatic brain injury (TBI) not following commands when admitted to acute inpatient rehabilitation.

DESIGN

Secondary analysis of prospectively collected data from the National Institute on Disability and Rehabilitation Research-funded Traumatic Brain Injury Model Systems (TBIMS).

SETTING

Inpatient rehabilitation hospitals participating in the TBIMS program.

PARTICIPANTS

Patients (N=108) with TBI not following commands at admission to acute inpatient rehabilitation were divided into 2 groups (early recovery: followed commands before discharge [n=72]; late recovery: did not follow commands before discharge [n=36]).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

FIM items.

RESULTS

For the early recovery group, depending on the FIM item, 8% to 21% of patients were functioning independently at discharge, increasing to 56% to 85% by 5 years postinjury. The proportion functioning independently increased from discharge to 1 year, 1 to 2 years, and 2 to 5 years. In the late recovery group, depending on the FIM item, 19% to 36% of patients were functioning independently by 5 years postinjury. The proportion of independent patients increased significantly from discharge to 1 year and from 1 to 2 years, but not from 2 to 5 years.

CONCLUSIONS

Substantial proportions of patients admitted to acute inpatient rehabilitation before following commands recover independent functioning over as long as 5 years, particularly if they begin to follow commands before hospital discharge.

[Comparative analysis of the determination of serum testosterobe levels by different methods]

The serum concentration of total testosterone were measured in 100 male patients aged 19-65 years who had visited the clinic and polyclinic of the Endocrinology Research Center, Russian Academy of Medical Sciences for complaints about different dysfunctions of the endocrine glands. Testosterone was measured by the well-known currently available technologies: automatic Vitros ECi, Architect, and Access multianalyzers, manual Delfia and DRS enzyme immunoassay kits, and radioimmunoassay (RIA) that had been developed within the framework of the WHO Human Reproduction Programme and adjusted by the reference assay (gas chromatography/mass spectroscopy). The closest results were obtained when determining the level of testosterone by RIA and by means of the Vitros ECi multianalyzer (13.1 vs 13.0 nmol/l, medians). All other technologies demonstrated a low correlation with RIS and had positive biases, especially with the use of the Delfia kits (as high as 60 and, at low concentrations, 100%). The positive bias tends to decrease in patients with higher testosterone levels ( > 10 nmol/l) for all studied methods.