Cognitive Confusion Research Articles

Long-Term Neurotoxic Effects and Alzheimer's Disease Risk of Early EHDPP Exposure in Zebrafish: Insights from Molecular Mechanisms to Adult Pathology.

2-Ethylhexyl diphenyl phosphate (EHDPP), ubiquitously monitored in environmental media, is highly bioaccumulative and may pose long-term risks, even after short-term exposure. In this investigation, larval zebrafish were exposed to 0.05, 0.5, and 5.0 μg/L EHDPP from 4 to 120 h postfertilization (hpf) to examine the long-term neurotoxicity effects of early exposure. Exposure to 5.0 μg/L EHDPP yielded hyperactive locomotor behavior, which was characterized by increased swimming speed, larger turning angles, and heightened sensitivity to light-dark stimulation. The predicted targets of EHDPP (top 100 potential macromolecules) were primarily associated with brain diseases like Alzheimer's disease (AD). Comparisons of differentially expressed genes (DEGs) from AD patients (GSE48350) and RNA-seq data from EHDPP-exposed zebrafish confirmed consistently abnormal regulatory pathways. EHDPP's interaction with M1 and M5 muscarinic acetylcholine receptors likely disrupted calcium homeostasis, leading to mitochondrial dysfunction and neurotransmitter imbalance as well as abnormal locomotor behavior. Especially, 5.0 μg/L EHDPP exposure during early development (4-120 hpf) triggered early- and midstage AD-like symptoms in adulthood (180 dpf), characterized by cognitive confusion, aggression, blood-brain barrier disruption, and mitochondrial damage in brains. These findings provide deep insights into the long-term neurotoxicity effects and Alzheimer's disease risks of early EHDPP exposure at extremely low dosages.

Chasing Paradoxical Shadows

AbstractShadows bring a sense of animated vitality to any building, and their representations on drawings add a sense of depth and believability to that which is being illustrated. Nat Chard, Professor of Experimental Architecture at University College London (UCL), has a longstanding interest in movement, optics, photography and the intangible spaces in between them. His Institute of Paradoxical Shadows cleaves the shadow from its material datum, leaving it hanging, a suspended spectral entity, encountered through a séance‐like trance of cognitive confusion.

Sex differences in the association between peripheral inflammation and melancholia symptoms

Melancholia represents a particular subtype of depressive symptomatology. Unlike Major Depressive Disorder (MDD), Melancholia has not been conclusively associated with peripheral inflammation, although there may be some methodological reasons confounding that finding. To overcome some of those methodological limitations, the correlation between one index of peripheral inflammation (C-Reactive Protein: CRP) and Melancholia was investigated in a community sample of 40 male and 51 female participants (aged 18–75 years) who provided a blood sample and self-report data on an established measure of Melancholia (MEL). Results indicated that females had significantly higher concentrations of CRP than males, and that there were different patterns of association between the MEL items and CRP for males and females. Although the predominant differences were for the MEL symptoms of cognitive confusion (females only) and feelings of low self-worth (males only), each sex had distinct networks of associations between CRP and the eight MEL items used here. These findings may provide some explanation of the lack of clear results regarding the CRP-Melancholia link in the previous literature, and also argue for development of clinical assessment and treatment approaches that differ for males and females.

Virtual fashion experiences in virtual reality fashion show spaces.

Virtual reality (VR) provides a new fashion space and fashion experience. This study focuses on immersive VR and fashion shows to empirically explore the VR fashion space and fashion experience. Insights specific to fashion have not been presented in as much depth in the literature; thus, the current findings are particularly valuable and insightful. This study employed three immersive VR (IVR) fashion show stimuli and in-depth interviews according to a semi-structured questionnaire. Collected data were analyzed based on the concept of VR space and VR experience derived through literature research. The VR fashion space was divided into three types and VR experiences of cognitive presence, sensible immersion, emotional immersion, and aesthetic interaction were derived accordingly. First, the physical representation of a fashion show induced a cognitive and emotional sense of presence, in which users felt as though they had moved to the same time and place as those at the fashion show. Second, participants experienced cognitive confusion owing to the differences with a priori experiences in the fashion show space (i.e., reality and imagination coexist). Third, participants transcended the limitations of physical reality while in the fashion show space of pataphysics (which was realized with human imagination), and they moved beyond the stage of confusion that is experienced while facing realistic objects to connect to creative inspiration. The difference in the properties of VR space may be associated with distinct VR fashion experiences. The findings suggest that (1) a priori elements such as sociocultural contexts and personal experiences differ in the experiential dimension of virtual space, (2) the VR fashion show space induces a psychological experience between brand and consumer, and (3) creative inspiration and exploratory play can be greatly induced in a user if the immersive fashion space is further from the original source.

Cognitive impairment analysis of public health emergencies from cognitive psychology perspective

BackgroundPublic health emergencies (such as epidemics, natural disasters and chemical accidents) have aroused widespread concern in society, threatening physical health and affecting mental health and cognitive function. Despite concerns about these effects, the cognitive impairment of the masses during such events remains unclear. Cognitive psychology studies individual thinking, perception, learning, etc., and provides a useful framework for analyzing the impact of emergencies on mass cognitive function.Subjects and MethodsThe Stanford Acute Stress Response Questionnaire (SASRQ) and 3-minute Disorder Assessment Scale (3D-CAM) were used to study the effects of emergency events on cognitive function. 500 participants were randomly selected and divided into an exposed group and a non-exposed group. The exposed group received cognitive tests after the event, while the non-exposed group was tested at the same time as the control group.ResultsThe SASRQ scores of the emergency exposure group showed a significant increase in cognitive stress (P<0.05). The cognitive confusion in the exposed group was significantly higher than that in the non-exposed group (P<0.01). SPSS23.0 statistical analysis confirmed the significance of these differences.ConclusionsStudies have shown that public health emergencies can negatively impact cognitive function in the population, including increased cognitive stress and confusion. This highlights the importance of cognitive psychology in understanding and responding to the impact of unexpected events on individual cognition. In the future, more attention should be paid to the psychological cognitive state of the masses to better meet the challenges of public health emergencies.

Zolpidem and Possible Side Effects on Brain Circulation: A Case Report and Review of Literature

The brain is one of the most sensitive organs to hypoxia and the most vulnerable to ischemia and vascular events. Zolpidem, as a GABA-A receptor agonist, has an inhibiting effect on the central nervous system. In this study, the possible side effects of zolpidem on brain perfusion were reported in a patient with zolpidem addiction. Moreover, the correlated literature has been reviewed. The patient was a 33-year-old man who was referred with a complaint of cognitive impairment, gait disturbance, confusion, and seizure. The patient reported taking the daily dose of 270 mg of zolpidem. He developed acute dystonia, rigidity, and bradykinesia during treatment with haloperidol in the psychiatric ward. Brain MRI and EEG were requested due to the prolongation of cognitive impairment and parkinsonism symptoms. The Neurologist utilized Brain MRA to determine the source of microvascular lesions found in the brain MRI. Unexpectedly, a reduction in Anterior Cerebral Artery (ACA) perfusion was detected after a comprehensive evaluation by Brain MRA. In addition, impairment of several cognitive domains was observed in the follow-up visit. Zolpidem could reduce cerebral perfusion in various vascular territories. It seems that in patients who take zolpidem with higher than therapeutic doses, vascular complications and a decreased cerebral perfusion have occurred, resulting in more neurological complications, including cognitive disorders and vascular events. A holistic investigation of the patient with zolpidem abuse and neurological symptoms would be recommended to determine the probable vascular complication of zolpidem.

Influence of Athletes' Self-Consciousness on the Factor of Choking under Pressure

Previous studies have shown that self-consciousness traits are closely related to choking under pressure (Baumeister, 1984; Wang et al., 2004). However, it has not be distinguished between private and public self-consciousness. This study investigated the influence of private and public self-consciousness of athletes on the factors of choking under pressure. 281 subjects were asked to respond to a questionnaire on choking factors (Murayama and Sekiya, 2012) and a self-consciousness scale (Tsuji, 1993), and data from 253 subjects were analyzed. The results showed that higher private and public self-consciousness had more choking experience. Furthermore, we examined the influence of private and public self-consciousness on the factors of choking and found that private self-consciousness showed significant positive effects to be associated with changes in motor control, vicious circles, abnormal physical sensations, and conscious processing (attention to movement). In contrast, public self-consciousness showed significant positive effects on changes in motor control and vicious circles, perceptual and cognitive confusion, feelings of physical heaviness and weakness, passivity, and safety-oriented strategies. The results indicate that private and public self-consciousness affect different factors of choking under pressure.

329 ANTICHOLINERGIC BURDEN IN PEOPLE LIVING WITH DEMENTIA ATTENDING GERIATRIC MEDICINE AND PSYCHIATRY FOR OLDER PERSONS SERVICES

Abstract Background Anticholinergic burden is associated with an increase in cognitive decline, delirium and confusion. We aimed to examine the Anticholinergic Cognitive Burden (ACB) of patients referred to local dementia services, and the prescribing of acetylcholinesterase inhibitors in patients with a significant anticholinergic burden. We also looked at frequency of prescribing of classes of some medications known to increase anticholinergic burden. Methods A retrospective chart review was carried out of new referrals attending local Geriatric Medicine and/or Psychiatry For Older Persons outpatient services with a diagnosis of dementia between 2017 and 2018. Medications in use at the time of patient review were obtained. ACB was calculated using ACB score. Results were analysed descriptively. Results 163 patients over 65 years old were included in this study, 94 (57.6%) were female. 30% (N = 49) had a significant anticholinergic burden (ACB >3). The mean ACB was 1.69 (Range 0 – 8). 38% of all patients (N = 63) were prescribed an acetylcholinesterase inhibitor, and of those, 20% (N = 13) had a significant anticholinergic burden. Polypharmacy (use of 5 medications or more) was evident with 76% (N = 124) patients. Regarding groups of medications known to increase ACB, 35.5% (N = 58) were prescribed antipsychotics and 18.4% (30) were prescribed benzodiazepines. Conclusion There is a significant anticholinergic burden among people living with dementia attending the geriatric medicine and psychiatry of later life services. Some patients with a significant anticholinergic burden were being prescribed acetylcholinesterase inhibitors. This suggests acetylcholinesterase inhibitors may be prescribed without also discontinuing inappropriate medications that are contributing to the anticholinergic burden. We should look to further reduce the anticholinergic burden of patients attending the dementia services by avoiding these medications or using alternatives where available.

Understanding the Role of Top Management Practices in Organizational Hybridization

Hybrid organizations is a well-studied field, known for being challenged by tensions of competing and rivalling logics, causing cognitive confusion, mission drift and loss of performance (Boone, Özcan, & Li, 2021). We investigate how a top management team (TMT) navigate an organizational transformation from a not-for profit to a hybrid form, initiated by a deregulation of the energy industry in Europe. Surprisingly, we found that apparently conflicting logics may not always be the victim of competition and compromise, often suggested in literature, but can become “enveloped”, forming a hybrid of both logics. “Enveloping logics” is a concept of one logic framing another logic, embracing both equally. We conducted a qualitative case study, analyzing intimate interviews of TMT members and archival data over a period of 20 years. In that period the company developed from a regulated monopoly, dominated by a not-for profit-logic into a hybrid organization. TMT practices, adopted from outside the company, and from acquired and merged companies, was found to play a central role in creating hybrid logics. We developed a grounded theory process model explaining how the TMT enveloped logics over a period of 6 years, and what role adapting and deploying TMT practices played herein.

Rivastigmine for ECT-induced cognitive adverse effects in late life depression (RECALL study): A multicenter, randomized, double blind, placebo-controlled, cross-over trial in patients with depression aged 55 years or older: Rationale, objectives and methods.

BackgroundCognitive side-effects are an important reason for the limited use of electroconvulsive therapy (ECT). Cognitive side-effects are heterogeneous and occur frequently in older persons. To date, insight into these side-effects is hampered due to inconsistencies in study designs and small sample sizes. Among all cognitive side-effects, confusion and delirious states are especially troublesome for patients, relatives and clinicians. In particular inter-ictal delirium-like states are worrisome, since they may lead to premature treatment discontinuation. Besides a need for further insight into determinants of cognitive side-effects of ECT, there is a great need for treatment options.Methods and designThe Rivastigmine for ECT-induced Cognitive Adverse effects in Late Life depression (RECALL) study combines a multicenter, prospective cohort study on older patients with depression, treated with ECT, with an embedded randomized, placebo-controlled cross-over trial to examine the effect of rivastigmine on inter-ictal delirium. Patients are recruited in four centers across the Netherlands and Belgium. We aim to include 150 patients into the cohort study, in order to be able to subsequently include 30 patients into the trial. Patients are included in the trial when inter-ictal delirium, assessed by the Confusion Assessment method (CAM), or a drop in Mini Mental State Examination (MMSE) score of ≥4 during ECT, develops. In the cohort study, comprehensive measurements of ECT-related cognitive side-effects—and their putative determinants—are done at baseline and during the ECT-course. The primary outcome of the clinical trial is the effectiveness of rivastigmine on inter-ictal delirium-severity, assessed with a change in the Delirium Rating Scale-Revised-98. Secondary outcomes of the clinical trial are several ECT-characteristics and side-effects of rivastigmine.DiscussionThis study is the first clinical trial with a focus on ECT-induced, inter-ictal delirium. The cohort provides the basis for recruitment of patients for the cross-over trial and additionally provides an excellent opportunity to unravel cognitive side-effects of ECT and identify putative determinants. This paper describes the rationale and study protocol.Clinical trial registrationEudraCT 2014-003385-24.

Frequency of pattern of clinical and laboratory features in patients presenting with neuroleptic malignant syndrome at Department of Neurology, Jinnah Postgraduate Medical Center (JPMC), Karachi

Objectives. Neuroleptic malignant syndrome (NMS) is a life-threatening adverse reaction of antipsychotic drugs, especially of dopamine receptor antagonists (DRA’s). Excitation, exuberant behavior, violent behavior and lack of insight predispose the patients to the use of depot preparations and high doses of the antipsychotics. These behaviors also make the patients suffer from dehydration leading to cognitive impairment, confusion and incontinence. In addition to clinical and pharmacological risk factors, legal and ethical risk factors may be contributory towards the incidence, diagnosis and prognosis of NMS in Pakistan. Material and methods. This study was conducted as a descriptive, observational study to determine the frequency of deranged pattern of clinical and laboratory feature patients presenting with Neuroleptic Malignant Syndrome at Department of Neurology, Jinnah Postgraduate Medical Center (JPMC), Karachi. Data was prospectively collected from patients after taking a verbal consent. 55 patients who met the diagnostic criteria were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant. Outcomes. A total of 55 patients who met the inclusion and exclusion criteria were included in this study. Mean age, duration of NMS symptoms, length of hospital stay, SBP and DBP in our study was 39.41±12.67 years, 10.56±7.29 hours, 9.74±3.21 days, 135.87±10.97 mmHg and 83.21±6.42 mmHg. 24 (43.6%) and 31 (56.4%) were male and female. Out of 55 patients, 81.8%, 38.2%, 69.1%, 56.4%, 47.3%, 74.5% and 25.5% had fever, autonomic dysfunction, EPS symptoms, altered GCS, elevated CPK, elevated WBC and abnormal LFT. Conclusions. NMS is an important preventable clinical entity. Early diagnosis and judicious use of antipsychotics is warranted to prevent mortality and heightened morbidity.

Ethical and Legal Issues in Psychotherapy.

Ethical and Legal Issues in Psychotherapy.

The first year of neurology and COVID-19: The importance of understanding neurological and biopsychosocial symptoms in acute and post neurocovid disease

After the first year since its first reporting Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing Coronavirus disease 2019 (COVID-19), has infected nearly 120 million people and resulted in almost more than 2 million deaths globally. After one year from the first report of neurological symptoms in a Chinese patient, more than 55 countries to date have reported symptoms including impaired taste or smell, headache, dizziness, delirium, agitation, stroke, hypoxic ischaemic brain injury, seizures, coma, meningo-encephalitis, Guillain-Barré syndrome, myalgia, amongst others. Consequences seen in the follow-up periods of COVID-19 infection are also becoming more and more apparent mostly with reports of persistent problems with smell or taste, cognitive impairment, headaches, confusion, difficulty concentrating and sleep disturbance. Recently more and more studies on long term consequences of acute COVID are being published, such as the Study NEXT, a longitudinal study done in a population of hospitalized patients in Brescia. First studies show that not only clinical but also biopsychosocial effects are becoming increasingly important as long as more data are collected. Although further research is needed to understand which patients are most vulnerable to neurological manifestations in the acute, long or post COVID-19 disease, however after this first year it is clear that neurological, biopsychosocial and mental health data need to be not only collected but also analysed in a manner that could help the understanding of characteristics, timing, and severity of neurological manifestations of COVID-19.

Symposium Title: Viscera-Brain Axis and Mental Health

Cobalamin deficiency is a common disorder associated with numerous neuropsychiatric presentations. Prior literature addresses the neurocognitive and affective symptoms, which include psychotic presentations. We present the first reported case of an individual with isolated auditory and visual hallucinations in the absence of other neurocognitive, mood, or psychotic symptoms.Mr. C, a 74-year-old male with a psychiatric history of PTSD (in remission), presented to the emergency department with one month of gait instability, frequent urinary incontinence while sleeping, and near-daily auditory and visual hallucinations. Given hallucinations, psychiatry was consulted. Mr. C had no other active psychiatric symptoms at time of interview and demonstrated a high degree of insight about his hallucinations. There were no cognitive deficits, delusions, or confusion discernible on exam. Medical work-up was remarkable for vitamin B12 of 148 pg/mL (normal 200-900 pg/mL) and increased red cell distribution width of 17% (normal 11.5-14.5%) with normal folate. Cobalamin was replenished with a 1000 mcg injection of cyanocobalamin and daily oral supplementation (100 mcg). He experienced complete resolution of hallucinations over five days.Our case demonstrates that hallucinations can be a presenting symptom of cobalamin deficiency without other neurocognitive, psychotic, or mood symptoms. We will review the literature on psychosis and cobalamin deficiency, discuss the neurobiological explanations for neuropsychiatric effects of cobalamin deficiency, and provide diagnostic and treatment recommendations.Consultation-liaison psychiatrists should be aware of isolated auditory and visual hallucinations as a presentation of cobalamin deficiency since prompt treatment can lead to rapid resolution of symptoms.

A Research on the Mechanism of Excellent Social Belief of Learning Records, Affection, Driving out Laziness and Maintaining

Cobalamin deficiency is a common disorder associated with numerous neuropsychiatric presentations. Prior literature addresses the neurocognitive and affective symptoms, which include psychotic presentations. We present the first reported case of an individual with isolated auditory and visual hallucinations in the absence of other neurocognitive, mood, or psychotic symptoms.Mr. C, a 74-year-old male with a psychiatric history of PTSD (in remission), presented to the emergency department with one month of gait instability, frequent urinary incontinence while sleeping, and near-daily auditory and visual hallucinations. Given hallucinations, psychiatry was consulted. Mr. C had no other active psychiatric symptoms at time of interview and demonstrated a high degree of insight about his hallucinations. There were no cognitive deficits, delusions, or confusion discernible on exam. Medical work-up was remarkable for vitamin B12 of 148 pg/mL (normal 200-900 pg/mL) and increased red cell distribution width of 17% (normal 11.5-14.5%) with normal folate. Cobalamin was replenished with a 1000 mcg injection of cyanocobalamin and daily oral supplementation (100 mcg). He experienced complete resolution of hallucinations over five days.Our case demonstrates that hallucinations can be a presenting symptom of cobalamin deficiency without other neurocognitive, psychotic, or mood symptoms. We will review the literature on psychosis and cobalamin deficiency, discuss the neurobiological explanations for neuropsychiatric effects of cobalamin deficiency, and provide diagnostic and treatment recommendations.Consultation-liaison psychiatrists should be aware of isolated auditory and visual hallucinations as a presentation of cobalamin deficiency since prompt treatment can lead to rapid resolution of symptoms.

A fatigue-conscious dual resource constrained flexible job shop scheduling problem by enhanced NSGA-II: An application from casting workshop

Dual resource constrained flexible job shop scheduling problem (DRCFJSP) becomes a hot research topic in recent years. However, worker fatigue is barely considered in DRCFJSP, which will result in unsuitable task assignments for workers and bring about negative effects such as muscle fatigue and cognitive confusion. To this end, a fatigue-conscious DRCFJSP is proposed in this paper, aiming at simultaneously relieving fatigue and promoting productivity by joint scheduling of machines and workers. A multi-objective optimization model is constructed to minimize the maximum worker fatigue and makespan. Furthermore, an enhanced NSGA-II (ENSGA) is developed in this paper to cope with the proposed problem. In the ENSGA, four dispatch rules are designed to generate high-quality solutions at the initialization stage. Two neighborhood structures based on a novel method of defining the critical path are designed to strengthen the ability of local search. Finally, with the comprehensive experiments on extensive test instances and a case study from real-world casting workshop, the effectiveness of proposed ENSGA for solving the fatigue-conscious DRCFJSP is verified, and the significance of the proposed joint scheduling approach is elucidated. This work renders the decision-maker practical and effective scheduling with fatigue-conscious for the machine and worker constrained flexible manufacturing system.

The symptomatology of cerebrospinal fluid HIV RNA escape: a large case-series.

To characterize the clinical, laboratory and radiological characteristics of persons with HIV (PWH) presenting with cerebrospinal fluid (CSF) HIV RNA escape. Retrospective case review of PWH presenting with symptomatic CSF HIV RNA escape at seven tertiary HIV clinical sites in the United Kingdom and Italy. PWH with symptomatic CSF HIV RNA escape episodes were identified and data obtained from medical records. CSF HIV RNA escape was defined as quantifiable CSF HIV RNA in unquantifiable plasma HIV RNA or CSF HIV RNA greater than plasma HIV RNA in cases where plasma HIV RNA was quantifiable. The onset of clinical symptoms was classified as acute (<2 weeks-6 months), or chronic (>6 months) and differences in presentation in those with CSF HIV RNA below and above 1000 copies/ml determined. We identified 106 PWH with CSF HIV RNA escape (65 male); 68 (64%) PWH had acute presentations and 38 (36%) had chronic presentations. Cognitive decline (n = 54; 50.9%), confusion (n = 20; 18.9%) and headache (n = 28; 26.4%) were the most common presentations, with cognitive decline being more common in PWH who presented chronically compared with PWH who presented acutely (73.7% vs. 35.3%, P = 0.0002). Sixty PWH had CSF HIV RNA at least 1000 copies/ml and presented more frequently with confusion (n = 15/60; 25.0%) compared with PWH with CSF HIV RNA less than 1000 copies/ml at presentation (n = 5/46; 10.9%; P = 0.03). Cognitive decline, confusion and headache are the most frequent presenting symptoms of CSF HIV RNA escape and their relative frequency varied according to symptom onset and CSF HIV RNA concentration.

The effectiveness of acceptance and commitment therapy on cognitive flexibility, rumination, and distress tolerance in persons with Migraine headache

Introduction: Tolerating migraine pain has a variety of psychological consequences that should be considered in the context of psychotherapy applications. Aim: The purpose of the current study was to determine the effectiveness of acceptance and commitment therapy based on cognitive flexibility, rumination and confusion tolerance in headache patients. Method: This research was a quasi-experimental with pre-test and post-test design with a control group. Among female students of Guilan University during the second semester of the 2018-2019 academic year, the numbers of 32 patients with migraine headache were selected by accessible sampling method and then assigned randomly into two groups included experimental (n=14) and control (n=18) groups. Eight sessions in 60 minutes per week were under-treatment based on acceptance and commitment in the group. Before and after the sessions, both groups answered voluntarily using Dennis &amp; Wenderval’s (2010) Cognitive Flexibility Inventory, Nolen-Hoeksema &amp; Davis Ruminative Responses Scale (1999), and Simons &amp; Gaher Distress Tolerance Scale (2005). Data were analyzed by the Mann-Whitney U test. Results: The results revealed that the experimental group had significantly lower scores in rumination (U= 62.00, P=0.005) and higher scores in distress tolerance (U=69.50, P&lt;0.01) than the control group after the intervention. Intervention on cognitive flexibility in the headache group indicated no significant difference (U= 133.00, P&lt;0.70). Conclusion: Achieved results from the current research revealed that the acceptance and commitment therapy could be an appropriate alternative to reduce the rumination in people having migraine headache and to increase the distress tolerance in people having chronic pains.

POS0739 DEVELOPMENT OF A CONCEPTUAL MODEL TO UNDERSTAND DISEASE BURDEN IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS AND LONG-TERM ORGAN DAMAGE

Background:Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disease resulting in increased morbidity and mortality and reduced health-related quality of life (HRQoL). Patients with SLE are at risk of developing irreversible long-term organ damage (LTOD) caused by both disease activity and cumulative medication toxicities. Data regarding the overall disease burden and impact of LTOD in patients with SLE are limited.Objectives:The primary objective of this qualitative study was to develop a conceptual model to describe the burden experienced by patients with SLE and LTOD.Methods:This study (GSK Study 209754) was conducted in three phases. First, a targeted literature review was performed to aid the development of an initial draft conceptual model. Key opinion leaders (KOLs) with experience in SLE and LTOD were then interviewed to assess the clarity, language, comprehensibility, and potential use of the conceptual model, and to help shape the patient interview materials. Finally, one-on-one interviews were performed with patients with SLE and LTOD in any of the 12 organ areas (defined by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), to gather patient perspectives on the common symptoms, functional impacts, treatment experiences, and HRQoL factors associated with LTOD. Data from the interviews were coded and analysed using NVivo software to identify patterns in responses concerning the key concepts of the overall patient burden of LTOD, and used to identify concepts to include in the model.Results:The literature review produced the preliminary conceptual model of LTOD. Results of the KOL interviews (n=5 clinicians and n=1 patient advocate) indicated that the preliminary conceptual model broadly captured the patient experience of LTOD. KOLs emphasised the difference between SLE activity (flares) and LTOD; the conceptual model was subsequently updated in accordance with these recommendations. Interviews conducted with patients with confirmed single (n=9) and multiple LTOD (n=31) indicated that the burden of LTOD associated with SLE was more severe, debilitating, and life threatening than that caused by SLE flares. Almost all patients (39/40) reported aspects of their lives that were more severely affected since their LTOD diagnosis. All 40 patients reported LTOD-related physical impacts, which often affected patients’ ability to perform everyday tasks. The most frequent physical impacts reported were a loss of vitality (39/40), long-term complications (e.g. unstable blood pressure, extreme pain, poor mobility, inflammation, dialysis, infection; 36/40), and severe fatigue (29/40). Cognitive impairments that became more pronounced after their LTOD diagnosis were reported by 27/40 of patients. Typically characterised as “brain fog”, these impairments were described as slower cognitive processing, forgetfulness, confusion, and aphasia. Economic impacts associated with LTOD included patients’ inability to work (31/40), costs of care (33/40), and non-medical-related costs (17/30). Psychosocial impacts reported by patients with LTOD affected their emotional state (39/40), ability to socialise (40/40) and relationships (30/40). Additionally, 30/40 patients reported symptoms as more severe since their LTOD diagnosis, including pain (14/40), fatigue (9/40), and oedema (8/40). Patients’ treatment goals were largely aligned with their experienced impacts of LTOD, including managing the disease and symptoms (25/40), limiting further organ damage (15/40), and improving HRQoL (11/40).Conclusion:The findings from this research clearly indicate that the patient burden of LTOD far surpasses that of SLE without LTOD. These data were incorporated and refined into a conceptual model that fully represents the patient experience of LTOD. The model will help researchers, clinicians, and patients to better understand the impact of SLE-related LTOD progression.Funding:GSKAcknowledgements:Medical writing assistance was provided by Casmira Brazaitis, PhD, Fishawack Indicia Ltd., UK, part of Fishawack Health, and was funded by GSK.Disclosure of Interests:Lynne Broderick Consultant of: GSK, Wen-Hung Chen Shareholder of: GSK, Employee of: GSK, Roger Levy Shareholder of: GSK, Employee of: GSK, April Foster Consultant of: GSK, Cindy Umanzor Consultant of: GSK, Deven Chauhan Shareholder of: GSK, Employee of: GSK

Theoretical structure of Eco-cities: subject review

Given the importance of ecology and its entry into various fields in general and the urban environment particularly; ecological cities take wide ranges of application at multiple regional and global levels. However, it repeatedly noted that there was a state of cognitive confusion and overlapping in the term ecology comes from the diversity of implementation within several disciplines. Architects, designers, and planners have instilled biological development directly into the formal principles as well as the social structures of the ecological cities. Therefore, the research presents a rapid review of the most relevant areas that dealt with the ecological cities by research and analysis at various levels, from the concept and definition of the term, architecture, direction, design, planning, and housing to know the most significant similarities and differences of ecological cities within the various urban specialties. The findings reveal the application of the term Eco-city is branched and fallen under several names within one main goal to preserve the ecosystems and the natural environment while developing an appropriate microclimatic zone and achieving sustainable and healthy comfort levels for their residents through different urban indicators and techniques.