Confusional State Research Articles

The Impact of the Wars of June 1967 and October 1973 on Contemporary Hebrew Poetry

Objectives: This study aims to investigate the impact of the June 1967 and October 1973 Wars on Zionists’ racist attitude towards Arabs. It also aims to suggest that Hebrew literature, especially poetry, is one of the most important methods that has been consistently used by the Zionist movement in fulfilling its project.
 Methods: The study adopts the textual analysis approach to literature and poetry through employing close reading.
 Results: The two wars deeply affected Israeli society and literature, reinforcing the prevalent racist attitude towards Arabs among the members of that society. Indeed, the poems written by pro-Zionist poets were based on a racist ideology. However, Hebrew writing often captured the mood of Israeli society, which was mostly characterized by fear and confusion, in the aftermath of the wars. In fact, Hebrew literature increasingly reflected this state of affairs after the October 1973 War. All Israeli sectors were experiencing a state of confusion after the 1973 war, an idea which was underpinned by the belief that those who are confused cannot lead, a belief which affected Zionists’ treatment of Arabs.
 Conclusions: The study concludes that literature played a major role in Israeli society, especially during and after the two wars. More specifically, poetry played an effective role in shaping people’s ideas, tendencies, decisions, and political choices, especially during the elections. The study also concludes that racism and hostility towards Arabs explicitly prevailed in Hebrew literature after the two wars.

Discussion: Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus.

Discussion: Commercial Insurance Rates and Coding for Lymphedema Procedures: The Current State of Confusion and Need for Consensus.

Patterns of neurotoxicity among patients receiving chimeric antigen receptor T-cell therapy: A single-centre cohort study.

Immune effector cell-associated neurotoxicity syndrome (ICANS) is an important complication of chimeric antigen receptor T-cell (CAR-T) therapy. This study aims to identify the patterns of neurotoxicity among patients with ICANS at a tertiary referral centre in Australia. This single-centre, prospective cohort study included all consecutively recruited patients who underwent CAR-T therapy for eligible haematological malignancies. All patients underwent a comprehensive neurological assessment and cognitive screening before CAR-T infusion, during the development of ICANS, and 1 month after treatment. Baseline demographic characteristics, incidence, and neurological patterns of neurotoxicity management were evaluated. Over a 19-month period, 23% (12) of the 53 eligible patients developed neurotoxicity (10/12 [83%] being grade 1). All patients showed changes in handwriting and tremor as their initial presentation. Changes in cognition were manifested in most of the patients, with a more substantial drop noted in their Montreal Cognitive Assessment compared to immune effector cell-associated encephalopathy scores. All manifestations of neurotoxicity were short-lived and resolved within a 1-month period, with a mean duration of 8.2 days (range = 1-33). The patterns of CAR-T-related neurotoxicity often include change in handwriting, tremor, and mild confusional state, especially early in their evolution. These may remain undetected by routine neurological surveillance. These features represent accessible clinical markers of incipient ICANS.

Golidocitinib, a selective JAK1 tyrosine-kinase inhibitor, in patients with refractory or relapsed peripheral T-cell lymphoma (JACKPOT8 Part B): a single-arm, multinational, phase 2 study

Golidocitinib, a selective JAK1 tyrosine-kinase inhibitor, has shown encouraging anti-tumour activity in heavily pre-treated patients with relapsed or refractory peripheral T-cell lymphoma in a phase 1 study (JACKPOT8 Part A). Here, we report the full analysis of a phase 2 study, in which we assessed the anti-tumour activity of golidocitinib in a large multinational cohort of patients. We did a single-arm, multinational, phase 2 trial (JACKPOT8 Part B) in 49 centres in Australia, China, South Korea, and the USA. Eligible patients were adults (aged ≥18 years) with relapsed or refractory peripheral T-cell lymphoma who had received at least one previous line of systemic therapy and an Eastern Cooperative Oncology Group performance status of 0-2. Patients were given oral golidocitinib 150 mg once daily until disease progression or other discontinuation criteria were met. The primary endpoint was the CT-based objective response rate, assessed by an independent review committee (IRC) per Lugano 2014 classification. The activity analysis set included all patients who received at least one dose and whose pathological diagnosis of peripheral T-cell lymphoma had been retrospectively confirmed by a central laboratory and who had at least one measurable lesion at baseline assessed by IRC. The safety analysis set included all patients who received at least one dose of study drug. This study is registered with ClinicalTrials.gov, NCT04105010, and is closed to accrual and follow-up is ongoing. Between Feb 26, 2021, and Oct 12, 2022, we assessed 161 patients for eligibility, of whom 104 (65%) were enrolled and received at least one dose of study drug; the activity analysis set included 88 (85%) patients (median age 58 years [IQR 51-67], 57 [65%] of 88 were male, 31 [35%] were female, and 83 [94%] were Asian). As of data cutoff (Aug 31, 2023; median follow-up was 13·3 months [IQR 4·9-18·4]), per IRC assessment, the objective response rate was 44·3% (95% CI 33·7-55·3; 39 of 88 patients, p<0·0001), with 21 (24%) patients having a complete response and 18 (20%) having a partial response. In the safety analysis set, 61 (59%) of 104 patients had grade 3-4 drug-related treatment-emergent adverse events. The most common grade 3-4 drug-related treatment-emergent adverse events were neutrophil count decreased (30 [29%]), white blood cell count decreased (27 [26%]), lymphocyte count decreased (22 [21%]), and platelet count decreased (21 [20%]), which were clinically manageable and reversible. 25 (24%) patients had treatment-related serious adverse events. Deaths due to treatment-emergent adverse events occurred in three (3%) patients: two (2%) due to pneumonia (one case with fungal infection [related to golidocitinib] and another one with COVID-19 infection) and one (1%) due to confusional state. In this phase 2 study, golidocitinib showed a favourable benefit-risk profile in treating relapsed or refractory peripheral T-cell lymphoma. The results of this study warrant further randomised clinical studies to confirm activity and assess efficacy in this population. Dizal Pharmaceutical.

Analysis the structural complexity of “Time” in Hans Zimmer’s score for ”Inception”

This study explores the intricate structure of "Time", a piece in Hans Zimmer's. The study aims to analyze the complex layers of "Time" and its influence on the overall impression of the picture. The primary study question investigates how the structural components of the composition, such as its recurring motifs, slow progression, and emotional climaxes, correspond to and amplify the movie's examination of time and reality. The process entails a qualitative analysis utilizing a literature review and an observational assessment of the film's audio-visual synchronization. By analyzing scholarly publications and conducting a literature study, the research reveals how Zimmer's minimalist approach and his inventive utilization of electronic sounds produce a distinctive auditory encounter that reflects the film's themes. Examining pivotal scenes that prominently display the concept of "Time" allows us to understand the intentional decisions made in the composition and execution of the music. The research findings indicate that the intricate composition of "Time" greatly amplifies the viewer's sense of being fully engaged in the film. The changing dynamics and recurring patterns of the piece not only mirror the emotional progress of the characters but also act as a guiding force for the viewer, helping them navigate through the complex storyline of the film. The emotional trajectory depicted in "Time"—evolving from a state of tension and confusion to one of resolution and hope—mirrors the thematic trajectory of the film, emphasizing its crucial function as an integral element in the narrative process. This analysis illustrates that the popularity of "Inception" is not exclusively attributed to its visual and narrative originality but is equally ascribed to its refined utilization of music. "Time" demonstrates how film music may significantly impact the audience's emotional and intellectual involvement, solidifying its position as a significant piece in modern cinema.

Use of a Data Repository to Identify Delirium as a Presenting Symptom of COVID-19 Infection in Hospitalized Adults: Cross-Sectional Cohort Pilot Study.

Delirium, an acute confusional state highlighted by inattention, has been reported to occur in 10% to 50% of patients with COVID-19. People hospitalized with COVID-19 have been noted to present with or develop delirium and neurocognitive disorders. Caring for patients with delirium is associated with more burden for nurses, clinicians, and caregivers. Using information in electronic health record data to recognize delirium and possibly COVID-19 could lead to earlier treatment of the underlying viral infection and improve outcomes in clinical and health care systems cost per patient. Clinical data repositories can further support rapid discovery through cohort identification tools, such as the Informatics for Integrating Biology and the Bedside tool. The specific aim of this research was to investigate delirium in hospitalized older adults as a possible presenting symptom in COVID-19 using a data repository to identify neurocognitive disorders with a novel group of International Classification of Diseases, Tenth Revision (ICD-10) codes. We analyzed data from 2 catchment areas with different demographics. The first catchment area (7 counties in the North-Central Florida) is predominantly rural while the second (1 county in North Florida) is predominantly urban. The Integrating Biology and the Bedside data repository was queried for patients with COVID-19 admitted to inpatient units via the emergency department (ED) within the health center from April 1, 2020, and April 1, 2022. Patients with COVID-19 were identified by having a positive COVID-19 laboratory test or a diagnosis code of U07.1. We identified neurocognitive disorders as delirium or encephalopathy, using ICD-10 codes. Less than one-third (1437/4828, 29.8%) of patients with COVID-19 were diagnosed with a co-occurring neurocognitive disorder. A neurocognitive disorder was present on admission for 15.8% (762/4828) of all patients with COVID-19 admitted through the ED. Among patients with both COVID-19 and a neurocognitive disorder, 56.9% (817/1437) were aged ≥65 years, a significantly higher proportion than those with no neurocognitive disorder (P<.001). The proportion of patients aged <65 years was significantly higher among patients diagnosed with encephalopathy only than patients diagnosed with delirium only and both delirium and encephalopathy (P<.001). Most (1272/4828, 26.3%) patients with COVID-19 admitted through the ED during our study period were admitted during the Delta variant peak. The data collected demonstrated that an increased number of older patients with neurocognitive disorder present on admission were infected with COVID-19. Knowing that delirium increases the staffing, nursing care needs, hospital resources used, and the length of stay as previously noted, identifying delirium early may benefit hospital administration when planning for newly anticipated COVID-19 surges. A robust and accessible data repository, such as the one used in this study, can provide invaluable support to clinicians and clinical administrators in such resource reallocation and clinical decision-making.

Subcutaneous Mosunetuzumab Is Active and Has a Manageable Safety Profile in Patients with Previously Untreated, Low-Tumor Burden Follicular Lymphoma: Initial Results from the Phase II Morningsun Study

Background: Mosunetuzumab is a CD20xCD3 bispecific antibody that is approved for the intravenous (IV) treatment of patients with relapsed/refractory (R/R) follicular lymphoma (FL) who have received at least two prior lines of systemic therapy, and is suitable for administration in the outpatient setting. In an ongoing Phase I/II study (NCT02500407), IV mosunetuzumab induced durable responses and had a manageable safety profile in patients with heavily pre-treated R/R indolent and aggressive B-cell non-Hodgkin lymphomas (NHL) when administered as a fixed-duration treatment (Budde et al. J Clin Oncol 2022). Subcutaneous (SC) dosing was also evaluated and showed similar efficacy to IV dosing and a manageable safety profile (Budde et al. ASH 2022). MorningSun (NCT05207670) is an ongoing, open-label, multicenter, Phase II study evaluating the efficacy, safety and pharmacokinetics of SC mosunetuzumab in patients with selected B-cell NHLs, including those without prior treatment (Flinn et al. ASCO 2022). For the first time, we present initial efficacy and safety data for patients with previously untreated, low-tumor burden FL who were enrolled into MorningSun at community and academic centers in the United States. Methods: Inclusion criteria include previously untreated Grade (Gr) 1 or 2 FL, low tumor burden by GELF criteria, Ann Arbor stage III or IV disease, and ECOG performance status 0-2. Mosunetuzumab is administered without mandatory hospitalization by SC injection in 21-day cycles. In Cycle (C) 1, mosunetuzumab is given on Day (D) 1 (5mg), D8 (45mg) and D15 (45mg). In C2+, mosunetuzumab is given on D1 only (45mg). Treatment is continued for up to 17 cycles (~1 year). Patients who are in complete metabolic response (CMR) at C8 can discontinue active treatment and enter long-term follow-up. Premedication with dexamethasone (20mg) is mandatory in C1 and C2 and optional thereafter. Acetaminophen and diphenhydramine may also be given. The primary endpoint is the rate of progression-free survival at 24 months. Results: At data cut-off (March 6, 2023), 30 patients had been enrolled (19 at community centers and 11 at academic centers). Median age was 56 years. All patients had ECOG performance status 0-1, and a minority had B symptoms ( Table 1). The median duration of follow-up was 4.2 months (range: 0.2-11.1) and the median number of cycles received was 7 (range: 1-13). Among 24 patients who had at least one post-baseline tumor assessment, 23 achieved an objective response (95.8%; 95% CI: 78.9-99.9), including 20 who achieved a CMR (83.3%; 95% CI: 62.6-95.3). All responses were observed at the first post-baseline tumor assessment in C4 (median time to response: 2.6 months; 95% CI: 2.6-2.8). At cut-off, responses were ongoing in all patients who achieved CMR and 2 of 3 patients who achieved partial metabolic response. The most common adverse event (AE) was injection site reaction (53.3% of patients), all of which were Gr 1 (43.3%) or Gr 2 (10.0%). Cytokine release syndrome (CRS) occurred in 43.3%. Most patients had Gr 1 CRS ( Table 2). No Gr ≥3 CRS events or discontinuations due to CRS were reported. CRS occurred in C1 only. All CRS events resolved. Other common (&amp;gt;20%) AEs were headache (50.0%), nausea (30.0%), fatigue (26.7%), pyrexia (23.3%), chills (23.3%) and alanine aminotransferase increased (23.3%). Gr ≥3 AEs in ≥5% of patients were neutrophil count decreased (2 patients; 6.7%). Serious AEs (SAEs) in ≥5% were CRS (2 patients; 6.7%). No SAEs of infection were reported. AEs potentially consistent with immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 2 patients (Gr 1 confusional state and Gr 1 memory impairment in one patient each); both events resolved. No mosunetuzumab-related AEs leading to discontinuation occurred and no Gr 5 (fatal) AEs were reported. Conclusions: Initial MorningSun data support that SC mosunetuzumab is active in patients with previously untreated, low-tumor burden FL. Safety data demonstrate a manageable safety profile that is consistent with that seen in patients with R/R B-cell NHLs and is supportive of outpatient administration.

Fixed Duration Mosunetuzumab Plus Polatuzumab Vedotin Has Promising Efficacy and a Manageable Safety Profile in Patients with BTKi Relapsed/Refractory Mantle Cell Lymphoma: Initial Results from a Phase Ib/II Study

Background: New treatment options are needed for patients (pts) with relapsed/refractory (R/R) mantle cell lymphoma (MCL), especially for pts with progressive disease (PD) after Bruton's tyrosine kinase inhibitor (BTKi) therapy. Outcomes for R/R MCL pts with PD after the BTKi ibrutinib are very poor, demonstrated by a median overall survival of 2.9 months (Martin et al. Blood 2016). While chimeric antigen receptor (CAR) T-cell therapies are approved for pts with R/R MCL; treatment is associated with high toxicity and difficulty with accessibility. Mosunetuzumab (Mosun) is a CD20xCD3 T-cell engaging bispecific antibody that engages and redirects T cells to eliminate malignant B cells. Polatuzumab vedotin (Pola) is a CD79b-targeted antibody-drug conjugate that inhibits cell division and induces apoptosis in B cells. This ongoing Phase Ib/II study (NCT03671018) is investigating Mosun in combination with Pola (M-Pola) in pts with R/R B cell non-Hodgkin lymphoma. Here, we report initial safety and efficacy data from an ongoing Phase II expansion cohort of pts with R/R MCL who had received prior BTKi therapy. Methods: Eligiblepts had histologically confirmed R/R MCL and had received ≥2 prior regimens (including an anti-CD20 agent, BTKi, and anthracycline- or bendamustine-based therapy). Mosun was administered subcutaneously (SC) by step-up dosing on Days (D) 1 (5mg), 8 (45mg), and 15 (45mg) of Cycle (C) 1, then 45mg on D1 of every cycle from C2D1, every 3 weeks for a total of 17 cycles. Pola (1.8mg/kg intravenous [IV] infusion) was administered on D1 of C1-6. All pts received corticosteroid premedication prior to C1 of treatment. From C2, premedication was optional for pts who did not experience cytokine release syndrome (CRS) in the previous cycle. Response was assessed by investigators using Lugano 2014 criteria (Cheson et al. J Clin Oncol 2014). Results: As of October 27, 2022, 20 pts had received M-Pola (n=10 active on treatment, n=1 completed treatment, n=9 discontinued Mosun treatment). Median age of all pts was 68.0 (range: 44-82) years, 75% were male, 95% had Ann Arbor stage III/IV disease, and 40% had a MIPI score ≥6 at study entry. Median number of prior lines of therapy (LOT) was 3 (range: 2-9). All pts had received prior BTKi therapy; 7 pts (35%) had received prior CAR T-cell therapy; and 85% (17/20) of pts were refractory to their last LOT. Median time since last LOT was 1.6 (range: 0-39) months. The proportions of pts with high-risk MCL factors at baseline were: 65% of pts with Ki-67 proliferation index ≥50%; 50% with blastoid/pleomorphic variants; and 20% with TP53 mutation. The overall median time on study was 7.2 (range: 0.4-17.5) months. The most common (≥25%) Mosun and/or Pola-related adverse events (AEs) in all pts (n=20) were CRS (50%), injection site reaction (50%), fatigue (45%), dyspnea (35%), paresthesia (30%), diarrhea (30%), myalgia (30%), infusion-related reaction (25%), and nausea (25%). Two (10%) Grade (Gr) 5 AEs occurred, both of which were due to COVID-19 pneumonia; neither were deemed treatment-related by the investigator. Ten pts (50%) experienced CRS events; 9 pts experienced Gr 1 events, and 1 pt experienced a Gr 2 event, which was managed with tocilizumab and low-flow oxygen. One pt was managed with corticosteroids and no pts required pressors or ICU admission. All CRS events resolved by the data cut-off. Treatment-related neurologic AEs, potentially consistent with ICANs, occurred in 3 pts (15%; Gr 1 confusional state and Gr 2 amnesia, 1 pt; Gr 1 agitation, 1 pt; and Gr 2 memory impairment, 1 pt). Neuropathy occurred in 3 pts (15%); all events were Gr 1. Four pts (20%) had AEs leading to treatment discontinuation: 1 pt with Gr 3 uveitis (related to M-Pola); 1 pt with Gr 3 pneumonitis (related to M-Pola); and 2 pts with Gr 5 COVID-19 pneumonia (both unrelated to M-Pola). Overall response rate (ORR) and complete response (CR) rates were 75% and 70%, respectively (Figure). Best ORR and CR rates were generally consistent in high-risk MCL subgroups (Figure). Median duration of CR was not evaluable (NE; 95% confidence interval: 3.8-NE). Conclusions: Fixed-duration Mosun SC in combination with Pola IV induced high CR rates in pts with R/R MCL who had previously received BTKi therapy, including those in high-risk subgroups and those who had received prior CAR T-cell therapy. CRs were observed early and persisted during the follow up period. M-Pola had a manageable safety profile, and all CRS events were low grade.

Nonconvulsive Status Epilepticus and Encephalopathy Related to Ifosfamide - A Case Report

Introduction: Ifosfamide (IFX) is an alkylating drug used for chemotherapy to manage a wide range of malignancies including testicular, ovarian, head-and-neck cancers, lymphomas, and sarcomas. Central nervous system (CNS) toxicity is known to occur in 10%–40% of patients who are administered high doses of IFX. CNS toxicity includes an encephalopathy with underlying nonconvulsive status epilepticus manifesting with altered sensorium, mental confusion, seizures, ataxia, visual hallucinations, akinetic mute state extrapyramidal features, or coma. Case Report: We describe the case of a 65-year-old woman with a rapidly evolving confusional state and progressive decline in the fluency of speech progressing to mutism immediately after IFX chemotherapy. Results: Electroencephalogram (EEG) revealed evidence of nonconvulsive status epilepticus. The patient was managed with anticonvulsants, discontinuing IFX, and intravenous methylene blue infusion. Subsequently, the patient had significant improvement to an alert state with normalization of EEG abnormality. Conclusion: CNS toxicity following IFX usually manifests within 24 h of the drug administration, although clinical manifestations of toxicity may occur up to 4–6 days and a significant number of these patients may have a nonconvulsive status as the cause of the encephalopathy. Patients with encephalopathy following IFX should be evaluated with early EEG to assess for the presence or absence of a nonconvulsive status. Patients with a positive EEG would benefit from prompt and aggressive anticonvulsant therapy along with cessation of IFX therapy with or without intravenous methylene blue administration.

P10 Collapse, confusion and acute kidney injury presenting in the context of bullous skin disease in a young male patient

P10 Collapse, confusion and acute kidney injury presenting in the context of bullous skin disease in a young male patient

42 Resolution of delirium upon discharge &amp; mortality rates among frail older persons attending an Emergency Department frailty service

Abstract Background Delirium is an acute confusional state, frequently associated with older hospitalised patients and has been found to be related to several adverse outcomes including longer length of stay and mortality. Better baseline cognition has been linked with a lower risk of delirium however those with high baseline cognition may experience greater cognitive decline post delirium. Methods We undertook a retrospective study of 92 patients who attended the Frailty service in the Emergency Department between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and collected additional data collected to define baseline cognitive status, delirium resolution, and length of stay and discharge disposition. Results Delirium prevalence in this cohort was estimated at 22%. Overall delirium had resolved for our patients at discharge in 56% of cases. In the cognitively intact at baseline group (29%) delirium had resolved at discharge in 33% of cases only. For patients with baseline cognitive impairment (71%) delirium had resolved in 50% of cases. The mortality rate for patients with delirium was 14% with average CFS of 6. All patients who died had cognitive impairment at baseline. The mortality rate for patients without delirium was 1.4%. Length of stay ranged from 0 to 80 days. Length of stay for patients with delirium &amp; baseline cognitively intact was 39 days. Length of stay for patients with delirium and baseline cognitively impaired was 8 days. Conclusion Two thirds of patients who were cognitively intact at baseline experienced longer length of stays &amp; non resolution of delirium at discharge. There may be a need for dedicated follow up of these patients post-acute discharge. There was a higher mortality rate for patients with delirium and baseline cognitive impairment. Future studies may address illness acuity, delirium severity and duration &amp; emergency department length of stay as influencers on mortality rate.

Tetraphenylethene modified diphenylsulfone derivatives exhibiting a highly twisted conformation, aggregation-induced emission enhancement and mechanochromic luminescence

Two AIEE-active luminophores TPE-DPS-H and TPE-DPS-F, which are constructed by tetraphenylethene unit as electron donor and diphenylsulfone segment as electron acceptor, are prepared using the classical Heck coupling reaction. Through the combination of tetraphenylethene unit and diphenylsulfone segment, both of them possess highly distorted molecular conformation and AIEE (aggregation-induced emission enhancement) characteristics. The emission efficiencies of TPE-DPS-H and TPE-DPS-F in the solid state reach 35.86% and 32.74%, respectively. Interestingly, both TPE-DPS-H and TPE-DPS-F show fluorescent response to mechanical force. Among them, TPE-DPS-H displays reversible and high-contrast mechanochromic luminescence. The emitting color of TPE-DPS-H in the solid state changes from bright cyan to green after grinding with a wavelength shift of 32 nm. XRD and DSC experiments indicate that the phase conversion from well-ordered crystalline state to confused amorphous state is responsible for mechanochromic luminescent performances of TPE-DPS-H and TPE-DPS-F.

Acțiunile Detașamentului „18 Pază Zona Petroliferă” pentru apărarea zonei Ploiești în perioada 23 august-1 septembrie 1944

When the Second World War broke out, Romania was undergoing in a rather difficult economic, political, military and especially diplomatic situation. Germany’s territorial expansion triggered the fall of the system of alliances Bucharest was relying on, given that France signed the armistice in April 1940. That is why the pressures exerted by Germany forced Romania’s entry under Berlin’s sphere of influence, an actual example being that the German Military Mission was sent into our country, with the clear purpose, among others, to take over oil resources and processing capacities in the Ploiești area. The act of 23 August 1944, through which Romania turned its weapons against Germany, with the clear intention of joining the United Nations, led to a state of confusion among Romanian and German troops deployed in Valea Prahovei. However, the dynamic orders of the Romanian General Staff were to annihilate any German resistance in the area, even by the force of arms, if needed. This mission was assigned to the 18th Oilfield Guard Detachment, commanded by Brigadier General Grigore Moșteoru. This large unit was subordinated to the 5th Territorial Army Corps, commanded by Major General Constantin Vasiliu-Rășcanu. The conclusion of this study illustrates the effort and heroism of Romanian troops, who annihilated, between 31 August and 1 September 1944, sometimes after heavy battles and human losses, any resistance of the German units who were thus forced to retreat to the North and lose all control over the oil resources in the Ploiești area. These aspects are highlighted from a military, economic and socio-historical perspective, by using the documentation technique.

Art-based self-care during COVID-19

ABSTRACT Background The COVID-19 global pandemic was a profoundly traumatic experience, in which healthcare workers were stressed, anxious, and overwhelmed as they laboured amidst chaos, upheaval, and mounting death. During such challenging and uncertain times, it is imperative to prioritise self-care in order to maintain mental and emotional wellbeing. Aims This study explored the impact of an art-based self-care practice on the resilience of a healthcare worker during a 14-day quarantine on a trip to South Korea during COVID-19. Methods Interpretive phenomenological analysis (IPA) was employed to analyze written reflections of artwork created during my quarantine. I employed a grounding art therapy directive consisting of six steps: find a comfortable position, identify my feelings, allow thoughts or images to arise, create and respond to the images, engage in art dialogue with the artwork, and give a name to the whole process. Results Three phases emerged reflecting a journey in which states of powerlessness and confusion gave way to a release of frozen feelings and a renewal of body awareness. Elaborated healing images then emerged representing a return of hope, spirituality, growth, and a longing to reconnect with others. Conclusions Amidst such a chaotic overwhelming traumatic experience art-based self-care practices can be a way to regain a sense of control and self-efficacy. Implications for practice/policy/future research Art-based self-care practices can be valuable for healthcare workers during times of crisis and stress. Including semi-structured interviews inquiring into the experiences of a larger number of participants and controlled experimental designs would help validate these findings. Plain-language summary The COVID-19 global pandemic was a profoundly traumatic experience, affecting individuals worldwide and causing acute anxiety, stress, and sense of overwhelm. Healthcare workers, in particular, were stressed and exhausted due to work overload. During such challenging times, it is imperative to prioritise self-care to increase resilience. I had been working as art therapist in a psychiatric unit of a hospital for 9 months when I had to return to my birthplace of South Korea to attend to a family matter. Facing a 14-day quarantine, I decided to practice art-based self-care as a way to soothe and attend to my anxious emotional state. I wanted to understand the benefits of art-based self-care on resilience in healthcare workers. The directive consisted of six steps: find a comfortable position, identify my feelings, allow thoughts or images to arise, create and respond to the images, allow verbal responses to the images, and give a name to the whole process. I examined the written reflections of the artwork I created during daily self-care practice. The results reflect a journey, in which a state of fragmentation and exhaustion gave way under the exploration of my complex inner state, releasing diverse emotions, and leading to bodily awareness and emotional restoration. I rediscovered a sense of hope and a spiritual inclination to reconnect with others. Art-based self-care helped facilitate reconnection with myself, my needs, my body, and others, which in turn enabled me to prioritise self-care during the stresses of COVID-19. Policymakers and healthcare organisations should consider incorporating art-based self-care programmes for healthcare workers to support their resilience and emotional wellbeing. Future researchers should consider interviewing a larger number of healthcare workers who follow the grounding art-therapy directive I used. Stronger research designs could be used to further support my findings and inform future interventions for healthcare workers.

Update on the diagnosis and treatment of delirium

Delirium is an acute confusional state with typically fluctuating disturbances of attention, cognition, and qualitative awareness. Its incidence depends on the patient group. In the development of delirium, predisposing factors such as age, frailty, multimorbidity, surgical interventions, and pre-existing dementia are of high clinical relevance. The diagnosis of delirium should be based on symptoms and validated screening methods (e.g., Confusion Assessment Method). As delirium is adirect physiological consequence of amedical condition, the potential underlying cause(s) should be diagnosed. Prevention and therapy are primarily multimodal, non-pharmacological treatments such as reorientation, early mobilization, and sleep improvement. If symptomatic pharmacological treatment is necessary (e.g., due to delirium-related agitation), careful drug selection should be made depending on the patient population and symptoms.

Reference and confusion

ABSTRACT Being in a state of confusion is, unfortunately, an ordinary part of human experience. What is going on in our heads exactly, when we are confused about something? Surely, there are many different ways of being confused, but in his engaging new book Talking About, Elmar Unnsteinsson takes on the special case of what he calls identity confusion. He suggests that understanding what happens when we are in a state of identity confusion – and what kinds of things this confusion allows us to, or inhibits us from doing – will dissolve Frege's puzzle. And more importantly, it will pave the road to a new theory of reference which relies on what he calls the Edenic Constraint – a constraint that makes acts of reference unavailable to victims of identity confusion. I argue that this account is convincing if the Edenic Constraint is restricted to certain cases of combinatory confusion – namely those that involve conflicting intentions – but that it is less plausible that the reference mechanism fails in cases of combinatory confusion that don't involve conflicting intentions, or in any cases of separatory confusion.

Race against time: “9/11: One Day in America” and the amnesia of America’s archive

I engage in a discourse analysis of National Geographic’s docuseries “9/11: One Day in America” to argue that the series’ multi-layered effort at commemoration, geared as a long-awaited “full” telling of the 9/11 story, but committed to honoring a specific group of victims and survivors, is enabled by a disorienting temporality that raises questions about the role of national memorials and archives at this moment. Temporality is essential to the development of narrative, and with narrative a central element in the making of memory worlds, temporality cannot be underestimated as a key factor in how memories take shape. “One Day” depends on structural instantiations of time to develop its narrative as authentic memory, reflecting a paradoxical linear yet circular pattern that simultaneously authenticates and undermines the veracity of the story it tells. “One Day” transports viewers into lower Manhattan and through the events of 9/11 via a vividly illustrated timeline. But while a linear version of time in “One Day” supports the telling of survivor stories and the memorialization of the dead, the overarching effect of the timeline for viewers is circular, transporting viewers back in time to 2001 and a state of fear and confusion, forcing collective memory to exist in a repetitive temporality that excuses a turn away from history and consequences. The resulting circular mechanism for commemoration allows cultural institutions, like the ones represented in “One Day,” to emphasize the past at the expense of more critical understandings of both history and the future.

Descriptive spectrum of thiamine deficiency in pregnancy: Apotentially preventable condition.

Pregnancy, a nutritionally demanding situation in terms of macro- and micronutrient supply owing to heightened maternal, placental, and fetal needs, significantly affects thiamine reserves. Thiamine deficiency during pregnancy and the postpartum period, presenting with varied manifestations and outcomes, is a relatively common condition in our population. The study aimed to understand the various manifestations and outcomes of acute thiamine deficiency in pregnant and postpartum women, emphasizing the significance of early recognition and thiamine therapy to prevent serious complications during pregnancy and after childbirth. This prospective study conducted in a tertiary care center in North India enrolled consecutive pregnant and postpartum women presenting with clinical features consistent with thiamine deficiency disorders, such as thiamine deficiency-related neuropathy, high-output heart failure, heart failure with reduced ejection fraction, Wernicke's encephalopathy, gastric beriberi, and thiamine-responsive acute pulmonary hypertension. In addition to capturing medical history including drug intake, dietary consumption, and comorbidities, women underwent brief relevant clinical examinations and laboratory assessments, including whole-blood thiamine levels. Response to intravenous thiamine supplementation was also monitored. Data of 31 women (12 pregnant, 19 postpartum) with a diagnosis of acute thiamine deficiency and a mean age of 28.88 ± 2.69 years were analyzed. The mean thiamine level was 1.28 ± 0.44 μg/dL with mean blood lactate of 3.46 ± 3.33. The most common presentation was gastric beriberi (n = 10), followed by paraparesis (n = 6), high-output heart failure (n = 6), acute pulmonary hypertension, heart failure with reduced ejection fraction (n = 3 each), and an acute confusional state (n = 2). All patients responded to thiamine challenge. In the context of borderline thiamine status, particularly in our population with endemic thiamine deficiency and heightened demand for thiamine during pregnancy and the peripartum period, the deficiency can have varied and serious manifestations of dry and wet beriberi. Early recognition of the clinical features and thiamine therapy can be life-saving. There is a need for validated clinical criteria owing to the non-availability of thiamine testing in resource-limited settings.

Hyperactive and Hypoactive Delirium: What we know so Far

Delirium is a common and severe neuropsychiatric syndrome characterized by acute changes in attention, cognition, and consciousness. It can present in different clinical forms, including hyperactive and hypoactive delirium. Hyperactive delirium is characterized by increased psychomotor activity, agitation, and disruptive behavior, while hypoactive delirium is characterized by reduced psychomotor activity, somnolence, and decreased responsiveness. The diagnosis of hyperactive and hypoactive delirium involves a comprehensive evaluation of medical history, physical examination, and laboratory tests to identify underlying causes and exclude other conditions. Prompt recognition and accurate diagnosis are crucial for appropriate management and treatment. The management of hyperactive and hypoactive delirium aims at addressing the underlying etiology, ensuring patient safety, and alleviating distressing symptoms. Treatment strategies include the optimization of medical conditions, discontinuation or adjustment of offending medications, and supportive care. Pharmacological interventions, such as the use of sedative medications for hyperactive delirium or stimulant agents for hypoactive delirium, may be considered when necessary. Multidisciplinary collaboration involving healthcare professionals, including physicians, nurses, and therapists, is essential for the comprehensive care of patients with hyperactive and hypoactive delirium. In conclusion, hyperactive and hypoactive delirium are distinct clinical manifestations of an acute confusional state. Their identification, diagnosis, and management require a multidimensional approach to address the underlying causes and alleviate symptoms. Early recognition and appropriate interventions are crucial for improving patient outcomes and enhancing their overall well-being.

State of Confusion: Ohio's Restrictive Abortion Landscape and the Production of Uncertainty in Reproductive Health Care.

This study examines an underexplored source of medical uncertainty: the political context of care. Since 2011, Ohio has passed over 16 abortion-restrictive laws. We know little about how this legislation affects reproductive health care outside of abortion clinics. Drawing on focus groups and interviews with genetic counselors and obstetrician-gynecologists, we examine how abortion legislation impacts their work. We find that interpretation and implementation of legislation is not straightforward and varies by institution and region of the state. An ever-changing legislative landscape combined with uneven implementation of restrictions into policy produces uncertainty in reproductive health care. We also found uncertainty about the legal consequences of abortion in restrictive contexts, with obstetrician-gynecologists reporting greater concerns given their proximity to care provision. We argue that uncertainty can result in stricter interpretations of regulations than necessitated by the law, thereby amplifying the impacts of an already restrictive context for abortion care.