Cut Off Research Articles

Association of Preoperative Neutrophil to Lymphocyte Ratio with Early Postoperative Acute Kidney Injury Following Isolated Off-Pump Coronary Artery Bypass Grafting

Objective: Acute kidney injury (AKI) is a frequent complication after off-pump coronary artery bypass grafting (OPCAB) that complicates recovery, increases treatment cost and mortality. Neutrophil to lymphocyte ratio (NLR) is a systemic inflammatory marker easily derived from complete blood count that has many prognostic potentials. The purpose of this study was to evaluate if there is an association of preoperative NLR with early postoperative AKI following isolated OPCAB. Methods: This cross-sectional study was carried out in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD) on a total of 60 patients aged 31-70 years with no preoperative renal dysfunction undergoing isolated OPCAB between August 2021 and July 2022. Group A included 30 patients with preoperative NLR < 2.65 and Group B included 30 patients with preoperative NLR ≥ ≥≥2.65. Patients were monitored for development of early postoperative AKI according to serum creatinine criteria of Kidney Disease Improving Global Outcomes (KDIGO) 2012 guideline. Results: Two patients from group A and twenty patients from group B developed early postoperative AKI (p < 0.001). Events of AKI were significantly higher in group B patients at all postoperative time points. Multivariate binary logistic regression analysis revealed preoperative NLR ≥ ≥≥2.65 as an independent predictor of early post OPCAB AKI (p = 0.004, OR = 13.746). In receiver operating curve (ROC) analysis area under curve (AUC) was 0.933 (95% CI 0.874-0.992, p < 0.001). It showed 90.91% sensitivity and 73.7% specificity at the pre-set cut off value of NLR at 2.65 where optimal predictability of post-OPCAB AKI occurred with 66.67% positive predictive value, 93.33% negative predictive value and 80% accuracy. Conclusion: Preoperative NLR is significantly associated with early postoperative AKI following isolated OPCAB and therefore it should be incorporated in routine clinical practice for early prediction of AKI and implementing timely preventive strategies. (Bangladesh Heart Journal 2024; 39(2): 151-160

Abstract P399: Defining A Negative Space: A Scoping Review of Hypertension

Study Objectives: This scoping review seeks to examine the existing body of literature to reveal consensus or absence thereof regarding the definition and management strategies for asymptomatic hypertension. Methods: The review was conducted using Joanna Briggs Institute guidelines. We searched the CINAHL (EBSCO), Scopus, Ovid EMBASE, and PubMed (MEDLINE) databases using keywords and index terms (“hypertension”, “high blood pressure”, “elevated blood pressure”, “asymptomatic”, “symptomless”, “symptom free”, “emergenc*”, “urgent”) to identify adult patients with hypertension in an emergency or outpatient setting. After review and quality assessment, we retained 35 texts for inclusion. Results: The definition of “asymptomatic hypertension” varied widely between the texts. There was significant variation in which society or academic guideline served as the reference and what the blood pressure cut offs were; all specified a lack of end-organ damage. A majority included a definition for hypertensive urgency, most commonly based on elevated blood pressure with vague symptoms. End-organ damage was poorly defined – studies instead described the absence of hypertensive emergency. The most common emergencies mentioned were myocardial infarction, renal failure, and hypertensive encephalopathy. Of the texts which provided recommendations, all recommended a thorough history and physical examination. Only one study recommended additional testing for asymptomatic patients – an ECG and creatinine test. Treatment recommendations for asymptomatic patients relied predominantly on ACEP clinical policy, with a majority of studies advocating for gradual reduction of blood pressure rather than an immediate one, as well as referral for outpatient management. Conclusion: There is a need for unified guidelines on the definition and management of asymptomatic hypertension to ensure effective and consistent patient care. Additionally, there is no consensus for further diagnostic testing in patients with a negative history and physical exam, and there is strong agreement that rapid blood pressure decrease in asymptomatic patients can be detrimental. Addressing this gap in guideline consistency and evidence base could enhance clinical outcomes and streamline healthcare processes across different settings. Future research should focus on establishing consensus and developing management strategies that are adaptable to both emergency and primary care environments.

509. DOES SARCOPENIA AFFECT THE OUTCOME OF PATIENTS WITH ESOPHAGEAL CARCINOMA AFTER ESOPHAGECTOMY?

Abstract Background Sarcopenia is increasingly recognized as an independent predictor of clinical outcomes of cancer patients such as post-operative complications and prolonged hospital stays. Additionally, sarcopenia can also negatively impact overall survival because of reduced ability to tolerate treatments like neoadjuvant therapy and surgery. At particular risk among cancer patients is the esophageal cancer population because of tumor stenosis leading to dysphagia and impossibility of oral feeding in many patients. The purpose of the current study was to investigate the effect of preoperative sarcopenia on postoperative complications in patients undergoing esophagectomy for esophageal cancer. Methods This retrospective study includes all patients who underwent full-robotic abdominothoracic esophageal resection because of esophageal cancer at our institution between 06/2020 and 12/2022. The skeletal muscle index (SMI) was assessed using the preoperative computed tomographic staging scans by measuring the cross-sectional muscle area at the third lumbar vertebral level. Following cut off SMI values were used to define sarcopenia: men: 52,4 cm2/m2, women: 38,5 cm2/m2 according to Prado et al (Lancet Oncol, 2008). Recorded parameters included demographic data, neo-adjuvant treatment, histologic findings, postoperative course and overall- and disease-free survival. Results A total of 113 cases were included in this preliminary analysis. 97 patients (86%) were classified as having sarcopenia. Of these, 38 patients (40%) had a preoperatively or during esophageal resection implemented percutaneous endoscopic jejunostomy (PEJ) tube to ensure enteral nutrition. Despite age, groups were comparable regarding neoadjuvant treatment and histologic findings (mean age sarcopenic patients: 66y vs. 61y non-sarcopenic patients, p = 0.03). There was no difference in the incidence of occurrence of anastomotic leakage, pulmonary complications, need for re-operation, length of (ICU) stay and overall- and disease-free survival between sarcopenic and non-sarcopenic patients. Conclusion Incidence of sarcopenia is very high among esophageal cancer patients. In our study population, however, preoperative sarcopenia failed to predict complications or long-term outcome after esophagectomy for esophageal cancer. 40% of the sarcopenic patients received a PEJ. This relatively high proportion of implemented PEJ could have contributed to the observed comparable outcomes between sarcopenic and non-sarcopenic patients. This observation underlines the importance of prehabilitation and nutritional support for patients with preoperative sarcopenia.

Effects of Number of Filters and Frequency Cutoff in Continuous Interleaved Sampling and Frequency Amplitude Modulation Encoding Schemes in Cochlear Implant

Cochlear implants are devices designed to transform sound into electrical signals perceived by the brain, making them vital prostheses for deaf individuals. This study examines two schemes used in cochlear implants, namely Continuous Interleaved Sampling (CIS) and Frequency Amplitude Modulation Encoding (FAME), to compare their performance while varying the number of bandpass filters and cutoff frequencies used. Both schemes were simulated using 8 and 5 bandpass filters, and cutoff frequencies of 2000 Hz and 200 Hz. Results show that the CIS scheme can maintain signal intelligibility despite the loss of some frequency components when the number of bandpass filters is lowered. Conversely, FAME retains more frequency details but presents perceptible delays. With a cut off frequency of 200 Hz, signals processed with CIS loses intelligibility significantly, whereas FAME-processed signals remain intelligible both at 200 Hz and 2000 Hz cut off frequencies. It is therefore concluded that FAME can provide better cochlear implant performance despite the lower number of bandpass filters and lower frequency cutoff.

Will the new definition of a building structure as a subjectof real estate tax put an end to interpretation disputes?

Cascading terminological connections with the provisions of construction law have led to a pathological mechanismof amending the real estate tax without changing the tax act, but through changes to a large group of normativeacts that, prima facie, have nothing to do with taxes. As a result of the Constitutional Tribunal’s judgmentin case SK 14/21, the Ministry of Finance prepared an amendment to the Act on local taxes and fees, which is intendedto cut off connections with the provisions of construction law.

IA-Body Composition CT at T12 in Idiopathic Pulmonary Fibrosis: Diagnosing Sarcopenia and Correlating with Other Morphofunctional Assessment Techniques.

Body composition (BC) techniques, including bioelectrical impedance analysis (BIVA), nutritional ultrasound® (NU), and computed tomography (CT), can detect nutritional diagnoses such as sarcopenia (Sc). Sc in idiopathic pulmonary fibrosis (IPF) is associated with greater severity and lower survival. Our aim was to explore the correlation of BIVA, NU and functional parameters with BC at T12 level CT scans in patients with IPF but also its relationship with degree of Sc, malnutrition and mortality. This bicentric cross-sectional study included 60 IPF patients (85.2% male, 70.9 ± 7.8 years). Morphofunctional assessment (MFA) techniques included BIVA, NU, CT at T12 level (T12-CT), handgrip strength, and timed up and go. CT data were obtained using FocusedON®. Statistical analysis was conducted using JAMOVI version 2.3.22 to determine the cutoff points for Sc in T12-CT and to analyze correlations with other MFA techniques. the cutoff for muscle area in T12-CT was ≤77.44 cm2 (area under the curve (AUC) = 0.734, sensitivity = 41.7%, specificity = 100%). The skeletal muscle index (SMI_T12CT) cutoff was ≤24.5 cm2/m2 (AUC = 0.689, sensitivity = 66.7%, specificity = 66.7%). Low SMI_T12CT exhibited significantly reduced median survival and higher risk of mortality compared to those with normal muscle mass (SMI cut off ≥ 28.8 cm/m2). SMI_T12CT was highly correlated with body cell mass from BIVA (r = 0.681) and rectus femoris cross-sectional area (RF-CSA) from NU (r = 0.599). Cronbach's α for muscle parameters across different MFA techniques and CT was 0.735, confirming their validity for evaluating muscle composition. T12-CT scan is a reliable technique for measuring low muscle mass in patients with IPF, specifically when the L3 vertebrae are not captured. An SMI value of <28.8 is a good predictor of low lean mass and 12-month mortality in IPF patients.

Salient magnetic resonance imaging findings in the differential diagnosis of benign, borderline and malignant ovarian mucinous tumors.

In mucinous ovarian tumors, preoperative prediction of histological subgroup is important for treatment approach. Therefore, we aimed to determine salient magnetic resonance imaging (MRI) findings and estimate optimal cut off values for quantitative features in differential diagnosis of benign, borderline and malignant mucinous ovarian tumors. Between January 2011 and December 2021, preoperative MRI scans of 50 patients with mucinous ovarian tumors (n = 54) were evaluated retrospectively. MRI findings [size, signal intensity, contrast pattern, features of loculation, wall, septa and mural nodule (MN), diffusion restriction] were investigated. There were benign, borderline, and malignant groups based on histopathological results. The relationship between radiological and histopathological results was analyzed by performing Kruskal Wallis test, Pearson's chi-squared test, receiver operating characteristic analysis. In our study, there were 54 mucinous ovarian tumors in 50 patients. Of 54, 33 were benign, 13 borderline and eight malignant tumors. In comparison of three groups, tumor size, number of loculation, number and frequency of MN were higher and apparent diffusion coefficient (ADC) value were lower in malignant group (p < 0.05). Septa thickness was lower with optimal cut off value of 2.45mm in benign group compared to borderline and malignant groups [sensitivity: 79%, specificity: 75%, AUC (Area under the curve): 0.861] (p < 0.05). T2-weighted (T2-w) signal intensity ratio (SIR) of MN was higher in borderline compared to malignant group, with a cut-off value of 3.9 (sensitivity: 85%, specificity: 83%, AUC: 0.943) (p < 0.05). Ascites was also significant in malignant group (p < 0.05). T2-w SIR of MN with a cut off value of 3.9 is beneficial for differential diagnosis. By awareness of some salient MRI findings (size, septa thickness, number of loculation, number and T2-w SIR of MN, ADC value and ascites), preoperative prediction of histological subgroup of mucinous tumors for appropriate treatment planning is possible.

Serum ferritin measurements differ according to assay used: implications for iron therapy in restless legs syndrome.

Serum ferritin levels are used to determine the need for iron supplementation in patients with RLS. The purpose of the study was to determine whether immunoassay measurement of serum ferritin yields varying levels according to different manufacturer assays, with resultant variation in cut off values. We compared serum ferritin levels using 116 clinical samples assessed by the Beckman and Roche methods. While there was a high correlation between results obtained from the 2 methods (R2 = 0,99), the absolute values differed. The equivalent ferritin measures determined by Beckman, Roche were: 50 mcg/dL, 83 mcg/dL; 75 mcg/dL, 121 mcg/dL; 100 mcg/dL, 158 mcg/dL; and 300 mcg/dL, 457 mcg/dL. It is uncertain which assays were used to measure serum ferritin in the seminal studies on which current guidelines for iron therapy for RLS are based. In view of this uncertainty, as well as the limited data on which current recommendations are based, clinicians should be flexible in using recommended serum ferritin cut off values, also utilizing percentage transferrin saturation. Assuming that Beckman or equivalent assays were used, centers using the Roche method need to adjust the cut offs for administration of oral iron and intravenous iron recommended by current practice guidelines to avoid withholding treatment for RLS patients who might benefit from iron supplementation.

Feasibility of individualized home exercise programs for patients with head and neck cancer-study protocol and first results of a multicentre single-arm intervention trial (OSHO #94).

Patients with head and neck cancer (PwHNC) benefit from targeted exercise interventions: symptom relief, compensation for dysfunction, improvement in quality of life (QoL). Data on acceptance physical interventions in PwHNC are rare. The 'OSHO #94' trial investigates the short- and medium-term effects of individualized home exercise in PwHNC on QoL, physical activity and functionality. The study includes a feasibility phase (proof of concept) in order to evaluate the acceptance. Here we present the study protocol as well as the feasibility results. This prospective, multicentre, single-arm intervention study includes PwHNC ≥18 years of age in aftercare or palliative care with stable remission under immunotherapy. The study opened in January 01, 2021, with estimated completion by December 31, 2024. The PwHNC receive an individualized home exercise program consisting of mobilization, coordination, strengthening and stretching exercises. This should be carried out at least three times a week over 12 weeks for 15 to 30 minutes, supplemented by aerobic training two to three times a week for 30 minutes (intervention). Once weekly telephone calls with a physiotherapist are performed. Subsequently, there is a 12-week follow-up (FU) without exercise specifications/contact. Outcomes are measured before and after the intervention and following the FU. Primary outcome of the feasibility phase (n = 25) was the determination of the dropout rate during the intervention with a termination cut off if more than 30% PwHNC withdrew premature. The primary outcome of the OSHO #94' trial (N = 53) is the change in global QoL score from pre- to post-intervention (EORTC QLQ-C30). Secondary outcomes include clinical and patient-reported measures, training details as well as functional diagnostic data (e.g. level of physical activity, training frequency, flexibility, fall risk and aerobic performance). 25 PwHNC were enrolled onto the feasibility cohort. Only16% (4/25 patients) did not complete the study. Therefore, recruitment of PwHNC was continued. The dropout rate was adjusted from 30% (N = 60) to 20% (N = 53, calculated sample size n = 42 PwHNC and 20% (n = 11) to dropout). Individualized home exercise programs in PwHNC in aftercare seem feasible. Consequently, the aim is now to evaluate the short and medium-term effects of individualized home exercise.

Efficacy of the Dapivirine Vaginal Ring Accounting for Imperfect Adherence.

Product adherence is critical to obtaining objective estimates of efficacy of pre-exposure prophylactic interventions against HIV-1 infection. With imperfect adherence, intention-to-treat analyses assess the collective effects of complete, sub-optimal and non-adherence, providing a biased and attenuated estimate of the averagecausal effect of an intervention. Using data from the MTN-020/ASPIRE phase III trial evaluating HIV-1 efficacy of the dapivirine vaginal ring, we conducted per-protocol, and adherence-adjusted causal inference analyses using principal stratification and marginal structural models. We constructed two adherence cut offs of ≥ 0.9mg (low cutoff) and > 4.0mg (high cutoff) that represent drug released from the ring over a 28-day period. The HIV-1 efficacy estimate (95% CI) was 30.8% (3.6%, 50.3%) (P = 0.03) from the per-protocol analysis, and 53.6% (16.5%, 74.3%) (P = 0.01) among the highest predicted adherers from principal stratification analyses using the low cutoff. Marginal structural models produced efficacy estimates (95% CIs)ranging from 48.8 (21.8, 66.4) (P = 0.0019) to 56.5% (32.8%, 71.9%) (P = 0.0002). Application of adherence-adjusted causal inference methods are useful in interpreting HIV-1 efficacy in secondary analyses of PrEP clinical trials.

The Immigration and Strategic Assimilation of Bene Menashe: A Zomian Jewish Community in Israel

ABSTRACT Based on ethnographic fieldwork conducted among a community of immigrants from the Eastern Indian states of Manipur and Mizoram, Bene Menashe, this article deals with how these immigrants have used ethnic identity to further integrate into mainstream Jewish and Israeli society. Originally known as the Kuki-Chin-Mizo, Bene Menashe claim to be descendants of the lost tribes of Israel, cut off from other Jews for 2,700 years. Several thousand members of the community have emigrated to Israel since the 1990s. Bene Menashe’s background as a singular community of East Asian immigrants in the peripheral town of KA and as recent converts to Judaism, as well as their Zomian (Upland Southeast Asian) background, are central to the community’s negotiation of ethnoreligious identity. Their efforts to integrate into contemporary Israeli society often contrast with the drive of Israeli cultural agents to emphasise the group’s lost tribal heritage, and the community has also both emphasised and sought to discard their previous ethnic identity. Bene Menashe in KA, this article shows, employ several strategies to further their ‘strategic assimilation’ into Israeli society.

Magnitude of anemia and associated factors among adults with tuberculosis in Galkaio Public Health Facilities Puntland, Somalia 2024: A cross-sectional study design

Background: Treatment of anemia associated with TB may involve addressing the underlying cause, such as improving nutrition or managing inflammation, and sometimes may require blood transfusions. Objective: The objective of this study is to assess the magnitude of anemia and associated factors among adults with tuberculosis in Galkaio town Public Health Facilities Puntland, Somalia 2024. Methods: A facility-based cross-sectional study was used. A total sample of 422 adults with tuberculosis include in this study. Attending Health facilities in Galkaio town. Systematic random sampling technique was used to select the study participants. Structured questionnaires were used to obtain information related to socio-demographic characteristics. Data from both questioner and laboratory were checked and cleaned for completeness and consistency. Data was entered into Epi data version 3.1 and was analyzed using Statistical Package for the Social Science (SPSS) Version 20 statistical software. Both bivariate with cut off &lt; 0.25 and multivariate with cut off &lt; 0.05 analysis has been used to check the strength of association between dependent and independent variables. Result: The overall magnitude of anemia was 82.7% CI :( 78.09, 86.31).In multivariable logistic regression analyses, the odds of anemia were 4.23 times higher for patients aged between 41-50 years [AOR=4.23, 95% CI (1.92,9.34)] compared to those aged between 18-30 years, 6.12 times higher for patients unable to read and write compared to those who had a college diploma and above [AOR=6.12, 95% CI (2.63,14.2)], and 5.71 times higher for patients who had not started taking Anti-TB drugs compared to those who had started [AOR=5.71, 95% CI (2.68,12.14)]. Conclusion: the magnitude of anemia among adults with tuberculosis in the study area was found to be high (82.7%). The study revealed that age, gender, occupation, TB treatment status, started taking Anti-TB drugs, and BMI as key factors associated with anemia. These findings underscore the importance of targeted interventions and healthcare strategies for at-risk individuals, with the aim of reducing the burden of anemia.

Comparison of community ambulation intensity determined from overground and treadmill walking cadence cut points: Is there a relationship between step activity measures and predicted VO2 max in healthy children and adults?

BackgroundThis study was designed to evaluate the effect of using maximal cadence criteria cut points established during overground and treadmill walking, on intensity outputs measured during community ambulation. The second aim was to establish the relationship between cardiovascular fitness (predicted VO2 max capacity) and community ambulation intensity performance, in typically developing individuals. Research QuestionWhat is the effect on intensity measures when using cadence cut point criteria derived from overground and treadmill walking and does predicted VO2 max correlate with exercise related community activity in a typically developing population? MethodsA group of 37 typically developing participants between 8 and 27 years of age, underwent a graded submaximal VO2 testing protocol followed by a typical week of community ambulation, recorded with a step activity monitor. Maximum cadence criteria established during overground and treadmill walking were applied and the data were compared. The weekly step activity variables included: total steps, total ambulatory time, intensity, duration, and volume. Predicted VO2 Max was calculated, and correlations calculated to step activity outputs. ResultsResults showed significant differences (p<0.001) between cadence cut point criteria across all intensity measures except in the amount of time spent in the 30–60 % intensity category (p=0.182). Predicted VO2 max did not significantly correlate with step activity outputs related to exercise (moderate+ intensity and long duration ambulatory bouts; p>0.277). SignificanceThis study illustrates the importance of close consideration in applying recommended cut off criteria when assessing intensity outputs from step activity data. Cadence from both overground and treadmill walking were collected in a controlled lab setting, but the influence of the treadmill mechanical and forced cadence criteria must be considered when selecting intensity cut points.

Family, global conflict, and imperial migration: Paul Messi’s First World War

ABSTRACT The German Empire collapsed at the end of the First World War, necessitating a re-negotiation of the legal and social status of its former imperial subjects. This article discusses the wartime experience of Paul Messi, a Cameroonian language assistant at the Colonial Institute, Hamburg. Messi moved to Germany in 1913 to succeed his uncle, Karl Atangana who had returned to Cameroon to become Paramount Leader of the Ewondo and Bane. Atangana had secured the position in Germany for his nephew along with providing him with a stipend. The outbreak of war saw Messi stranded in Hamburg, suffering from ill health and cut off from financial assistance. However, due to Atangana’s petitioning to the German government, his daughter Katharina, and Messi were reunited in Madrid before repatriation in 1919. The return to Cameroon was difficult, Messi, despite his desire to leave Germany, was treated as a suspect person by the French authorities. Focusing on Messi’s account of his experiences, this paper highlights how the war not only disrupted intra-empire familial connections but also how these connections enabled a negotiated return to Mandate Cameroon in the early post-war period.

The prevalence of pain catastrophising in nulliparous women in Nepal; the importance for childbirth.

In Lower-Middle-Income-Countries women are encouraged to present at a birthing facility for skilled care, but attending early can be associated with additional harm. Women admitted in latent labour are more likely to receive a cascade of unnecessary interventions compared with those attending a birthing facility during active labour. One reason that women present early is pain, with higher rates of admission among those who pain catastrophise. The aim of this study was to explore the prevalence of pain catastrophising in nulliparous women in Nepal and to identify predictors for pain catastrophising. A cross sectional study was conducted using a semi-structured survey. The survey was completed by 170 women (18-32 years) in one higher education institution in Kathmandu. The survey included the pain catastrophising scale (PCS), current and previous pain and information about period pain, sociodemographic variables of age, ethnicity, and religion. The prevalence of pain catastrophising reported at a cut off score of PCS≥20 was 55.9% and at a cut off score of PCS≥30 was 17.1%. All women with a PCS ≥30 reported having painful periods. Those with a PCS≥20 were four times [95%CI 1.93-8.42] more likely to report painful periods affecting their daily activities (p<0.001) and those with PCS≥30 three times [95%CI1.10-10.53] more likely (p<0.05). In both cases ethnicity and age were not associated. Women with higher PCS were less likely to take pain medication. A high prevalence of pain catastrophising was reported. It is important to understand how women's previous negative experiences of pain and pain catastrophising are perceived and if they are contributing to the rise in obstetric intervention, particularly caesarean births, in Nepal. We recommend repeating this study with a larger sample representing a more diverse population.

Factors associated with Edinburgh Cognitive and Behavioural ALS Screen (ECAS) alteration at time of diagnosis, in amyotrophic lateral sclerosis

BackgroundEdinburgh Cognitive and Behavioral ALS Screen (ECAS) is a validated assessment designed to screen cognitive functions and behavioral disorders in amyotrophic lateral sclerosis (ALS). Objective of this study is to determine the factors associated with ECAS impairment in a cohort of ALS patients without a co-morbid diagnosis of dementia, at the time of diagnosis. MethodsWe enrolled 71 non-demented ALS patient. We collected clinical and demographic data, ALS familiarity, analysis of the most commonly mutated genes in ALS, ALS Milano Torino Staging System and ALS Functional Rate Scale revised scores, progression rate; finally, we recorded whether symptoms onset involved spinal or bulbar area. The alteration of the ECAS was estimated based on age and education-adjusted-validated cut off for each of the items included in ECAS. A multivariable regression analysis was done. ResultsThe significant determinants of ECAS alterations were: bulbar onset in both ALS-specific test and total ECAS score; bulbar onset and familiarity in ALS-non-specific test; finally, familiarity and diagnosis delay in ALS-behavioral test. All the subjects carrying C9orf72 mutations had alteration of both total ECAS score and ALS-specific tests. DiscussionAt diagnosis, bulbar-onset ALS, family history, diagnosis delay and C9orf72 hexanucleotide repeat expansion may contribute to impairment of ECAS.

Solid oxide fuel cell (SOFC) control strategy enhancement by adaptive neuro-fuzzy inference system (ANFIS)

Global warming is a vital problem that many researchers tried to solve with so many solutions such as: reducing electricity production with conventional generators by using renewable energy resources and using hydrogen as an alternative to fossil fuels. The universal Economic crisis came across to cut off certain quantities at scheduled times. This, directly, affects renewable energy sources connected to the grid due to voltage and frequency variations. To solve this dilemma, in this paper, the grid-connected solid oxide fuel cell (SOFC) model which is fed by green hydrogen to produce AC power, is developed by an Adaptive neuro-fuzzy inference system (ANFIS). It is one of the artificial intelligence applications to improve grid-connected SOFC dynamic response. ANFIS is mathematically presented and simulated using MATLAB/SIMULINK. The results show that the ANFIS controller has succeeded in enhancing most of the desired control and operation signals.

Compact microstrip lowpass filter with wide stopband and sharp transition band using radial stub resonator

This study introduces a compact microstrip lowpass filter that offers a wide stopband and a low transition band. The couple radial stubs are designed for having sharp roll-off. The filter has a −3 dB cut off frequency of 1.6 GHz, with a transition band ranging from 1.6 to 1.7 GHz with attenuation levels of −3 dB and −20 dB, respectively. To ensure a wide stopband, the filter utilizes bended transmission lines with stepped impedance suppressing cells, resulting in a stopband attenuation of 20 dB from 1.7 to 28 GHz. The insertion loss in the passband is less than 0.1 dB, and the overall size of the filter is 0.127 × 0.087 λg2.

Experiences of and treatment preferences for insomnia in autistic adults: An Interpretative Phenomenological Analysis

Insomnia and insomnia symptoms are frequent experiences of autistic people resulting in pronounced daytime effects and poor quality of life. This study employed an Interpretive Phenomenological Analysis approach to explore lived experiences of autistic adults with insomnia, perspectives on current available interventions and future treatment preferences. Twelve participants (aged 21–48 years old) were interviewed following screening for insomnia, using the Sleep Condition Indicator (scores ranged from 1 to 12; cut off >16). Each interview was analysed individually developing Personal Experiential Themes for each case, which were then mapped across cases based on identified patterns and connections. Results yielded rich personal accounts and identified two Group Experiential Themes: “The Night is Friendlier” and “It Doesn't Really Work for Me”. Participants described experiences with sleeplessness throughout their adult lives and often since childhood. They discussed how the night time offers them a more relaxed and safe space to freely behave as they wish. Advice and interventions were viewed by participants via the prism of underlying social issues, such as autism acceptance and trust, and how these structures can affect participants' experiences with insomnia, help seeking and effectiveness of current interventions. Our results highlight the need for inclusion of autistic people in insomnia research through co-production and co-creation as well as clinical practice and delivery. This is the first study to integrate perspectives and experiences of autistic people towards insomnia and sleep-related advice by health care professionals. Findings are discussed in relation to theoretical and practical implications, as well as directions for future research.

Substituting Na for Excess Li in Li1+x(Ni0.6Mn0.4)1−xO2 Materials

NMC640, a series of Li1+x(Ni0.6Mn0.4)1−xO2 materials, are important Co-free mid-Ni cathode materials for Li-ion batteries, offering high energy density and better cost-efficiency than Ni-rich counterparts. These materials require excess Li compared to stoichiometric composition to improve the electrochemical performance in terms of rate capability and cycling stability. Although lithium-to-transition metal ratios up to 1.15 can be used to optimize the performance, less than 80% of this lithium is electrochemically active during cycling up to a 4.4 V upper cut off. This study explores whether some percentage of the inactive Li can be replaced by sodium to make these materials more cost-effective and bring potential improvements in electrochemical performance. Various amounts of excess Li were substituted by sodium in the structure. The results show that sodium can be integrated into the layered oxide structure without forming any impurity phases and effectively decreases the cation mixing observed in these layered structures. However, this does compromise cycling stability and rate capability. Na tends to occupy Li sites rather than transition metal sites, resulting in electrochemical instability and capacity loss. Even though excess Li is not electrochemically active, it cannot be effectively replaced by sodium without compromising battery performance of Li1+x(Ni0.6Mn0.4)1−xO2 materials.