Behavioral Disturbances Research Articles

Behavioral and Psychological Symptoms of Dementia and Mortality Risk Among People With Cognitive Impairment: An 8-year Longitudinal Study From the NCGG-STORIES.

Behavioral and psychological symptoms of dementia (BPSD) are common among people with dementia from the early stages and can appear even in mild cognitive impairment (MCI). However, the prognostic impact of BPSD is unclear. This study examined the association between BPSD and mortality among people with cognitive impairment. This longitudinal study involved 1,065 males and 1,681 females (mean age: 77.1 years for males and 78.6 years for females) with MCI or dementia diagnosis from the National Center for Geriatrics and Gerontology-Life Stories of People with Dementia (NCGG-STORIES), a single-center memory clinic-based cohort study in Japan that registered first-time outpatients from 2010-2018. Information about death was collected through a mail survey returned by participants or their close relatives, with an up to 8-year follow-up. BPSD was assessed using the Dementia Behavior Disturbance Scale (DBD) at baseline. During the follow-up period, 229 (28.1%) male and 254 (15.1%) female deaths occurred. Cox proportional hazards regression analysis showed that higher DBD scores were significantly associated with increased mortality risk among males, but not females (compared with the lowest quartile score group, hazard ratios for the highest quartile score group were 1.59; 95% confidence interval, [CI] 1.11-2.29 for males and 1.06; 95% CI, 0.66-1.70 for females). Among the DBD items, lack of interest in daily living, excessive daytime sleep, and refusal to receive care had a higher mortality risk. The findings suggest a potential association between BPSD and poor prognosis among males with cognitive impairment.

PP510 Topic: AS22–Quality and Safety/Errors/Data Management/Other: DEVELOPMENT OF A PATIENT CENTERED APPROACH TO THE MANAGEMENT OF ACUTE SEVERE BEHAVIOURAL DISTURBANCE IN PICU: A QUALITY IMPROVEMENT INITIATIVE.

PP510 Topic: AS22–Quality and Safety/Errors/Data Management/Other: DEVELOPMENT OF A PATIENT CENTERED APPROACH TO THE MANAGEMENT OF ACUTE SEVERE BEHAVIOURAL DISTURBANCE IN PICU: A QUALITY IMPROVEMENT INITIATIVE.

Ascorbic acid Mitigates behavioural disturbances associated with letrozole-induced PCOS via switching-off JAK2/STAT5 and JAK2/ERK1/2 pathways in rat hippocampus

PurposePolycystic ovary syndrome (PCOS) is an endocrine disorder with the highest prevalence among other disorders in sexually-active women. It is associated with broad-spectrum hormonal and metabolic disturbances with behavioural difficulties. Experimentally, letrozole administration causes similar findings. Ascorbic acid is powerful anti-oxidant; and its cellular levels decrease with “hyperglycemic and poor anti-oxidative” status, which is, a main hallmark of PCOS. Thus, ascorbic acid administration may prevent the induction of PCOS and its consequences.Basic procedures: Forty female rats were divided into four groups (n = 10 in each): normal control (CTRL), ascorbic acid (ASC), letrozole (LTZ), and ascorbic acid + letrozole (ASC + LTZ) group. Behavioural tests (Y-maze spontaneous alteration, tail suspension test, forced swimming test) were performed. In serum, hormones (testosterone, estradiol, progesterone), glycemia (blood glucose, insulin and HOMA-IR) and oxidative stress (SOD activity, GSH) markers were measured. In hippocampus, inflammation and apoptosis indicators (p-JAK2, p-STAT5, p-ERK1/2, NF-κB, BAX, Bcl2, BAX/Bcl2 ratio) and neurotransmitters (DA, 5-HT, NE, BDNF) were determined. Lastly, ovary histopathological investigation was conducted to confirm PCOS induction.Principal results: Letrozole induced PCOS with subsequent disturbances. Testosterone levels were augmented while estradiol and progesterone were declined. Fasting blood glucose, insulin, HOMA-IR and oxidative stress markers were elevated. The expression of p-JAK2, p-STAT5, p-ERK1/2, BAX and the levels of NF-κB were increased, but Bcl2 expression, monoamines and BDNF levels were lowered. Importantly, ASC abated the last mentioned parameters markedly. Major conclusions: Ascorbic acid mitigated the behavioural difficulties of PCOS possibly by switching-off JAK2/STAT5 and JAK2/ERK1/2 pathways in hippocampus along with its neurotransmission-improving, hormonal-normalizing, anti-hyperglycemic and anti-oxidative effects.

Monoallelic loss-of-function variants in GSK3B lead to autism and developmental delay.

De novo variants adjacent to the canonical splicing sites or in the well-defined splicing-related regions are more likely to impair splicing but remain under-investigated in autism spectrum disorder (ASD). By analyzing large, recent ASD genome sequencing cohorts, we find a significant burden of de novo potential splicing-disrupting variants (PSDVs) in 5048 probands compared to 4090 unaffected siblings. We identified 55 genes with recurrent de novo PSDVs that were highly intolerant to variation. Forty-six of these genes have not been strongly implicated in ASD or other neurodevelopmental disorders previously, including GSK3B. Through international, multicenter collaborations, we assembled genotype and phenotype data for 15 individuals with GSK3B variants and identified common phenotypes including developmental delay, ASD, sleeping disturbance, and aggressive behavior. Using available single-cell transcriptomic data, we show that GSK3B is enriched in dorsal progenitors and intermediate forms of excitatory neurons in the developing brain. We showed that Gsk3b knockdown in mouse excitatory neurons interferes with dendrite arborization and spine maturation which could not be rescued by de novo missense variants identified from affected individuals. In summary, our findings suggest that PSDVs may play an important role in the genetic etiology of ASD and allow for the prioritization of new ASD candidate genes. Importantly, we show that genetic variation resulting in GSK3B loss-of-function can lead to a neurodevelopmental disorder with core features of ASD and developmental delay.

The COVID-19 Pandemic Increased the Risk of Eating Disorders and Emotional Eating Symptoms: A Review of the Current Clinical Evidence

Background: There has been recent evidence to suggest that people who suffer from eating disorders (EDs) or other eating behavior disturbances, such as emotional eating (EE), are particularly vulnerable post-COVID-19. This narrative literature review aims to comprehensively analyze and scrutinize the existing clinical studies regarding the effects of the COVID-19 pandemic on people with EDs or EE. Moreover, due to the COVID-19 pandemic, it is very important to find out whether a person’s emotional state may lead them to wrongly confront their emotional behavior with food consumption. Methods: A thorough search of several databases (PubMed, Scopus, Web of Science, Public Library of Science, Google Scholar, CINAHL Complete, PsycINFO, and Academic Search Complete) was performed to identify available clinical studies on the COVID-19 pandemic published between 2020 and 2024 using relevant keywords. Results: There is substantial evidence that the COVID-19 pandemic exerted negative effects on persons suffering from EDs, including those who are symptomatic, those who are in remission, and those with an EE behavior. Characteristically, people diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED) showed considerable symptomatic worsening after the first wave of the COVID-19 pandemic. Clinical studies investigating the effects of the COVID-19 pandemic on persons suffering from EE have also clearly demonstrated that their mood disturbances negatively affected their eating behaviors. These studies have also shown that vulnerable people were at greater risk of EE development and progression during the COVID-19 pandemic. Conclusion: The COVID-19 pandemic seems to have exerted a significant deleterious effect on people who have a history of suffering from EDs or EE. The COVID-19 pandemic has been related to the frequency of dysfunctional eating behaviors, thus decreasing therapeutic intervention efficiency in people with EDs as well as in those with disturbed eating behaviors such as EE. In this aspect, further clinical studies are strongly recommended to investigate the exact effects of the COVID-19 pandemic as well as to explore their potential long-term deleterious complications in the post-pandemic period. Public strategies and policies should be applied to provide special healthcare for this group of patients.

Regional cerebral blood flow in behavioral variant of FTD: hypoperfusion patterns and clinical associations.

Findings from functional neuroimaging techniques, such as single-photon emission computed tomography (SPECT), may add useful evidence improving Frontotemporal Dementia (FTD) diagnosis. The aim of the present study was to investigate patterns of hypoperfusion in a group of patients diagnosed with the behavioral variant of FTD (bvFTD) and to explore the relationship between brain perfusion and clinical characteristics. Brain perfusion of 23 bvFTD patients was measured with SPECT scintigraphy in lobes and Brodmann areas (BAs) and the NeurogamTM software was used for image analysis. To assess behavioral disturbances and dementia severity, patients' informants completed the Frontotempotal Behavioral Inventory and the Frontotemporal Dementia Rating Scale. Descriptive statistics were used for the detection of pathological hypoperfusion in lobes and selected BAs. Associations among patients' clinical characteristics and perfusion in lobes were explored via non-parametric correlations. Participants presented pathological hypoperfusion in frontal, limbic and temporal lobes. The most prominent deficit was observed in limbic lobes, where all participants showed pathological hypoperfusion. Decreased perfusion was also observed in limbic, frontal and temporal BAs. Perfusion in the left and right frontal lobe was associated with behavioral disturbances and disease severity, which was also correlated with perfusion in right limbic, left and right temporal areas. Patterns of limbic, frontal and temporal hypopefusion were reported in the present study, along with associations between brain perfusion, behavioral disturbance and severity of dementia. Perfusion patterns can help to understand further associated brain biomarkers, contributing to early diagnosis and intervention in bvFTD.

OSFED Subtypes: The Need for Better Definitions.

Other specified feeding and eating disorders (OSFED) is a diagnostic category in DSM-5 describing individuals with clinically significant eating behavioral disturbances that do not meet criteria for full-threshold eating disorder diagnoses. OSFED includes five example subgroups: atypical anorexia nervosa, sub-threshold bulimia nervosa, sub-threshold binge-eating disorder, purging disorder, and night eating syndrome. A recent review of OSFED by Dang et al. aims to examine differences between OSFED and full-threshold eating disorders as well as between OSFED and healthy populations but is limited by the lack of clear definitions of OSFED subtypes and methodological differences across studies. Clearer diagnostic definitions for OSFED subtypes are needed. Consideration should also be given to indicators of lifetime history of full-threshold conditions, diagnostic drift, and remission criteria as OSFED categories undergo further study.

Behavioral disorders in Parkinson disease: current view.

Patients with Parkinson disease (PD) frequently experience several behavioral symptoms, such as anxiety, apathy, irritability, agitation, impulsive control and obsessive-compulsive or REM sleep behavior disorders, which can cause severe psychosocial problems and impair quality of life. Occurring in 30-70% of PD patients, these symptoms can manifest at early stages of the disease, sometimes even before the appearance of classic motor symptoms, while others can develop later. Behavioral changes in PD show distinct patterns of brain atrophy, dopaminergic and serotonergic deterioration, altered neuronal connectivity in frontostriatal, corticolimbic, default mode and other networks due to a cascade linking molecular pathologies and deficits in multiple behavior domains. The changes suggest a multi-system neurodegenerative process in the context of a specific α-synucleinopathy inducing a variety of biochemical and functional changes, the neurobiological basis and clinical relevance of which await further elucidation. This paper is intended to review the recent literature with focus on the main behavioral disturbances in PD patients, their epidemiology, clinical features, risk factors, animal models, neuroimaging findings, pathophysiological backgrounds, and treatment options of these deleterious lesions.

Pharmacotherapy for behavioural manifestations in frontotemporal dementia: An expert consensus from the European Reference Network for Rare Neurological Diseases (ERN-RND).

Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by pervasive personality and behavioural disturbances with severe impact on patients and caregivers. In current clinical practice, treatment is based on nonpharmacological and pharmacological approaches. Unfortunately, trial-based evidence supporting symptomatic pharmacological treatment for the behavioural disturbances in FTD is scarce despite the significant burden this poses on the patients and caregivers. The study examined drug management decisions for several behavioural disturbances in patients with FTD by 21 experts across European expert centres affiliated with the European Reference Network for Rare Neurological Diseases (ERN-RND). The study revealed the highest consensus on drug treatments for physical and verbal aggression, impulsivity and obsessive delusions. Antipsychotics (primarily quetiapine) were recommended for behaviours posing safety risks to both patients and caregivers (aggression, self-injury and self-harm) and nightly unrest. Selective serotonin reuptake inhibitors were recommended for perseverative somatic complaints, rigidity of thought, hyperphagia, loss of empathy and for impulsivity. Trazodone was specifically recommended for motor unrest, mirtazapine for nightly unrest, and bupropion and methylphenidate for apathy. Additionally, bupropion was strongly advised against in 10 out of the 14 behavioural symptoms, emphasizing a clear recommendation against its use in the majority of cases. The survey data can provide expert guidance that is helpful for healthcare professionals involved in the treatment of behavioural symptoms. Additionally, they offer insights that may inform prioritization and design of therapeutic studies, particularly for existing drugs targeting behavioural disturbances in FTD.

It’s a battlefield! A thematic analysis of narratives shared in Cape Town emergency departments

BackgroundThe Emergency Department(ED) team need to make sense of an ever-changing dynamic environment. The stories people tell about everyday occurrences are central to how sense-making occurs. These stories also contribute...

Imaging Glucose Metabolism and Dopaminergic Dysfunction in Sheep (Ovis aries) Brain Using Positron Emission Tomography Imaging Reveals Abnormalities in OVT73 Huntington's Disease Sheep.

Huntington's disease (HD) is a neurodegenerative disease that causes cognitive, movement, behavioral, and sleep disturbances, which over time result in progressive disability and eventually death. Clinical translation of novel therapeutics and imaging probes could be accelerated by additional testing in well-characterized large animal models of HD. The major goal of our preliminary cross-sectional study is to demonstrate the feasibility and utility of the unique transgenic sheep model of HD (OVT73) in positron emission tomography (PET) imaging. PET imaging studies were performed in healthy merino sheep (6 year old, n = 3) and OVT73 HD sheep (5.5 year old, n = 3, and 11 year old, n = 3). Region-of-interest and brain atlas labels were defined for regional analyses by using a sheep brain template. [18F]fluorodeoxyglucose ([18F]FDG) was employed to compare the regional brain glucose metabolism and variations in FDG uptake between control and HD sheep. We also used [18F]fluoro-3,4-dihydroxyphenylalanine ([18F]FDOPA) to compare the extent of striatal dysfunction and evaluated the binding potential (BPND) in key brain regions between the groups. Compared with healthy controls and 11 year old HD sheep, the 5.5 year old HD sheep exhibited significantly increased [18F]FDG uptake in several cortical and subcortical brain regions (P < 0.05-0.01). No difference in [18F]FDG uptake was observed between healthy controls and 11 year old HD sheep. Analysis of the [18F]FDOPA BPND parametric maps revealed clusters of reduced binding potential in the 5.5 year old and 11 year old HD sheep compared to the 6 year old control sheep. In this first-of-its-kind study, we showed the usefulness and validity of HD sheep model in imaging cerebral glucose metabolism and dopamine uptake using PET imaging. The identification of discrete patterns of metabolic abnormality using [18F]FDG and decline of [18F]FDOPA uptake may provide a useful means of quantifying early HD-related changes in these models, particularly in the transition from presymptomatic to early symptomatic phases of HD.

Embryo-restricted responses to maternal IL-17A promote neurodevelopmental disorders in mouse offspring.

Prenatal imprinting to interleukin 17A (IL-17A) triggers behavioral disorders in offspring. However, reported models of maternal immune activation utilizing immunostimulants, lack specificity to elucidate the anatomical compartments of IL-17A's action and the distinct behavioral disturbances it causes. By combining transgenic IL-17A overexpression with maternal deficiency in its receptor, we established a novel model of prenatal imprinting to maternal IL-17A (acronym: PRIMA-17 model). This model allowed us to study prenatal imprinting established exclusively through embryo-restricted IL-17A responses. We demonstrated a transfer of transgenic IL-17A across the placental barrier, which triggered the development of selected behavioral deficits in mouse offspring. More specifically, embryonic responses to IL-17A resulted in communicative impairment in early-life measured by reduced numbers of nest retrieval calls. In adulthood, IL-17A-imprinted offspring displayed an increase in anxiety-like behavior. We advocate our PRIMA-17 model as a useful tool to study neurological deficits in mice.

Damage evolution and acoustic emission characteristics of sandstone under different true triaxial cyclic loading and unloading modes

In the process of deep coal mining, the cyclic mining disturbance behavior produces significant cyclic loading and unloading effects, to ensure safe production in the mining area, it is necessary to study the damage characteristics and acoustic emission characteristics of the rock body under different cyclic loading and unloading effects. This study developed a TAWZ-5000/3000 rock true triaxial (disturbance) test system and used it to carry out true triaxial cyclic loading and unloading tests in different modes, with acoustic emission (AE) monitoring of the deformation and damage processes. The test results proved that a large number of cycles weakens the rock’s ability to control deformation, and this weakening ability is also related to the types of cyclic loading and unloading modes. The hysteresis loop characteristics and mechanical parameters show obvious path dependence. Based on the damage equivalence method, it is found that the absolute damage parameter increases with the increase of the number of cycles in the same mode, and the accumulation rate of the cumulative damage parameter is faster; the cumulative damage parameter in the equal amplitude cyclic loading and unloading (EAC) mode is always higher than that in the other two modes. The normalized AE ring count rate in the rock samples under cyclic loading and unloading has a significant relationship with the damage percentage, and the crack extension scale function (b-value) shows the “steady increase – strong fluctuation − significant decline” trend. By analyzing the AE characteristic parameters, namely rise time/amplitude (RA) and ringing count/duration (AF), it is found that the sandstones in EAC, graded cyclic loading and unloading (GC), and stepped cyclic loading and unloading (SC) modes are mainly damaged by tension-shear and shear, respectively. By analyzing the values of the acoustic emission parameters RA-AF, it is found that the sandstone is mainly damaged by tensile shear, tensile tension, and shear under EAC, GC, and SC modes, respectively, corresponding to the rock samples’ damage patterns. The study results have important guiding significance for preventing and controlling disasters in deep mines.

Huntington Disease Health Related Quality of Life, Function and Well Being: The Patient's Perspective.

Limited information is available on patients' experience living with Huntington's disease (HD). The primary objective of this study was to assess the health-related quality of life and well being of patients with HD. A non-interventional, cross-sectional study was conducted in 17 hospitals-based movement disorders units in Spain. Patients aged≥18years, genetically HD diagnosed [with a diagnostic confidence level score of 4, and an Independence Scale (IS) score≥70] were included. The primary variables were the Huntington's Disease Health-related Quality of Life (HDQLIFE) scores and results of the Satisfaction with Life Scale (SWLS). Secondary outcomes include the Unified HD Rating Scale (UHDRS), Beck Hopelessness Scale (BHS), Stigma Scale for Chronic Illness (SSCI-8), Beck Depression Inventory-Fast Screen (BDI-FS) and Problem Behaviours Assessment for HD short Version (PBA-S). A total of 102 patients were included. The mean age (SD) was 53.1 (12.1) years and 56% were male. Most of the patients (99.0%) showed motor symptoms (87.3%), behavioural and psychiatric disturbances (59.8%), or cognitive impairment (20.6%). HDQLIFE domain score means (SD) includes concern with death and dying 45.97 (9.60) end-of-life planning 37.91 (8.84), and meaning and purpose 44.74 (9.05). SWLS score mean was 24.25 (7.33). Depressive symptoms were found in 37.4% of patients and moderate-to-severe feelings of hopelessness in 32.9%. The prevalence of stigma was 55.9% (n=57). HD impacted quality of life, with prevalent motor, psychiatric symptoms and cognitive impairment. Patient perspectives may provide complementary information to implement specific interventions.

Efficacy of Vagal nerve stimulation on anxiety among elderly retired teachers during COVID-19 pandemic.

Excessive fear, worry and behavioral disturbances define anxiety, with particular significance attributed to vagal nerve, a crucial transmitter of information to the brain regions governing anxiety. Highlighting the importance of vagal nerve, transcutaneous auricular vagal nerve stimulation (TaVNS) emerges as a tolerable and safe technique. The success of non-invasive vagal nerve stimulation in alleviating anxiety underscores the pivotal role of the vagal nerve. The purpose of this study was to assess the effectiveness of physiotherapy interventions in mitigating anxiety among retired teachers during the COVID-19 pandemic, emphasizing the relevance of targeting the vagal nerve for improved mental well-being. 60 retired teachers diagnosed with anxiety were chosen through random allocation. Participants were divided into two groups: Group A (Experimental group) received transcutaneous auricular vagal nerve stimulation (TaVNS), and Group B (Control group) underwent the Jacobson relaxation technique. Intervention period spanned 4 weeks, with four sessions per week, lasting 30 minutes. The outcome measures included Generalized Anxiety Disorder-7 (GAD-7) questionnaire and salivary cortisol levels. Following the 4-week intervention, both groups exhibited a significant reduction in Generalized Anxiety Disorder-7 (GAD-7) scores and salivary cortisol levels (P < 0.001). Notably, Group A demonstrated a significantly higher effectiveness rate compared to Group B. The study concludes that transcutaneous auricular vagal nerve stimulation (TaVNS) is effective in reducing anxiety among retired teachers. Transcutaneous auricular vagal nerve stimulation (TaVNS) proves to be a powerful and effective intervention in alleviating anxiety among retired teachers, emphasizing its potential significance in enhancing mental well-being.

Non-Obscene Socially Inappropriate Behavior in Patients with Gilles de la Tourette Syndrome.

Background/Objectives: Behavioral disturbances are a common phenomenon associated with Gilles de la Tourette syndrome (GTS), which can manifest as non-obscene socially inappropriate behaviors (NOSIBs). The classification of NOSIB has not yet been clearly established. The objective of this study was to determine the frequency, age of onset, and clinical correlation of NOSIB with tic severity and the prevalence of comorbid psychiatric disorders in individuals with GTS. Methods: A total of 365 participants (272 male, 74.5%) with GTS were included in the study. Of these, 278 (76.2%) were children and adolescents. The mean age of the participants at evaluation was 14.4 ± 9.8 years, with a range of 4 to 64 years. The clinical data of NOSIB were collected during a routine, ambulatory examination using half-structured questionnaires developed by the authors. Results: NOSIB was observed in 86 patients with GTS, representing a prevalence of 23.6%. NOSIB commenced at a mean age of 6.6 ± 4.1 years (range 2-19). The mean age at onset of NOSIB was 1.4 ± 3.7 years after the onset of tics, with 18 cases (26.1%) preceding tics and 13 cases (18.8%) starting at the same age as tics. The results of the multivariate analysis confirmed the associations between NOSIB and YGTSS (p = 0.02) and coprophenomena (p < 0.01), as well as ADHD (p < 0.01), ODD (p = 0.01), ASD (p < 0.01), and anxiety disorders (p = 0.02). Conclusions: NOSIB is an early symptom of GTS that typically manifests in childhood and occurs in approximately a quarter of patients. Tic severity and the presence of psychiatric comorbidities, which indicate a more severe disease course, may serve as risk factors for NOSIB.

Prevalence of depressive symptoms among urban school adolescents in Vietnam: The role of youth, family, and school relationships

BackgroundAdolescents frequently encounter a spectrum of psychiatric conditions, predominantly depressive and anxiety disorders, along with various behavioral disturbances. ObjectiveThis investigation aims to delineate the prevalence of depressive disorders among adolescents in urban Vietnam and to elucidate the interrelationships between familial and school-related dynamics and adolescent depression. Materials and MethodsA cross-sectional survey was conducted in 2022, involving 507 students aged 15 to 17 from high schools in Hanoi, Vietnam. Reynolds Adolescent Depression Scale - Second Edition (RADS-2) was used to assess the presence of depressive symptoms. Social-demographic characteristics, adolescent-family and adolescent-school relationships, and academic environment characteristics of high school students were interviewed. Multivariate Tobit regression models were employed to discern contributory factors across four domains of RADS-2. ResultsAmong the 507 adolescents, the mean scores on the RADS scale were 15.1 ± 4.2 for the dysphoric mood domain, 16.4 ± 4.0 for the anhedonia-negative domain, 13.1 ± 4.4 for the negative self-evaluation domain, and 12.4 ± 3.7 for the somatic complaints domain. The analysis indicated that adolescents with suboptimal parental relationships, absence of confidants, frequent parental conflicts, exposure to parental arguments, substantial exam-related stress, or overwhelming academic demands were more likely to exhibit elevated depressive symptoms. Conversely, adolescents who were satisfied with their friendships at school and received care, support from teachers or friends, and involved in school's extracurricular activities lower exhibited levels of depression. ConclusionsFindings reveal the significant impact of family and peer relationships, as well as academic stress, on the development of depressive symptoms. These significant results inform the design and development of future interventions aimed at mitigating depression risks among high school students, emphasizing the crucial roles of both educational institutions and family dynamics.

A Comparison of Ketamine to Midazolam for the Management of Acute Behavioral Disturbance in the Out-of-Hospital Setting

ObjectiveAcute behavioral disturbance is characterized by altered mental status and psychomotor agitation. Pharmacological sedation may be required, risking potential respiratory compromise. We compared the need for emergent airway support following administration of midazolam or ketamine to treat acute behavioral disturbance in the prehospital setting. MethodsIn this retrospective cohort study of patients with acute behavioral disturbance in an urban Emergency Medical Service (EMS) system between 2017-2021, we compared the likelihood of prehospital advanced airway management following administration of midazolam or ketamine. Advanced airway management was defined as prehospital endotracheal intubation or supraglottic airway insertion. ResultsAmong 376 eligible patients, the median age was 35; and 78% were male. The most common etiologies of acute behavioral disturbance were substance use (51%), trauma (18%), and presumed postictal agitation (11%). In all, 162 patients (43%) initially received midazolam and 214 (57%) ketamine. The frequency of advanced airway management was similar between these respective groups (12% [n=19] vs 11% [n=24], difference 0.5%, 95% CI -6.0% to 7.0%). Adjusted for potential confounders, the odds of receiving advanced airway management did not differ between midazolam and ketamine (aOR 1.02, 95% CI 0.44 to 2.38), nor were differences observed in emergency department intubation rates (14% in midazolam recipients, 11% for ketamine) or overall mortality (2% in midazolam recipients, 1% for ketamine). ConclusionIn this cohort study of patients with acute behavioral disturbance, emergent airway support nor other outcomes differed following prehospital treatment with midazolam or ketamine.

Simulation algorithm of greenhouse soil water movement based on cellular automata

Soil moisture movement reveals the hydrological environment and irrigation characteristics of plants, which is very important and basic hydrological problem. A soil moisture movement algorithm based on cellular automata suitable for greenhouse was proposed to simulate the lateral flow and vertical penetration of soil water in different soil layers. Artemisia annua was used as an experimental plant, and two numerical simulations were set up to determine the minimum water replenishment and the degree of upward soil modification. To verify the performance of the model, corn was used as an experimental plant for application simulation. The numerical simulation results show that the effect of only water for plant cells is superior to soil cells, and the disturbance behavior of the underlying soil layer should be minimized during the cultivation process. The average MAE/RMSE of all soil layers is 0.86/1.06 and in deep layer (50 cm and 60 cm) is 0.53/0.64. It shows the model has a certain prediction and simulation ability, especially in deep soil layers. The proposed algorithm can simply calculate soil flow, set the minimum water replenishment, and evaluate the water replenishment efficiency, which can provide a theoretical reference for the water replenishment and soil replacement scheme.

SENSE-Cog Lewy: Investigating the Impact of Sensory Loss on the Diagnosis, Clinical Features and Prognosis of Lewy Body Dementia

Abstract Background Lewy Body Dementia (LBD) accounts for 20% of the nearly 65,000 people with dementia in Ireland, but fewer than 5% of those affected receive a formal diagnosis. LBD includes both Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB) and can be characterised by fluctuating and progressive cognitive difficulties, vivid visual hallucinations and REM sleep behaviour disturbances. Sensory function such hearing, vision and olfactory function declines with age—but increasing evidence shows that abnormal patterns of sensory dysfunction can be one of the earliest clinical signs and predictors of progression of neurodegenerative diseases such as Lewy body dementia and Parkinson’s disease dementia. Methods A scoping review was undertaken using Embase, CINAHL, PsychINFO and PubMed. Only reports on people with LBD (DLB and PDD) from any stage, prodromal to late stage were considered. Papers primarily addressing other forms of neurocognitive disorders were excluded. Sensory loss was conceptualised as the loss of smell, vision and hearing. Two reviewers independently assessed each study for inclusion, and disagreements were resolved by a third reviewer. Results Reports on sensory loss in LBD were very few and most often were comparing sensory loss across different dementia types. Strong associations were observed between olfactory loss and particular visual impairment patterns and the severity of both cognitive and non-cognitive DLB symptoms. Olfactory impairment is a potential early biomarker of DLB and PDD and severity of olfactory dysfunction can predict cognitive decline. Visual hallucinations, for example, were found to be closely linked to visual impairment patterns such as pareidolia. Conclusion This study highlights a knowledge gap regarding the patterns of sensory loss in LBD and their relationship with cognitive and non-cognitive LBD symptoms. Sensory assessments represent potentially valuable diagnostic and prognosis tool in LBD, with further research required to understand the aetiological mechanisms underlying sensory impairment in LBD and other dementias.