High Cutoff Research Articles

Evaluation of Global Dystonia Rating Scale as a predictor of unfavorable outcomes among acute antipsychotics poisoned patients

Worldwide, acute antipsychotic poisoning results in high morbidities and mortalities. Though extrapyramidal syndromes are commonly associated, the extent of extrapyramidal syndromes in relation to the severity of antipsychotic poisoning has not been addressed yet. Thus, this study aimed to assess the Global Dystonia Rating Scale (GDRS) as an unfavorable outcomes predictive tool in acute antipsychotic poisoning. A cross-sectional study included 506 antipsychotic-poisoned patients admitted to Tanta University Poison Control Center, Egypt, over three years was conducted. The mean GDRS was 9.1 ± 16.7 in typical antipsychotic poisoning, which was significantly higher than that of atypical antipsychotics (4.2 ± 11.5) (p = 0.003). Patients with GDRS> 20 showed significantly higher liability for all adverse outcomes (p < 0.05). However, poisoning with typical antipsychotics was associated with significantly more cardiotoxicity (p = 0.042), particularly prolonged QRS (p = 0.005), and intensive care unit (ICU) admission (p = 0.000). In contrary to the PSS, which failed to predict the studied adverse outcomes, GDRS significantly predicted all adverse outcomes (p < 0.000) for all antipsychotic generations. In atypical antipsychotics, GDRS above three accurately predicted cardiotoxicities, prolonged QTc interval, and respiratory failure with Area under curves (AUC) of 0.937, 0.963, and 0.941, respectively. In typical antipsychotic poisoning, at higher cutoffs (7.5, 27.5, 18, and 7.5), cardiotoxicities, prolonged QTc interval, and respiratory failure were accurately predicted (AUC were 0.974, 0.961, and 0.960, respectively). GDRS is an objective, substantially useful tool that quantifies dystonia and can be used as an early reliable predictor of potential toxicity in acute antipsychotic poisoning.

Abstract TP35: A 2-Stage Recruitment Design to Reduce MRI Screening Costs for a Theoretical Clinical Trial of WMH Progression

Background: White matter hyperintensities (WMH) are associated with risk of dementia and stroke, so are an important therapeutic target for clinical trials. The cost of broad MRI screening to identify those individuals with significant WMH, however, limits the feasibility of designing clinical trials which target WMH presence and which test treatments that slow progression. Hypothesis: A low-cost retinal or clinical screening measure prior to an MRI screening stage reduces the cost of recruiting persons with significant WMH burden in a hypothetical clinical trial vs an MRI-only screening design. Method: Data were from participants in the Atherosclerosis Risk in Communities-Neurocognitive study with clinical, retinal and WMH measurements ( N = 1311) at ages 53-70 years. Significant WMH burden was defined as a Cardiovascular Health Study score &gt;2. Three low-cost pre-screening measures were assessed: (1) retinal: a score incorporating multiple markers of abnormal retinal vasculature, (2) clinical: a score incorporating hypertension, diabetes, and age, (3) combined retinal-clinical: a score incorporating retinal and clinical factors. Given a prior published target sample for a WMH clinical trial (N= 646), we calculated a theoretical screening sample size based on the proportion of each pre-screening measure in the population multiplied by the proportion of significant WMH burden among those with a prevalent pre-screening feature. Total recruitment cost was calculated using standard retinal ($32.50) and MRI ($650) cost estimates. Results: Compared to the estimated cost of MRI-only screening (&gt;$4.24M, requiring MRI screening 6,526 participants), pre-screening for a high clinical score reduced total cost to $2.47M, but increased the initial screening group to 52,778 participants, of whom 3,801 would be screened by MRI). A high retinal-clinical score cutoff reduced costs to $2.9M while only requiring 13,572 screened participants (of these only 3,801 would require MRI). Conclusion: A 2-stage recruitment design with a low-cost pre-screening retinal and clinical measure is a promising approach, resulting in a reduction of theoretical recruitment costs for recruiting persons with significant WMH burden compared to an MRI-only design.

InCl3-Assisted Surface Defects Restoring to Enhance Lead-Free Cs2ZrCl6 Nanocrystals for X-Ray Imaging and Blue LED Applications.

As one type of recent emerging lead-free perovskites, Cs2ZrCl6 nanocrystals are widely concerned, benefiting from the eminent designability, high X-ray cutoff efficiency, and favorable stability. Improving the luminescence performance of Cs2ZrCl6 nanocrystals has great importance to cater for practical applications. In view of the surface defects frequently formed by the liquid phase method, the particle morphology and surface quality of this material are expected to be regulated if certain intervention is made in the synthesis process. In the work, differing from normal cell lattice modulation based on the ion doping, the grain size and surface morphology of Cs2ZrCl6 nanocrystals are optimized via adding a certain amount of InCl3 to the synthetic solution. The surface defects are restored to inhibit the defect-induced non-radiative transition, resulting in the improvement of the luminescence properties. Moreover, a flexible Cs2ZrCl6@polydimethylsiloxane film with excellent heat, water, and bending resistance and a light-emitting diode (LED) device are fabricated, exhibiting excellent application potential for X-ray imaging and blue LED.

Cutoffs to Identify Restricted Life-space Mobility in Older Adults Across Different Contexts: The International Mobility in Aging Study

different populations have different averages of life-space assessment scores and defining cutoff values of clinical significance by each population should take into consideration. Different cutoffs to define restricted life space have been reported. The most common is a score of 60 points. There are other cutoffs derived from receiver operating characteristic (ROC) analysis and used to classify older adults according to their ability in activities of daily living (ADLs) (52.3 points) or instrumental activities of daily living (IADLs) (56 points); other cutoffs are specialized for people with cognitive impairment (26.75 points) or people with spinal cord injury who need mobility aids (78.5 points). The aims were to identify cutoff points of Life Space Assessment (LSA) in older adults in different sites and to determine the relationship of the cutoff scores with mobility disability and depression. The study population was composed of community-dwelling adults aged 65–74 years who were not institutionalized. An ROC analysis was constructed, and the area under the curve (AUC) was calculated to identify the optimal cutoff that discriminates life-space restriction for each city. Logistic regressions were executed by site to comprehend the association among restricted LSA and mobility disability and depression. In total, 1890 participants were included in the analyses (52.38% women, 37.19% mobility disability and 21.32% had depression). Canada cities had the highest cutoff, while Tirana and Natal had the lowest cutoff (< 50). Kingston was the site with the highest association between life-space restriction and mobility disability (OR 5.4, 95% CI 2.9–10). Saint-Hyacinthe, Tirana, and Manizales had significant associations between depression and restricted life space (OR 3.25, 95% CI 1.53–6.89, OR 3.14, 95% CI 1.88–5.24, and OR 3.99, 95% CI 2.28–6.98, respectively). Different cutoffs to define restricted life-space have been identified in elderly people at different sites. The analysis of the relationship between the restricted life space and personal characteristics like depression and mobility disability supported these findings. The groupings produced by the cutoff points for each site showed notable variations. These findings emphasize the importance of population-based cutoffs to improve the general applicability of LSM criteria and take into consideration the importance of site-specific approaches.

Determining Pneumocystis jirovecii Colonisation from Infection Using PCR-Based Diagnostics in HIV-Negative Individuals.

Pneumocystis jirovecii pneumonia is increasingly diagnosed with highly sensitive PCR diagnostics in immunocompromised, HIV-negative individuals. We assessed the performance of our in-house quantitative PCR with the aim to optimise interpretation. Retrospective audit of all positive P. jirovecii qPCRs on induced sputum or BAL fluid at a single centre from 2012 to 2023. Medical and laboratory records were analysed and people with HIV were excluded. Cases were categorised as colonisation, high-probability PCP or uncertain PCP infection against a clinical gold standard incorporating clinico-radiological data. Quantitative PCR assay targeting the 5s gene was utilised throughout the time period. Of the 82 positive qPCRs, 28 were categorised as high-probability PCP infection, 30 as uncertain PCP and 24 as colonisation. There was a significant difference in qPCR values stratified by clinical category but not respiratory sample type. Current assay performance with a cutoff of 2.5 × 105 copies/mL had a sensitivity of 50% (95% CI, 30.65-69.35%) and specificity of 83.33% (95% CI, 62.62-95.26%). Youden Index calculated at 6.5 × 104 copies/mL had a sensitivity of 75% (56.64-87.32%, 95% CI) and specificity of 66.67% (46.71-82.03%, 95% CI). High and low cutoffs were explored. Significant variables associated with infection were age > 70 years old, the presence of fever, hypoxia or ground glass changes. A single qPCR cutoff cannot reliably determine P. jirovecii infection from colonisation. Low and high cutoffs are useful, however, a large "possible infection" cohort will remain where interpretation of clinic-radiological factors remains essential. Standardisation of assays with prospective validation in specific immunocompromised groups will allow greater generalisability and allow large-scale prospective assay validation to be performed.

High Voltage Cycling Stability of LiF-Coated NMC811 Electrode.

The development of LiNi0.8Mn0.1Co0.1O2 (NMC811) as a cathode material for high-energy-density lithium-ion batteries (LIBs) intends to address the driving limitations of electric vehicles. However, the commercialization of this technology has been hindered by poor cycling stability at high cutoff voltages. The potential instability and drastic capacity fade stem from irreversible parasitic side reactions at the electrode-electrolyte interface. To address these issues, a stable nanoscale lithium fluoride (LiF) coating is deposited on the NMC811 electrode via atomic layer deposition. The nanoscale LiF coating diminishes the direct contact between NMC811 and the electrolyte, suppressing the detrimental parasitic reactions. LiF-NMC811 delivers cycling stability superior to uncoated NMC811 with high cutoff voltage for half-cell (3.0-4.6 V vs Li/Li+) and full-cell (2.8-4.5 V vs graphite) configurations. The structural, morphological, and chemical analyses of the electrodes after cycling show that capacity decline fundamentally arises from the electrode-electrolyte interface growth, irreversible phase transformation, transition metal dissolution and crossover, and particle cracking. Overall, this work demonstrates that LiF is an effective electrode coating for high-voltage cycling without compromising rate performance, even at high discharge rates. The findings of this work highlight the need to stabilize the electrode-electrolyte interface to fully utilize the high-capacity performance of NMC811.

Elucidating in-situ heat generation of LiFePO4 semi-solid lithium slurry battery under specific cycling protocols

Semi-solid lithium slurry battery combines the advantages of the high energy density of lithium-ion battery and the flowability of flow battery electrodes and has attracted attention in energy storage. Elucidating the heat generation during cycling is crucial for evaluating the safety. However, there is a relative lack of research in this field of semi-solid lithium slurry battery. Herein, the heat generation of lithium iron phosphate (LiFePO4) semi-solid lithium slurry battery during cycling under specific cycling protocols is investigated in this work. The results show that the battery has lower heat generation when cycling at an ambient temperature of 35–50 ℃ and a charging cutoff voltage below 4.0 V, meanwhile, it maintains considerable capacity. However, when the charging cutoff voltage exceeds 4.4 V, the cyclic heat generation of the battery increases significantly, and the capacity attenuates significantly. Meanwhile, the classical equation for calculating battery heat generation of lithium-ion battery is no longer reliable. This is mainly because the electrolyte content of the semi-solid lithium slurry battery is too high (over 80 %), and at high charging cutoff voltage, the side decomposition reactions of the electrolyte increase significantly. Subsequent characterization of electrode materials also confirms this inference. This study can provide a clearer understanding of the safety of semi-solid lithium slurry battery and has guiding implications for industrial applications.

Handheld Lung Ultrasound to Detect COVID-19 Pneumonia in Inpatients: A Prospective Cohort Study.

Background: Chest imaging, including chest X-ray (CXR) and computed tomography (CT), can be a helpful adjunct to nucleic acid test (NAT) in the diagnosis and management of Coronavirus Disease 2019 (COVID-19). Lung point of care ultrasound (POCUS), particularly with handheld devices, is an imaging alternative that is rapid, highly portable, and more accessible in low-resource settings. A standardized POCUS scanning protocol has been proposed to assess the severity of COVID-19 pneumonia, but it has not been sufficiently validated to assess diagnostic accuracy for COVID-19 pneumonia. Purpose: To assess the diagnostic performance of a standardized lung POCUS protocol using a handheld POCUS device to detect patients with either a positive NAT or a COVID-19-typical pattern on CT scan. Methods: Adult inpatients with confirmed or suspected COVID-19 and a recent CT were recruited from April to July 2020. Twelve lung zones were scanned with a handheld POCUS machine. Images were reviewed independently by blinded experts and scored according to the proposed protocol. Patients were divided into low, intermediate, and high suspicion based on their POCUS score. Results: Of 79 subjects, 26.6% had a positive NAT and 31.6% had a typical CT pattern. The receiver operator curve for POCUS had an area under the curve (AUC) of 0.787 for positive NAT and 0.820 for a typical CT. Using a two-point cutoff system, POCUS had a sensitivity of 0.90 and 1.00 compared to NAT and typical CT pattern, respectively, at the lower cutoff; it had a specificity of 0.90 and 0.89 compared to NAT and typical CT pattern at the higher cutoff, respectively. Conclusions: The proposed lung POCUS protocol with a handheld device showed reasonable diagnostic performance to detect inpatients with a positive NAT or typical CT pattern for COVID-19. Particularly in low-resource settings, POCUS with handheld devices may serve as a helpful adjunct for persons under investigation for COVID-19 pneumonia.

Weak secondary cyclotron line in eclipsing high-mass X-ray binary Cen X-3

ABSTRACT We report the time-resolved spectroscopy results from two observations of Centaurus X-3, over one binary orbit with AstroSat and two binary orbits with Nuclear Spectroscopic Telescope Array (NuSTAR). NuSTAR covered two intensity states where the light curve showed transition in count rate from first to second binary orbit by a factor of ∼3. A phenomenological model comprising of partially absorbed power law with smoothed high energy cutoff, cyclotron absorption ∼24 and 6.4 keV iron emission gave good fit for AstroSat observation. NuSTAR spectra required two additional emission components, a broad one ∼5.7 keV and a narrow one ∼6.9 keV. A weak secondary absorption feature at ∼11.6 and ∼ 14.5 keV was seen in the residuals of the spectral fit for AstroSat and NuSTAR data, respectively. The secondary absorption energy showed no correlation with the cutoff energy. Its strength varied within 0.1–0.6 keV with its width ∼1.6 keV. Its energy and optical depth showed linear positive correlation with the fundamental cyclotron line energy and depth, respectively. The cyclotron line energy showed anticorrelation to flux described by a power law with negative index and the secondary absorption also showed similar trend to flux. Depth of secondary absorption was ∼45 per cent and centroid energy was ∼54 per cent of fundamental. Depth and energy ratio of secondary to fundamental lied within 2σ deviation from 0.5. We suggest this secondary absorption to be a redshifted dipolar cyclotron resonance feature exhibiting sub-harmonic behaviour.

Analytic and Clinical Validity of Myositis-Specific Antibodies by Line-Blot Immunoassay Is Essential.

This study assessed the concordance between line blot (LB) and immunoprecipitation (IP) assays for detecting myositis-specific antibodies (MSAs) in idiopathic inflammatory myopathies (IIMs) and their association with IIM subtypes. One hundred patients with IIM were enrolled, and MSA was detected using LB and IP. The IIM subtypes, including immune-mediated necrotizing myopathy-like, anti-tRNA synthetase syndrome-like, and clinically amyopathic dermatomyositis-like, were clinically diagnosed. The validity and reliability of the LB compared with the IP were evaluated. Optimal cutoff levels for LB were determined using various statistical methods including Cohen κ, Gwet's AC, diagnostic odds ratios, and receiver operating characteristic analysis. Line blot exhibited lower specificity and accuracy than IP in predicting IIM subtypes. Some MSAs performed better at higher LB cutoff values. Anti-signal recognition particle antibodies showed poor performance in predicting the immune-mediated necrotizing myopathy-like subtype using LB. Raising the cutoffs improved the reliability of anti-threonyl-tRNA synthetase and anti-signal recognition particle antibodies. Anti-histidyl-tRNA synthetase antibodies performed well at lower positivity, whereas diagnostic odds ratios increased for anti-transcription intermediary factor 1γ and anti-nuclear matrix protein 2 with higher cutoffs. Inconsistencies between LB and IP have been observed in patients with IIM. Individual optimal cutoffs for MSA by LB correlating with IP were determined. Rheumatologists should consider the differences between LB and IP results when classifying IIM subtypes.

Improvement of Thermodynamic Phase Stability and High-Rate Capability of Li Layered Oxides.

The use of elemental doping in lithium cobalt oxide (LCO) cathode material at high cutoff voltage is a widely adopted technique in the field of rechargeable batteries to mitigate multiple unfavorable phase transitions. However, there is still a lack of fundamental understanding regarding the rationality of each doping element implemented in this method, specifically considering the various thermodynamic stability and phase transitions. Herein, we investigated the effect of Ti doping on an O2 phase LCO (LCTO) cathode material that exhibited enhanced rate performance. We suggest that the incorporation of Ti into an O2 phase LCO results in the mitigation of multiple-phase transitions and the improvement of phase stability, thereby yielding a high-rate-capable cathode material. Through a combination of experimental and computational calculations, we demonstrate that Ti doping improves the thermodynamic stability and kinetics of Li-ions during the cycling process.

Prevalence of and associated factors for sarcopenia in patients with liver cirrhosis: A systematic review and meta-analysis

Sarcopenia is associated with poor outcomes in patients with cirrhosis. However, the prevalence of and associated factors for developing sarcopenia in this population remain to be determined. This study aimed to summarize the prevalence, characteristics, and associated factors of sarcopenia in patients with cirrhosis. Electronic searches were performed from inception to June 9, 2022 to identify the eligible studies. We meta-analyzed the prevalence of sarcopenia in overall patients with cirrhosis and subgroups. Both crude and adjusted odds ratios (ORs) were pooled using the random effects model. A total of 55 studies involving 13,158 patients from 17 countries were included. The overall prevalence of sarcopenia was 40.1% (95% CI 35.4%-44.9%) in patients with cirrhosis. The pooled prevalence was higher in males, Child-Pugh class C cirrhosis, decompensated stage, ascites, subjective global assessment class C cirrhosis, and when sarcopenia was defined by L3-SMI (third lumbar-skeletal muscle index) at a higher cutoff. In multivariate analysis, older age (adjusted OR 1.04, 95% CI 1.00-1.07), male (adjusted OR 4.75, 95% CI 2.72-8.28), lower body mass index (BMI) (adjusted OR 0.78, 95% CI 0.73-0.83), alcoholic liver disease (ALD) (adjusted OR 1.43, 95% CI 1.19-1.72), but not ascites and hepatic encephalopathy, were significantly associated with an increased risk of sarcopenia in patients with cirrhosis. Sarcopenia is a prevalent complication, and older age, male patients, lower BMI, and patients with ALD are associated with an increased risk of sarcopenia in patients with cirrhosis.

Modeling a Fluid-Coupled Single Piezoelectric Micromachined Ultrasonic Transducer Using the Finite Difference Method.

A complete model was developed to simulate the behavior of a circular clamped axisymmetric fluid-coupled Piezoelectric Micromachined Ultrasonic Transducer (PMUT). Combining Finite Difference and Boundary Element Matrix (FD-BEM), this model is based on the discretization of the partial differential equation used to translate the mechanical behavior of a PMUT. In the model, both the axial and the transverse displacements are preserved in the equation of motion and used to properly define the neutral line position. To introduce fluid coupling, a Green's function dedicated to axisymmetric circular radiating sources is employed. The resolution of the behavioral equations is used to establish the equivalent electroacoustic circuit of a PMUT that preserves the average particular velocity, the mechanical power, and the acoustic power. Particular consideration is given to verifying the validity of certain assumptions that are usually made across various steps of previously reported analytical models. In this framework, the advantages of the membrane discretization performed in the FD-BEM model are highlighted through accurate simulations of the first vibration mode and especially the cutoff frequency that many other models do not predict. This high cutoff frequency corresponds to cases where the spatial average velocity of the plate is null and is of great importance for PMUT design because it defines the upper limit above which the device is considered to be mechanically blocked. These modeling results are compared with electrical and dynamic membrane displacement measurements of AlN-based (500 nm thick) PMUTs in air and fluid. The first resonance frequency confrontation showed a maximum relative error of 1.13% between the FD model and Finite Element Method (FEM). Moreover, the model perfectly predicts displacement amplitudes when PMUT vibrates in a fluid, with less than 5% relative error. Displacement amplitudes of 16 nm and 20 nm were measured for PMUT with 340 µm and 275 µm diameters, respectively. This complete PMUT model using the FD-BEM approach is shown to be very efficient in terms of computation time and accuracy.

Derivation of the Screening of Nutritional Risk in Intensive Care risk prediction score: A secondary analysis of a prospective cohort study.

For patients who are critically ill, the recommended nutrition risk screening tools are the Nutrition Risk in the Critically Ill (NUTRIC) and the Nutritional Risk Screening 2002 (NRS-2002) have limitations. To develop a new screening tool, the Screening of Nutritional Risk in Intensive Care (SCREENIC score), and assess its predictive validity. A secondary analysis of a prospective cohort study was conducted. Variables from several nutritional screening and assessment tools were considered. The high nutrition risk cutoff point was defined using mNUTRIC as a reference. Predictive validity was evaluated using logistic regression and Cox regression. The study included 450 patients (64 [54-71] years, 52.2% men). The SCREENIC score comprised six questions: (1) does the patient have ≥2 comorbidities (1.3 points); (2) was the patient hospitalized for ≥2 days before intensive care unit (ICU) admission (0.9 points); (3) does the patient have sepsis (1.0 point); (4) was the patient on mechanical ventilation upon ICU admission (1.2 points); (5) is the patient aged >65 years (1.2 points); and (6) does the patient exhibit signs of moderate/severe muscle mass loss according to the physical exam (0.6 points). The high nutrition risk cutoff point was set at 4.0. SCREENIC demonstrated moderate agreement (κ = 0.564) and high accuracy (0.896 [95% CI, 0.867-0.925]) with mNUTRIC. It predicted prolonged ICU (odds ratio [OR] = 1.81 [95% CI, 1.14-2.85]) and hospital stay (OR = 2.15 [95% CI, 1.37-3.38]). The SCREENIC score comprises questions with variables that do not require nutrition history. Further evaluation of its applicability, reproducibility, and validity in guiding nutrition therapy is needed using large external cohorts.

Experimental Investigation on Layer Subdivision Water Injection in Multilayer Heterogeneous Reservoirs.

Layer subdivision is currently one of the principal techniques employed to solve interlayer contradictions during water injection in multilayer heterogeneous reservoirs, but experimental research on the mechanism and the corresponding implementation plans is lacking. In this study, a multilayer heterogeneous core model was designed, and physical simulation experiments with different subdivisions and variation coefficients were conducted. Furthermore, the influence of the subdivision degree on the water injection development effect was analyzed, and the dynamic characteristics of the oil displacement of each sublayer were compared. Finally, the boundary standard of the layer subdivision was discussed. The results demonstrate that the water breakthrough appears rapidly in the high-permeability layer, and water channeling is easily formed after water flooding. The remaining oil is mostly retained in the low-permeability layer. Layer subdivision water injection can effectively reduce the high water cutoff and improve the oil recovery. The oil recovery increases with the layer subdivision degree, while the incremental rate decreases gradually. The low-permeability layer is observed to be the main layer contributing to the increase in the total recovery of multilayer reservoirs, with a contribution rate that initially increases and subsequently decreases with the increasing subdivision degree, from 0.9 to 11.9, and 29.8%, and subsequently drops to 15.1% during the general water injection with 2-, 4-, and 8-layer subdivision mining. The heterogeneity variation coefficient of 0.55 is used as the subdivision standard to divide different permeability layers to be developed as 1 layer in the multilayer heterogeneous reservoir.

Bone Marrow Microenvironment and Hematopoietic Cell Types Are Differentially Affected By Transcriptomic Quality Control Filtering Metrics in Single Cell Data

A crucial step prior to analysis of single cell transcriptomic data includes filtering out low-quality (e.g., dying) cells and artifacts (e.g., empty droplets). Choosing appropriate quality control parameters leads to correct cell assignment, so that the data for downstream analysis is high-quality and is representative of all processed cell types. These metrics include high and low cut-offs for mitochondrial content, total number of genes, number of different genes, and ribosomal content per cell. They have been found to vary based on cell and tissue type, as well biological variables such as age and disease, and technical variables such as sequencing technology. The aim of this study was to investigate the variation of these quality control metrics in a data set that included stem, progenitor, and differentiated cell types of the hematopoietic, mesenchymal, and endothelial lineages. Furthermore, we set out to determine whether applying standard cut-offs may differentially affect different cell types. We calculated individual filtering parameters for each cell type using the R package ddqc (Subramanian et al. Genome Biol. 2022). Thus, any biological variability based on mitochondrial, ribosomal, and gene counts was accounted for. Notably, distribution of measurements for each of the above quality control metrics varied by cluster, and certain cell-type means were adjacent to commonly used cut-off values. For instance, we observed higher content of mitochondrial genes in osteoblasts, sinusoidal endothelial cells, a subset of adipocyte-primed mesenchymal cells (MSPC), as well as hematopoietic progenitor cells, pre-B, and B cells. On the other hand, subsets of erythroblasts, neutrophils, as well as arteriolar endothelial cells had the lowest mitochondrial content. In addition, lower total gene counts and lower gene complexity were found in adipocyte-primed MSPCs, neutrophils, and megakaryocyte-erythrocyte progenitors, while higher counts were found in granulocyte-monocyte progenitor cells, megakaryocyte/erythroid-primed multipotent progenitor cells and subsets of erythroblasts. Applying universal cutoff values to this data set would greatly reduce, and some cases, eliminate cell types that have high mitochondrial content or lower gene counts and complexity, while leaving those cell types on the opposite spectrum unaffected. This would also skew proportions of cells in downstream analyses, thus affecting biological interpretation of the results. Overall, our results demonstrate biological variability of the quality control metric distributions in a single cell transcriptomic data set that includes diverse bone marrow niche and hematopoietic cell types. This reveals novel biological information regarding distinct cell types as well as cautions that applying standard filtering paraments on such a data set would eliminate some cell types and bias downstream analysis for others. Optimization of filtering criteria will be important when broadening single cell analysis to multiplexed approaches incorporating transcriptome, genome, epigenome, and proteome-level data.

52 Developing and Calibrating a Sex-Specific Psychiatric Screener within the Post-Concussion Symptom Scale

Objective:Pre- and post-morbid mental health conditions can prolong recovery from concussion and are generally detrimental to athletic performance and quality of life. If psychiatric conditions can be identified in athletes at the time of baseline testing, psychological/psychiatric intervention can be implemented to prevent these complications. Given the time constraints on neuropsychological baseline testing, it is important to have time-efficient screening measures. As such, the purpose of this study was to develop and calibrate a psychiatric screening measure within the Post-Concussion Symptom Scale (PCSS) from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), which is commonly administered to athletes at baseline, thereby “killing two birds with one stone”: (1) screening for psychiatric conditions and (2) obtaining a baseline measurement of concussion-like symptoms.Participants and Methods:Participants were 278 undergraduate students from a Canadian university with a mean age of 21.87 years (SD=4.87, range=18 to 52) and a sex composition of 64% females (n=179, Age: M=21.29 years-old, SD=4.34, range: 18 to 52) and 36% males (n=179, Age: M=22.93 years-old, SD=5.57, range: 18 to 50). Participants were a convenience sample collected via online survey platform in exchange for bonus points toward courses through a participant pool system between January and July 2021. The psychiatric screener consisted of the affective subscale from the PCSS (irritability, sadness, feeling more emotional, nervousness) and the criterion measure was the Depression, Anxiety, and Stress Scales (DASS-42). Statistical analyses were conducted in R v.4.3 and included confirmatory factor analysis and receiver operating characteristic (ROC) curve analyses. Although a balance was sought between sensitivity and specificity, the former was prioritized given that this is intended as a screening measure. Males and females were analyzed separately as females tend to report more symptoms than males. Mild, moderate, and severe elevations were predicted for depression, anxiety, and stress, based on standard DASS cutoffs.Results:The CFA analyses revealed good fit for both the PCSS (CFI=.992; TLI=.991; RMSEA=.053; SRMR=.066) and DASS (CFI=.995; TLI=.995; RMSEA=.053; SRMR=.065) models. Cutoffs of &gt;3, &gt;4, and &gt;8 (SENS= .77-.80, SPEC= .52-.83) optimally classified males as having mild, moderate, and severe depression, respectively; and cutoffs of &gt;8, &gt;8, and &gt;9 (SENS= .79-.83, SPEC= .63-.67) optimally classified females as having mild, moderate, and severe depression, respectively. A cutoff of &gt;2 (SENS= .78-.81, SPEC= .35-.39) optimally classified males as having both mild and moderate anxiety (insufficient n in severe group); and &gt;7, &gt;8, and &gt;9 (SENS= .80-.85, SPEC= .63-.68) optimally classified females as having mild, moderate, and severe anxiety. Cutoffs of &gt;5and &gt;8(SENS= .80-.86, SPEC= .70-.85) were optimal for detecting mild and moderate stress in males (insufficient n in severe group); and &gt;8, &gt;8, and &gt;9 (SENS= .80.89, SPEC= .60-.75) were optimal in females.Conclusions:The affective subscale within the PCSS operates well as a psychiatric screening measure. In general, females had higher cutoffs and the cutoffs for mild and moderate levels of the conditions tended to be similar. Males were less onsistent, with cutoffs varying widely depending on the construct and severity.

A Semisolvated Sole-Solvent Electrolyte for High-Voltage Lithium Metal Batteries.

Lithium metal batteries (LMBs) coupled with a high-voltage Ni-rich cathode are promising for meeting the increasing demand for high energy density. However, aggressive electrode chemistry imposes ultimate requirements on the electrolytes used. Among the various optimized electrolytes investigated, localized high-concentration electrolytes (LHCEs) have excellent reversibility against a lithium metal anode. However, because they consist of thermally and electrochemically unstable solvents, they have inferior stability at elevated temperatures and high cutoff voltages. Here we report a semisolvated sole-solvent electrolyte to construct a typical LHCE solvation structure but with significantly improved stability using one bifunctional solvent. The designed electrolyte exhibits exceptional stability against both electrodes with suppressed lithium dendrite growth, phase transition, microcracking, and transition metal dissolution. A Li||Ni0.8Co0.1Mn0.1O2 cell with this electrolyte operates stably over a wide temperature range from -20 to 60 °C and has a high capacity retention of 95.6% after the 100th cycle at 4.7 V, and ∼80% of the initial capacity is retained even after 180 cycles. This new electrolyte indicates a new path toward future electrolyte engineering and safe high-voltage LMBs.

THU649 PCOS Phenotype In Unselected Populations (P-PUP) Study: Defining And Comparing Hirsutism Across Various Ethnic Groups In Unselected Populations

Abstract Disclosure: S. Kiconco: None. A.E. Joham: None. L.V. Suturina: None. X. Zhao: None. A. Gambineri: None. F.R. Tehrani: None. B.O. Yildiz: None. J. Kim: None. H.J. Teede: None. R. Azziz: None. Introduction Hirsutism is defined as the male pattern distribution of terminal hair in a female. It is one of the diagnostic features of polycystic ovary syndrome (PCOS), reflecting clinical hyperandrogenism, as measured by the modified Ferriman-Gallwey score (mFG). However, whether the mFG scores and the normative cut-off varies by ethnicity is unclear. We aimed to describe and compare the distribution of mFG score in different ethnic groups from eight countries using data from unselected (medically unbiased) populations to determine and compare the normative cut-off values between the different ethnic groups and the prevalence of hirsutism thereby defined. Methods We utilised data of 10,919 participants aged 15 to 80 years. Data were obtained from epidemiologic studies assessing unselected women conducted in different countries including China, Iran, Italy, Nigeria, Russia, South Korea, Turkey, and the United States of America. The distribution of mFG between ethnic groups was determined descriptively as medians. Cluster analysis (k means, k=2) and the receiver operating characteristics curve were used to determine the normative cut-offs for the mFG score. All medians, cut-offs and percentile values were compared between ethnic groups using the Kruskal-Wallis test at a 95% level of significance. Results Our data consisted of 11 ethnic groups from 8 countries. The Persian (4.8±4.7) and Italian (4.8±4.7) populations had higher median mFG scores than the rest of the ethnic groups, whilst Asian populations (Chinese, Korean and Buryat) had the lowest scores. Overall, the median distribution of mFG differed significantly by ethnicity. Using cluster analysis, the mFG cut offs range from 4 to 9, with the Persian ethnic group having the highest, followed by the Italian group, with cut-offs differing by ethnicity overall; however cut offs are similar for Black American, Turkish, Asian and Russian groups. Conclusion The distribution and normal cut off values for hirsutism differ significantly by ethnicity, with the Persian population having the highest cut offs. Ethnicity needs to be considered when assessing women for clinical hyperandrogenism. Presentation: Thursday, June 15, 2023

SAT107 Assessing Continuous Glucose Monitor Alarm Use By Families Of Children With Diabetes

Abstract Disclosure: V.S. Ochs: None. S.E. Woerner: Employee; Self; Lilly USA, LLC. A. Ustyol: None. L.A. DiMeglio: Advisory Board Member; Self; Merck, Abata. Consulting Fee; Self; Vertex. Background: Continuous glucose monitors (CGM) offer customizable alarms which alert persons with diabetes and their caregivers of current or pending glycemic changes. However, there has been little work studying real-world CGM alert setting use in large clinical populations. We sought to understand CGM alarm use through report analyses. Methods: After IRB approval we analyzed data from two-week CGM reports obtained clinically to determine common settings and compared those to target guidelines. Results: CGM download data from 150 children using a Dexcom® G6 were analyzed (median age 14y, (range: 1-19), 89% white, 9.5% black, and 1.5% Asian, 47% female, 51% pump users). Median A1c was 7.8% (range: 5.4-15). Median CGM glucose was 190 (range: 56-374). Average time in range was 47.7% (range: 3.4-99.1).A Low Alarm alert was set for 131 participants (87%) with a median sensor glucose alert threshold of 74 mg/dL (range: 60-100). The High Alarm was used by 109 children (73%) with a median threshold of 272 mg/dL (range: 120-400). The Signal Loss alarm was used by 103 (69%) participants with a median time until notification of 20 min (range: 20-240). Low Repeat and High Repeat alarms were used by only 50 (33%) and 36 (24%) of children, respectively. Rise Rate and Fall Rate alarms were used by 18 (12%) and 34 (23%). There was a significant difference between the median High alarm cutoff of 272 mg/dL and a recommended standard (e.g. PantherProgram.org) of 250 mg/dL (p=0.0016). The same was true with the median Low alarm cutoff of 74 mg/dL and a recommended 70 mg/dL (p&amp;lt;0.0001). There was significant difference between the median High Repeat notification time of 1 hour and the recommended 2 hours (p&amp;lt;0.0001). Pump users were 2.2x more likely to use High Repeat alarms compared to injection users (95% CI: 1.18-4.15, p&amp;lt;0.01). The same was true with the Low Repeat alarm being 1.8x more likely to be used by pumpers compared to injection users (95% CI: 1.12-2.99, p=0.01). There were no significant differences in Low, High, Rise Rate, Fall Rate, Urgent Low Soon, Urgent Low Soon Repeat, or Signal Loss alarms.When the group was divided based on age, above 12 and &amp;lt;=12, younger CGM users were 1.2 times more likely to use the Low alarm compared to older users (95% CI: 1.03-1.30). Also, younger CGM users were more likely to use the Rise Rate (RR=3.6, 95% CI:1.37-9.67), Low Repeat (RR=1.7, 95% CI:1.09-2.71), Signal Loss (RR=1.3, 95% CI:1.04-1.60), Urgent Low Soon (RR=1.2, 95% CI:1.07-1.41), and Urgent Low Soon Repeat (RR=1.2, 95% CI:1.05-1.38) alarms. There were no significant differences in High, High Repeat, or Fall Rate alarm settings. Conclusions: The wide variability of alarm settings used by patients indicates likely educational gaps in CGM onboarding and use. Ensuring CGM alarm best practices will help children with diabetes and their caregivers get needed real-time glycemic data while minimizing alarm fatigue. Presentation: Saturday, June 17, 2023