Periodic Discharges Research Articles

Freshwater discharge disrupts linkages between the environment and estuarine fish community

Freshwater diversions and damming have altered coastal ecosystems greatly, resulting in fundamental changes in salinity, eutrophication, and ensuing shifts in ecological communities. Recently, efforts to restore water delivery and water quality in coastal systems have increased. To explore the impacts of altered freshwater discharge to a subtropical estuary, here Bayesian structural equation models are used to quantify the relationships among water quality properties, nutrients, and predator (sport) and prey (forage) components of the fish community. During periods of relatively low freshwater input, predatory sport fish and lower trophic level forage fish guild dynamics were tightly coupled with water quality and one another. In this low freshwater discharge system, water quality and nutrients were the most strongly linked components of the system. Conversely, during periods of high-water discharge, there was virtually no link between water quality and sport or forage fish guilds, and the sport fish and forage fish guilds became the most tightly coupled components. Ultimately, freshwater discharge disrupted existing linkages within the broader ecosystem. Based on these results, we expect the restoration of low freshwater flow into the estuary would strengthen the relationship between the fish community and the environment. As restoration of estuaries and rivers continues globally, freshwater delivery to downstream systems will be altered. Following the approach presented here, Bayesian structural equation models can be used to generate insight regarding potential system wide shifts following alteration of freshwater delivery, thereby providing a critically important tool for evaluating management strategies.

Seasonal pollution and surface characteristics of microplastics in surface water in the Wanzhou section of the Three Gorges Reservoir, China

The pollution of freshwater environments with microplastics (MPs) has attracted increasing attention owing to their threats to aquatic ecosystems and human health. Here, we sampled and analyzed MPs from mainstream, tributary, and backwater areas in the Wanzhou section of the Three Gorges Reservoir (TGR) in impoundment and flood periods. Microplastic pollution was the most severe in the backwater areas. The average abundance of MPs reached the highest value in the flood period (5.27±3.47×107 items km−2), which was 3–5 times that in the impoundment period. In the 0.3–5 mm size class, the 1–5 mm fraction was the most abundant, accounting for more than 81% in the flood period and 68% of the total MP particle abundance in the impoundment period in the mainstream and backwater areas. However, 0.3–1 mm MPs contributed more than 50% in the tributaries during the impoundment period. Polystyrene, polypropylene, and polyethylene MPs were detected in foam, fragment, sheet, and line-shaped MP particles. White, opaque, foamed polystyrene MPs contributed 32–81% to total MP particle abundance in the watershed. Microplastic particle surfaces showed signs of damage and oxidation, and ten different elements were found. Oxygen was clustered on the surface of foam and fragment MPs. Microplastic pollution was severe in the Wanzhou watershed. Especially in the backwater areas, oxidized MPs of variable shapes derived mainly from surface runoff in the flood period and sewage discharge in the impoundment period were abundant. The results of this study contribute to understanding seasonal pollution patterns and surface characteristics of MPs in the TGR and similar watersheds.

Clinical and Electrographic Features in Beta-Lactam Antibiotic Induced Neurotoxicity (P3-1.012)

<h3>Objective:</h3> To characterize clinical and electrographic features of patients with beta-lactam antibiotic-induced neurotoxicity in presence of and without renal impairment (RI). <h3>Background:</h3> EEG findings like periodic discharges, triphasic waves, or status epilepticus have been associated with beta-lactam neurotoxicity in critically ill patients with renal impairment. <h3>Design/Methods:</h3> Medical records of patients undergoing EEG due to encephalopathy while receiving cefepime, cefazoline and meropenem at the KUMC from 2009–2018 were reviewed. Demographic data, creatinine levels, clinical information, electrographic findings, and AEDs used were obtained. Exclusion criteria included unknown antibiotic start date, no clinical changes after antibiotic onset, worsening unrelated to antibiotics, or mental improvement on antibiotics. Patients were divided into with and without RI. Descriptive statistical methods and Chi-square/Fisher’s exact tests were applied. <h3>Results:</h3> 196 patients were identified. After applying our exclusion criteria, 39 patients were included, of which 14 (36%) were males and 25 (64%) were females. Thirty-three patients (85%) were on cefepime. Further analysis was focused on cefepime only since the number of patients on other antibiotics was nonsignificant. Symptoms reported were altered mental status (64%) [43% had RI], myoclonus (15%) [100% had RI] and seizures (9%) [67% had RI]. A tendency to have myoclonus was seen in patients with RI (p=0.049). EEG findings were generalized slowing (91%), triphasic waves (56%), GPDs (42%), and LPDs (12%). Six patients were found with NCSE, of which 4 (67%) had RI (p=0.490). Twenty-four (73%) patients symptomatically improved after stopping cefepime. Improvements in EEG were seen in 14 out of 22 patients who had repeat EEGs or were followed with EEG monitoring. <h3>Conclusions:</h3> Seizures were infrequently seen in patients with beta-lactam neurotoxicity. Removal of offending agents can improve clinical outcomes and prognosis in cefepime induced neurotoxicity. <b>Disclosure:</b> Dr. Ortiz Guerrero has nothing to disclose. Dr. Shah has nothing to disclose. Dr. Uysal has nothing to disclose.

Algorithm to Annotate Epileptiform Abnormalities in EEG Reports (P10-1.002)

<h3>Objective:</h3> To create code that expedites the analysis of electroencephalography (EEG) reports by detecting and automatically tabulating epileptiform abnormalities (EAs). <h3>Background:</h3> EAs are important in seizure/epilepsy detection and in acute brain injury monitoring like delayed cerebral ischemia after subarachnoid hemorrhages (Kim et al., 2017; Chen et al., 2022, Punia et al., 2015). However, reviewing EEG reports is time-consuming and error-prone; thus, we created an algorithm for rapid EEG report EA annotation. <h3>Design/Methods:</h3> We manually reviewed 1274 reports for EAs: seizures, sporadic epileptiform discharges, generalized and lateralized periodic discharges (GPDs, LPDs), lateralized rhythmic delta activity (LRDA), bilateral independent periodic discharges (BIPDs), brief potentially ictal rhythmic discharges (BIRDs), and bilateral independent rhythmic delta activity (BIRDA). We also reviewed for generalized rhythmic delta activity (GRDA). We compiled 104 positive and 240 negative phrases indicating EA+GRDA presence/absence, which were then used to build code that phrase matched and tabulated findings in each report. 80% of data was used for training, 20% for testing. Due to conflicts in reports and phrasing ambiguities, a “needs review” category was created for secondary manual review. 39 ambiguous phrases triggered this secondary review (ex: GRDA cannot be excluded). <h3>Results:</h3> The algorithm had 1.56% reports with errors identifying EAs+GRDA. 62.11% were accurately matched without need for secondary review. 36.33% were marked as needing review. Of those, 53.76% were marked for potential conflicts stating both the presence and the absence of an EA+GRDA, 26.88% for “periodic” or “rhythmic” term use without localization specified (generalized vs. lateralized), 2.15% for phrases that could indicate multiple forms of EAs+GRDA, requiring manual clarification, and 17.20% for a coding error (later rectified). <h3>Conclusions:</h3> These results suggest that this algorithm can automate EAs+GRDA extraction and expedite review of EEG reports. This tool allows researchers to assess the relationship of EAs+GRDA in large datasets more easily in future research. <b>Disclosure:</b> Ms. Choi has nothing to disclose. Mr. Uppal has nothing to disclose. Ms. Chen has nothing to disclose. The institution of Dr. Gilmore has received research support from NIH. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Aquestive. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for marinus. Dr. Hirsch has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Hirsch has received personal compensation in the range of $0-$499 for serving as a Consultant for Accure. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurelis. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Rafa Laboratories, Ltd. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received publishing royalties from a publication relating to health care. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Neuropace. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Natus. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a speaker with UCB. Dr. Sivaraju has nothing to disclose. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities. Dr. Kim has nothing to disclose.

Temporal dynamics of triphasic waves and generalized periodic discharges (P10-1.012)

<h3>Objective:</h3> To quantitatively compare triphasic waves and generalized periodic discharges on scalp EEG. <h3>Background:</h3> Distinguishing epileptiform generalized periodic discharges (GPDs) and triphasic waves (TWs) can be challenging (Foreman <i>et al.</i>, 2016), and consequential since groups may benefit from anti-seizure medications differently. Discharge regularity is an important feature recapitulated in computational models of TWs (Song <i>et al.</i>, 2019) and GPDs (Ruijter <i>et al.</i>, 2017). Recent analysis of GPDs in patients after cardiac arrest have shown that regularity of GPD duration, morphology, and amplitude, based on visual scoring, portend worse prognoses (Nadjar <i>et al.</i>, 2022). This suggests that variability of discharges could be a quantifiable tool in distinguishing GPDs from TWs. <h3>Design/Methods:</h3> We retrospectively collected inpatient EEG recordings marked to show GPDs and TWs from Harborview Medical Center between 11/2020 and 5/2021. The best derivation of a 30 second artifact free period on average reference montage was low pass filtered (0–15hz) for analysis. After visually identifying discharges, interdischarge intervals (IDIs) were calculated based on maximal deflection of each discharge. For each EEG, variance of IDIs was normalized by median IDI, to calculate a regularity index (RI). RI of GPDs and TWs were compared with a one-tailed Wilcoxon rank sum test. <h3>Results:</h3> 24 EEGs with TWs and 33 EEGs with GPDs were studied. Median RI for TWs was 0.438 with a variance of 3.08. Median RI for GPDs was 0.368 with a variance of 4.31. Groups were not statistically different (<i>p</i>=0.08). Excluding EEGs of following cardiac arrest, 23 EEGs with TWs and 10 EEGs with GPDs were studied. Median RI of TWs was 0.430 with variance of 3.14. Median RI of GPDs was 3.14 with variance of 13.7. Groups were not statistically different (<i>p</i>=0.27). <h3>Conclusions:</h3> Comparison of normalized variability in IDI does not distinguish TWs from GPDs but may have utility in the context of other clinical data. <b>Disclosure:</b> Dr. Plummer has nothing to disclose. Dr. Raut has nothing to disclose. Dr. Brunton has received personal compensation for serving as an employee of University of Washington. The institution of Dr. Brunton has received research support from National Science Foundation . The institution of Dr. Brunton has received research support from Air Force Office of Scientific Research. The institution of Dr. Brunton has received research support from National Science Foundation. Dr. Hakimian has received personal compensation in the range of $500-$4,999 for serving as a Consultant for OptumRx. Dr. Hakimian has stock in Various.

CHANTER Syndrome: A Rare Cause of Encephalopathy and Ischemic Lesions (P2-5.017)

<h3>Objective:</h3> To present a rare case of Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) Syndrome. <h3>Background:</h3> CHANTER syndrome is a recently recognized constellation of clinical and radiologic findings. The clinical features include acutely depressed consciousness with obstructive hydrocephalus secondary to cerebellar edema. MRI findings are restricted diffusion in the cerebellar cortex, hippocampi, and basal nuclei. CHANTER is distinguished from ischemic stroke by lack of distribution in a specific vascular territory or vascular occlusion present on angiographic imaging. Etiology may be a primary metabolic or mitochondrial failure of the gray matter with anoxic injury precipitated by opiates or other drugs of abuse. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 70-year-old right-handed hypertensive woman with HIV, end-stage renal failure, and lymphoma in remission was in respiratory distress. Seizures of unclear duration were noted on ambulance arrival and midazolam was administered. She was intubated and loaded with levetiracetam for status epilepticus. Norepinephrine was given during a hypotensive episode. Neurological examination was remarkable for lack of motor response to noxious stimuli and present brainstem reflexes consistent with coma. Opiates were detected in urine. MRI brain showed multiple small foci of restricted diffusion involving bilateral cerebellar hemispheres, hippocampi, basal ganglia, and in the right parietal cortex. MR angiography of the head and neck was normal. Video EEGs showed severe diffuse slowing, generalized periodic discharges that became blunted with triphasic morphology after lorazepam and levetiracetam administration. Cardiac monitoring and echocardiogram were unremarkable. Her alertness improved and withdrew minimally all extremities to painful stimuli. She was discharged to a long-term skilled nursing facility. <h3>Conclusions:</h3> This case highlights a rare clinical manifestation suggestive of CHANTER syndrome. Unlike other cases previously described, the cerebellar lesions were not sufficiently large to cause hydrocephalus. However, the clinical recovery was very limited. Status epilepticus and transient hypotension may have played a role in the poor recovery. <b>Disclosure:</b> Dr. Hiana has nothing to disclose. Dr. Soh has nothing to disclose. Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.

EEG Characteristics of Mortality in Patients with Altered Mental Status and Seizures: A Matched Case-Control Study (P8-7.001)

<h3>Objective:</h3> We aim to identify electroencephalographic markers as an indicator of mortality in non-neurological patients admitted to an intensive care unit (ICU) presenting with altered mental status (AMS) and seizures (subtle and non-convulsive). <h3>Background:</h3> Seizures can be seen in up to 30% of patients with AMS and can be associated with worse outcomes. However, most studies include patients with acute neurological illnesses. EEG features can provide physiological biomarkers of disease severity that can be utilized in predicting outcomes of patients with AMS and seizures. <h3>Design/Methods:</h3> Matched case-control study from a retrospective review of 432 patients admitted to our institution and underwent continuous electroencephalogram (cEEG) due to AMS. We included patients &gt;18 years and excluded if admitted for neurological diagnosis and non-first-time EEG recording. A total of 26 patients with seizures were found (Sz-EEG). We matched 26 controls to Sz-EEG patients by demographic and cEEG duration ± 12 hours (NoSz-EEG). APACHE-II score, Charlson comorbidity index (CCI), and EEG characteristics on seizure day were collected. <h3>Results:</h3> NoSz-EEG group had higher prevalence of coronary artery disease (p=0.04). After adjusting for confounders, including critical illness severity scores, Sz-EEG group had significantly higher mortality than NoSz-EEG group (p=0.036). The presence of spontaneous burst-suppression (BS, p=0.0029), sporadic epileptiform activity (EA, p&lt;0.0001) and lateralized periodic discharges (LPDs, p= &lt;0.0001) was significantly higher in the Sz-EEG group. BS pattern, EA and LPDs were present in 30% (8/26), 23% (6/26) and 23% (6/26), respectively, of Sz-EEG patients that died during hospitalization. <h3>Conclusions:</h3> Our matched case-control study showed that non-neurological patients with AMS and seizures had significantly higher mortality. BS, EA and LPDs patterns were the EEG features with higher prevalence in the Sz-EEG patients. These results suggest that EEG could be a marker of severity of encephalopathy in critically-ill patients. Larger studies are required to assess the strength of predictability of EEG biomarkers and outcomes. <b>Disclosure:</b> Mr. Alghorazi has nothing to disclose. Mr. Huang has nothing to disclose. Dr. Tsai has nothing to disclose. Zhu Hongtu, 5036 has nothing to disclose. Dr. Wabulya has nothing to disclose. Dr. Rubinos has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Qualtrics Inc. Dr. Rubinos has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for American Epilepsy Society . The institution of Dr. Rubinos has received research support from University of North Carolina .

Neurosyphilis Presenting as Limbic Encephalitis: a Case Report (P10-10.007)

<h3>Objective:</h3> To present an interesting case of neurosyphilis mimicking limbic encephalitis. <h3>Background:</h3> Neurosyphilis can occur at any stage of infection and it classically presents as meningitis, cranial neuropathies, vasculitis, tabes dorsalis, or neuropsychiatric manifestations, however rarely temporal lobe abnormalities resembling limbic encephalitis have been reported. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 51-year-old male with no past medical history presents initially with 3 weeks of altered mental status, confusion and memory loss. Prior to admission to the hospital, he presented with a generalized tonic-clonic seizure. His MRI showed T2 hyperintensities in the left hippocampus, amygdala, and mesial temporal lobe with associated diffusion restriction. Cerebrospinal fluid (CSF) studies showed 58 white blood cells/mm3 (73% lymphocytes), a protein concentration of 165 mg/dL and a glucose concentration of 35 mg/dL. HIV serology, serum cryptococcal Antigen, HSV and VZV PCR on CSF and neuronal autoantibodies on serum were negative. EEG showed left lateralized periodic discharges. The patient was initially treated with empiric anti-infective therapy including acyclovir, ceftriaxone, and ampicillin. Subsequently, serum syphilis screen was positive with reflex Rapid Plasma Reagin (RPR) titer at 1:64. CSF Venereal Disease Research Laboratory (VDRL) was positive at 1:64. In light of these results, the patient was transitioned to intravenous aqueous penicillin G 24 million units daily through continuous infusion. His mental status markedly improved after a few days of treatment. Repeat EEG showed only mild encephalopathy. He was discharged on levetiracetam and high dose IV penicillin G to complete a 14-day course. <h3>Conclusions:</h3> Syphilis is commonly known as a great imitator; it is a treatable condition so it should not be missed. We need to be more cognizant of this diagnosis when evaluating patients with temporal lobe involvement on MRI, lymphocytic pleocytosis and hypoglycorrhachia. Although HSV and autoimmune diseases are the most common causes of limbic encephalitis, as presented in our case, syphilis testing should be considered. <b>Disclosure:</b> Dr. Hu has nothing to disclose. Dr. El Helou has nothing to disclose. Nayrobi Pena Cotui has nothing to disclose. Dr. Balobaid has nothing to disclose. Dr. Montalvo Perero has nothing to disclose.

Wernicke’s Encephalopathy Preceded by COVID-19 Infection: A Case Report (P2-7.006)

<h3>Objective:</h3> To describe a case of post-infectious encephalopathy following COVID-19 with MRI brain changes suggestive of Wernicke’s encephalopathy and a transient presence of anti-GAD65 autoantibodies in the cerebrospinal fluid (CSF). <h3>Background:</h3> Chronic malnutrition and alcoholism are known risk factors for developing Wernicke’s encephalopathy. However, it is not typically associated with thiamine deficiency resulting from acute starvation as in this case of severe respiratory syndrome due to coronavirus-2 (SARS-CoV-2). <h3>Design/Methods:</h3> NA <h3>Results:</h3> A 59 year-old female presented to the neurointensive care unit with subacute disorientation, decreased verbal fluency, memory deficits, gait dysfunction, confusion, and rapid weight loss that progressed to coma over two months following COVID-19 infection. Initial lumbar puncture (LP) one month following infection was notable for positive anti-GAD65 autoantibodies and elevated protein which was suggestive of post-infectious encephalitis. MRI brain at the time of initial evaluation was unremarkable for abnormalities and the patient’s symptoms continued to progress to include depressed mentation. Subsequent MRIs of the brain with and without contrast showed T2 FLAIR abnormalities in the periaqueductal grey, lateral walls of the third ventricle, splenium, and mammillary bodies. Repeat LP showed similar CSF profile and absence of anti-GAD65 autoantibodies. Electroencephalogram showed slowing with frequent generalized periodic discharges. Patient’s treatment course included high dose thiamine, methylprednisolone, intravenous immunoglobulin, and plasmapheresis without clinical improvement. The patient did not show meaningful cognitive recovery and was transitioned to comfort care. <h3>Conclusions:</h3> The patient’s progression to coma was suspected to be due to development of COVID-19 encephalopathy precipitating Wernicke’s encephalopathy in the setting of severely diminished oral intake. Because Wernicke’s encephalopathy is potentially reversible with thiamine administration, we propose that early empiric treatment should be considered in all patients suffering from persistent encephalopathy following COVID-19 infection. <b>Disclosure:</b> Dr. Volski has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Chakrabarti Pulakanti has nothing to disclose. Dr. Dolla has nothing to disclose.

Inter-Rater Reliability of EEG-Based Encephalopathy Grading (S30.008)

<h3>Objective:</h3> To measure inter-rater reliability of experts in assessing encephalopathy severity using the VE-CAM-S grading system. <h3>Background:</h3> The VE-CAM-S (Visual EEG Confusion Assessment Method – Severity) scale quantifies encephalopathy severity based on EEG features. However, inter-rater reliability of experts using the scale has yet to be assessed. <h3>Design/Methods:</h3> We created an online test with thirty-two 15-second EEG samples. Each question asked users to indicate the presence/absence of each of 29 EEG features, 11 of which were used in the VE-CAM-S. Gold-standard was based on consensus of 3 authors (IS, FN, MBW). Ten experts from 6 institutions participated. We quantified performance by average spearman correlation of VE-CAM-S scores with the gold standard, and average sensitivity/specificity. We performed a qualitative analysis to identify errors in recognizing EEG features that most affected VE-CAM-S scores. <h3>Results:</h3> The average [95%CI] correlation between VE-CAM-S scores with the gold standard was 0.73 [0.59–0.86]. Specificity was very high (&gt;90%) for all but generalized delta (77%). Sensitivity was high (&gt;70%) for all but brief generalized attenuations (69%), generalized periodic discharges (67%), generalized theta (63%), BIRDS (57%), generalized alpha (57%), extreme delta brushes/EDB (50%), and generalized beta (50%). Probable reasons for errors were subtlety of some findings; confusing some findings (e.g., generalized beta vs. myogenic artifact, burst suppression vs. brief generalized attenuations); failure to correctly recognize BIRDs (mislabeled as focal IEDs) and EDB (mislabeled as GRDA). The largest errors occurred when experts missed or falsely identified features that carry higher weight in the VE-CAM-S scoring rubric. <h3>Conclusions:</h3> Expert agreement in VE-CAM-S scoring is high. Error analysis identified several ways to improve future versions, including breaking high-stakes features into smaller parts; creating a “cheat sheet” with scored examples to allow scorers to choose the closest match; and designing teaching materials to help scorers recognize subtle variations of high-stakes patterns. <b>Disclosure:</b> Ms. Zahoor has nothing to disclose. Ms. Banks has nothing to disclose. Mr. Tesh has nothing to disclose. Dr. Eckhardt has stock in Moderna. Dr. Sun has nothing to disclose. Dr. Greenblatt has nothing to disclose. Dr. Herlopian has nothing to disclose. Dr. Karakis has nothing to disclose. Dr. Katyal has nothing to disclose. Dr. Nayak has nothing to disclose. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Canada. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Paladin Canada. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai Canada. The institution of Dr. Ng has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Canada. Dr. Ng has received publishing royalties from a publication relating to health care. Dr. Williams has nothing to disclose. Dr. Sheikh has nothing to disclose. Dr. Nascimento has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Zogenix. The institution of Dr. Nascimento has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biocodex. Dr. Nascimento has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Nascimento has received research support from Zogenix. The institution of Dr. Nascimento has received research support from Biocodex. The institution of Dr. Nascimento has received research support from Greenwich. Dr. Nascimento has received publishing royalties from a publication relating to health care. Dr. Nascimento has a non-compensated relationship as a Editorial Team Member with Neurology RFS that is relevant to AAN interests or activities. Dr. Nascimento has a non-compensated relationship as a Production Team with Neurology Podcast that is relevant to AAN interests or activities. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities.

Thermal performance analysis of a large scale water pit heat storage

Solar thermal application is an effective approach to achieve carbon neutrality. The large scale water pit heat storage (PTES) is a key component to ensure the stability of large-scale solar thermal plants. Based on the model of type 1535-1301, this paper performs a 2D simulation investigation of the long-term thermal performance of PTES using Trnsys. The accuracy of this model was verified by comparison with measured data from the solar plant in Dronninglund, Denmark. The results show that the average error between the model and the actual measurements is only 3%. In addition, it can be found that the PTES average temperature decreases from 24°C to 12°C before the 80th day due to heat losses. During the charging period from the 80th to 250th days, the PTES average temperature increases to 68°C. In which the PTES formed a temperature stratification with 80°C at the top and 40°C at the bottom. The sloping soil temperature boundary expands and shows a non-uniform stratification of 70-10°C with 10m thickness. The average temperature of the PTES gradually decreases to 16°C during the discharge period after the 250th day. The actual charging and discharging energy are 11,868 MWh and 11,250 MWh per year, respectively, and the total heat loss is 1,157 MWh. The storage efficiency is as high as 90.1% because PTES is used for both long-term and short-term energy storage. This paper reveals the dynamic thermal process of PTES throughout the year to provide a reference for designers.

Readiness for hospital discharge post-initial invasive percutaneous transhepatic biliary drainage: A mixed-methods study

This study explores perceptions regarding hospital discharge readiness among patients with post-first invasive percutaneous transhepatic biliary drainage (PTBD), family caregivers, and healthcare providers who are involved during the discharge period. A convergent mixed-method design was applied. A purposive sample of 30 patients completed a scale measuring readiness for hospital discharge, and 30 participants, including patients, family caregivers, and healthcare providers, participated in in-depth interviews. Descriptive analyses were combined with quantitative data, thematic analyses with qualitative data, and joint displays with mixed analyses. Findings indicate that readiness for hospital discharge was high, the expected support subscale was at the highest possible level, and the personal status subscale was at the lowest level. Three main themes emerged from an analysis of the interview transcripts: improved health conditions, self-care knowledge, and homecare preparedness. Self care knowledge had three sub-themes: taking care of biliary drainage, consuming a suitable diet, and observation of abnormal symptoms. Being ready for hospital discharge contributes to a safer transition from hospital to home. Healthcare providers need to reconsider the criteria for discharge and clarify patients’ individual needs. Patients, family caregivers, and healthcare providers need to be prepared for hospital discharge.

Hierarchical Ni@CNTs-bridged MoxC/Ni2P heterostructure micro-pillars for enhanced seawater splitting and Mg/seawater battery

In this study, a high-efficiency hybrid catalyst of Ni nanoparticles-encapsulated carbon nanotubes-bridged molybdenum carbide/nickel phosphide heterostructures (Ni@CNTs-MoxC/Ni2P) is prepared via a facile synthesis route. The catalyst having hierarchical structure with rich heterogeneous interfaces of MoxC/Ni2P micro-pillars bridged with Ni@CNTs offers an efficient connection among different active phases to guarantee good conductivity and stability. It also results in large electroactive surface with abundant multiple electroactive sites and creates unique modified electronic properties to effectively increase density of states near the Femi level and well adjust adsorption free energy, thus highly beneficial to simultaneously promote bifunctional OER and HER performances. The Ni@CNTs-MoxC/Ni2P only requires small overpotentials of 54 mV for HER and 228 for OER at 10 mA cm–2 in alkaline electrolyte, superior to recently reported bifunctional catalysts. The electrolyzer cell of Ni@CNTs–MoxC/Ni2P(+,-) requires a low operating voltage of 1.53 and 1.56 V at 10 mA cm–2 in alkaline freshwater and natural seawater, respectively. The Mg/seawater battery from Ni@CNTs–MoxC/Ni2P-based cathode exhibits a high peak power density of 7.01 mW cm−2 with a stable discharge period of 100 h. The results suggest that Ni@CNTs-MoxC/Ni2P is a promising candidate for future seawater splitting and prospective Mg/seawater battery application.

Application of the Calcium Looping Process for Thermochemical Storage of Variable Energy

The calcium looping (CaL) process, which exploits the reversible calcination of calcium carbonate, has been proposed as a solution to the challenges facing deployment of concentrated solar power (CSP). As an extension of the work undertaken to date, this project proposes a novel configuration of the CSP-CaL process which may offer advantages over other proposed configurations, including a reduction in process equipment requirements, elimination of pressure differentials between vessels, and a reduction in compression duty during the energy discharge period. The results obtained through process simulation indicate that the proposed process can achieve round-trip efficiencies in the range of 32–46% and energy storage densities in the range of 0.3–1.0 GJ/m3. These parameters are strongly dependent on the residual conversion of the CaO sorbent as well as the efficiency of the power cycles used to remove heat on the carbonator side of the process.

Anthropogenic impact and antibiotic resistance among the indicator and pathogenic bacteria from several industrial and sewage discharge points along the coast from Pydibhimavaram to Tuni, East Coast of India

Increasing urbanisation and industrialisation of the Visakhapatnam region have brought domestic sewage and industrial wastewater discharge into the coastal ocean. This study examines the indicator and pathogenic bacteria's quantitative abundance and antibiotic susceptibility. This study collected surface and subsurface water samples from ten different regions (147 stations; 294 samples), including 12 industrial discharge points, surrounding stations and two harbours from the coast of Pydibheemavaram to Tuni. Physicochemical parameters like salinity, temperature, fluorescence, pH, total suspended matter, nutrients, chlorophyll-a and dissolved oxygen showed a difference between regions. We noticed the presence of indicator (Escherichia coli and Enterococcus faecalis) and pathogenic (Aeromonas hydrophila, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Salmonella and Shigella, Vibrio cholera and Vibrio parahaemolyticus) bacteria among the samples. Waters from the near harbour and Visakhapatnam steel plant showed lower bacterial load with no direct input from industries to the coastal water. Samples collected during the industrial discharge period had a higher bacterial load, including E. coli. Enteric bacteria were found in higher numbers at most stations. Some isolates were resistant to multiple antibiotics with higher antibiotic resistance and multiple antibiotic resistance indexes compared with the other coastal water habitats in the Bay of Bengal. The occurrence of these bacteria above the standard limits and with multiple antibiotic resistance in the study region may pose a potential threat to the local inhabitants. It can create an alarming situation in the coastal waters in the study region.

The benthic food web connects the estuarine habitat mosaic to adjacent ecosystems

Energy flows from land to sea and between pelagic and benthic environments have the potential to increase the connectivity between estuaries and adjacent ecosystems as well as among estuarine habitats. To identify such energy flows and the main trophic pathways of energy transfer in the Minho River estuary, we investigated the spatial and temporal fluctuations of carbon and nitrogen stable isotope ratios in benthic (and their potential food sources) and epibenthic consumers. Sampling was conducted along the estuarine salinity gradient from winter to summer of 2011. We found that the carbon (δ13C = 13C/12C) and nitrogen (δ15N = 15N/14N) stable isotope ratios of the most abundant benthic and epibenthic consumers varied along the salinity gradient. The δ13C values increased seaward, whereas the opposite pattern was found for the δ15N, especially during the summer. The stable isotope ratios revealed two trophic pathways in the Minho estuary food web. The first pathway is supported by phytoplankton and represented by filter feeders such as zooplankton and some deposit feeders, particularly amphipods and polychaetes. The second pathway is supported by detritus and composed essentially of deposit feeders, which by being consumed, allow detritus to be incorporated into higher trophic levels. Spatial and temporal feeding variations in the estuarine benthic food web are driven by hydrology and proximity to adjacent ecosystems (terrestrial, marine). During high river discharge periods, the δ13CPOC (ca. -28‰) and C:NPOM (>10) values suggested an increase of terrestrial-derived OM to the particulate OM pool, which was then used by suspension feeders. During low river discharge periods, marine intrusion increased upriver, which was reflected in benthic consumers' 13C-enriched stable isotope values. No relationship was found between food quality (phytoplankton vs. detritus) and food chain length because the lowest and highest values were associated with freshwater and saltmarsh areas, respectively, both dominated by the detrital pathway. This study demonstrates that benthic consumers enhance the connectivity between estuaries and its adjacent ecosystems by utilizing subsidies of terrestrial and marine origin and that benthic-pelagic coupling is an important energy transfer mechanism to the benthic food web.

Clinical and Electroencephalographic Predictors of Seizures and Status Epilepticus in 12,450 Critically Ill Adults: A Retrospective Cohort Study.

Status epilepticus (SE) is associated with significantly higher morbidity and mortality than isolated seizures. Our objective was to identify clinical diagnoses and rhythmic and periodic electroencephalogram patterns (RPPs) associated with SE and seizures. Retrospective cohort study. Tertiary-care hospitals. Twelve thousand four hundred fifty adult hospitalized patients undergoing continuous electroencephalogram (cEEG) monitoring in selected participating sites in the Critical Care EEG Monitoring Research Consortium database (February 2013 to June 2021). Not applicable. We defined an ordinal outcome in the first 72 hours of cEEG: no seizures, isolated seizures without SE, or SE (with or without isolated seizures). Composite groups included isolated seizures or SE (AnySz) and no seizure or isolated seizures. In this cohort (mean age: 60 ± 17 yr), 1,226 patients (9.8%) had AnySz and 439 patients (3.5%) had SE. In a multivariate model, factors independently associated with SE were cardiac arrest (9.2% with SE; adjusted odds ratio, 8.8 [6.3-12.1]), clinical seizures before cEEG (5.7%; 3.3 [2.5-4.3]), brain neoplasms (3.2%; 1.6 [1.0-2.6]), lateralized periodic discharges (LPDs) (15.4%; 7.3 [5.7-9.4]), brief potentially ictal rhythmic discharges (BIRDs) (22.5%; 3.8 [2.6-5.5]), and generalized periodic discharges (GPDs) (7.2%; 2.4 [1.7-3.3]). All above variables and lateralized rhythmic delta activity (LRDA) were also associated with AnySz. Factors disproportionately increasing odds of SE over isolated seizures were cardiac arrest (7.3 [4.4-12.1]), clinical seizures (1.7 [1.3-2.4]), GPDs (2.3 [1.4-3.5]), and LPDs (1.4 [1.0-1.9]). LRDA had lower odds of SE compared with isolated seizures (0.5 [0.3-0.9]). RPP modifiers did not improve SE prediction beyond RPPs presence/absence ( p = 0.8). Using the largest existing cEEG database, we identified specific predictors of SE (cardiac arrest, clinical seizures prior to cEEG, brain neoplasms, LPDs, GPDs, and BIRDs) and seizures (all previous and LRDA). These findings could be used to tailor cEEG monitoring for critically ill patients.

COMPARISON ON STUDY OF LITHIUM ION AND LEAD ACID CHARGING AND DISCHARGING CHARACTERISTICS

A lithium-ion or Li-ion battery is a type of rechargeable battery which uses the reversible reduction of lithium ions to store energy. It is the predominant battery type used in portable consumer electronics and electric vehicles. Energy density: 250–693 Wh/L (0.90–2.49 MJ/L) Specific energy: 100–265 Wh/kg (0.360–0.954 MJ/kg) Charge/discharge efficiency: 80–90% Cycle durability: 400–1,200 cycles Self-discharge rate: 0.35% to 2.5% per month depending on state of charge Specific power: c. 250–340 W/kg Lithium batteries, as opposed to alkaline, are capable of giving off a strong energy surge after a long period of low discharge. This makes them ideal for fire alarms. Alkaline batteries provide good, long-term power, but they lose strength over time. On the other side , the Lead acid battery are inexpensive compared to newer technologies, lead–acid batteries are widely used even when surge current is not important and other designs could provide higher energy densities. Energy density: 80–90 Wh/L Nominal cell voltage: 2.1 V Self-discharge rate: 3%–20%/month Specific energy: 35–40 Wh/kg Charge temperature interval: Min. −35°C, max. 45°C Charge/discharge efficiency: 50%–95% Cycle durability: &lt;350 cycle In order to observe the characteristic nature of Lead acid &amp; Lithium ion battery , a review is made on the subject using Matlab Simulink and Simscape.

Extreme freshwater discharge events exacerbated by climate change influence the structure and functional response of the chironomid community in a biodiversity hotspot

Global climate change is expected to exacerbate extreme discharge events in freshwater ecosystems as a consequence of changes in precipitation volume and snow cover duration. Chironomid midges were used as a model organism in this study because of their small size and short life cycles, which enable fast colonization of new habitats and great resilience. This resilience is often expressed in easy recolonization after an extreme event. Chironomid samples together with physico-chemical water measurements were collected for 14 years, between 2007 and 2020, in a karst tufa barrier that is part of the Plitvice Lakes National Park in Croatia. More than 13,000 individuals belonging to >90 taxa were collected. Mean annual water temperature increased by 0.1 °C during this period. Multiple change-point analysis revealed three main periods by discharge patterns: the first one from January 2007 to June 2010, the second from July 2010 to March 2013, characterised by extreme low discharge, and the third from April 2013 to December 2020, characterised by an increase in extreme peak discharge values. Based on multilevel pattern analysis, indicator species of the first and the third discharge period were detected. The ecological preferences of these species indicate an environmental change related to the changes in discharge. Along with species composition, functional composition has changed with the abundance of passive filtrators, shredders and predators increasing over time. Species richness and abundance did not change over the period of observation, thus emphasizing the importance of species-level identification in detecting the earliest community response to change that would otherwise be overlooked.

Performance evaluation of external compound parabolic concentrator integrated with thermal storage tank for domestic solar refrigeration system.

The aim of this research was to develop a model for a solar refrigeration system (SRS) that utilizes an External Compound Parabolic Collector and a thermal energy storage system (TESS) for solar water heating in Chennai, India. The system parameters were optimized using TRNSYS software by varying factors such as collector area, mass flow rate of heat transfer fluid, and storage system volume and height. The resulting optimized system was found to meet 80% of hot water requirements for the application on an annual basis, with an annual collector energy efficiency of 58% and an annual TESS exergy efficiency of 64% for a discharge period of 6h per day. In addition, the thermal performance of 3.5kW SRS was studied by connecting it to an optimized solar water heating system (SWHS). The system was found to generate an average cooling energy of 12.26MJ/h annually, with a coefficient of performance of 0.59. By demonstrating the ability to efficiently generate both hot water and cooling energy, the results of this study indicate the potential for utilizing a SWHS in combination with STST and SRS. The optimization of system parameters and the use of exergy analysis provide valuable insights into the thermal behavior and performance of the system, which can inform future designs and improve the overall efficiency of similar systems.