Physical Deterioration Research Articles

A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study.

Internet gaming disorder (IGD) leads to social disturbances and isolation, neglect of daily responsibilities, behavioral disorders, and physical impairments. This study aimed to investigate the effect of IGD on spine biomechanics, range of motion in the neck and low back, and lung functions and respiratory muscle strength in children and adolescents. Sixty-four children and adolescents with IGD (Group I) and 41 healthy controls (Group II) were included in the study. The outcomes were assessed with the Visual Analogue Scale (VAS), Internet Addiction Scale, active range of motion (AROM) in the neck and lumbar spine, posture and spinal alignment, lung function tests, and respiratory muscle strength. There is a significant difference in pain intensity at rest, during activity, and daily sitting time between groups (p < 0.05). Craniovertebral angle, shoulder asymmetry, thoracic kyphosis angle, cervical extension and rotation, and right lumbar rotation significantly decreased in Group I than in Group II (p < 0.05). Besides, the PEF, FEF 25-75%, and respiratory muscle strength were lower in Group I than in Group II (p < 0.05). With a multiple linear regression model, MEP, FEV1, and weekly time spent playing online games were significant predictors of internet addiction intensity (R2 = 0.28; p = 0.02, p = 0.01, and p < 0.001, respectively). Postural misalignment and increased sedentary time cause physical health deterioration and negatively affect lung functions in children and adolescents with IGD. Consequently, considering both psychological and physical health is necessary to assess the problematic nature of internet gaming. A comprehensive assessment and multidisciplinary team approach is essential to managing the IGD.

A Challenging Conundrum; Learning Disability, Schizophrenia and Autism - a Case Report

IntroductionPsychiatric disorders are common in patients with learning disabilities. There are also patients with the triad of autism, schizophrenia and learning disability. Patients with this background can be admitted to general hospitals for psychiatric or non-psychiatric reasons.We are presenting a case who had a very complicated clinical course and her discharge planning was challenging.ObjectivesThe objective of this work was to show the challenges in the investigation, medical management, and discharge planning of the patients with concomitant learning disability, schizophrenia and autism.MethodsWe scrutinized the patient’s casenotes, including blood results and all relevant imaging. We paid a particular attention to all the entries from the psychiatry team, general medical doctors, oncologists, learning disability team and discharge planners.ResultsThe lady had a protracted 4-month inpatient admission throughout which she was physically and verbally aggressive to hospital staff. She was deemed to lack capacity for hospital admission and treated in her best interests under Mental Capacity Act (MCA), frequently requiring sedation with Haloperidol and Lorazepam. Following consultation with the local Psychiatrist her medications were altered to: Risperidone 2 mg BD, Diazepam 5 mg OM, 5 mg afternoon and 10 mg evening, Procyclidine 5 mg BD, Chlorpromazine 25 mg BD, Promethazine 25 mg OD PRN, and Midazolam 10 mg buccal PRN.A change in her clinical condition was noted by the Psychiatry team; increased agitation, confusion and dysarthria. A repeat blood test was advised, due to patient refusal this took weeks to achieve despite the use of buccal Midazolam following Anaesthesiologist advice. Although blood tests were not significantly deranged, she was treated for presumed urinary tract infection with a course of antibiotics. A urine sample was unobtainable.She reported right breast pain and underwent a mammogram. This showed a hypoechoic lesion 8x7x9 mm. Following consultation with a Breast Surgeon and Oncologist, Letrozole was replaced with Tamoxifen. The Psychiatric team concluded that the clinical deterioration with dysarthria was related to anxiety, associated with Autistic patients. The movement disorder was deemed secondary to antipsychotics exacerbated by stress and anxiety.The patient’s discharge planning was complex. She was declined by numerous care homes. At time of writing, she remains an inpatient.ConclusionsThe management of patients with a triad of Learning Disability, Schizophrenia and Autism is extremely difficult, particularly within an acute medical setting. Physical deterioration could be related to medication adverse effects or change in environment. Anxiety and stress are linked to these conditions. The challenging behaviour that these patients often have will make discharge planning very difficult as specialised care homes to accommodate these unique patients are very limiteDisclosure of InterestNone Declared

Pulmonary Rehabilitation Associated with Noninvasive Ventilation on Physical Capacity and Quality of Life in Post-COVID-19: A Randomized Controlled Double-Blinded Clinical Trial Protocol.

The coronavirus disease-2019 (COVID-19) pulmonary rehabilitation (PR) seems to be a better choice to improve physical and functional capacity after acute infection. However, there is a lack of evidence regarding the effects of different strategies to optimize post-acute phase rehabilitation and reduce long COVID-19 physical deteriorations. To compare the use of a noninvasive ventilation (NIV) plus aerobic exercise strategy during PR program with to a standard PR (without NIV) on physical capacity and quality of life outcomes in post-COVID-19. Double-blinded randomized controlled clinical trial. A total of 100 individuals discharged from hospital in a post-acute phase of severe COVID-19 will be randomized into two groups: PR + NIV (Group 1) and PR (Group 2). Inclusion criteria include participants who present symptomatic dyspnea II and III by the modified Medical Research Council, aged 18 years or older. Both groups will receive aerobic and resistance exercise, and inspiratory muscle training. However, group 1 will perform aerobic training with bilevel NIV. Cardiopulmonary exercise test will assess the O2 peak uptake, 6-minute walk test will assess the walking distance and short-form 36 will assess the quality of life before and after 8 weeks (after 24 PR sessions). Moreover, patients will be contacted by telephone every 3 months for one year to record possible adverse events, hospitalizations, and death. All data will be registered in RedCap, and analyses will be performed in the STATA v13 software. RBR-3t9pkzt.

DESALINATION OF UNDERWATER CERAMIC CULTURAL HERITAGE: THE EXAMPLE OF KERPE UNDERWATER EXCAVATION

Salinity, which is one of the chemical properties of the marine environment, is mixed into seawater due to the dynamic exchange processes between the atmosphere and the hydrosphere and the dissolution of the shells of marine organisms on the seabed. The amount of soluble salts is measured in parts per million (ppm), but in this article, it is measured in parts per thousand (ppt). When soluble salts are not removed by appropriate conservation methods, they crystalize in the pores of artefacts that constitute underwater cultural heritage. These crystals cause physical deterioration in ceramics, which are porous cultural heritage, such as fragmentation from the surface and microscopic cracks. For this reason, the first step in repairing cultural remains recovered from underwater archaeological excavations is to determine the physical properties of the artefacts, such as porosity and salt absorption capacity, as well as the type and amount of salt accumulated in their pores. Thus, the appropriate desalination method can be selected, and estimates can be made on how long the desalination process will take. This paper studied ceramic sherds of Roman and Byzantine amphorae and cooking vessels recovered during underwater excavations in the ancient harbor of Kerpe Bay in Kocaeli, Turkey, in 2022. The aim of the study was to make a preliminary examination for further studies, including instrumental analyses, and to determine the types and amounts of salt deposited on the samples. The samples were desalinated for one month in 200 ml containers with weekly changes of deionized water, and the desalination water was tested to measure salinity and determine the dissolved salt species. Spot tests were used to determine dissolved salts. Sulphate, chloride and carbonate were found in the samples due to these tests. The porosity of the samples was determined by the water absorption method.

Social-Economic Factors Affecting Accessibility to Sanitation and Hygiene Services Among People Living with Disabilities in Kitui County, Kenya

Persons living with disabilities refer to individuals with persistent mental, physical, sensory or intellectual deterioration while interacting with varied barriers may prevent equal participation in society compared to other population. People living with disabilities (PLWD) are greater than five times probable to be found in the position of being unable to access sanitation and hygiene services as compared to normal people in the same community. There are significant gaps and limited knowledge in implementation of WASH policies across the country. This study aimed was to determine the social-economic factors affecting accessibility to sanitation and hygiene services among PLWD in Kitui County, Kenya. The study employed a cross sectional survey method. Socio-economic status indicated a high proportion of participants with limited education (51.1% with no formal education, 35.2% with primary education), and a pervasive low income (98.6% earning less than 10,000) and unemployment (85.3%). Socio-economic variables, including occupation (B = -0.212, p = 0.032), income (B = -1.068, p = 0.184), and education level (B = 0.457, p &lt; 0.001), exhibited notable associations. This study identified substantial challenges hindering people with disabilities (PLWD) from accessing adequate sanitation and hygiene, revealing critical issues related to socio-economic factors, physical and environmental barriers, communication gaps, and institutional shortcomings.

Feeling-BIM: A digital model to support maintenance decisions, based on automatic inspection and dwellers’ feelings

Maintenance decisions often extend beyond physical deterioration, with stakeholders' experiences playing crucial roles. Traditionally, building assessments rely on visual inspections, but manual methods have limitations (e.g., time and cost expensive, relying on subjective assessment). “Feeling-BIM” proposes a new methodology whose concept integrates automated facade inspection with residents' sentiments. Incorporating residents' feelings acknowledges the prevalence of subjective criteria in maintenance decisions, with a particular focus on facade stains that influence interventions and building aesthetics. Three buildings with the same archetype and in the same street, in different degradation conditions, are analysed as case study. A sentiment analysis is performed, to evaluate the ability of residents to clearly distinguish between facades in the best condition and those identified by automated inspection as having a higher presence of stains. “Feeling-BIM” empowers decision-makers with a more comprehensive perspective on facades’ condition, ensuring that decisions are well-informed and balanced, considering both objective and subjective factors.

Field Evaluation of Land Deterioration in Al - Mohammadi Basin Valley at Western Desert

The recurrent study was in including lots scientific details on land deterioration for Almehmedi valley basin. This basin is represented as distinguish sites because it possesses different morphology, geological properties, climate pattern, various land resources such as soils, vegetation and water resources. Conceptualization of this study was entirely prepared then results were different to discover the range of land degradation using field evolution on this basin, which its area was 1971.49 km2. Therefore basin lands were divided into six land unites via geomorphological terms. These terms were done using optical explanation on Land sat 8 satellite image. These unites are high plateaus, flat plateaus, unbath, valleys, alluvial fans, flood plain. Moreover field investigation was applied using GLASOD physical, biological, chemical and saline deterioration. Thus, their cause was explained and measured the deterioration amounts within land units using tables maps. The research study could clouded basin field spatial differences resulted in differing the valley basin from other lands. Furthermore, it resulted in spatial relations amongst human iturimm and natural in this area.

Turning Lemons into Lemonade: Social Support as a Moderator of the Relationship Between Technostress and Quality of Life Among University Students.

The overuse of internet-based technologies as a means of coping with the stress they generate has resulted in an alarming level of addiction, adversely impacting the quality of life and overall health of younger individuals. This social detachment, in turn, contributes to both physical and mental health deterioration. The potential remedy for this predicament lies in the application of social support as an antidote to internet addiction. In this context, our present study employs the Stress-Strain-Outcome model to explore the indirect effects of internet addiction and the moderating role of social support in relation to the influence of technostress on the quality of life of adults. We adopted a time-lagged design to collect data from university graduates and evaluated our study hypotheses using Mplus. Our empirical findings highlight the significant influence of technostress on internet addiction, with the latter significantly mediating the relationship between technostress and quality of life. Furthermore, our results reveal that social support effectively moderates the indirect effects of technostress on quality of life through its impact on internet addiction. These findings can help researchers and educators better understand the underlying mechanisms between technostress and quality of life with social support as the silver lining. This form of social support holds the potential not only to alleviate internet addiction but also to positively enhance the quality of life and overall wellbeing of individuals facing these challenges. The implications of these findings and avenues for future research are also discussed.

Do Adolescents Really Recover from Anorexia? Or the Lack of Standardised Definition May Mask their Process?: A Systematic Review

Anorexia Nervosa (AN) is an eating disorder that causes physical, behavioural and psychological deterioration. Although diagnostic criteria are clearly defined, there has been no consensus on what recovery is. This study aimed to review prior studies indicating recovery criteria, as well as recovery rates of patients with adolescent-onset AN. Related studies were searched through databases MEDLINE, PsycINFO and CINAHL. A total of 15 English studies with patients had adolescent-onset and DSM-5/ICD-11 diagnoses. A systematic review was conducted by following the PRISMA expanded checklist and qualities of eligible articles were evaluated via the Quality Criteria Checklist (QCC). Of the 15 studies, two studies mentioned only physical dimension of recovery, whereas rest of the 13 studies covered behavioural and psychological dimensions. EDE-Q was found as the most frequently used scale. Follow-up years of the patients fluctuated from one to 30 years, and the recovery rate varied from 30.6% to 72%. There are some difficulties faced in defining recovered patients. Since no consensus was achieved, every researcher set their recovery criteria. Until the policymakers of field standardize definition of recovery from AN, researchers should be aware of the fact that inconsistencies in definition can affect results of their research.

The role of hornification in the deterioration mechanism of physical properties of unrefined eucalyptus fibers during paper recycling

Physical properties of cellulosic paper deteriorate significantly during paper recycling, which hinders the sustainable development of the paper industry. This work investigates the property deterioration mechanism and the role of hornification in the recycling process of unrefined eucalyptus fibers. The results showed that during the recycling process, the hornification gradually deepened, the fiber width gradually decreased, and the physical properties of the paper also gradually decreased. After five cycles of reuse, the relative bonding area decreased by 17.6%, while the relative bonding force decreased by 1.8%. Further results indicated that the physical property deterioration of the paper was closely related to the decrease of fiber bonding area. The fiber bonding area decreased linearly with the reduction of re-swollen fiber width during paper recycling. Re-swollen fiber width was closely related to the hornification. Hornification mainly reduces the bonding area of unrefined eucalyptus fiber rather than the bonding force. The work elucidates the role of hornification in the recycling process of unrefined eucalyptus fibers and the deterioration mechanism of paper physical properties, which will be helpful to control the property deterioration of paper and achieve a longer life cycle.

Enhancing functional features of pectin‐based coating by incorporating cellulose nanofibre/peppermint oil

SummaryFruit loss frequently occurs due to physical and microbial deterioration. This study aimed to develop an emulsified coating formulation based on pectin (BP)/cellulose nanofibre (CNF)/(peppermint essential oil) PEO using the Pickering technique with an appropriate level of CNF as a stabiliser and to study its effect on grape quality during storage. The incorporation of 0.4% PEO‐stabilised with various 0.1%–0.325% CNF into 0.5% BP edible coatings was developed. A 0.175% concentration of CNF was found to be appropriate for stabilising the emulsion system. This technique improved the functional performance of BP coatings, including their antifungal activity against Penicillium digitatum by 64.94% on the 7th day of incubation. Moreover, light transmission at UV and visible wavelengths and elongation improved by 23.17% and 71.26% respectively compared to the pure BP‐based coating. Scanning electron microscopy and Fourier‐transform infrared spectroscopy were used to characterise the biocompatibility of each coating formulation. The PEO‐CNF emulsion coating may be an alternative for the active coating of fresh fruit commodities.

Should I stay or should I go: an assessment of criteria for safe day of surgery discharge of displaced supracondylar humerus fractures.

Immobilization type and in-hospital observation following surgical management of displaced supracondylar fractures are subject to surgeon preference and training. Our goal was to determine criteria for immediate discharge and optimal type of immobilization. Medical records of 661 patients with type III, IV or flexion-type displaced supracondylar humerus fractures treated at a level 1 pediatric trauma center from January 2013 to September 2019 were reviewed. Patients were separated into 'admission appropriate' (AA = 113) and 'discharge appropriate' (DA = 548) sub-cohorts. Neurovascular deficit at presentation (P < 0.001), post-operative physical exam deterioration (P < 0.001), age (P < 0.001) and post-operative immobilization modality (P = 0.02) were significantly different between AA and DA groups. When comparing patients who presented with neurologic deficit to those neurovascularly intact, there was a significant difference in whether circumferential immobilization was used post-operatively (P < 0.001), IV medication need (P < 0.001), discharge or admission (P < 0.001), neurologic decline (P < 0.001), return to ED (P = 0.008) and vascular compromise (P = 0.05). Twenty-four of the 56 (43%) patients who were AA and had no neurovascular finding on presentation had their immobilization adjusted (bivalved or loosened) to accommodate for swelling overnight. Only 1 was initially maintained in a splint or bivalved cast; the other 23 were initially maintained post-operatively in circumferential immobilization (P = 0.01). Our findings suggest that patients with intact neurovascular exams at presentation are candidates for early discharge, and splinting or bivalved casting may be preferable, especially in patients who are discharged.

2.5-Year changes of connectivity dynamism are relevant for physical and cognitive deterioration in multiple sclerosis

Background: In MS, functional connectivity (FC) dynamism may influence disease evolution. Objectives: The objective is to assess time-varying functional connectivity (TVFC) changes over time at 2.5-year follow-up in MS patients according to physical and cognitive worsening. Methods: We collected 3T magnetic resonance imaging (MRI) for TVFC assessment (performed using sliding-window analysis of centrality) and clinical evaluations at baseline and 2.5-year follow-up from 28 healthy controls and 129 MS patients. Of these, 79 underwent baseline and follow-up neuropsychological assessment. At 2.5 years, physical/cognitive worsening was defined according to disability/neuropsychological score changes. Results: At follow-up, 25/129 (19.3%) MS patients worsened physically and 14/79 (17.7%) worsened cognitively. At baseline, MS patients showed reduced TVFC versus controls. At 2.5-year follow-up, no TVFC changes were detected in controls. Conversely, TVFC decreased over time in parieto-temporal regions in stable MS patients and in default-mode network in worsened MS. In physically worsened MS, basal ganglia TVFC reductions were also found. Reduced TVFC over time in the putamen in physically worsened and reduced TVFC in the precuneus in cognitively worsened were significant versus stable MS. Discussion: At 2.5-year follow-up, default-mode network TVFC reductions were found in worsening MS. Moreover, reduced deep gray matter TVFC characterized physically worsened patients, whereas precuneus involvement characterized cognitively worsened MS patients.

Homeworking among healthcare workers during the COVID-19 pandemic.

This commentary article considers the experiences of homeworking among healthcare workers during the pandemic, with a focus on mental and physical health consequences. While positive outcomes were observed, such as improved sleep hygiene and increased patient capacity, negative effects like burnout, social disconnection and physical health deterioration were prevalent. Further research is necessary to assess long-term effects and evaluate if remote working practices can be adopted to support healthcare workers.

Cabozantinib plus atezolizumab versus sorafenib for advanced hepatocellular carcinoma (COSMIC-312): final results of a randomised phase 3 study

The aim of the COSMIC-312 trial was to evaluate cabozantinib plus atezolizumab versus sorafenib in patients with previously untreated advanced hepatocellular carcinoma. In the initial analysis, cabozantinib plus atezolizumab significantly prolonged progression-free survival versus sorafenib. Here, we report the pre-planned final overall survival analysis and updated safety and efficacy results following longer follow-up. COSMIC-312 was an open-label, randomised, phase 3 study done across 178 centres in 32 countries. Patients aged 18 years or older with previously untreated advanced hepatocellular carcinoma were eligible. Patients must have had measurable disease per Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1), and adequate marrow and organ function, including Child-Pugh class A liver function; those with fibrolamellar carcinoma, sarcomatoid hepatocellular carcinoma, or combined hepatocellular cholangiocarcinoma were ineligible. Patients were randomly assigned (2:1:1) using a web-based interactive response system to a combination of oral cabozantinib 40 mg once daily plus intravenous atezolizumab 1200 mg every 3 weeks, oral sorafenib 400 mg twice daily, or oral single-agent cabozantinib 60 mg once daily. Randomisation was stratified by disease aetiology, geographical region, and presence of extrahepatic disease or macrovascular invasion. Dual primary endpoints were for cabozantinib plus atezolizumab versus sorafenib: progression-free survival per RECIST 1.1, as assessed by a blinded independent radiology committee, in the first 372 randomly assigned patients (previously reported) and overall survival in all patients randomly assigned to cabozantinib plus atezolizumab or sorafenib. The secondary endpoint was progression-free survival in all patients randomly assigned to cabozantinib versus sorafenib. Outcomes in all randomly assigned patients, including final overall survival, are presented. Safety was assessed in all randomly assigned patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov, NCT03755791. Between Dec 7, 2018, and Aug 27, 2020, 432 patients were randomly assigned to combination treatment, 217 to sorafenib, and 188 to single-agent cabozantinib, and included in all efficacy analyses. 704 (84%) patients were male and 133 (16%) were female. 824 of these patients received at least one dose of study treatment and were included in the safety population. Median follow-up was 22·1 months (IQR 19·3-24·8). Median overall survival was 16·5 months (96% CI 14·5-18·7) for the combination treatment group and 15·5 months (12·2-20·0) for the sorafenib group (hazard ratio [HR] 0·98 [0·78-1·24]; stratified log-rank p=0·87). Median progression-free survival was 6·9 months (99% CI 5·7-8·2) for the combination treatment group, 4·3 months (2·9-6·1) for the sorafenib group, and 5·8 months (99% CI 5·4-8·2) for the single-agent cabozantinib group (HR 0·74 [0·56-0·97] for combination treatment vs sorafenib; HR 0·78 [99% CI 0·56-1·09], p=0·05, for single-agent cabozantinib vs sorafenib). Grade 3 or 4 adverse events occurred in 281 (66%) of 429 patients in the combination treatment group, 100 (48%) of 207 patients in the sorafenib group, and 108 (57%) of 188 patients in the single-agent cabozantinib group; the most common were hypertension (37 [9%] vs 17 [8%] vs 23 [12%]), palmar-plantar erythrodysaesthesia (36 [8%] vs 18 [9%] vs 16 [9%]), aspartate aminotransferase increased (42 [10%] vs eight [4%] vs 17 [9%]), and alanine aminotransferase increased (40 [9%] vs six [3%] vs 13 [7%]). Serious adverse events occurred in 223 (52%) patients in the combination treatment group, 84 (41%) patients in the sorafenib group, and 87 (46%) patients in the single agent cabozantinib group. Treatment-related deaths occurred in six (1%) patients in the combination treatment group (encephalopathy, hepatic failure, drug-induced liver injury, oesophageal varices haemorrhage, multiple organ dysfunction syndrome, and tumour lysis syndrome), one (<1%) in the sorafenib group (general physical health deterioration), and four (2%) in the single-agent cabozantinib group (asthenia, gastrointestinal haemorrhage, sepsis, and gastric perforation). First-line cabozantinib plus atezolizumab did not improve overall survival versus sorafenib in patients with advanced hepatocellular carcinoma. The progression-free survival benefit of the combination versus sorafenib was maintained, with no new safety signals. Exelixis and Ipsen.

Experimental Research on the Permeability of Granite Under Different Temperature Cycles

In this paper, through the permeability test of granite under different temperature cycles, the change law of porosity and permeability of rock samples after different temperature cycles was studied, and the relationship between the P-wave velocity and porosity and permeability was established by regression analysis. The results show that the porosity and permeability of the granite samples decreased significantly in one to three high-temperature cycles, showing a logarithmic change, and with the increase of the number of cycles, the decreasing rate gradually decreased after five to 10 thermal cycles, which is beneficial to the long-term development of deep geothermal resources. Under thermal cycles at different temperatures, the P-wave velocity of granite has a logarithmic correlation with permeability and porosity. As the number of cycles increases, the relationship between permeability, porosity, and P-wave velocity changes from a logarithmic relationship between one to three cycles to a linear relationship between five to 10 cycles. After thermal cycle treatment at different temperatures, there is an excellent logarithmic relationship between the P-wave velocity and porosity and permeability, and it has a high correlation. The porosity and permeability of granite can be estimated nondestructively by measuring the wave velocity. Using a scanning electron microscope (SEM) to observe the granite at 450℃, trivial particles appeared between the pore structure, and the internal structure of the rock sample was destroyed under the action of the thermal cycle. The change mechanism of physical property deterioration in deep geothermal energy mining is revealed, guiding deep geothermal energy mining.

Surgical Management of a Thalamic Arteriovenous Malformation in a Young Male in a Low Resource Setting: An Illustrative Case Report

Introduction: The natural history of patients with arteriovenous malformations (AVMs) suggests that 10-17% die due to hemorrhage and 40-50% experience serious physical deterioration of their working capacity in their 20-40-year period after presentation and treatment. Deep basal ganglia and thalamus lesions account for 3-12% of all AVMs and some literature suggests that these lesions have a more hostile clinical course. Case Presentation: 16-year-old male, a student with no known chronic illnesses came to our hospital as a referral from Lubaga hospital. He presented with fifteen days’ history of sudden onset of severe headache with no known relieving or exacerbating factors. This was associated with episodes of vomiting, altered mentation, right sided weakness, however there was no history of convulsions, blurring of vision or trauma. This was the first time for this kind of presentation. On admission: He was lethargic, moderately dehydrated, not pale nor jaundiced. BP was 109/52mmHg, HR of 60bpm, SPO2=96% on room air. Glasgow Coma Scale score of 14/15, V=4, PEAL, soft neck, normal muscle bulky with a power of 2/5 on the left side and 4/5 on the right side. Successful surgical resection of the AVM was done at Mbarara regional referral Hospital-Uganda. Currently the patient is back in the community and has returned to school. Conclusion: Children who present with intracranial hemorrhage from a previously undiagnosed AVM have a 12% chance of sudden death. Clinical triggers of hemorrhage are unpredictable, and all fatal cases were in locations with high risk of potential herniation. These data support a proactive, aggressive approach toward definitive treatment of AVMs in children and adults. Patients with diagnosed AVM can once again get a chance to survive like other children in the community in LMICs like Uganda by undergoing open surgery, although advanced opportunities are still limited.

1883 The Psychological Impact of Hospital Discharge on the Older Person

Abstract Introduction Older people often require hospitalisation but prolonged length of stay and deconditioning in the acute setting is associated with adverse outcomes. 35% of older people do not recover functionally after discharge. Less is known on the psychological impact and coping mechanisms of vulnerable older people after discharge. Our aim was to explore factors signalling psychological vulnerability in older patients, post-discharge to inform better discharge planning. Methods A systematic search for studies reporting poor discharge outcomes in older people was performed in Medline, CINAHL, PsycInfo between 2010-2022. The search terms were ’older patients &amp;gt;65 year’, ‘post-discharge’, ’psychological distress’, ’loneliness’, ‘anxiety’, ‘depression’, and ‘length of hospital stay’. Exclusion criteria included COVID-19 disease, dementia (+/- severe cognitive impairment), individuals aged &amp;lt;65 and those under palliative care services. Results 1,666 records were identified of which 878 were excluded as they were outside of our date limits or were not in English Language. 681 were excluded after application of exclusion criteria and 699 were excluded because of insufficient details. 31 duplicates were removed leaving 38 articles that were assessed for eligibility. 7 of these reports were found suitable, comprising of 1,131 patients. Three highly relevant themes identified relating to post-discharge outcomes across all studies were social isolation, lack of support, depression, apathy and fear, which led to further psychological distress. Older patients with tendency toward depressive symptoms had an increase likelihood of death. Conclusion It appears discharge processes fail to address psychological factors that permit successful transition from hospital. Pre-discharge screening of psychological symptoms and coping ability may assist in identifying older patients who are at risk of mental as well as subsequent physical deterioration. Better knowledge of positive and negative predictors of a successful transition from hospital to home would enable more holistic, effective, and inclusive discharge planning processes for older people.

Long-term clinical course and treatment outcomes of individuals with Nodding Syndrome

Nodding Syndrome is a poorly understood epilepsy disorder in sub-Saharan Africa. The cause(s) of the disease, risk factors and long-term outcomes are unknown or controversial. The objectives of this study were to describe the long-term clinical course and treatment outcomes of individuals suffering from Nodding Syndrome. In addition, we aimed to provide a comprehensive characterization of the epileptological and social features of patients with Nodding Syndrome.From 11/2014 to 4/2015, we conducted a hospital-based, cross-sectional and observational study in Mahenge, Tanzania. Seventy-eight individuals (female:male ratio: 40:38, age at examination: 21.1 ± 6.39 (SD) years) have been enrolled, of whom 38 (49%) had also been examined in 2005 and in 2009. The 10-year clinical course analysis of this revisited subgroup revealed a calculated case fatality of 0.8–2.3%. Progressive physical or cognitive deterioration has not been observed in any of the 78 individuals and more than half of the people studied (38/69; 55%) managed to live and work independently. 14/78 individuals (18%) were seizure-free, (no head nodding, no other seizure types), 13 of whom were taking antiseizure medication. Phenytoin was more effective against head nodding seizures (14/19 (74%)) than monotherapy with other available antiseizure medication (phenobarbitone 12/25 (48%) and carbamazepine 7/22 (32%), p = 0.02, chi-square test).Our ten-year clinical outcome data show that Nodding Syndrome is not a fatal disease, however, the response to treatment is worse than in epilepsy patients in general. Phenytoin may be more effective than carbamazepine and phenobarbitone, but further studies are needed to confirm this observation.

Euthanasia and Physician-Assisted Suicide in People With an Accumulation of Health Problems Related to Old Age: A Cross-Sectional Questionnaire Study Among Physicians in the Netherlands.

Objectives: We explored characteristics of people with an accumulation of health problems related to old age requesting euthanasia or physician-assisted suicide (EAS) and identified characteristics associated with granting EAS requests. Methods: We conducted a cross-sectional questionnaire study among Dutch physicians on characteristics of these people requesting EAS (n = 123). Associations between characteristics and granting a request were assessed using logistic regression analyses. Results: People requesting EAS were predominantly >80years old (82.4%), female (70.0%), widow/widower (71.7%), (partially) care-dependent (76.7%), and had a life expectancy >12months (68.6%). The most prevalent health problems were osteoarthritis (70.4%) and impaired vision and hearing (53.0% and 40.9%). The most cited reasons to request EAS were physical deterioration (68.6%) and dependence (61.2%). 44.7% of requests were granted. Granting a request was positively associated with care dependence, disability/immobility, impaired vision, osteoporosis, loss of control, suffering without prospect of improvement and a treatment relationship with the physician >12months. Conclusion: Enhanced understanding of people with an accumulation of health problems related to old age requesting EAS can contribute to the ongoing debate on the permissibility of EAS in people without life-threatening conditions.