Post Onset Research Articles

Inhibiting chondroitin sulfate synthase 1 ameliorates hyperplastic arterial remodelling

Abstract Introduction Hyperplastic arterial remodelling is characterized by intima-media thickening, lumen narrowing, inflammation and increased extracellular matrix (ECM) deposition. Chondroitin sulfate (CS) glycosaminoglycans, the unbranched polysaccharide chains of proteoglycans, are important components of ECM. We previously found CS accumulated in adversely remodelled heart and artery, aggravating cardiac deterioration. Objective We aim to explore a therapeutic strategy to interfere with CS synthesis and investigate its potential in ameliorating hyperplastic arterial remodelling. Methods Through single-cell RNA sequencing of non-cardiomyocytes cardiac cells from mouse myocardial infarction model, chondroitin sulfate synthase 1 (CHSY1) was identified as the primary CS synthase and was increased during disease progression. A Chsy1 knockout (KO) mouse strain was generated. Fibrosis and arterial remodelling were induced using: (i) 4 weeks of angiotensin II/phenylephrine (AngII/PE) infusion through subcutaneous osmotic minipumps; and (ii) transverse aortic constriction surgery. To assess the therapeutic potential of CHSY1 inhibition in ameliorating hyperplastic arterial remodelling, Chsy1 was knockdown by dsiRNA post disease onset. Mechanism of action was investigated using primary vascular smooth muscle cells (VSMCs). Results Chsy1 KO reduced CS and its stereoisomer dermatan sulfate in the heart to 42 ± 22% and 36 ± 7% respectively, whereas other types of glycosaminoglycans remain intact. KO mice were protected against phenotypes of hyperplastic arterial remodelling induced by the two disease models in both the coronary and carotid arteries. For example, 90.1% of coronary arterial fibrosis and 79.7% of macrophage infiltration induced by AngII/PE was declined in KO mice compared to WT mice, while cardiac function as stroke volume was augmented by 41.3%. Concomitantly, carotid arterial wall thickening was lower by 36.5% and distensibility was higher by 36.7%, validating Chsy1 as a potent target. As a therapeutic approach, weekly intravenous injection of dsiRNA achieved Chsy1 reduced to 30.2 ± 5.5% in the carotid artery and 72.5 ± 4.7% in the heart. Post disease onset, Chsy1 KD therapy reduced fibrosis by 59.9% in the coronary artery (P = 0.006) and improved stroke volume by 25.6% (P = 0.036). The structural integrity and function of carotid arteries were well-reserved, manifesting as improved distensibility (29%, P = 0.016), increased elastin/perimeter ratio (15%, P = 0.002), and reduced macrophage infiltration (38%, P = 0.029). In vitro, CHSY1 inhibition suppressed migration and cytokine production of macrophages, fibroblast-to-myofibroblast transition, and VSMC hyperproliferation. NOTCH3 signalling was found to be positively correlated with CHSY1 modulation. Conclusions We demonstrated that inhibiting CHSY1 is necessary and sufficient to block CS synthesis. Chsy1 KD by dsiRNA is an effective therapy to ameliorate hyperplastic arterial remodelling.

Comparative immune profiling in survivors of the 2023 Nipah outbreak in Kerala state, India.

Immune profiling of Nipah virus (NiV) infection survivors is essential for advancing our understanding of NiV pathogenesis, improving diagnostic and therapeutic strategies, and guiding public health efforts to prevent future outbreaks. There is currently limited data available on the immune response to NiV infection. We aimed to elucidate the specific immune mechanisms involved in protection against NiV infection by analyzing the immune profiles of survivors of the Nipah outbreak in Kerala, India 2023. Immune cell populations were quantified and compared between survivors (up to 4 months post onset day of illness) and healthy controls. Statistical analysis was performed to explore associations between immune profiles and clinical outcomes. Immune signatures common to all three cases were: a heretofore undescribed persistent lymphopenia including the CD4+ Treg compartment with the relative expansion of memory Tregs; trends indicative of global leukopenic modulation were observed in monocytes and granulocytes including an expansion of putatively immunosuppressive low-density granulocytes described recently in the context of severe COVID-19; altered mucosal homing with respect to integrin beta-7 (ITGB7) expressing subsets; increased mobilization of activated T-cells (CD4+ and CD8+) and plasmablasts in the early phase of infection. Comparative analysis based on clinical presentation and outcome yielded lower initial viremia, increased activated T-cell responses, expanded plasmablasts, and restoration of ITGB7 expressing CD8+ T-cells as possible protective signatures. This longitudinal study delineates putative protective signatures associated with milder NiV disease. It emphasizes the need for the development of immunotherapeutic interventions such as monoclonal antibodies to blunt early viremia and ameliorate pathogenesis.

Dynamics of May ‘onset’ of Indian summer monsoon over Northeast India

AbstractAcknowledging the prolonged duration of the rainy season in Northeast India (NEI) compared to Central India, the official onset of the Indian summer monsoon over NEI is traditionally marked around 5 June, with May rainfall categorized as ‘pre‐monsoon’. However, our study reveals that May rainfall in NEI occurs in active/break spells driven by persistent synoptic‐scale systems, contributing to a significant monsoon heat source during this period. Through an objective analysis, we determine that the climatological ‘onset’ in NEI actually occurs around 18 May, with withdrawal around 14 October, resulting in an extended rainy season of approximately 150 days. The enigma of the May onset, while the Intertropical Convergence Zone remains proximate to the equator, is addressed by identifying a conducive climate in May. This climate is characterized by low‐level cyclonic vorticity over the region, influenced by the interannual strengthening (weakening) by the Atlantic Niño (El Niño). The introduction of potential vorticity from extratropical transient Rossby waves in May significantly amplifies low‐level cyclonic vorticity by 3–4 times, acting as a catalyst for the monsoon onset in NEI. Furthermore, a 5–6 times intensification of northward moisture transport from the Bay of Bengal sustains the monsoon heat source post onset. The May onset is made feasible by the uplifting of low‐level cyclonic winds, facilitated by the horseshoe‐shaped orography around the Brahmaputra valley. This process is complemented by an increased local moisture content resulting from evapotranspiration. Our findings challenge conventional notions by demonstrating that a component of Indian summer monsoon rainfall in NEI is not directly related to the Intertropical Convergence Zone. This challenges the fundamental definition of the South Asian Monsoon and calls for a reassessment of the prevalent belief that the Indian monsoon season is confined to June–September in NEI.

The impact of a university-based intensive comprehensive aphasia programme (ICAP) on language, functional communication and quality of life in people with chronic aphasia

ABSTRACT Background Intensive Comprehensive Aphasia Programmes (ICAPs) are increasingly considered the preferred option for high intensity aphasia rehabilitation. This is due to the emerging evidence that shows the potential of the programme to improve language impairment as well as psychosocial wellbeing and quality of life (QoL) in persons with chronic aphasia. Aims The aim of the study was to investigate whether a university-based, student-led, online ICAP led to measurable improvements in language, functional communication and QoL in persons with aphasia (PwAs). Methods & Procedures Eleven PwAs (six women, five men; M age = 60.4 years; M time post onset = 14.6 months) participated in a 10-week ICAP that provided 36 hours of treatment in total. Outcome measures relating to language impairment, functional communication and QoL were administered before and after the ICAP and included a range of subtests of the Comprehensive Aphasia Test (CAT) and the Communication Activities of Daily Living – second edition (CADL-2), the Assessment for Living with Aphasia (ALA), the Aphasia Impact Questionnaire (AIQ-21) and the Communication Outcomes after Stroke Scale (Carer COAST). Pre- and post-ICAP performances were tested for significance using Wilcoxon signed-rank tests. In addition, effect sizes were calculated. Outcomes & Results Post-ICAP, significant gains occurred in the CAT subtests of auditory and reading comprehension as well as naming objects, with large effect sizes being noted for the subtests of reading comprehension and naming objects. Significant changes were also observed between the pre- and post-assessment scores for the AIQ-21 and the Carer COAST, whereby the latter yielded large effect sizes. By contrast, CADL-2 and ALA scores did not change significantly as a result of the ICAP intervention. Conclusions Results indicate that the ICAP effectively improved participants’ language and functional communication skills, as well as QoL for both PwAs and their communication partners. Findings further indicate that a student-led ICAP implemented in a university setting can be considered a viable and pragmatic solution to offering ICAPs to achieve the high intensity needed to effect positive changes in communication.

Learning and memory function preserved by delayed A1 adenosine receptor agonist treatment following soman intoxication in rats and a humanized esterase mouse model

Exposure to organophosphorus compounds, such as soman (GD), cause widespread toxic effects, sustained status epilepticus, neuropathology, and death. The A1 adenosine receptor agonist N-bicyclo-(2.2.1)-hept-2-yl-5′-chloro-5′-deoxyadenosine (ENBA), when given 1 min after GD exposure, provides neuroprotection and prevents behavioral impairments. Here, we tested the ability of ENBA at delayed treatment times to improve behavioral outcomes via a two-way active avoidance task in two male animal models, each consisting of saline and GD exposure groups. In a rat model, animals received medical treatments (atropine sulfate [A], 2-PAM [P], and midazolam [MDZ]) or AP + MDZ + ENBA at 15 or 30 min after seizure onset and were subjected to behavioral testing for up to 14 days. In a human acetylcholinesterase knock-in serum carboxylesterase knock-out mouse model, animals received AP, AP + MDZ, AP + ENBA, or AP + MDZ + ENBA at 15 min post seizure onset and were subjected to the behavioral task on days 7 and 14. In rats, the GD/AP + MDZ + ENBA group recovered to saline-exposed avoidance levels while the GD/AP + MDZ group did not. In mice, in comparison with GD/AP + MDZ group, the GD/AP + MDZ + ENBA showed decreases in escape latency, response latency, and pre-session crossings, as well as increases in avoidances. In both models, only ENBA-treated groups showed control level inter-trial interval crossings by day 14. Our findings suggest that ENBA, alone and as an adjunct to medical treatments, can improve behavioral and cognitive outcomes when given at delayed time points after GD intoxication.

What can we learn about integration of novel words into semantic memory from automatic semantic priming?

ABSTRACT According to the Complementary Learning Systems model of word learning, only integrated novel words can interact with familiar words during lexical selection. The pre-registered study reported here is the first to examine behavioural and electrophysiological markers of integration in a task that relies primarily on automatic semantic processing. 71 young adults learned novel names for two sets of novel concepts, one set on each of two consecutive days. On Day 2, learning was followed by a continuous primed lexical decision task with EEG recording. In the N400 window, novel names trained immediately before testing differed from both familiar and untrained novel words, and, in the time window between 500–800 ms post onset, they also differed from novel names that had undergone a 24-hour consolidation, for which a small behavioural priming effect was observed. We develop an account that attributes the observed effects to processes rooted in episodic, rather than semantic, memory.

Longitudinal course and predictors of health-related quality of life, mental health, and fatigue, in non-hospitalized individuals with or without post COVID-19 syndrome.

Long-term information on health-related quality of life (HRQOL) and mental health of non-hospitalized individuals with "post COVID-19 syndrome" (PCS) is scarce. Thus, the objectives of the present study were to compare HRQOL and mental health of individuals with and without PCS in a German sample of non-hospitalized persons after SARS-CoV-2 infection, to characterize the long-term course up to 2 years and to identify predictors for post COVID-19 impairments. Individuals with past SARS-CoV-2 infection were examined at the University Hospital of Augsburg from November 2020 to May 2021 and completed a postal questionnaire between June and November 2022. Participants who self-reported the presence of fatigue, dyspnea on exertion, memory problems or concentration problems were classified as having PCS. HRQOL was assessed using the Veterans RAND 12-Item Health Survey, mental health was measured by the Patient Health Questionnaire and the Fatigue Asessment Scale was used to assess fatigue severity. Multivariable linear regression models with inverse probability weighting were used to determine the association between PCS and health outcomes. From the 304 participants (58.2% women, median age 52 years), 210 (69.1%) were classified as having PCS in median 26 months after SARS-CoV-2 infection. Persons with PCS showed significantly more often depressive and anxiety disorders. PCS was independently and significantly associated with higher levels of depression, post-traumatic stress and fatigue, as well as poorer physical and mental HRQOL in median 9 months as well as 26 months after SARS-CoV-2 infection. A large number of acute symptoms and a prior diagnosis of depression were independently associated with poor mental health and HRQOL. While post-traumatic stress and mental HRQOL improved from 9 months to 26 months post infection onset, depressiveness, fatigue and physical HRQOL remained stable in both, persons with and without PCS. PCS in non-hospitalized persons after SARS-CoV-2 infection is often associated with long-term impairments of mental health and HRQOL outcomes.

A Prospective and Repeat Cross-Sectional Study of Bullying Victimization Among Adolescents From Before COVID-19 to the Two School Years Following the Pandemic Onset

ABSTRACT We examined bullying victimization spanning from before the pandemic to the two school years post COVID-19 onset in adolescents. We used survey data from Canadian secondary school students collected during the 2019–20, 2020–21, and 2021–22 academic years. Generalized Estimating Equations models were used to estimate the population average odds of past 30-day bullying victimization by other students, using both longitudinal (N = 3716) and repeat cross-sectional (N = 23,862; 19,413; 21,897) data. The odds of bullying victimization were lower in 2020–21 and higher in 2021–22 relative to 2019–20. Elevated odds of bullying victimization were found among gender diverse, higher weight, and relatively less affluent students. While remote schooling during the pandemic may have provided a reprieve for some students, bullying appears to have rebounded with the lifting of COVID-19 restrictions to exceed pre-pandemic levels. More effective strategies are essential to prevent bullying and improve school contexts for equity denied populations.

Long-term prognosis and health-related quality of life for people with Aphasia in Sweden

ABSTRACT Background People with aphasia (PWA) after ischemic stroke often have difficulties in communication and social participation. To individualise rehabilitation and optimise recovery, there is a need for knowledge regarding prevalence of aphasia, and language functions in relation to long-term recovery and health-related quality of life (HRQoL). In this study, we examined these issues in a Swedish setting. Methods We screened consecutive persons with first-ever ischemic stroke admitted to Skåne University Hospital, Sweden, at baseline (median day 4 post stroke onset) for aphasia with the Language Screening Test (LAST). We then performed a detailed follow-up of PWA at 1, 3, and 12 months after stroke onset with the Swedish version of the Comprehensive Aphasia Test (CAT) for evaluation of cognition and language, and with the self-reported Aphasia Impact Questionnaire (AIQ) for evaluation of HRQoL. We analysed aphasia recovery and potential associations between aphasia severity, language functions, stroke severity according to National Institutes of Health Stroke Scale (NIHSS), and HRQoL. Results Initial aphasia was present in 27% (n = 60 of 221) of stroke persons in the acute phase. At 1 month after stroke onset, 74% (n = 40 of 54 survivors with initial aphasia) had remaining aphasia, at 3 months 67% (n = 34 of 51) had aphasia and at 12 months post stroke 61% (n = 30 of 49) had remaining aphasia. Improvement of aphasia was greatest during the first months after onset, with significant improvement regarding naming (p= 0.01), repetition (p= 0.03) and comprehension of written language (p= 0.01). HRQoL remained significantly associated with aphasia severity after adjusting for stroke severity and age. At 3 months, 87% (n = 26) of PWA reported that aphasia affected their ability to communicate with the environment, had negative consequences on level of participation (73%, n = 22), and their emotional well-being (87%, n = 26). There were no significant temporal changes regarding HRQoL between 3 and 12 months post stroke. Conclusion Chronic aphasia was observed in 61% of all alive persons presenting with baseline aphasia after ischemic stroke. Aphasia has negative consequences on HRQoL for PWA and aphasia severity impacts HRQoL regardless of stroke severity.

Differences in glucose homeostasis and islet injury among diverse mice strains post acute pancreatitis

Diverse animal models have been used to study postpancreatitis diabetes mellitus (PPDM) development; however, no study has yet conducted a comparative analysis of the specific differences in glucose homeostasis and islet injury between these models. Therefore, we investigated the differences in pancreatic islet injury and glucose homeostasis among diverse strains in a cerulein-induced acute pancreatitis (AP) model to determine the appropriate animal model for PPDM. BALB/cJ, C57BL/6J, C57BL/6 N, and FVB/NJ mice were administered cerulein to induce AP. Serum amylase levels, pancreatic acinar injury, blood glucose homeostasis, islet function, and islet injury were measured and analyzed. All strains exhibited elevated amylase secretion post pancreatitis, and BALB/cJ, C57BL/6J, and C57BL/6 N mice exhibited sex-related differences. All strains exhibited pancreatic acinar injury post pancreatitis but mostly recovered within 15 days. Overall, glucose homeostasis remained balanced post pancreatitis in all strains compared to that in the control groups, except in FVB/NJ male and female mice, which exhibited an imbalance in glucose homeostasis on day 7 post pancreatitis. All the strains, except BALB/cJ mice, exhibited a decline in Homeostasis model assessment-β(HOMA-β) values post pancreatitis, with significant decrease in C57BL/6J females and FVB/NJ males. Islet size decreased post pancreatitis in all strains, except BALB/cJ mice. Pancreatic islet insulin secretion levels significantly decreased in male FVB/NJ mice post pancreatitis onset and did not recover within 15 days. Therefore, FVB/NJ male mice are a useful model for studying PPDM.

Iron dysregulation and inflammatory stress erythropoiesis associates with long-term outcome of COVID-19

Persistent symptoms following SARS-CoV-2 infection are increasingly reported, although the drivers of post-acute sequelae (PASC) of COVID-19 are unclear. Here we assessed 214 individuals infected with SARS-CoV-2, with varying disease severity, for one year from COVID-19 symptom onset to determine the early correlates of PASC. A multivariate signature detected beyond two weeks of disease, encompassing unresolving inflammation, anemia, low serum iron, altered iron-homeostasis gene expression and emerging stress erythropoiesis; differentiated those who reported PASC months later, irrespective of COVID-19 severity. A whole-blood heme-metabolism signature, enriched in hospitalized patients at month 1–3 post onset, coincided with pronounced iron-deficient reticulocytosis. Lymphopenia and low numbers of dendritic cells persisted in those with PASC, and single-cell analysis reported iron maldistribution, suggesting monocyte iron loading and increased iron demand in proliferating lymphocytes. Thus, defects in iron homeostasis, dysregulated erythropoiesis and immune dysfunction due to COVID-19 possibly contribute to inefficient oxygen transport, inflammatory disequilibrium and persisting symptomatology, and may be therapeutically tractable.

Exploring quality of life post sudden onset hearing loss: A convergent parallel approach.

Sudden onset hearing loss (SOHL) is rare and presents differently to individuals; hence, it is complex to diagnose. The impact on the quality of life (QoL) varies for individuals and their support structure. However, the exploration of research designs is warranted. This study explored the lived experiences of adults post-SOHL diagnosis and the impact on the QoL. Facilitators of emotional and social aspects of counselling provided by audiologists post-SOHL diagnosis were established. This was a convergent parallel research study. Data were collected from the two primary participants and three secondary participants, face-to-face and telephonically. The Hearing Handicap Inventory for Adults (HHIA) screening tool and the semi-structured interviews were used for data collection. The data sets were analysed independently,viz. descriptive analysis and thematic analysis, to confirm the impact on the QoL post-SOHL diagnosis. The HHIA scores obtained were 84% and 50% for P1 and P2, respectively. Key themes that emerged from the interviews revealed that communication difficulties mostly impacted the QoL, which in turn influenced their mental and social well-being. Aural rehabilitation was perceived as ineffective support, thus the inability to reduce the impact on the QoL post-SOHL diagnosis. The integrated findings indicated the impact on the QoL post-SOHL diagnosis. Convergent parallel methods should be considered by researchers to understand rare auditory pathologies and their impact on the QoL.Contribution:Person-centred care (PCC) and family-centred care (FCC) are facilitators of counselling that audiologists can employ as QoL management strategies post-SOHL diagnosis.

Healthcare perceptions of persons with traumatic brain injuries across providers: shortcomings in the chronic phase of care

ABSTRACT Objective This investigation sought to examine the perceptions of individuals with mild, moderate, and severe traumatic brain injury (TBIs) toward healthcare providers across rehabilitation contexts (acute, rehabilitation, and chronic). Methods The mCARE-TBI survey was distributed via Qualtrics throughout the US and Canada. Sixty-four survey responses met criteria for analysis. Participants were ≥18 years old, one-year post onset, reported no unrelated neurological deficits prior to the single TBI, and reported no prior diagnosed psychiatric disorders. The mCARE was the primary outcome measure. Comparisons were made between provider ratings on each question. Results Significant differences were found between chronic-phase care, compared to acute care and rehabilitation. Group differences were found in transitioning home after discharge and in between each therapy discipline and both nurses and doctors, as well as for really listening and pairwise differences between therapy disciplines and both nurses and doctors. Group effects were found for showing compassion and care and being positive. Conclusions All disciplines need to improve communication, and transition care/discharge planning. Dismissal of ongoing impairments continues to be an area of perceived concern with doctors in particular. Communication training is needed, particularly for nurses and doctors.

The diagnostic yield of colonoscopic surveillance following resection of early age onset colorectal cancer.

The primary benefit of post-colorectal cancer (CRC) colonoscopic surveillance is to detect and remove premalignant lesions to prevent metachronous CRC. Current guidelines for long-term colonoscopic surveillance post early age onset CRC (EOCRC) resection are based on limited evidence. The aims of this study were to assess the diagnostic yield of colonoscopic surveillance post-EOCRC resection and identify molecular and clinicopathological risk factors associated with advanced neoplasia. A retrospective cohort study of prospectively collected data was conducted at St Mark's hospital, London, United Kingdom, for patients diagnosed with EOCRC who underwent at least one episode of post-CRC colonoscopic surveillance between 1978 and 2022. We collected clinicopathological data including tumour molecular status and neoplasia detection rates. In total, 908 colonoscopic surveillance procedures were performed in 195 patients over 2581.3 person-years of follow-up. The diagnostic yields of metachronous CRC, advanced adenomas and non-advanced adenomas were 1.76%, 3.41% and 22.69% respectively. Sixteen patients (8.21%) developed metachronous CRC, and the majority (87.5%) were detected more than 3years post index EOCRC diagnosis. Detection of advanced neoplasia was significantly higher in EOCRC patients with Lynch syndrome (26.15%) compared with those in whom Lynch syndrome was excluded (13.13%) (OR, 2.343; 95% CI, 1.014-5.256; p=0.0349). During colonoscopic surveillance post-EOCRC resection, the long-term risk of developing metachronous advanced neoplasia remains high in the context of Lynch syndrome, but this trend is not as clearly evident when Lynch syndrome has been excluded.

Pandemic-related practice changes and CVD risk management in community clinics.

Understanding how the COVID-19 pandemic affected cardiovascular disease (CVD) risk monitoring in primary care may inform new approaches for addressing modifiable CVD risks. This study examined how pandemic-driven changes in primary care delivery affected CVD risk management processes. This retrospective study used electronic health record data from patients at 70 primary care community clinics with scheduled appointments from September 1, 2018, to September 30, 2021. Analyses examined associations between appointment type and select care process measures: appointment completion rates, time to appointment, and up-to-date documentation for blood pressure (BP) and hemoglobin A1c (HbA1c). Of 1,179,542 eligible scheduled primary care appointments, completion rates were higher for virtual care (VC) vs in-person appointments (10.7 percentage points [PP]; 95% CI, 10.5-11.0; P < .001). Time to appointment was shorter for VC vs in-person appointments (-3.9 days; 95%CI, -4.1 to -3.7; P < .001). BP documentation was higher for appointments completed pre- vs post pandemic onset (16.2 PP; 95% CI, 16.0-16.5; P < .001) and for appointments completed in person vs VC (54.9 PP; 95% CI, 54.6-55.2; P < .001). HbA1c documentation was higher for completed appointments after pandemic onset vs before (5.9 PP; 95%CI, 5.1-6.7; P < .001) and for completed VC appointments vs in-person appointments (3.9 PP; 95% CI, 3.0-4.7; P < .001). After pandemic onset, appointment completion rates were higher, time to appointment was shorter, HbA1c documentation increased, and BP documentation decreased. Future research should explore the advantages of using VC for CVD risk management while continuing to monitor for unintended consequences.

The social dimension of quality of life following spinal cord injury or disease: an international ICF-linking study.

International Classification of Functioning, Disability and Health (ICF) linking study. Analyze cognitive interview data using the ICF as an analytic framework, to examine aspects of social life relevant to quality of life (QoL) according to people with spinal cord injury or disease (SCI/D). This study builds upon results of an international study about the cross-cultural validity of the International SCI QoL Basic Data Set (QoL-BDS). Four specialized outpatient clinics in SCI/D rehabilitation, from the US, Brazil and Australia. Analysis of qualitative data from 39 cognitive interviews with SCI/D patients at least one year post onset. Participants were asked to define their concept of QoL, overall life satisfaction, physical health and psychological health, and other relevant matters. Four independent researchers coded text fragments related to the items, and fragments were linked to ICF chapters d6-d9, following established linking rules. The proportion of text referring to social life was 35.8% (definition QoL), 24.9% (QoL life as whole), 6.0% (physical health) and 34.9% (psychological health). The most frequent ICF categories were d760 Family relationships, d770 Intimate relationships and d920 Recreation and leisure. Most frequent responded social topics to the 'other issues' item were d770 Intimate relationships, d760 Formal relationships, and d870 Economic self-sufficiency. The importance of social life aspects to the QoL was highlighted based on responses of SCI/D patients, clearly demonstrated through the ICF linking process. Adding a satisfaction with social life item to the QoL-BDS has made this instrument a more comprehensive measure.

Long term follow up and outcomes of Covid-19 vaccine associated myocarditis in Victoria, Australia: A clinical surveillance study

BackgroundMyocarditis and myopericarditis are well described adverse events of special interest (AESI) following COVID-19 vaccinations. Although reports are reassuring regarding initial clinical outcomes, information about longer term outcomes remains limited. We aimed to further this knowledge and report outcomes to 6 months post diagnosis from a single population cohort. MethodsReports of myocarditis following COVID-19 vaccination were followed up by SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), the state-wide vaccine safety service for Victoria, Australia. Confirmed myocarditis cases (Brighton Collaboration Criteria levels 1–3) were followed up via surveys at 1, 3 and 6 months post symptom onset. Responses received between 22 February 2021 and 30 September 2022 were analysed. Results87.5 % (N = 182) of eligible participants completed at least 1 survey report. 377 reports were analysed. 76.9 % of completed reports were from male patients. The median age of patients was 21 years [IQR: 16 to 32].54.8 % (n = 74) of survey reports at 6 months, reported ongoing symptoms. At all follow-up time points, females were significantly more likely to have ongoing symptoms. At 6 months, 51.9 % of male respondents reported symptom resolution compared to 22.6 % of female patients (p = 0.002). Females were also more likely to continue medication and have ongoing exercise restrictions. However, males were significantly more likely to have higher initial peak troponin results and abnormal initial cardiac imaging investigations. ConclusionsThere appears to be a significant proportion of patients who experience ongoing symptoms to 6 months post onset amongst patients that experience these AESI. Male patients were more likely to report earlier and more complete symptom recovery, despite significantly higher average initial peak troponin. This difference in phenotypic presentation in females compared to males warrants further investigation and there is a need for longer term follow up data.

Experimental study of volumetric sand production with gas flow

The presence of sand in a production stream has been a common issue for wells drilled in high permeability sandstone formations. In the case of gas producing reservoirs, sand production can be particularly hazardous due to the high gas velocities. It can among others lead to erosion of downhole components and surface equipment and to significant production downtime. A comprehensive experimental study was conducted to investigate the effects of gas flow on sand production. This was accomplished by comparing gas flow tests to tests with oil or water flow. In these tests, hollow cylinder sandstone specimens, initially wet or at ambient humidity conditions, were isotropically compressed under simultaneous fluid injection. One-phase as well as two-phase flow experiments were carried out to simulate important processes encountered in gas fields, like water capillary flow or water-cut. The results showed that sand onset was delayed in the gas flow experiments, which agrees with experimental observations in the literature. The delayed sand onset, i.e., higher sand onset stress, was related to water evaporation due to gas flow, termed flow-through drying, which strengthens the rock. The water-sensitive strength of sandstones was also examined by completing a series of uniaxial compression tests at various water saturations. The analysis of the volumetric sand production data and the X-ray CT-scans of the tested specimens showed that the decreased capillary bonds between grains when only one fluid is present in the pores, e.g., one-phase water or gas flow, results in continuous sand production of individual grains or small-sized flakes, creating large voids in the vicinity of the hole. Under such conditions, the constantly enlarging failure zone eventually causes the total collapse of the specimen. In contrast, specimens with higher capillary cohesion due to a water-oil or water-gas interphase show post sand onset stability and lower sand rate where, due to higher grain to grain cohesion, chunks of failed rock material remain in the hole and provide additional support that prevents the rapid collapse of the specimen even as the applied stress increases.

Comparison of statistical approaches to predicting norovirus laboratory reports before and during COVID-19: insights to inform public health surveillance

Social distancing interrupted transmission patterns of contact-driven infectious agents such as norovirus during the Covid-19 pandemic. Since routine surveillance of norovirus was additionally disrupted during the pandemic, traditional naïve forecasts that rely only on past public health surveillance data may not reliably represent norovirus activity. This study investigates the use of statistical modelling to predict the number of norovirus laboratory reports in England 4-weeks ahead of time before and during Covid-19 pandemic thus providing insights to inform existing practices in norovirus surveillance in England. We compare the predictive performance from three forecasting approaches that assume different underlying structure of the norovirus data and utilized various external data sources including mobility, air temperature and relative internet searches (Time Series and Regularized Generalized Linear Model, and Quantile Regression Forest). The performance of each approach was evaluated using multiple metrics, including a relative prediction error against the traditional naive forecast of a five-season mean. Our data suggest that all three forecasting approaches improve predictive performance over the naïve forecasts, especially in the 2020/21 season (30–45% relative improvement) when the number of norovirus reports reduced. The improvement ranged from 7 to 22% before the pandemic. However, performance varied: regularized regression incorporating internet searches showed the best forecasting score pre-pandemic and the time series approach achieved the best results post pandemic onset without external data. Overall, our results demonstrate that there is a significant value for public health in considering the adoption of more sophisticated forecasting tools, moving beyond traditional naïve methods, and utilizing available software to enhance the precision and timeliness of norovirus surveillance in England.

EFFECT OF ONDANSETRON IN MITIGATION OF POST-OPERATIVE SHIVERING IN COMPARISON TO FORCED AIR WARMER AND DEXAMETHASONE IN PATIENTS UNDERGOING INFRA UMBLICAL SURGERIES UNDER SUBARACHNOID BLOCK - A PROSPECTIVE RANDOMISED STUDY

Background: Subarachnoid block in a ubiquitous technique used in the field of anaesthesia to facilitate any number of surgeries below the level of the umbilicus. However, this technique is frequently associated with post anaesthesia shivering caused by the sympathetic blockade and peripheral vasodilatation. Materials and Methods:We compared the efficacy of Ondansetron against dexamethasone and isolated forced air warming in the mitigation of sub arachnoid blockade induced shivering. We enrolled a total of 120 individuals scheduled to undergo elective infra umbilical surgeries and randomly allocated them into three groups designating each other to receive Dexamethasone (Group D), Ondansetron (Group O) and Forced air warming (Group W). we compared the three group inn respect to pre operative and post operative temperature and onset of shivering. Shivering was graded according to the Crossley Mahajan Scale. Results: We found that the statistical analysis yielded comparable results in term of demographic parameters and no statistical significance among the three group with respect to mitigation of Shivering(Chi square value = 8.5, P = 0.075).