Bedside assessment of consciousness and awareness after a severe brain injury might be hampered by confounding clinical factors (i.e., pitfalls) interfering with the production of behavioral or motor ...responses to external stimuli. Despite the use of validated clinical scales, a high misdiagnosis rate is indeed observed. We retrospectively analyzed a cohort of 49 patients with severe brain injury admitted to an acute neuro-rehabilitation program. Patients’ behavior was assessed using the Motor Behavior Tool and Coma Recovery Scale Revised. All patients underwent systematic assessment for pitfalls including polyneuropathy and/or myopathy and/or myelopathy, major cranial nerve palsies, non-convulsive status epilepticus, aphasia (expressive or comprehensive), cortical blindness, thalamic involvement and frontal akinetic syndrome. A high prevalence (75%) of pitfalls potentially interfering with sensory afference (polyneuropathy, myopathy, myelopathy, and sensory aphasia), motor efference (polyneuropathy, myopathy, motor aphasia, and frontal akinetic syndrome), and intrinsic brain activity (thalamic involvement and epilepsy) was found. Nonetheless, the motor behavior tool identified residual cognition (i.e. a cognitive motor dissociation condition) regardless of the presence of these pitfalls in 70% of the patients diagnosed as unresponsive using the Coma Recovery Scale Revised. On one hand, pitfalls might contribute to misdiagnosis. On the other, it could be argued that they are clues for diagnosing cognitive motor dissociation rather than true disorders of consciousness given their prominent effect on the sensory–motor input–output balance.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Effective long-term participation of communities in disaster risk reduction measures in landslide-prone areas continues to be a challenge. This study aims to evaluate the extent to which ...community-based soil-bioengineering techniques allow for effective mitigation of shallow landslide events given technical, environmental, economic and socio-cultural sustainability criteria. The Red Cross has been implementing community-based disaster risk reduction programs aimed at increasing resilience at the community level in Honduras since 2005. Since 2010, 230 landslide hazard sites have been stabilized using soil-bioengineering measures (the use of living plant material to provide certain engineering functions) based on a carefully and systematically developed partnership with local communities. In 2018, an assessment of 73 sites established between 2010 and 2014 showed that (1) 83% of the sites were adequately maintained and (2) 69% of the sites fulfilled the function of soil stabilization. A cost–benefit analysis was conducted for two sites and indicated a cost–benefit ratio of 4.5 and 6 respectively. Some of the key factors for these high success rates include the fact that bioengineering is a locally adapted, easily implemented, cost-effective technology that offers landowners multiple benefits by increasing food security and creating income-generation opportunities. The Red Cross has recognized the importance of empowering communities by building self-confidence so that they can ultimately take responsibility for their own future. The creation of well-functioning local emergency committees has proven highly effective in achieving this goal. When adequately trained, these committees are able to support the replication and maintenance of disaster-risk reduction measures at the community-level in the long term. This case study supports the hypothesis that carefully designed participatory approaches are essential for achieving sustainable, long-term transformative change and risk reduction.
The adsorption of Cu–porphyrin derivatives terminated with peripheral carboxyphenyl side groups on hydroxylated TiO2(110) surfaces is investigated by combined scanning tunneling microscopy (STM), ...atomic force microscopy (AFM), and density functional theory (DFT). Two distinct contrasts of the molecules are revealed by STM and tunneling spectroscopy. Via single-molecule manipulations, the origin of these peculiar contrasts is found to arise from the presence or not of hydroxyl groups below the molecules. Hence, the electronic coupling of the molecule with the underlying TiO2 surface is locally modified altering the amount of charge transfer and thus their charge state at the molecular scale. Our results particularly underline the fundamental role of hydroxyls of TiO2 on the charge state of adsorbed organic molecules potentially used in dye-sensitized solar cells.
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IJS, KILJ, NUK, PNG, UL, UM
ICU-acquired weakness, comprising Critical Illness Polyneuropathy (CIP) and Myopathy (CIM) is associated with immobilization and prolonged mechanical ventilation. This study aims to assess ...feasibility of early detection of CIP and CIM by peroneal nerve test (PENT) and sensory sural nerve action potential (SNAP) screening in patients with septic shock and invasively ventilated for more than 72 h.
We performed repetitive PENT screening from 72 h after intubation until detecting a pathological response. We tested SNAPs in pathological PENT to differentiate CIP from CIM. We performed muscle strength examination in awake patients and recorded time from intubation to first in-bed and out-of-bed mobilization.
Eighteen patients were screened with PENT and 88.9% had abnormal responses. Mean time between intubation and first screening was 94.38 (± 22.41) hours. Seven patients (38.9%) had CIP, two (11.1%) had CIM, one (5.6%) had CIP and CIM, six (33.3%) had a pathological response on PENT associated with ICU-acquired weakness (but no SNAP could be performed to differentiate between CIP and CIM) and two patients had (11.1%) had no peripheral deficit. In patients where it could be performed, muscle strength testing concorded with electrophysiological findings. Twelve patients (66.7%) had out-of-bed mobilization 10.8 (± 7.4) days after admission.
CIP and CIM are frequent in septic shock patients and can be detected before becoming symptomatic with simple bedside tools. Early detection of CIP and CIM opens new possibilities for their timely management through preventive measures such as passive and active mobilization.
Abstract The aim of this prospective, observational cohort study was to investigate and assess diverse neuroimaging biomarkers to predict patients’ neurological recovery after coma. 32 patients ...(18–76 years, M = 44.8, SD = 17.7) with disorders of consciousness participated in the study. Multimodal neuroimaging data acquired during the patient’s hospitalization were used to derive cortical glucose metabolism ( 18 F-fluorodeoxyglucose positron emission tomography/computed tomography), and structural (diffusion-weighted imaging) and functional connectivity (resting-state functional MRI) indices. The recovery outcome was defined as a continuous composite score constructed from a multivariate neurobehavioral recovery assessment administered upon the discharge from the hospital. Fractional anisotropy-based white matter integrity in the anterior forebrain mesocircuit ( r = 0.72, p < .001, 95% CI: 0.87, 0.45), and the functional connectivity between the antagonistic default mode and dorsal attention resting-state networks ( r = − 0.74, p < 0.001, 95% CI: − 0.46, − 0.88) strongly correlated with the recovery outcome. The association between the posterior glucose metabolism and the recovery outcome was moderate ( r = 0.38, p = 0.040, 95% CI: 0.66, 0.02). Structural ( adjusted R 2 = 0.84, p = 0.003) or functional connectivity biomarker ( adjusted R 2 = 0.85, p = 0.001), but not their combination, significantly improved the model fit to predict the recovery compared solely to bedside neurobehavioral evaluation ( adjusted R 2 = 0.75). The present study elucidates an important role of specific MRI-derived structural and functional connectivity biomarkers in diagnosis and prognosis of recovery after coma and has implications for clinical care of patients with severe brain injury.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Mechanical vibration of muscle tendons in specific frequencies – termed functional proprioceptive stimulation (FPS) – has the ability to induce the illusion of a movement which is congruent with a ...lengthening of the vibrated tendon and muscle. The majority of previous reports of the brain correlates of this illusion are based on functional neuroimaging. Contrary to the electroencephalogram (EEG) however, such technologies are not suitable for bedside or ambulant use. While a handful of studies have shown EEG changes during FPS, it remains underinvestigated whether these changes were due to the perceived illusion or the perceived vibration. Here, we aimed at disentangling the neural correlates of the illusory movement from those produced by the vibration sensation by comparing the neural responses to two vibration types, one that did and one that did not elicit an illusion. We recruited 40 naïve participants, 20 for the EEG experiment and 20 for a supporting behavioral study, who received functional tendon co-vibration on the biceps and triceps tendon at their left elbow, pseudo-randomly switching between the illusion and non-illusion trials. Time-frequency decomposition uncovered a strong and lasting event-related desynchronization (ERD) in the mu and beta band in both conditions, suggesting a strong somatosensory response to the vibration. Additionally, the analysis of the evoked potentials revealed a significant difference between the two experimental conditions from 310 to 990ms post stimulus onset. Training classifiers on the frequency-based and voltage-based correlates of illusion perception yielded above chance accuracies for 17 and 13 out of the 20 subjects respectively. Our findings show that FPS-induced illusions produce EEG correlates that are distinct from a vibration-based control and which can be classified reliably in a large number of participants. These results encourage pursuing EEG-based detection of kinesthetic illusions as a tool for clinical use, e.g., to uncover aspects of cognitive perception in unresponsive patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Adsorption of carboxylic-substituted Zn porphyrin molecules (COOH-ZnTPP) on the (011) surface of rutile TiO2 is examined by scanning tunneling microscopy at room temperature. The molecules are either ...flat, stabilized by the surface defects, or mobile with their movement limited to a reconstruction row of the substrate. Upon increasing the molecular coverage the molecules form 1D structures along the 1–10 direction, in which molecular boards are no longer parallel to the surface. This behavior is contrasted with the structures formed by Zn-TPP lacking the carboxylic group, which remain flat up to a monolayer coverage.
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IJS, KILJ, NUK, PNG, UL, UM
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