•Most patients show cognitive impairment months after hospitalization with COVID-19.•Cognitive impairments correlate with subjective cognitive problems and quality of life.•Cognitive impairments ...scale with pulmonary dysfunction and d-dimer during illness.
The ongoing Coronavirus Disease 2019 (COVID-19) pandemic has affected more than 100 million people and clinics are being established for diagnosing and treating lingering symptoms, so called long-COVID. A key concern are neurological and long-term cognitive complications. At the same time, the prevalence and nature of the cognitive sequalae of COVID-19 are unclear. The present study aimed to investigate the frequency, pattern and severity of cognitive impairments 3–4 months after COVID-19 hospital discharge, their relation to subjective cognitive complaints, quality of life and illness variables. We recruited patients at their follow-up visit at the respiratory outpatient clinic, Copenhagen University Hospital, Bispebjerg, approximately four months after hospitalisation with COVID-19. Patients underwent pulmonary, functional and cognitive assessments. Twenty-nine patients were included. The percentage of patients with clinically significant cognitive impairment ranged from 59% to 65% depending on the applied cut-off for clinical relevance of cognitive impairment, with verbal learning and executive functions being most affected. Objective cognitive impairment scaled with subjective cognitive complaints, lower work function and poorer quality of life. Cognitive impairments were associated with d-dimer levels during acute illness and residual pulmonary dysfunction. In conclusion, these findings provide new evidence for frequent cognitive sequelae of COVID-19 and indicate an association with the severity of the lung affection and potentially restricted cerebral oxygen delivery. Further, the associations with quality of life and functioning call for systematic cognitive screening of patients after recovery from severe COVID-19 illness and implementation of targeted treatments for patients with persistent cognitive impairments.
The power sector withdraws more freshwater annually than any other sector in the US. The current portfolio of electricity generating technologies in the US has highly regionalized and ...technology-specific requirements for water. Water availability differs widely throughout the nation. As a result, assessments of water impacts from the power sector must have a high geographic resolution and consider regional, basin-level differences. The US electricity portfolio is expected to evolve in coming years, shaped by various policy and economic drivers on the international, national and regional level; that evolution will impact power sector water demands. Analysis of future electricity scenarios that incorporate technology options and constraints can provide useful insights about water impacts related to changes to the technology mix. Utilizing outputs from the regional energy deployment system (ReEDS) model, a national electricity sector capacity expansion model with high geographical resolution, we explore potential changes in water use by the US electric sector over the next four decades under various low carbon energy scenarios, nationally and regionally.
•Cognitive impairments were seen after 1 year in half of people hospitalised with COVID-19.•Cognitive sequelae were stable over time from 3 months to 1 year after hospitalisation.•Cognitive ...impairments impeded work functioning and quality of life.•Early cognitive impairments were related to subsequent depressive symptoms after 1 year.•Screening for and addressing cognitive impairments after severe COVID-19 may be important.
The ongoing Coronavirus Disease (COVID-19) pandemic has so far affected more than 500 million people. Lingering fatigue and cognitive difficulties are key concerns because they impede productivity and quality of life. However, the prevalence and duration of neurocognitive sequelae and association with functional outcomes after COVID-19 are unclear. This longitudinal study explored the frequency, severity and pattern of cognitive impairment and functional implications 1 year after hospitalisation with COVID-19 and its trajectory from 3 months after hospitalisation. Patients who had been hospitalised with COVID-19 from our previously published 3-months study at the Copenhagen University Hospital were re-invited for a 1-year follow-up assessment of cognitive function, functioning and depression symptoms. Twenty-five of the 29 previously assessed patients (86%) were re-assessed after 1 year (11±2 months). Clinically significant cognitive impairments were identified in 48-56 % of patients depending on the cut-off, with verbal learning and executive function being most severely affected. This was comparable to the frequency of impairments observed after 3 months. Objectively measured cognitive impairments scaled with subjective cognitive difficulties, reduced work capacity and poorer quality of life. Further, cognitive impairments after 3 months were associated with the severity of subsequent depressive symptoms after 1 year. In conclusion, the stable cognitive impairments in approximately half of patients hospitalized with COVID-19 and negative implications for work functioning, quality of life and mood symptoms underline the importance of screening for and addressing cognitive sequelae after severe COVID-19.
The US electricity sector is currently responsible for more than 40% of both energy-related carbon dioxide emissions and total freshwater withdrawals for power plant cooling (EIA 2012a Annual Energy ...Outlook 2012 (Washington, DC: US Department of Energy), Kenny et al 2009 Estimated Use of Water in the United States 2005 (US Geological Survey Circular vol 1344) (Reston, VA: US Geological Survey)). Changes in the future electricity generation mix in the United States will have important implications for water use, particularly given the changing water availability arising from competing demands and climate change and variability. However, most models that are used to make long-term projections of the electricity sector do not have sufficient regional detail for analyzing water-related impacts and informing important electricity- and water-related decisions. This paper uses the National Renewable Energy Laboratory's Regional Energy Deployment System (ReEDS) to model a range of low-carbon electricity futures nationally that are used to calculate changes in national water use (a sample result, on water consumption, is included here). The model also produces detailed sub-regional electricity results through 2050 that can be linked with basin-level water modeling. The results will allow for sufficient geographic resolution and detail to be relevant from a water management perspective.
Kohlmeier-Degos (K-D) disease is a rare obliterative vasculopathy that can present as a benign cutaneous form or with potentially malignant systemic involvement. The gastrointestinal tract is most ...frequently involved in systemic disease and mortality is often related to bowel perforations. Herein, we provide information to providers and patients regarding gastrointestinal K-D symptomology, pathology, treatment, and diagnosis, with a focus on the importance of timely diagnostic laparoscopy. We present three new cases of gastrointestinal K-D to highlight varying disease presentations and outcomes. BODY: Based on reviewed reports, perforation is preceded by at least one gastrointestinal symptom: abdominal pain/cramping, anorexia/weight loss, vomiting, diarrhea, nausea, gastrointestinal bleeding, obstipation, constipation, and abdominal fullness. Perforation most commonly occurs in the small intestine and often results in sepsis and death. Although underutilized, laparoscopy is the most sensitive and specific diagnostic technique, demonstrating serosal porcelain plaques similar to those on the skin and characteristic for K-D. The combination of eculizumab and treprostinil is presently the most effective treatment option for gastrointestinal K-D. The pathology of gastrointestinal K-D is characterized by an obliterative intimal arteriopathy eventuating in occlusive acellular deposits of mucin and collagen along with an extravascular pauci-cellular sclerosing process resembling scleroderma confined to the subserosal fat. C5b-9 and interferon-alpha are both expressed in all caliber of vessels in the affected intestine. While C5b-9 blockade does not prevent the intimal expansion, enhanced type I interferon signaling is likely a key determinant to intimal expansion by, causing an influx of monocytes which transdifferentiate into procollagen-producing myofibroblast-like cells.
Prompt laparoscopic evaluation is necessary in any K-D patient with an abdominal symptom to facilitate diagnosis and treatment initiation, as well as to hopefully decrease mortality. Those with gastrointestinal K-D should start on eculizumab as soon as possible, as onset of action is immediate.
As we review the future of Queensland's rangelands, it is useful to highlight some key initiatives that have shaped their conservation and management, particularly those by The Royal Society of ...Queensland (RSQ). Indeed, we are indebted to Sir James Ramsay, Governor of Queensland and RSQ Patron, for his historical remarks in opening The Brigalow Belt of Australia Symposium in 1982 (Ramsay, 1984).
Myasthenia gravis (MG) is a rare autoimmune disease characterised by muscle weakness, and progression from ocular (oMG) to generalised (gMG) symptoms results in a substantial negative impact on ...quality of life (QoL). This systematic review aimed to provide an overview of the patient burden experienced by people living with gMG.
Electronic database searches (conducted March 2022), supplemented by interrogation of grey literature, were conducted to identify studies reporting patient burden outcomes in patients with gMG in Europe, the Middle East and Africa. Results were synthesised narratively due to the heterogeneity across trials.
In total, 39 patient burden publications (representing 38 unique studies) were identified as relevant for inclusion in the systematic review, consisting of 37 publications reporting formal patient-reported outcome measures (PROMs), and two publications describing alternative qualitative assessments of patient experience. The studies included a variety of measures including generic and disease-specific PROMs, as well as symptom-specific PROMs focusing on key comorbidities including depression, anxiety, fatigue and sleep disturbance. The findings showed some variation across studies and PROMs; however, in general there was evidence for worse QoL in patients with gMG than in healthy controls or in patients with oMG, and a trend for worsening QoL with increasing MG severity.
This review highlights the importance of considering patient QoL when developing and assessing treatment and management plans for patients with gMG. However, the heterogeneity identified across studies illustrates the need for further representative and well-powered studies in large cohorts administering consistent, validated questionnaires.
The protocol for this systematic review was registered in PROSPERO: CRD42022328444.
Spontaneous pulmonary vein (PV) activity triggers atrial fibrillation (AF) in humans. Although AF frequently occurs in horses, the origin remains unknown. This study investigated the structural and ...electro-anatomical properties of equine PVs to determine the potential presence of an arrhythmogenic substrate.
Endocardial three-dimensional electro-anatomical mapping (EnSite Precision) using high-density (HD) catheters was performed in 13 sedated horses in sinus rhythm. Left atrium (LA) access was obtained retrogradely through the carotid artery. Post-mortem, tissue was harvested from the LA, right atrium (RA), and PVs for histological characterization and quantification of ion channel expression using immunohistochemical analysis.
Geometry, activation maps, and voltage maps of the PVs were created and a median of four ostia were identified. Areas of reduced conduction were found at the veno-atrial junction. The mean myocardial sleeve length varied from 28 ± 13 to 49 ± 22 mm. The PV voltage was 1.2 ± 1.4 mV and lower than the LA (3.4 ± 0.9 mV, P < 0.001). The fibrosis percentage was higher in PV myocardium (26.1 ± 6.6%) than LA (14.5 ± 5.0%, P = 0.003). L-type calcium channel (CaV1.2) expression was higher in PVs than LA (P = 0.001). T-type calcium channels (CaV3.3), connexin-43, ryanodine receptor-2, and small conductance calcium-activated potassium channel-3 was expressed in PVs.
The veno-atrial junction had lower voltages, increased structural heterogeneity and areas of slower conduction. Myocardial sleeves had variable lengths, and a different ion channel expression compared to the atria. Heterogeneous properties of the PVs interacting with the adjacent LA likely provide the milieu for re-entry and AF initiation.
Hydrology/water management and electricity generation projections have been modeled separately, but there has been little effort in intentionally and explicitly linking the two sides of the ...water-energy nexus. This paper describes a platform for assessing power plant cooling water withdrawals and consumption under different electricity pathways at geographic and time scales appropriate for both electricity and hydrology/water management. This platform uses estimates of regional electricity generation by the Regional Energy Deployment System (ReEDS) as input to a hydrologic and water management model-the Water Evaluation and Planning (WEAP) system. In WEAP, this electricity use represents thermoelectric cooling water withdrawals and consumption within the broader, regional water resource context. Here we describe linking the electricity and water models, including translating electricity generation results from ReEDS-relevant geographies to the water-relevant geographies of WEAP. The result of this analysis is water use by the electric sector at the regional watershed level, which is used to examine the water resource implications of these electricity pathways.
We propose a three-pronged methodology to characterise the wake behind a circulation control wing. The study relies on time-resolved particle image velocimetry (TR-PIV) measurements in a water tunnel ...for a range of blowing intensities. The first method is the well-known proper orthogonal decomposition (POD). The second tool is a new implementation of the power spectrum. Finally, a modified Q-criterion vortex detection and quantification method is presented. The results show the complementary advantage of the three methods in analysing wake flows with varying conditions.
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