Objective
An alarming proportion (>30%) of patients affected by SARS-CoV-2 (COVID-19) continue to experience neurological symptoms, including headache, dizziness, smell and/or taste abnormalities, ...and impaired consciousness (brain fog), after recovery from the acute infection. These symptoms are self-reported and vary from patient to patient, making it difficult to accurately diagnose and initiate a proper treatment course. Objective measures to identify and quantify neural deficits underlying the symptom profiles are lacking. This study tested the hypothesis that oculomotor, vestibular, reaction time, and cognitive (OVRT-C) testing using eye-tracking can objectively identify and measure functional neural deficits post COVID-19 infection.
Methods
Subjects diagnosed with COVID-19 (
n
= 77) were tested post-infection with a battery of 20 OVRT-C tests delivered on a portable eye-tracking device (Neurolign Dx100). Data from 14 tests were compared to previously collected normative data from subjects with similar demographics. Post-COVID subjects were also administered the Neurobehavioral Symptom Inventory (NSI) for symptom evaluation.
Results
A significant percentage of post COVID-19 patients (up to 86%) scored outside the norms in 12 out of 14 tests, with smooth pursuit and optokinetic responses being most severely affected. A multivariate model constructed using stepwise logistic regression identified 6 metrics as significant indicators of post-COVID patients. The area under the receiver operating characteristic curve (AUC) was 0.89, the estimated specificity was 98% (with cutoff value of 0.5) and the sensitivity was 88%. There were moderate but significant correlations between NSI domain key variables and OVRT-C tests.
Conclusions
This study demonstrates the feasibility of OVRT-C testing to provide objective measures of neural deficits in people recovering from COVID-19 infection. Such testing may serve as an efficient tool for identifying hidden neurological deficits post COVID-19, screening patients at risk of developing long COVID, and may help guide rehabilitation and treatment strategies.
Despite the current push toward the practice of evidence-based medicine and comparative effectiveness research, clinicians' decisions may be influenced not only by evidence, but also by cognitive ...biases. A cognitive bias describes a tendency to make systematic errors in certain circumstances based on cognitive factors rather than evidence. Though health care providers have been shown in several studies to be susceptible to a variety of types of cognitive biases, research on the role of the sunk-cost bias in clinical decision-making is extremely limited. The sunk-cost bias is the tendency to pursue a course of action, even after it has proved to be suboptimal, because resources have been invested in that course of action. This study explores whether health care providers' medical treatment recommendations are affected by prior investments in a course of treatment. Specifically, we surveyed 389 health care providers in a large urban medical center in the United States during August 2009. We asked participants to make a treatment recommendation based on one of four hypothetical clinical scenarios that varied in the source and type of prior investment described. By comparing recommendations across scenarios, we found that providers did not demonstrate a sunk-cost effect; rather, they demonstrated a significant tendency to over-compensate for the effect. In addition, we found that more than one in ten health care providers recommended continuation of an ineffective treatment.
► U.S. Clinicians did not demonstrate a sunk-cost effect when making a hypothetical clinical decision. ► Instead, clinicians demonstrated active avoidance and overcorrection for sunk-cost effects. ► Absence of sunk-cost effect held regardless of type of prior investment or provider demographic characteristics. ► A surprising number of clinicians would recommend a patient continue treatment that is ineffective. ► Recommendation for continuation of ineffective treatment reflected unrealistic optimism about future treatment efficacy.
Hydrothermal treatment of zinc chloride, 1,3,5-benzenetricarboxylic acid (H
3BTC), and 4,4′-dipyridylamine (dpa) afforded two different complexes depending on reaction conditions, which were ...characterized by single-crystal X-ray diffraction, infrared spectroscopy, and elemental analysis. Under acidic conditions, a discrete neutral molecular species with formulation Zn(HBTC)
2(Hdpa)
2 (
1) was isolated, which aggregates into two-dimensional hydrogen-bonded layers. Under more basic conditions, the two-dimensional layered coordination polymer Zn(BTC)(Hdpa) (
2) is obtained, which manifests covalent linkage of Zn(BTC)(Hdpa) serpentine chain motifs into 3-connected undulating 4.8
2 topology 2-D layers. Both
1 and
2 possess tetrahedral coordination at Zn. Use of cadmium nitrate in the synthesis resulted in Cd(BTC)(H
2O)(Hdpa) (
3), which displays a similar layer topology as
2 but with significant adjustments imparted by octahedral coordination at Cd. In all cases, supramolecular hydrogen bonding promoted by Hdpa ligands provide an important assistive structure-directing role. All materials display blue luminescence upon excitation with ultraviolet light, ascribed to intraligand transitions. Crystallographic data:
1: monoclinic,
C2/
c,
a=25.389(6)
Å,
b=9.811(2)
Å,
c=17.309(4)
Å, and
β=128.957(3)°,
2: monoclinic,
P2
1/
c,
a=13.212(17)c,
b=17.15(2)
Å,
c=7.506(10)
Å, and
β=93.71(2)°, and
3: monoclinic,
C2/
c,
a=14.241(6)
Å,
b=15.218(6)
Å,
c=17.976(7)
Å, and
β=109.330(6)°.
Hydrothermal synthesis has afforded a family of luminescent complexes based on divalent
d
10 cations with 1,3,5-benzenetricarboxylate (BTC) and 4,4′-dipyridylamine (dpa) ligands. Zn(HBTC)
2(Hdpa)
2 (
1) is a discrete neutral molecular species. Zn(BTC)(Hdpa) (
2, pictured) and Cd(BTC)(H
2O)(Hdpa) (
3) are 2-D coordination polymers with different morphologies depending on coordination geometry at the metal. All three materials exhibit blue–violet luminescence on exposure to ultraviolet radiation.
Highlights • Anti-NMDA-receptor encephalitis is a paraneoplastic syndrome caused by teratomas. • The syndrome includes psychiatric symptoms followed by autonomic dysregulation. • Rapid diagnosis and ...removal of the tumor is essential for optimizing outcomes. • Following recovery, counsel on contraceptive options, particularly LARC methods. • If no tumor is identified initially, monitor for development of ovarian teratoma.
We present a near surface air temperature (NSAT) fused data product over the contiguous United States using Level 2 data from the Atmospheric Infrared Sounder, on the Aqua satellite, and the ...Cross‐track Infrared Microwave Sounding Suite (CrIMSS), on the Suomi National Polar‐orbiting Partnership satellite. We create the fused product using Spatial Statistical Data Fusion, a procedure for fusing multiple data sets by modeling spatial dependence in the data, along with ground station data from NOAA's Integrated Surface Database (ISD) which is used to estimate bias and variance in the input satellite data sets. Our fused NSAT product is produced twice daily and on a 0.25° latitude‐longitude grid. We provide detailed validation using withheld ISD data and comparison with ERA5‐Land reanalysis. The fused gridded product has no missing data; has improved accuracy and precision relative to the input satellite data sets, and comparable accuracy and precision to ERA5‐Land; and includes improved uncertainty estimates. Over the domain of our study, the fused product decreases daytime bias magnitude by 1.7 and 0.5 K, nighttime bias magnitude by 1.5 and 0.2 K, and overall RMSE by 35% and 15% relative to the AIRS and CrIMSS input data sets, respectively. Our method is computationally fast and generalizable, capable of data fusion from multiple data sets estimating the same quantity. Finally, because our product reduces bias, it produces long‐term data sets across multi‐instrument remote sensing records with improved bias stationarity, even as individual missions and their data records begin and end.
Plain Language Summary
We have used a data fusion technique called spatial statistical data fusion (SSDF) to create an improved near surface air temperature (NSAT) data set by fusing two separate satellite data sets. NSAT is important for a variety of applications, such as drought, wildfire, and extreme heat research and prediction. The two input NSAT data sets come from the Atmospheric Infrared Sounder (AIRS) instrument on the Aqua satellite, and the Cross‐track Infrared Microwave Sounding suite on the Suomi National Polar‐orbiting Partnership satellite. Our fused NSAT product is produced twice daily and on a 0.25° latitude‐longitude grid. We also performed a detailed validation using withheld reference data (which was not included in the bias‐correction data) and comparison with ERA5‐Land reanalysis. The new fused product has no missing data; has improved accuracy and precision relative to the input satellite data sets, and comparable accuracy and precision to ERA5‐Land; and includes improved uncertainty estimates. SSDF is computationally fast and generalizable, capable of data fusion from multiple data sets so long as they estimate the same quantity. Finally, because our product reduces bias, it provides a means of creating high‐quality continuous long‐term data sets across the years, as individual satellite missions and their data records begin and end.
Key Points
We demonstrate spatial statistical fusion for Level 2 remote sensing data sets which estimate the same observable
We introduce a new daily and nightly fused near‐surface air temperature product from satellite hyperspectral sounders over contiguous United States
The fused product decreases bias and RMSE by 1 K and 25% respectively relative to input data sets, averaged over the domain of the study
Background
Low titer O+ whole blood (LTOWB) is being increasingly used for resuscitation of hemorrhagic shock in military and civilian settings. The objective of this study was to identify the impact ...of prehospital LTOWB on survival for patients in shock receiving prehospital LTOWB transfusion.
Study design and methods
A single institutional trauma registry was queried for patients undergoing prehospital transfusion between 2015 and 2019. Patients were stratified based on prehospital LTOWB transfusion (PHT) or no prehospital transfusion (NT). Outcomes measured included emergency department (ED), 6‐h and hospital mortality, change in shock index (SI), and incidence of massive transfusion. Statistical analyses were performed.
Results
A total of 538 patients met inclusion criteria. Patients undergoing PHT had worse shock physiology (median SI 1.25 vs. 0.95, p < .001) with greater reversal of shock upon arrival (−0.28 vs. −0.002, p < .001). In a propensity‐matched group of 214 patients with prehospital shock, 58 patients underwent PHT and 156 did not. Demographics were similar between the groups. Mean improvement in SI between scene and ED was greatest for patients in the PHT group with a lower trauma bay mortality (0% vs. 7%, p = .04). No survival benefit for patients in prehospital cardiac arrest receiving LTOWB was found (p > .05).
Discussion
This study demonstrated that trauma patients who received prehospital LTOWB transfusion had a greater improvement in SI and a reduction in early mortality. Patient with prehospital cardiac arrest did not have an improvement in survival. These findings support LTOWB use in the prehospital setting. Further multi‐institutional prospective studies are needed.
Background
Proper function of the gastro‐esophageal high pressure zone is essential for the integrity of the antireflux barrier. Mechanisms include tonic contractions and the decreased tone during ...transient lower esophageal sphincter relaxations.
Methods
We characterized the pharmacology of nicotinic receptors mediating relaxations of the human upper gastric sphincter (clasp and sling fibers) using currently available subtype selective nicotinic antagonists in tissue from organ transplant donors. Donors with either a history of gastro‐esophageal reflux disease or histologic evidence of Barrett's esophagus were excluded. Clasp and sling muscle fiber strips were used for one of three paradigms. For paradigm 1, each strip was exposed to carbachol, washed, exposed to nicotinic antagonists then re‐exposed to carbachol. In paradigm 2, strips were exposed to a near maximally effective bethanechol concentration then nicotine was added. Strips then were washed, exposed to nicotinic antagonists then re‐exposed to bethanechol followed by nicotine. In paradigm 3, strips were exposed to bethanechol then choline or cytisine.
Key Results
100 μM methyllycaconitine has no inhibitory effects on relaxations, eliminating homomeric α7 subtypes. Subtypes composed of α4β2 subunits are also eliminated because choline acts as an agonist and dihydro‐beta‐erythroidine is ineffective.
Conclusions & Inferences
Because mecamylamine blocks the relaxations and both choline and cytisine act as agonists in both clasp and sling fibers, the nicotinic receptor subtypes responsible for these relaxations could be composed of α3β4β2, α2β4, or α4β4 subunits.
The nicotinic receptors responsible for relaxation of the gastric clasp and sling fibers that compose the upper gastric sphincter were investigated in 14 whole human stomach and esophagus specimens obtained from organ transplant donors using currently available nicotinic receptor subtype selective agonists and antagonists. Because mecamylamine blocks the relaxations and both choline and cytisine act as agonists in both clasp and sling fibers, the nicotinic receptor subtypes responsible for these relaxations could be composed of either α3β4β2 subunits (producing Type III currents) or α2β4/α4β4 subunits (producing Type IV currents). If these nicotinic receptors in clasp and sling fibers are different than the ganglionic nicotinic receptors found elsewhere that mediate major functions such as blood pressure, then selective inhibition of the unique nicotinic receptors in the UGS may be an effective treatment for GERD.
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