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We validate a deep learning model predicting comorbidities from frontal chest radiographs (CXRs) in patients with coronavirus disease 2019 (COVID-19) and compare the model’s performance with hierarchical condition category (HCC) and mortality outcomes in COVID-19. The model was trained and tested on 14,121 ambulatory frontal CXRs from 2010 to 2019 at a single institution, modeling select comorbidities using the value-based Medicare Advantage HCC Risk Adjustment Model. Sex, age, HCC codes, and risk adjustment factor (RAF) score were used. The model was validated on frontal CXRs from 413 ambulatory patients with COVID-19 (internal cohort) and on initial frontal CXRs from 487 COVID-19 hospitalized patients (external cohort). The discriminatory ability of the model was assessed using receiver operating characteristic (ROC) curves compared to the HCC data from electronic health records, and predicted age and RAF score were compared using correlation coefficient and absolute mean error. The model predictions were used as covariables in logistic regression models to evaluate the prediction of mortality in the external cohort. Predicted comorbidities from frontal CXRs, including diabetes with chronic complications, obesity, congestive heart failure, arrhythmias, vascular disease, and chronic obstructive pulmonary disease, had a total area under ROC curve (AUC) of 0.85 (95% CI: 0.85–0.86). The ROC AUC of predicted mortality for the model was 0.84 (95% CI,0.79–0.88) for the combined cohorts. This model using only frontal CXRs predicted select comorbidities and RAF score in both internal ambulatory and external hospitalized COVID-19 cohorts and was discriminatory of mortality, supporting its potential use in clinical decision making. Author summary Artificial Intelligence algorithms in Radiology can be used not only on standard imaging data like chest radiographs to predict diagnoses but can also incorporate other data. We wanted to find out if we could combine administrative and demographic data with chest radiographs to predict common comorbidities and mortality. Our deep learning algorithm was able to predict diabetes with chronic complications, obesity, congestive heart failure, arrythmias, vascular disease, and chronic obstructive pulmonary disease. The deep learning algorithm was also able to predict an administrative metric (RAF score) used in value-based Medicare Advantage plans. We used these predictions as biomarkers to predict mortality with a second statistical model using logistic regression in COVID-19 patients both in and out of the hospital. The degree of discrimination both the deep learning algorithm and statistical model provide would be considered ‘good’ by most, and certainly much better than chance alone. It was measured at 0.85 (95% CI: 0.85–0.86) by the area under the ROC curve method for the artificial intelligence algorithm, and 0.84 (95% CI:0.79–0.88) by the same method for the statistical mortality prediction model.

During delayed oculomotor response tasks, neurons in the lateral intraparietal area (LIP) and the frontal eye fields (FEF) exhibit persistent activity that reflects the active maintenance of behaviorally relevant information. Despite many computational models of the mechanisms of persistent activity, there is a lack of circuit-level data from the primate to inform the theories. To fill this gap, we simultaneously recorded ensembles of neurons in both LIP and FEF while macaques performed a memory-guided saccade task. A population encoding model revealed strong and symmetric long-timescale recurrent excitation between LIP and FEF. Unexpectedly, LIP exhibited stronger local functional connectivity than FEF, and many neurons in LIP had longer network and intrinsic timescales. The differences in connectivity could be explained by the strength of recurrent dynamics in attractor networks. These findings reveal reciprocal multi-area circuit dynamics in the frontoparietal network during persistent activity and lay the groundwork for quantitative comparisons to theoretical models.

Cryptococcal meningitis is a rare disease caused by Cryptococcus neoformans or Cryptococcus gatii as the fungal pathogen in humans. The disease is highly prevalent in people living with human immunodeficiency virus (HIV) and is the major cause of mortality in an immunocompromised individual. This life-threatening disease does not often occur with specific signs and symptoms. We reported a case of an early adulthood HIV-infected patient with a mild headache and low-grade fever. There was no altered mental status or other significant specific manifestations. Blood examination, chest radiography, and computed tomography scan revealed no significant results. C. neoformans were isolated from a culture of the cerebrospinal fluid specimen as the conventional gold standard examination for cryptococcal meningitis. A positive result was confirmed in the India ink staining preparation. The patient was treated with fluconazole monotherapy for the induction and consolidation phase and showed a positive disease progression during observations.

Purpose The incidence and mortality rates of arterial ischemic stroke (AIS) among pediatric patients have been frequently reported. While pediatric stroke can have multiple severe effects, its risk factors have not been methodically examined. This systematic review and meta-analysis were completed to summarize the existing evidence regarding risk factors for AIS in pediatric patients. Methods To gather relevant articles published in the past 15 years, searches were conducted of PubMed and Scopus. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were analyzed using Review Manager 5.4. Results From the initial screening of 507 articles, five articles comprising a total of 1,423 participants were selected for qualitative analysis. Two of these additionally underwent quantitative analysis. Among the total participants, 1,108 children with AIS (77.9%) had arteriopathy as the underlying disease. Types of arteriopathy included moyamoya disease (24.28%), arterial dissection (23.29%), focal cerebral arteriopathy (16.16%), and vasculitis (14.71%). The meta-analysis revealed that being between 6 and 9 years of age (OR, 2.19; 95% CI, 1.76 to 2.73; P

Abstract Background Stroke is one of the main causes of disability, in which nearly 2/3 of survivors experience disability and interferes with the patient’s daily functional activities. Hypertension, dyslipidemia, obesity, and smoking habits are the main causes of stroke in young adults. Vascular abnormalities are also risk factor for stroke in young adults. Advanced imaging examinations such as cerebral digital subtraction angiography (DSA) can provide a clear picture of the vasculature of the blood vessels of the human brain and provide a real-time picture of the hemodynamic status, blood flow and collateral circulation of the cerebral vessels. Results There were approximately 999 patients who had DSA cerebral examination during the study period. The total young adult population was 147 [92 males (62.4%) and 55 females (37.6%)]. There were 82 patients with ischemic stroke (60.7%). The main etiology of ischemic stroke in this study was intracranial atherosclerotic disease (ICAD) [44 (53.65%)]. The young adult population had 53 hemorrhagic stroke patients (39.3%). The main cause of hemorrhagic stroke is hypertensive vasculopathy (41.5%), followed by a ruptured cerebral arteriovenous malformation (CAVM) (37.7%). There were 12 patients with cerebral sinus venous thrombosis (CSVT). Headache is the main complaint of patients with venous stroke, followed by seizures and hemiparesis. The transverse sinus is the most common site for occlusion (66.7%). Conclusion This study describes the characteristics and prevalence of stroke in young adults based on the results of cerebral DSA examination. Stroke in young adults is not uncommon. Several traditional risk factors in old age are now found in young people. Lifestyle modification is needed to reduce the prevalence of stroke in young adults.

Background: Segmental zoster paresis (SZP) is a very uncommon complication characterized by localized weakening of the upper or lower limbs. Case report: A 69-year-old man came with complaints of weakness in the right leg two months ago. He had weakness in his right leg after two days of having herpes on his right leg. There was paresthesia and hypesthesia on neurological examination according to the L1-L3 dermatome. Neurophysiology examination revealed a neuropathy in the right femoral nerve. Discussion: Varicella-zoster virus, being a neurotrophic virus, primarily invades and incubates in the dorsal root or cerebral ganglion nerve cells. Etiological investigations in SZP patients have revealed that the anterior root is the most prevalent location of inflammation and degeneration. Conclusion: SZP is a rare complication following VZV infection that can lead to misdiagnosis and overtreatment in clinical practice. The neurophysiological examination is very important in diagnosing segmental zoster paresis.

Abstract Background Migraine and stroke are neurovascular diseases that have become a public health problem and a relatively high economic burden. The relationship between migraine and stroke has been described in the literature for a long time. Several studies reveal that migraine can be a risk factor for stroke. Methods We systematically searched PubMed using the PRISMA method and keywords according to MeSH terms to prepare this systematic review. We included published articles discussing migraine as a risk factor for ischemic stroke with a cohort study design and English article and listed the statistical value of the study. Results In our meta-analysis, we found that migraine significantly increases the incidence of ischemic stroke. There were 12 studies included in this systematic review, and a meta-analysis was performed. The results showed a significant association between migraine and ischemic stroke (HR 1.205, 95% CI 1.151–1.262 p = 0.000), migraine with aura and ischemic stroke (HR 1.442, 95% CI 1.241–1.675 p = 0.000), and migraine without aura and ischemic stroke (HR 1.126, 95% CI 1.048–1.211 p = 0.001). The exact mechanism of stroke caused by migraine is still unclear, although, in some theories, several mechanisms have been described that are thought to be the cause of stroke. Several important points of the cause of stroke in migraine are hemodynamic changes, endothelial dysfunction, cervical artery dissection, vascular reactivity, hypercoagulability, and abortive migraine drugs. Conclusions Both migraine with aura and without aura are risk factors for ischemic stroke. Several mechanisms that may cause ischemic stroke in migraine have been described, of which CSD-induced endothelial dysfunction is the primary pathophysiology of ischemic stroke in migraine.

HSVE (Herpes simplex virus encephalitis) is an infection caused by herpes simplex virus type 1 (HSV-1) or type 2 that produces neurologic problems. HSVE is associated with significant morbidity and mortality in adults even with antiviral medication, and it is a fatal disease in babies and children regardless of treatment. The most likely pathways include retrograde transmission through the olfactory or trigeminal nerves, as well as hematogenous spread. The most common presenting symptoms are encephalopathy, fever, convulsions, headache, and regional neurologic dysfunction. An accurate history and physical examination are required to identify Herpes simplex virus encephalitis (HSVE), and a prompt assessment is advised after the diagnosis has been established. HSVE is a neurodegenerative disease that may be fatal. Rapid diagnostic work-up and early diagnosis in all suspected or confirmed cases will result in early initiation of intravenous acyclovir, which may decrease morbidity and death.

Introduction. Cerebral toxoplasmosis is one of the diseases of the central nervous system that can occur in people with AIDS. Cerebral toxoplasmosis occupies third place among fatal diseases that can occur in people with AIDS. Prevalence of toxoplasmosis is about 25-30% of the world’s human population, and in Asia it is as high as 40%. Risk factors for developing cerebral toxoplasmosis is needed to be sought to find out risk factors that triggers and acts as protective factors for toxoplasmosis cerebral in HIV-positive patients. Methods. Two reviewers searched PubMed and Medline to identify cohort, case-control and cross-sectional studies. Two independent reviewers searched the databases, identified studies and extracted data. Inclusion and exclusion criteria were applied for the data screening. Results. Four studies were included. Two prospective cohort studies, one multicenter cohort study and one case control study. Age was not found to have a role as a risk factor. Gender was shown to have significant in one study (Male vs female OR 0.47 95% CI 0.25-0.88, p = 0.02). CD4 100.000 was associated with 5.10 times higher to develop cerebral toxoplasma. Prophylaxis therapy using cotrimoxazole can reduce the risk of cerebral toxoplasmosis. Conclusion. Age, female sex, low CD4 cell count, and high HIV viral load increase the risk of cerebral toxoplasmosis, whereas ART therapy and prophylaxis with cotrimoxazole can reduce the risk.

This outro is a generative collective conversation between emerging and established scholars in the field of Global Service Learning, at this moment in pandemic time. We met, on zoom, to think expansively about what these pandemic times of rupture have opened up for us in our scholarship and practice. Our orientation was towards reflexivity and relationality. We developed questions to guide our conversation in these two areas, and each of us responded to the questions and to each other. We think together about our own positionalities and ways that we are called to GSL in ways that are explicitly relational. We end by reflection on our own commitments to the field of GSL and why we stay in it knowing the contradictions, the extractive nature of the field, the deep need for decolonization and fraughtness of the space.

In some neurological diseases, advanced examinations can be used as diagnostic tools. Several indicators have also been discovered that can be used to assess the severity of neuronal damage and neurological disease progression. Neurofilament light chain (NfL) is a cytoskeleton protein that makes up the structure of neuron axons and is released when a neuron is injured, allowing it to assess neuronal injury severity. NfL was first used to diagnose central nervous system disorders like dementia, multiple sclerosis, and other neurodegenerative diseases. But, NfL levels have also been elevated in peripheral nervous system disorders, like in several neuropathic conditions, including amyloid neuropathy, HIV-associated neuropathy, diabetic peripheral neuropathy, leprosy neuropathy, and other neuropathy, according to various investigations. Theoretically, all abnormalities induced by axonal injury will increase blood NfL levels, allowing NfL testing to be utilized as a measurement tool. NfL levels can also be a predictive indicator to monitor treatment efficacy and peripheral neuropathy progression.

Coastal habitats, such as salt marshes and dune systems, can protect communities from hazards by reducing coastline exposure. However, these critical habitats and their diverse ecosystem services are threatened by coastal development and the impacts from a changing climate. Ever increasing pressure on coastal habitats calls for coastal climate adaptation efforts that mitigate or adapt to these pressures in ways that maintain the integrity of coastal landscapes. An important challenge for decisionmakers is determining the best mitigation and adaptation strategies that not only protect human lives and property, but also safeguard the ability of coastal habitats to provide a broad suite of benefits. Here, we present a potential pathway for local-scale climate change adaptation planning through the identification and mapping of natural habitats that provide the greatest benefits to coastal communities. The methodology coupled a coastal vulnerability model with a climate adaptation policy assessment in an effort to identify priority locations for nature-based solutions that reduce vulnerability of critical assets using feasible land-use policy methods. Our results demonstrate the critical role of natural habitats in providing the ecosystem service of coastal protection in California. We found that specific dune habitats play a key role in reducing erosion and inundation of the coastline and that several wetland areas help to absorb energy from storms and provide a protective service for the coast of Marin county, California, USA. Climate change and adaptation planning are globally relevant issues in which the scalability and transferability of solutions must be considered. This work outlines an iterative approach for climate adaptation planning at a local-scale, with opportunity to consider the scalability of an iterative science-policy engagement approach to regional, national, and international levels.

Introduction. The most common type of dementia is Alzheimer’s disease (AD). AD is characterized by loss of memory and cognitive impairment. In epidemiological studies, low folate could disturb vitamin B12 absorption, which leads to the inflammatory process, and it explains the association between both vitamins and Alzheimer’s disease. Material and methods. We did a systematic search through PubMed and Embase according to the PRISMA protocol. We included studies published in the last 5 years (from 2015 to June 2020). Data will be extracted by two reviewers. We assess the quality of studies using JADAD Scale for randomized-controlled trials. Results. We found 426 journals in our search strategy. In the end, 2 studies met the eligibility criteria and were included in this review. These two randomized controlled trials revealed that folic acid improved cognitive function in Alzheimer’s disease (p < 0.05) and mild cognitive impairment (p = 0.028). Discussion. In this systematic review, we found that daily folic acid supplements could improve cognitive function in patients with Alzheimer’s disease and mild cognitive impairment. The exact mechanism is unknown, but it is believed that folic acid supplementation improves cognitive function by reducing the levels of peripheral inflammatory cytokines Conclusion. Daily oral folic acid supplemental (400 µg and 1.2 mg) for 6-12 months improves cognitive function in Alzheimer’s disease and mild cognitive impairment.

While climate impacts are increasing (e.g., rising seas, increasing storm damage) so too is the desire to protect natural systems and capitalize on their protective benefits and other services. Linking ecosystem services science through mapping efforts can help students learn methods for including the value of nature in climate adaptation decisions. This hands-on lab activity was developed to introduce students to the theory and application of ecosystem service valuation and mapping at the land-sea interface. By working with case study data from British Columbia, students learn to apply ecosystem service concepts and easy-to-use, opensource software to answer engaging questions within a real-world policy and planning context.