Exploring the needs of stroke patients after discharge from rehabilitation centres in Saudi Arabian communities: An IPA qualitative exploratory study design.

There are about 29 strokes per 100,000 people, annually, in the Kingdom of Saudi Arabia (KSA). These patients require long-term rehabilitation services to enhance recovery and independence in the community. Currently there are limited long-term rehabilitation services in KSA and research is needed to establish pathways for provision of community-based rehabilitation (CBR). To develop effective new CBR models, understanding the experiences and needs of stroke patients in KSA who have undergone poststroke care services is essential. This study aims to gain insight into stroke patients' needs after their discharge from rehabilitation centres in Saudi Arabia. An interpretive phenomenological analysis (IPA) study was undertaken using semi-structured interviews. Participants were eligible if they had a stroke, completed their in-hospital rehabilitation sessions and had been discharged within the past three years. Semi-structured interviews were conducted using interview guides. Transcripts were translated and analysed using interpretive phenomenological analysis. Twenty-four (15 males and 9 females) participants were recruited from two hospitals in KSA. The key findings suggested that patients experienced limited community rehabilitation services postdischarge unless they were financially able to pay for private therapy. Coping barriers including Medical, Psychological, Social, and Financial and facilitators including Faith, Recovery, Social support and leisure were identified. Participants suggested strategies to improve services within hospital and community for rehabilitation, needs of staff, access to services and ongoing care. Further work is required to develop, implement and evaluate a community rehabilitation intervention that includes education, and self-management elements to support stroke survivors in the community in KSA.

An Interpretable Two-Phase Modeling Approach for Lung Cancer Survivability Prediction.

Although lung cancer survival status and survival length predictions have primarily been studied individually, a scheme that leverages both fields in an interpretable way for physicians remains elusive. We propose a two-phase data analytic framework that is capable of classifying survival status for 0.5-, 1-, 1.5-, 2-, 2.5-, and 3-year time-points (phase I) and predicting the number of survival months within 3 years (phase II) using recent Surveillance, Epidemiology, and End Results data from 2010 to 2017. In this study, we employ three analytical models (general linear model, extreme gradient boosting, and artificial neural networks), five data balancing techniques (synthetic minority oversampling technique (SMOTE), relocating safe level SMOTE, borderline SMOTE, adaptive synthetic sampling, and majority weighted minority oversampling technique), two feature selection methods (least absolute shrinkage and selection operator (LASSO) and random forest), and the one-hot encoding approach. By implementing a comprehensive data preparation phase, we demonstrate that a computationally efficient and interpretable method such as GLM performs comparably to more complex models. Moreover, we quantify the effects of individual features in phase I and II by exploiting GLM coefficients. To the best of our knowledge, this study is the first to (a) implement a comprehensive data processing approach to develop performant, computationally efficient, and interpretable methods in comparison to black-box models, (b) visualize top factors impacting survival odds by utilizing the change in odds ratio, and (c) comprehensively explore short-term lung cancer survival using a two-phase approach.

Electronic and structural properties of single-crystal Jahn-Teller active Co1+x Mn2-x O4 thin films.

Recent investigations on spinel CoMn2O4 have shown its potential for applications in water splitting and fuel cell technologies as it exhibits strong catalytic behavior through oxygen reduction reactivity. To further understand this material, we report for the first time the synthesis of single-crystalline Co1+x Mn2-x O4 thin films using molecular beam epitaxy. By varying sample composition, we establish links between cation stoichiometry and material properties using in-situ x-ray photoelectron spectroscopy, x-ray diffraction, scanning transmission electron microscopy, x-ray absorption spectroscopy, and spectroscopic ellipsometry. Our results indicate that excess Co ions occupy tetrahedral interstitial sites at lower excess Co stoichiometries, and become substitutional for octahedrally-coordinated Mn at higher Co levels. We compare these results with density functional theory models of stoichiometric CoMn2O4 to understand how the Jahn-Teller distortion and hybridization in Mn-O bonds impact the ability to hole dope the material with excess Co. The findings provide important insights into CoMn2O4 and related spinel oxides that are promising candidates for inexpensive oxygen reduction reaction catalysts.

Electronic and Structural Properties of Single-crystal Jahn-Teller Active Co1+xMn2-xO4Thin Films.

Recent investigations on spinel CoMn2O4have shown its potential for applications in water splitting and fuel cell technologies as it exhibits strong catalytic behavior through oxygen reduction reactivity. To further understand this material, we report for the first time the synthesis of single-crystalline Co1+xMn2-xO4thin films using molecular beam epitaxy. By varying sample composition, we establish links between cation stoichiometry and material properties using in-situ x-ray photoelectron spectroscopy, x-ray diffraction, scanning transmission electron microscopy, x-ray absorption spectroscopy, and spectroscopic ellipsometry. Our results indicate that excess Co ions occupy tetrahedral interstitial sites at lower excess Co stoichiometries, and become substitutional for octahedrally-coordinated Mn at higher Co levels. We compare these results with density functional theory models of stoichiometric CoMn2O4to understand how the Jahn-Teller distortion and hybridization in Mn-O bonds impact the ability to hole dope the material with excess Co. The findings provide important insights into CoMn2O4and related spinel oxides that are promising candidates for inexpensive oxygen reduction reaction catalysts.

Luminescent Spectral Rulers for Noninvasive Displacement Measurement through Tissue.

A luminescent spectral ruler was developed to measure micrometer to millimeter displacements through tissue. The spectral ruler has two components: a luminescent encoder patterned with alternating stripes of two spectrally distinct luminescent materials and an analyzer mask with periodic transparent windows the same width as the encoder stripes. The analyzer mask is placed over the encoder and held so that only one type of luminescent stripe is visible through the window; sliding the analyzer over the encoder modulates the luminescence spectrum acquired through the analyzer windows, enabling detection of small displacements without imaging. We prepared two types of spectral rulers, one with a fluorescent encoder and a second with an X-ray excited optical luminescent (XEOL) encoder. The fluorescent ruler used two types of quantum dots to form stripes that were excited with 633 nm light and emitted at 645 and 680 nm, respectively. Each ruler type was covered with chicken breast tissue to simulate implantation. The XEOL ruler generated a strong signal with negligible tissue autofluorescence but used ionizing radiation, while the fluorescence ruler used non-ionizing red light excitation but required spectral fitting to account for tissue autofluorescence. The precision for both types of luminescent spectral rulers (with 1 mm wide analyzer windows, and measured through 6 mm of tissue) was <2 µm, mostly limited by shot noise. The approach enabled high micrometer to millimeter displacement measurements through tissue and has applications in biomechanical and mechanochemical measurements (e.g., tracking postsurgical bone healing and implant-associated infection).

First principles studies of the interactions between alkali metal elements and oxygen-passivated nanopores in graphene.

We characterize the structure-property relationship of alkali metal elements in oxygen-passivated graphene pores using the density functional theory that accounts for quantum mechanical effects and charge transfer. Our description is based on the structural and electronic properties of the system and shows common trends among the different alkali metals and pores. We find that these nanopores which serve as docking sites for alkali metal elements give the strongest binding when the size of the pore is similar to the element's van der Waals radius. A linear correlation between the binding energy and the energy location of the alkali element valence state is found for all elements and pores. Analysis of the charge transfer reveals that alkali adsorption increases the local charge in the perimeters of the pore by amounts that depend on the geometry. Moreover, charge distributions in pristine graphene resemble those of an ideal conductor despite its semimetallic character and atomic thickness while oscillations in the vicinity of O-passivated nanopores are observed. Our results suggest that charge transfer is localized within a few nanometers of the pore and, therefore, allude to high density energy storage. The outcomes of this work are significant towards the application of porous graphene as effective membranes for ion filtration of water and electrode applications.

The TNF receptor family member Fn14 is highly expressed in recurrent glioblastoma and in GBM patient-derived xenografts with acquired temozolomide resistance.

Background: Glioblastoma (GBM) is a difficult to treat brain cancer that nearly uniformly recurs, and recurrent tumors are largely therapy resistant. Our prior work has demonstrated an important role for the tumor necrosis factor-like weak inducer of apoptosis (TWEAK) receptor fibroblast growth factor-inducible 14 (Fn14) in GBM pathobiology. In this study, we investigated Fn14 expression in recurrent GBM and in the setting of temozolomide (TMZ) resistance. Methods: Fn14 mRNA expression levels in nonneoplastic brain, primary (newly diagnosed) GBM, and recurrent GBM (post-chemotherapy and radiation) specimens were obtained from The Cancer Genome Atlas data portal. Immunohistochemistry was performed using nonneoplastic brain, patient-matched primary and recurrent GBM, and gliosarcoma (GSM) specimens to examine Fn14 protein levels. Western blot analysis was used to compare Fn14 expression in parental TMZ-sensitive or matched TMZ-resistant patient-derived xenografts (PDXs) established from primary or recurrent tumor samples. The migratory capacity of control and Fn14-depleted TMZ-resistant GBM cells was assessed using the transwell migration assay. Results: We found that Fn14 is more highly expressed in recurrent GBM tumors than their matched primary GBM counterparts. Fn14 expression is also significantly elevated in GSM tumors. GBM PDX cells with acquired TMZ resistance have higher Fn14 levels and greater migratory capacity than their corresponding parental TMZ-sensitive cells, and the migratory difference is due, at least in part, to Fn14 expression in the TMZ-resistant cells. Conclusions: This study demonstrates that the Fn14 gene is highly expressed in recurrent GBM, GSM, and TMZ-resistant GBM PDX tumors. These findings suggest that Fn14 may be a valuable therapeutic target or drug delivery portal for treatment of recurrent GBM and GSM patients.

Differential expression of the TWEAK receptor Fn14 in IDH1 wild-type and mutant gliomas.

The TNF receptor superfamily member Fn14 is overexpressed by many solid tumor types, including glioblastoma (GBM), the most common and lethal form of adult brain cancer. GBM is notable for a highly infiltrative growth pattern and several groups have reported that high Fn14 expression levels can increase tumor cell invasiveness. We reported previously that the mesenchymal and proneural GBM transcriptomic subtypes expressed the highest and lowest levels of Fn14 mRNA, respectively. Given the recent histopathological re-classification of human gliomas by the World Health Organization based on isocitrate dehydrogenase 1 (IDH1) gene mutation status, we extended this work by comparing Fn14 gene expression in IDH1 wild-type (WT) and mutant (R132H) gliomas and in cell lines engineered to overexpress the IDH1 R132H enzyme. We found that both low-grade and high-grade (i.e., GBM) IDH1 R132H gliomas exhibit low Fn14 mRNA and protein levels compared to IDH1 WT gliomas. Forced overexpression of the IDH1 R132H protein in glioma cells reduced Fn14 expression, while treatment of IDH1 R132H-overexpressing cells with the IDH1 R132H inhibitor AGI-5198 or the DNA demethylating agent 5-aza-2'-deoxycytidine increased Fn14 expression. These results support a role for Fn14 in the more aggressive and invasive phenotype associated with IDH1 WT tumors and indicate that the low levels of Fn14 gene expression noted in IDH1 R132H mutant gliomas may be due to epigenetic regulation via changes in DNA methylation.

Simultaneous onset of Alzheimer's disease in a husband and wife in their mid-fifties: what do we really know about environmental factors?

INTRODUCTION: Environmental factors can play a role in the pathogenesis of Alzheimer's disease. We present a case of the simultaneous onset of Alzheimer's disease in two middle aged adults. CASE PRESENTATION: A married couple ages 54 year and 51-year-old female cohabiting together were diagnosed with Alzheimer's disease within the same year. The patient's both developed cognitive decline shortly after a major renovation of their property and followed a similar disease course. The diagnosis was supported by clinical presentation and tissue pathology on autopsy. CONCLUSION: Environmental factors may play a role in the pathogenesis of Alzheimer's disease. Further understanding of the disease cascade is required.

Alzheimer Disease Pathology in Middle Age Reveals a Spatial-Temporal Disconnect Between Amyloid-ß and Phosphorylated Tau.

We studied the brain distribution of amyloid-ß (Aß) and phosphorylated tau (τ) in 20 consecutive autopsy cases between the ages of 51 and 65, with no history of neurologic disease during life. We note that early accumulations of Aß and τ occur in distinct neuroanatomical distributions. In the locus ceruleus and medial temporal lobe allocortex τ often occurs in the absence of diffuse Aß and that Aß occurs in the neocortex in the absence of τ. In those cases with both Aß and τ were present in the sections, there was no overlap at the microanatomical or cellular level. APOE genotype was also assessed, showing no specific relationship with the presence or distribution of Aß and τ, although the numbers of cases were limited. These findings indicate that the early appearances of hallmark proteins of Alzheimer's disease are disconnected both in time and in space, suggesting that both are reactive phenomena with no mechanistic relationship in aging or preclinical disease.

Expecting the unexpected: predicting physiological and psychological wildfire preparedness from perceived risk, responsibility, and obstacles.

People who live in wildfire-prone communities tend to form their own hazard-related expectations, which may influence their willingness to prepare for a fire. Past research has already identified two important expectancy-based factors associated with people's intentions to prepare for a natural hazard: Perceived risk (i.e., perceived threat likelihood and severity) and perceived protection responsibility. We expanded this research by differentiating the influence of these factors on different types of wildfire preparedness (e.g., preparations for evacuation vs. for defending the house) and measured actual rather than intended preparedness. In addition, we tested the relation between preparedness and two additional threat-related expectations: the expectation that one can rely on an official warning and the expectation of encountering obstacles (e.g., the loss of utilities) during a fire. A survey completed by 1,003 residents of wildfire-prone areas in Perth, Australia, revealed that perceived risk (especially risk severity) and perceived protection responsibility were both positively associated with all types of preparedness, but the latter did not significantly predict preparedness after controlling for other predictors and demographics. Also, the two new expectancy-based factors were significantly associated with all types of preparedness, and remained significant predictors of some types of preparedness after controlling for other predictors and demographics: the expectation of being able to rely on an official fire warning and expecting to lose electricity both still predicted less preparedness around house resilience, and expecting to lose water still predicted increased planning preparedness. We discuss public policy implications that follow from this research.

Allograft pathology in patients transplanted for idiopathic dilated cardiomyopathy.

There are few morphologic studies on idiopathic dilated cardiomyopathy (CM) treated with transplant. We prospectively correlated gross, histologic, and clinical findings pertaining to hearts explanted in a 5-year period from patients with a clinical diagnosis of nonischemic CM and also correlated left ventricular diameter with preoperative echocardiographic reports. Of 64 patients with a clinical diagnosis of dilated cardiomyopathy (DC), 42 were men (age, 51 ± 13 y) and 22 were women (age, 42 ± 18 y). The pathologic diagnosis was idiopathic (dilated) cardiomyopathy (DC) in 55 patients (86%) and features of specific CM in 9 patients (14%). Specific diagnoses were fibrofatty change consistent with arrhythmogenic right ventricular cardiomyopathy (n=6), amyloidosis (n=2), and sarcoidosis (n=1), none of which were suspected clinically. The 55 hearts with idiopathic DC had a mean heart weight of 508 (range, 220 to 980) g. Pathologic subsets of the DC group included 4 hearts without enlargement, cavity dilatation, or significant histologic findings (minimal DC); 3 hearts with histologic evidence of healed myocarditis; and 5 hearts with mildly noncompacted left ventricle with hypertrabeculation. Five patients had prior mitral or tricuspid valve replacement/repairs to manage heart failure. There were 7 postpartum DC cases, 1 with a histologic pattern of healed myocarditis and 1 alcoholism-associated DC. Familial DC comprised 16% (9 of 55) of patients. In patients without prior assist device placement, pathologic left ventricular cavity diameter correlated with echocardiographic end-diastolic volume (r , 0.8, P<0.0001). Morphologically, DC is a heterogeneous group. Areas of fibrofatty change and features of noncompaction are not uncommon. Left ventricular measurement at explant correlates well with echocardiographic findings, with a relatively consistent underestimation of the diameter.

An exploratory study of the follow-up care needs of patients treated for colorectal cancer.

AIMS AND OBJECTIVES: To explore patient perceptions of their experiences of follow-up care after treatment for colorectal cancer. BACKGROUND: The optimal follow-up strategy for colorectal cancer is not known, and although patients are seen in traditional outpatient follow-up clinics, this system may not meet psycho-social and information needs. DESIGN: An exploratory qualitative study. METHOD: In-depth interviews were conducted with 27 patients who had completed treatment for colorectal cancer. The data were analysed using thematic analysis. RESULTS: One dominant theme emerged from the data with several sub-themes. The dominant theme was 'knowing what to expect' after bowel surgery. The subthemes related to 'living with altered bowel function', the ways patients gathered information about their condition through 'trial and error' and 'information and support from specialist nurses'. Patients who did not have a stoma were particularly vulnerable and expressed a need for more information on knowing what to expect after surgery. The role of the colorectal nurse specialist was vital in providing information and support; in particular, nurse-led clinics provided continuity of care and information that was tailored to individual need. CONCLUSIONS: Traditional hospital follow-up does not always address patients' psycho-social and information needs. Nurse-led services were commented on favourably in terms of providing information that was tailored to individual need as well as being responsive to urgent patient concerns; future innovative strategies for providing follow-up care for patients with colorectal cancer should draw on the specialist knowledge and skills of these nurses. RELEVANCE TO CLINICAL PRACTICE: Nurse-led clinics and/or telephone follow-up by specialist nurses may be effective models of care for this particular patient group, providing appropriate access for meeting clinical, psycho-social and information needs.