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A failure to fully recover following coronavirus disease 2019 (COVID-19) may have a profound impact on high-functioning populations ranging from frontline emergency services to professional or amateur/recreational athletes. The aim of the study is to describe the medium-term cardiopulmonary exercise profiles of individuals with "persistent symptoms" and individuals who feel "recovered" after hospitalization or mild-moderate community infection following COVID-19 to an age, sex, and job-role matched control group. A total of 113 participants underwent cardiopulmonary functional tests at a mean of 159 ± 7 days (∼5 mo) following acute illness; 27 hospitalized with persistent symptoms (hospitalized-symptomatic), 8 hospitalized and now recovered (hospitalized-recovered); 34 community managed with persistent symptoms (community-symptomatic); 18 community managed and now recovered (community-recovered); and 26 controls. Hospitalized groups had the least favorable body composition (body mass, body mass index, and waist circumference) compared with controls. Hospitalized-symptomatic and community-symptomatic individuals had a lower oxygen uptake (V̇o

Individuals who contract coronavirus disease 2019 (COVID-19) can suffer with persistent and debilitating symptoms long after the initial acute illness. Heart rate (HR) profiles determined during cardiopulmonary exercise testing (CPET) and delivered as part of a post-COVID recovery service may provide insight into the presence and impact of dysautonomia on functional ability.Using an active, working-age, post-COVID-19 population, the purpose of this study was to (1) determine and characterize any association between subjective symptoms and dysautonomia; and (2) identify objective exercise capacity differences between patients classified "with" and those "without" dysautonomia.Patients referred to a post-COVID-19 service underwent comprehensive clinical assessment, including self-reported symptoms, CPET, and secondary care investigations when indicated. Resting HR75 bpm, HR increase with exercise89 bpm, and HR recovery25 bpm 1 minute after exercise were used to define dysautonomia. Anonymized data were analyzed and associations with symptoms, and CPET outcomes were determined.Fifty-one of the 205 patients (25%) reviewed as part of this service evaluation had dysautonomia. There were no associations between symptoms or perceived functional limitation and dysautonomia (P.05). Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate (219 ± 37 W vs 253 ± 52 W; P.001) and peak oxygen consumption (V̇oDysautonomia is associated with objective functional limitations but is not associated with subjective symptoms or limitation.

Dogs are good models for studying behaviour and cognition as they have complex social capabilities. In the current study, we observed how human emotional valences (positive, neutral and negative) affected aspects of dogs’ behaviour. We expected that dogs would exhibit more approaching behaviours in the positive condition and more signs of avoidance in the negative one. We analysed videos of 70 adult pet dogs of various breeds taken from an experiment in which one of two actors expressed an emotion and dogs could freely explore the environment for 30 s. Our results show that dogs exhibit differential behaviour when presented with different emotional valences. Two behaviours arose that might be linked to a reciprocal positive emotional state in dogs: tail raised between 90° and 180° and physical contact during sniffing. These behaviours are associated with an active search for information. In the positive conditions, dogs were more willing to explore the social environment and gather information from the actors.

Introduction/Background This case explores some classic rheumatology topics - systemic sclerosis and antibodies. It is now well recognised that there are a magnitude of different antibodies, beside the typical anti-Scl-70, anticentromere or anti-RNA polymerase III, that can be associated with systemic sclerosis however in 5-10% of cases all antibody tests are negative, yet the patient still displays characteristic clinical features of the disease. We need to ensure such patients are correctly diagnosed, followed up and managed. Description/Method This case looks at the uncommon presentation of systemic sclerosis without any positive antibody results. I consulted with a 53-year-old male with a past medical history of hypertension, type 2 diabetes, GORD, hypothyroidism, depression and hyperlipidaemia. He had previously been seen in the rheumatology clinic with costochondritis and Raynaud’s phenomenon. At this time, he had antibody tests which were all negative (ANA and ENA). He had nailfold capillaroscopy which showed some concerns with widening of capillaries in areas and some linear haemorrhages. This was felt to not be diagnostic of Systemic sclerosis but advised continued follow up and repeat tests. Unfortunately, he failed to attend a subsequent clinic appointment and was lost to follow up. He was referred back to the Rheumatology department in 2021 with worsening symptoms of Raynaud’s. At this time he also described symptoms of reflux and dysphagia. He was suffering from generalised fatigue and pains. On examination he had tightening of the skin on his hands and was prayer sign positive. His antibody tests were repeated, again all coming back negative. We then arranged for repeat nailfold capillaroscopy and thermographic testing. This showed very little rewarming after cold challenge with delay even at 30 degrees. The nailfold capillaroscopy showed generalised widening of the capillaries with occasional distortion and tortuosity. There were multiple linear haemorrhages. This study was reported showing definite abnormality in keeping with a diagnosis of systemic sclerosis. Discussion/Results This highlights the rare but now well recognised phenomenon of antibody negative systemic sclerosis which makes up around 5-10% of cases. It also shows how nailfold capillaroscopy can be a key tool in diagnosing this, and the features to look out for in order to do so - capillary widening, haemorrhage and loss of architecture. The case demonstrates some of the more common features of antibody negative systemic sclerosis including a higher proportion of male patients and prominent GI features. There are generally less severe vascular features including pulmonary hypertension and telangiectasia, with Raynaud’s less often leading to digital ulcers and pitting. In this case we suggested uptitration of his nifedipine to try and help control his Raynaud’s symptoms. Given the significant GI features this patient was experiencing we referred him on for further evaluation by the gastroenterology team. I think some aspects of this case were blurred by his comorbidities, especially diabetes, and some of his skin disease and pains were attributed to this. However, with hindsight and seeing how his symptoms progressed, I think we could question if more could have been done earlier in the course of this patient’s disease - maybe when the initial abnormal, if not diagnostic, capillaroscopy results were available. Unfortunately, the patient not attending further clinic appointments reduced the opportunities to do this, but this also raised a good question about how we try to ensure patient engagement and deal with patients who don’t attend follow up. Key learning points/Conclusion This was an excellent case for us to be able to learn about systemic sclerosis and the spectrum of disease it encompasses. It was interesting to learn about the different features and presentations of the disease, and how these different phenotypes correlate to certain antibodies classically being present, or as in this case, not present. It also enabled me to consider how we manage complex patients with multiple comorbidities and variable compliance. I feel that this conference would allow us to learn from other complex cases and how to best manage patients with similar issues, including systemic sclerosis, prominent pain issues, and gastrointestinal issues within rheumatology.

Children are often surrounded by other humans and companion animals (e.g., dogs, cats); and understanding facial expressions in all these social partners may be critical to successful social interactions. In an eye-tracking study, we examined how children (4-10 years old) view and label facial expressions in adult humans and dogs. We found that children looked more at dogs than humans, and more at negative than positive or neutral human expressions. Their viewing patterns (Proportion of Viewing Time, PVT) at individual facial regions were also modified by the viewed species and emotion, with the eyes not always being most viewed: this related to positive anticipation when viewing humans, whilst when viewing dogs, the mouth was viewed more or equally compared to the eyes for all emotions. We further found that children's labelling (Emotion Categorisation Accuracy, ECA) was better for the perceived valence than for emotion category, with positive human expressions easier than both positive and negative dog expressions. They performed poorly when asked to freely label facial expressions, but performed better for human than dog expressions. Finally, we found some effects of age, sex, and other factors (e.g., experience with dogs) on both PVT and ECA. Our study shows that children have a different gaze pattern and identification accuracy compared to adults, for viewing faces of human adults and dogs. We suggest that for recognising human (own-face-type) expressions, familiarity obtained through casual social interactions may be sufficient; but for recognising dog (other-face-type) expressions, explicit training may be required to develop competence. HIGHLIGHTS: We conducted an eye-tracking experiment to investigate how children view and categorise facial expressions in adult humans and dogs Children's viewing patterns were significantly dependent upon the facial region, species, and emotion viewed Children's categorisation also varied with the species and emotion viewed, with better performance for valence than emotion categories Own-face-types (adult humans) are easier than other-face-types (dogs) for children, and casual familiarity (e.g., through family dogs) to the latter is not enough to achieve perceptual competence.

BackgroundThe medium-long impact of coronavirus disease 2019 (COVID-19) on active populations is yet to be fully understood, with potential individual and operational impact on military service personnel (SP). The M-COVID study was established to investigate cardiopulmonary, functional, cognitive, and mental health post-COVID-19 SP outcomes, across the spectrum of acute COVID-19 severity.MethodObservational four-cohort study; hospitalised, community-based illness with on-going symptoms (communitysymptomatic), community-based illness now recovered (community-recovered) and age, sex, job-role matched control. Participants underwent extensive clinical assessment involving cardiopulmonary imaging, submaximal and maximal exercise testing, pulmonary function, cognitive assessment, blood tests, electrocardiogram and questionnaires on mental health and physical function.Results113 participants (aged 39±9, 86% male) were recruited; Hospitalised (n=35), community-symptomatic (n=34), community-recovered (n=18) and control (n=26), 159±72 days following acute illness. Hospitalised and community-symptomatic groups were older (p=0.003), with a higher body mass index (pConclusionsRecovered SP who suffered mild-moderate COVID-19 do not differ from an age, sex and job-role matched controls. This is reassuring for the vast majority of individuals who have had acute COVID-19 not requiring hospital management. Individuals who were hospitalised or continue to suffer symptoms may require a specific, comprehensive clinical and occupational assessment prior to a full return to duty.

The ability to infer emotional states and their wider consequences requires the establishment of relationships between the emotional display and subsequent actions. These abilities, together with the use of emotional information from others in social decision making, are cognitively demanding and require inferential skills that extend beyond the immediate perception of the current behaviour of another individual. They may include predictions of the significance of the emotional states being expressed. These abilities were previously believed to be exclusive to primates. In this study, we presented adult domestic dogs with a social interaction between two unfamiliar people, which could be positive, negative or neutral. After passively witnessing the actors engaging silently with each other and with the environment, dogs were given the opportunity to approach a food resource that varied in accessibility. We found that the available emotional information was more relevant than the motivation of the actors (i.e. giving something or receiving something) in predicting the dogs’ responses. Thus, dogs were able to access implicit information from the actors’ emotional states and appropriately use the affective information to make context-dependent decisions. The findings demonstrate that a non-human animal can actively acquire information from emotional expressions, infer some form of emotional state and use this functionally to make decisions.

Objectives: To investigate cardiopulmonary, functional, cognitive, and mental health post-COVID-19 outcomes in a young, physically active working-age population, across the spectrum of acute COVID-19 severity. Methods: Observational cohort study of 4 groups; hospitalised, community illness with on-going symptoms (community-symptomatic), community illness now recovered (community-recovered) and controls. Participants underwent extensive clinical assessment involving cardiopulmonary imaging, submaximal and maximal exercise testing, pulmonary function, cognitive assessment, blood tests, electrocardiogram and questionnaires on mental health and physical function. Results: 113 participants (aged 39±9 and 86% male) were recruited into four groups, Hospitalised (n=35), community-symptomatic (n=34), community-recovered (n=18) and control (n=26), at 159±72days following acute illness. Hospitalized and community-symptomatic groups were older, with a higher body mass index, and worse mental health, fatigue, and quality of life scores. Hospitalised and community-symptomatic participants also performed less well on sub-maximal and maximal exercise testing. Hospitalised individuals had impaired ventilatory efficiency (higher VE/V̇CO2 slope), achieved less work at the anaerobic threshold and at peak than other groups and had a significantly reduced forced vital capacity. Clinically significant abnormal cardiopulmonary imaging findings were present in 6% of hospitalised participants. Those who recovered from COVID-19 had no significant differences when compared with controls.Conclusion: Recovered individuals who suffered mild-moderate COVID-19 do not differ from an age, sex and job-role matched control population. Individuals who were hospitalised or continue to suffer symptoms require a specific, comprehensive assessment prior to a return to full physical activity.

Both the public and clinicians are interested in the application of scientific knowledge concerning problem animal behaviour and its treatment. However, in order to do this effectively it is essential that individuals have not only scientific literacy but also an appreciation of philosophical concepts underpinning a particular approach and their practical implications on the knowledge generated as a result. This paper highlights several common misunderstandings and biases associated with different scientific perspectives relevant to clinical animal behaviour and their consequences for how we determine what may be a useful treatment for a given patient. In addition to more reflective evaluation of results, there is a need for researchers to report more information of value to clinicians; such as relevant treatment outcomes, effect sizes, population characteristics. Clinicians must also appreciate the limitations of population level study results to a given case. These challenges can however be overcome with the careful critical reflection using the scientific principles and caveats described.

IntroductionThere have been more than 425 million COVID-19 infections worldwide. Post-COVID illness has become a common, disabling complication of this infection. Therefore, it presents a significant challenge to global public health and economic activity.MethodsComprehensive clinical assessment (symptoms, WHO performance status, cognitive testing, CPET, lung function, high-resolution CT chest, CT pulmonary angiogram and cardiac MRI) of previously well, working-age adults in full-time employment was conducted to identify physical and neurocognitive deficits in those with severe or prolonged COVID-19 illness.Results205 consecutive patients, age 39 (IQR30.0–46.7) years, 84% male, were assessed 24 (IQR17.1–34.0) weeks after acute illness. 69% reported ≥3 ongoing symptoms. Shortness of breath (61%), fatigue (54%) and cognitive problems (47%) were the most frequent symptoms, 17% met criteria for anxiety and 24% depression. 67% remained below pre-COVID performance status at 24 weeks. One third of lung function tests were abnormal, (reduced lung volume and transfer factor, and obstructive spirometry). HRCT lung was clinically indicated in ConclusionDespite low rates of residual cardiopulmonary pathology, in this cohort, with low rates of premorbid illness, there is a high burden of symptoms and failure to regain pre-COVID performance 6-months after acute illness. Cognitive assessment identified a specific deficit of the same magnitude as intoxication at the UK drink driving limit or the deterioration expected with 10 years ageing, which appears to contribute significantly to the symptomatology of long-COVID.

Following Social Constructivism Theory [30, 31], this study explored EFL learners' writing performance in a China-US learning project. A total of 43 sophomores in China participated in two essay writing activities where they received feedback from a native English-speaking teacher (NEST). This quasi-experimental study included 20 students in the experimental group receiving video feedback and 23 students in the control group receiving e-written feedback. Students' writing performance was analyzed using the Mann-Whitney U test due to the small sample size. The results of the quantitative analysis of students' pretest and posttest writing scores indicated that their writing proficiency significantly improved in the two groups. The effectiveness of receiving different modes of feedback was not significantly different in the writing posttest scores between the two groups. The findings suggested that both video and e-written feedback provided by the NEST were equal in enhancing EFL learners' essay writing quality.

Thirty-three students used their personal mobile devices to access digital media in a paper-based textbook containing Quick Response (QR) codes. The students worked in small groups with minimal intervention from the course instructor to participate in activities and complete assignments. Information regarding student satisfaction with the course, as well as their perceptions of the benefits and disadvantages of the instructional method employed, were gathered through a questionnaire and a reflective writing activity. The results indicated that overall satisfaction was high (M = 3.38), especially regarding the role of the instructor (M = 3.35) and interaction (M = 3.35). However, participants indicated a lower level of satisfaction with the materials (M = 2.89). Further inquiry revealed that dissatisfaction with the course materials was due to the lack of a stable Wi-Fi connection at the university rather than the design or content of the textbooks.

Quantum computing systems need to be benchmarked in terms of practical tasks they would be expected to do. Here, we propose 3 "application-motivated" circuit classes for benchmarking: deep (relevant for state preparation in the variational quantum eigensolver algorithm), shallow (inspired by IQP-type circuits that might be useful for near-term quantum machine learning), and square (inspired by the quantum volume benchmark). We quantify the performance of a quantum computing system in running circuits from these classes using several figures of merit, all of which require exponential classical computing resources and a polynomial number of classical samples (bitstrings) from the system. We study how performance varies with the compilation strategy used and the device on which the circuit is run. Using systems made available by IBM Quantum, we examine their performance, showing that noise-aware compilation strategies may be beneficial, and that device connectivity and noise levels play a crucial role in the performance of the system according to our benchmarks., Comment: 33 pages, 17 figures; v2 - typos corrected; v3 - rearrangements and compression for clarity, reformatted for publication

The purpose of this preliminary study was to investigate foreign investors’ acceptance and usage of property technology (PropTech) in the Japanese real estate market. To that end, a purposive sample of eleven participants were recruited to complete an online survey. The survey consisted of a modified and previously validated measure of acceptance based on the unified theory of acceptance and use of technology (UTAUT), as well as a usage scale, demographic items, and open-ended questions. The results of the survey showed that participants were generally accepting of PropTech in the Japanese context. The highest mean values were associated with the subscales of effort expectancy and performance expectancy, while the lowest mean value was found in the social influence subscale. Usage of PropTech was slightly more concerned with the gathering of information on properties and markets than transactions or portfolio management. Interviews were also conducted with two of the participants. Interview responses showed that there is a relative lack of available PropTech resources in Japan, especially for non-Japanese speakers. PropTech which is focused on foreign investors in Japan would fill a needed gap in the industry. This is especially true of property portals and social media forums that would help investors to connect, communicate, and learn.

Therapeutic plasma exchange (TPE) involves the extracorporeal separation of plasma from the cellular components of blood with replacement fluid, such as human albumin or fresh frozen plasma. A number of studies across the world revealed that more than one third of TPE procedures were performed for neurological disorders. Myasthenia gravis (MG), Guillain-Barré syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) were the most frequently cited indications for TPE, followed by multiple sclerosis (MS). However, treatments of these conditions have evolved over the years and it is likely that this has impacted on clinical practice. Here we present our experience of using TPE to treat neurological disorders. We reviewed the medical records of all 63 patients who received 349 procedures over 70 therapeutic cycles between 2012 and 2015 in a tertiary neurology centre. In total only 2 patients with GBS and MG were treated with TPE. The commonest indication was voltage gated potassium channel (VGKC) complex antibody associated disorders followed by CIDP and MS. There were 11 patients with limbic encephalitis. Nine of them had antibodies against VGKC complex and two had N-methyl-D-aspartate (NMDA) receptor antibodies. Sixty four percent of patients with limbic encephalitis and overall 78% of patients responded to TPE. The complication rate associated with this procedure was 8.6 per 100 therapeutic cycle. There was no treatment related mortality. We observed a change in indications of TPE compared to historical studies. It was less frequently used to treated GBS and MG. It was found to be safe and effective.

Previous studies have shown that new onset bundle branch block (BBB) is associated with increased mortality in acute myocardial infarction (MI). This association seems particularly significant for right bundle branch block in ST-elevation MI (STEMI), but new onset left bundle branch block has also

Researchers investigated perceptions of Japanese college students toward the use of digital games in English-language learning. The study was conducted at one large private university in Japan. Undergraduate students who were enrolled in 14 English-language courses were invited to complete a paper-based survey during class time. The survey included the following constructs: ease of use, learning opportunities, experience, preferences, and actual use. Participants were also invited to share potential advantages and disadvantages for digital game use in the classroom. Two hundred and twenty-two students completed the survey. Results indicate that most students viewed the potential integration and utilization of digital games as positive. However, some students expressed concern that the use of games may not be an effective or efficient method of learning.