Nevin Manimala

J Math Biol. 2022 Sep 12;85(3):27. doi: 10.1007/s00285-022-01789-1.

ABSTRACT

We consider interactions between players in groups of size [Formula: see text] with payoffs that not only depend on the strategies used in the group but also fluctuate at random over time. An individual can adopt either cooperation or defection as strategy and the population is updated from one time step to the next by a birth-death event according to a Moran model. Assuming recurrent symmetric mutation and payoffs to cooperators and defectors according to the composition of the group whose expected values, variances, and covariances are of the same small order, we derive a first-order approximation for the average abundance of cooperation in the selection-mutation equilibrium. In general, we show that increasing the variance of any payoff for defection or decreasing the variance of any payoff for cooperation increases the average abundance of cooperation. As for the effect of the covariance between any payoff for cooperation and any payoff for defection, we show that it depends on the number of cooperators in the group associated with these payoffs. We study in particular the public goods game, the stag hunt game, and the snowdrift game, all social dilemmas based on random benefit b and random cost c for cooperation, which lead to correlated payoffs to cooperators and defectors within groups. We show that a decrease in the scaled variance of b or c, or an increase in their scaled covariance, makes it easier for weak selection to favor the abundance of cooperation in the stag hunt game and the snowdrift game. The same conclusion holds for the public goods game except that the variance of b has no effect on the average abundance of C. Moreover, while the mutation rate has little effect on which strategy is more abundant at equilibrium, the group size may change it at least in the stag hunt game with a larger group size making it more difficult for cooperation to be more abundant than defection under weak selection.

PMID:36094659 | DOI:10.1007/s00285-022-01789-1

JAMA Neurol. 2022 Sep 12. doi: 10.1001/jamaneurol.2022.2741. Online ahead of print.

ABSTRACT

IMPORTANCE: Because Tourette syndrome (TS) is a paroxysmal disorder, symptomatic relief in individuals with TS may be possible through the application of stimulation only during the manifestation of human tic neural signatures. This technique could be capable of suppressing both motor and vocal tics and would have similar effectiveness to conventional continuous deep brain stimulation (DBS).

OBJECTIVE: To evaluate the feasibility, safety, and clinical effectiveness of bilateral centromedian-parafascicular complex thalamic closed-loop DBS as a treatment for medication-refractory TS.

DESIGN, SETTING, AND PARTICIPANTS: This single-center double-blinded safety and feasibility trial was conducted between February 2014 and June 2020. Six individuals with TS were screened and recruited from the Norman Fixel Institute at the University of Florida. The primary outcome was measured at 6 months, and participants were followed up for the duration of the neurostimulator battery life. Independent ratings that compared closed-loop and conventional DBS were videotaped. The first 2 of 6 individuals with TS were excluded from the study because the technology for embedded closed-loop capability was not yet available. The date of analysis was August 2020.

INTERVENTIONS: DBS therapy controlled by an embedded closed-loop stimulation system.

MAIN OUTCOMES AND MEASURES: The primary clinical outcome measure was a minimum of a 40% reduction in the YGTSS score at 6 months following DBS. There was also a comparison of conventional DBS with closed-loop DBS using the Modified Rush Videotape Rating Scale for Tic.

RESULTS: The mean (SD) age at TS diagnosis for the cohort was 8.5 (2.9), and the mean (SD) disease duration was 23.7 (5.8) years. Four individuals with TS were analyzed (2 male, 2 female; mean [SD] age, 23.7 [5.8] years). The study showed the closed-loop approach was both feasible and safe. One of the novelties of this study was that a patient-specific closed-loop paradigm was created for each participant. The features and stimulation transition speed were customized based on the signal quality and the tolerance to adverse reactions. The mean (SD) therapeutic outcome with conventional DBS was 33.3% (35.7%) improvement on the YGTSS and 52.8% (21.9%) improvement on the Modified Rush Videotape Rating Scale. Two of 4 participants had a primary outcome variable improvement of 40% meeting the primary efficacy target. When comparing closed-loop DBS with conventional DBS using a Wilcoxon sign-rank test, there was no statistical difference between tic severity score and both approaches revealed a lower tic severity score compared with baseline. The study was feasible in all 4 participants, and there were 25 total reported adverse events with 3 study-related events (12%). The most common adverse events were headache and anxiety.

CONCLUSIONS AND RELEVANCE: Embedded closed-loop deep DBS was feasible, safe, and had a comparable outcome to conventional TS DBS for the treatment of tics.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02056873.

PMID:36094652 | DOI:10.1001/jamaneurol.2022.2741

AIDS Behav. 2022 Sep 12. doi: 10.1007/s10461-022-03847-7. Online ahead of print.

ABSTRACT

Internalized HIV stigma has been associated with depression among people living with HIV (PLWH). However, it is still unclear whether resilience would mediate the association between internalized HIV stigma and depression and how this indirect effect would be moderated by social support. Data were collected from 402 PLWH in South Carolina using a cross-sectional survey. Data were fitted using a path model that specified the extent to which internalized HIV stigma and depression were related through resilience and how this effect was moderated by social support. Sociodemographic characteristics were included in the model as covariates. The indirect effect of internalized HIV stigma on depression through resilience was statistically significant for high social support but not for low social support. To mitigate negative impacts of internalized HIV stigma on mental health of PLWH, intervention efforts should integrate multilevel components for promoting both resilience and social support.

PMID:36094638 | DOI:10.1007/s10461-022-03847-7

Obes Surg. 2022 Sep 12. doi: 10.1007/s11695-022-06245-z. Online ahead of print.

ABSTRACT

PURPOSE: Research suggests that internalised weight stigma may explain the relationship between perceived weight stigma and adverse psychological correlates (e.g. depression, disordered eating, body image disturbances). However, few studies have assessed this mechanism in individuals seeking bariatric surgery, even though depression and disordered eating are more common in this group than the general population.

MATERIALS AND METHODS: We used data from a cross-sectional study with individuals seeking bariatric surgery (n = 217; 73.6% female) from Melbourne, Australia. Participants (M_age = 44.1 years, SD = 11.9; M_BMI = 43.1, SD = 7.9) completed a battery of self-report measures on weight stigma and biopsychosocial variables, prior to their procedures. Bias-corrected bootstrapped mediations were used to test the mediating role of internalised weight stigma. Significance thresholds were statistically corrected to reduce the risk of Type I error due to the large number of mediation tests conducted.

RESULTS: Controlling for BMI, internalised weight stigma mediated the relationship between perceived weight stigma and psychological quality of life, symptoms of depression and anxiety, stress, adverse coping behaviours, self-esteem, exercise avoidance, some disordered eating measures and body image subscales, but not physical quality of life or pain.

CONCLUSION: Although the findings are cross-sectional, they are mostly consistent with previous research in other cohorts and provide partial support for theoretical models of weight stigma. Interventions addressing internalised weight stigma may be a useful tool for clinicians to reduce the negative correlates associated with weight stigma.

PMID:36094627 | DOI:10.1007/s11695-022-06245-z

Breast Cancer Res Treat. 2022 Sep 12. doi: 10.1007/s10549-022-06723-z. Online ahead of print.

ABSTRACT

PURPOSE: Cancer risks conferred by germline, heterozygous, ATM pathogenic/likely pathogenic variants (PSVs) are yet to be consistently determined. The current study assessed these risks by analysis of a large dataset of ATM heterozygote loss of function (LOF) and missense PSV carriers tested with a multigene panel (MGP).

METHODS: De-identified data of all individuals who underwent ATM sequencing as part of MGP between October 2015 and February 2020 were reviewed. In cancer cases, rates for the six most prevalent variants and for all LOF and missense PSV combined were compared with rates of the same PSV in ethnically matched, healthy population controls. Statistical analysis included Chi-square tests and odds ratios calculations.

RESULTS: For female breast cancer cases, LOF )1794/219,269) and missense (301/219,269) ATM PSVs were seen at higher rates compared to gnomAD non-cancer controls (n = 157/56,001 and n = 27/61,208; p < 0.00001, respectively). Notably, the rate of the c.103C > T variant was higher in controls than in breast cancer cases [p = 0.001; OR 0.31 (95% CI 0.1-0.6)]. For all cancer cases combined, compared with non-cancer population controls, LOF (n = 143) and missense (n = 15) PSVs reported in both datasets were significantly more prevalent in cancer cases [OR_LOF 1.7 (95% 1.5-1.9) OR_missense 3.0 (95% CI 2.3-4); p = 0.0001].

CONCLUSION: Both LOF and missense heterozygous ATM PSVs are more frequently detected in cases of several cancer types (breast, ovarian, prostate, lung, pancreatic) compared with healthy population controls. However, not all ATM PSVs confer an increased cancer risk (e.g., breast).

PMID:36094610 | DOI:10.1007/s10549-022-06723-z

Lasers Med Sci. 2022 Sep 12. doi: 10.1007/s10103-022-03643-8. Online ahead of print.

ABSTRACT

Laser hemorrhoidoplasty (LHP) is known as a new minimally invasive and painless procedure for symptomatic hemorrhoids. However, Milligan-Morgan (MM) may offer the best result of long-term cure rates. In this study, we aim to compare the efficacy between LHP and MM for hemorrhoidal disease treatment. Using specific keywords, we comprehensively go through the potential articles on PubMed, Europe PMC, and Google Scholar sources until April 19, 2022. All published studies on LHP and MM hemorrhoidectomy were collected. Statistical analysis was done by using Review Manager 5.4 software. Twelve studies with a total of 1756 patients with hemorrhoid grades II-IV were included for the analysis. Our pooled analysis revealed that LHP was associated with shorter operative time (p < 0.00001), shorter length of hospital stay (p = 0.0005), lower risk of urinary retention (p = 0.005) and anal stenosis (p = 0.0004), and lower VAS 24-h post-operative (p < 0.00001) when compared with MM. However, LHP and MM did not differ in terms of recurrence rate (p = 0.70). LHP was superior to MM procedure in terms of shortening the recovery time and minimizing post-operative complications for patients with hemorrhoidal disease.

PMID:36094598 | DOI:10.1007/s10103-022-03643-8

Clin Res Cardiol. 2022 Sep 12. doi: 10.1007/s00392-022-02100-4. Online ahead of print.

ABSTRACT

BACKGROUND: Infective endocarditis (IE) is characterized by high morbidity and mortality rates, despite recent improvements in diagnostics and treatment. We aimed to investigate incidence, clinical characteristics, and in-hospital mortality in a large-scale nationwide cohort.

METHODS: Using data from the German Federal Bureau of Statistics, all IE cases in Germany between 2007 and 2019 were analyzed. Logistic regression models were fitted to assess associations between clinical factors and in-hospital mortality.

RESULTS: In total, 86,469 patients were hospitalized with IE between 2007 and 2019. The mean age was 66.5 ± 14.7 years and 31.8% (n = 27,534/86,469) were female. Cardiovascular (CV) comorbidities were common. The incidence of IE in the German population increased from 6.3/100,000 to 10.2/100,000 between 2007 and 2019. Staphylococcus (n = 17,673/86,469; 20.4%) and streptococcus (n = 17,618/86,469; 20.4%) were the most common IE-causing bacteria. The prevalence of staphylococcus gradually increased over time, whereas blood culture-negative IE (BCNIE) cases decreased. In-hospital mortality in patients with IE was 14.9%. Compared to BCNIE, staphylococcus and Gram-negative pathogens were associated with higher in-hospital mortality. In multivariable analysis, factors associated with higher likelihood of in-hospital mortality were advanced age, female sex, CV comorbidities (e.g., heart failure, COPD, diabetes, stroke), need for dialysis or invasive ventilation, and sepsis.

CONCLUSIONS: In this contemporary cohort, incidence of IE increased over time and in-hospital mortality remained high (~ 15%). While staphylococcus and streptococcus were the predominant microorganisms, bacteremia with staphylococcus and Gram-negative pathogens were associated with higher likelihood of in-hospital mortality. Our results highlight the need for new preventive strategies and interventions in patients with IE. Infective endocarditis in Germany. BCNIE blood culture-negative infective endocarditis, IE infective endocarditis.

PMID:36094574 | DOI:10.1007/s00392-022-02100-4

Eur Arch Otorhinolaryngol. 2022 Sep 12. doi: 10.1007/s00405-022-07641-y. Online ahead of print.

ABSTRACT

PURPOSE: To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology.

METHODS: Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as “Oto-neurological symptoms”, “Nasal symptoms”, “Pharyngolaryngeal symptoms”, “Other Head and Neck symptoms” and “Other Reasons”. Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected.

RESULTS: The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group.

CONCLUSIONS: This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.

PMID:36094563 | DOI:10.1007/s00405-022-07641-y

Arch Pathol Lab Med. 2022 Sep 12. doi: 10.5858/arpa.2022-0005-OA. Online ahead of print.

ABSTRACT

CONTEXT.—: The prostate sampling methods for radical cystoprostatectomy (RCP) specimens may affect pathologic results.

OBJECTIVE.—: To investigate the impact on the tumor stage and clinicopathologic features according to the prostate sampling method for RCP specimens.

DESIGN.—: From 2016 to 2017, the prostate in RCP was minimally and conventionally embedded (group 1, n = 98). From 2017 to 2018, it was completely embedded (group 2, n = 102).

RESULTS.—: Group 2 was more likely to have prostatic ducts or acini involvement by urothelial carcinoma in situ component (27% versus 10%, P = .002) and prostate involvement (30% versus 13%, P = .003) than group 1. Although there were cases with prostatic stromal invasion in group 2 (14% versus 7%, P = .13), it was not statistically significant. In all, 6 cases were upstaged by subepithelial prostatic stromal invasion through intraurethral extension according to the 8th edition of the American Joint Committee on Cancer (AJCC) staging system. Tumor location and the presence of concurrent carcinoma in situ were strongly associated with prostate involvement of urothelial carcinoma. Prostatic adenocarcinoma (PA) was incidentally identified in 47 cases (23.5%). Incidental PA and clinically significant PA were more often identified in group 2 than group 1 (38% versus 8%, P < .01 and 15% versus 6%, P = .048, respectively).

CONCLUSIONS.—: A complete prostate examination in RCP specimens can be suggested, since the final pathologic stage can be changed through a thorough prostate examination especially in accord with the AJCC staging manual 8th edition. In addition, the complete prostate analysis could detect more incidental and clinically significant PA.

PMID:36094519 | DOI:10.5858/arpa.2022-0005-OA

J Athl Train. 2022 Sep 12. doi: 10.4085/1062-6050-0032.22. Online ahead of print.

ABSTRACT

CONTEXT: Multiple aspects of a multidomain assessment have been validated for identifying concussion, however, researchers have yet to determine which components are related to referral for vestibular therapy.

OBJECTIVE: To identify which variables from a multidomain assessment were associated with receiving a referral for vestibular therapy following a concussion.

DESIGN: Retrospective chart review, level of evidence 3.

PATIENTS OR OTHER PARTICIPANTS: Participants (n=331; age: 16.9±7.2; 39.3% female) were diagnosed with a concussion per international consensus criteria by a clinical neuropsychologist after presenting to a concussion specialty clinic.

MAIN OUTCOME MEASURES: Medical chart data was extracted from the first clinical visit regarding pre-injury medical history, computerized neurocognition, Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profiles Screen (CP-Screen) and Vestibular Ocular Motor Screening (VOMS) within 16.2±46.7 days of injury. Five backwards logistic regression models were built to associate the outcomes from each of the five included assessments with referral for vestibular therapy. A final logistic regression model was built using variables retained in the previous five models as potential predictors of referral for vestibular therapy.

RESULTS: The five models built from individual components of the multidomain assessment predicted referral for vestibular therapy (R2= 0.01-0.28) with 1 to 6 statistically significant variables. The final multivariate model (R2= 0.40) retained 9 significant variables, represented by each of the five multidomain assessments except neurocognition. Variables with the strongest association to vestibular therapy referral were motor vehicle accident mechanism of injury (odds ratio [OR]=15.45), migraine history (OR=3.25), increased headache when concentrating (OR=1.81) and horizontal vestibular ocular reflex (OR=1.63).

CONCLUSIONS: The present study demonstrates the utility of a multidomain assessment, and identifies outcomes associated with a referral for vestibular therapy following a concussion.

PMID:36094515 | DOI:10.4085/1062-6050-0032.22