Nevin Manimala

J Neurosurg. 2021 May 21:1-9. doi: 10.3171/2020.11.JNS202580. Online ahead of print.

ABSTRACT

OBJECTIVE: Magnetic resonance imaging-guided focused ultrasound (MRgFUS) provides real-time monitoring of patients to assess tremor control and document any adverse effects. MRgFUS of the ventral intermediate nucleus (VIM) of the thalamus has become an effective treatment option for medically intractable essential tremor (ET). The aim of this study was to analyze the correlations of clinical and technical parameters with 12-month outcomes after unilateral MRgFUS thalamotomy for ET to help guide future clinical treatments.

METHODS: From October 2013 to January 2019, data on unilateral MRgFUS thalamotomy from the original pivotal study and continued-access studies from three different geographic regions were collected. Authors of the present study retrospectively reviewed those data and evaluated the efficacy of the procedure on the basis of improvement in the Clinical Rating Scale for Tremor (CRST) subscore at 1 year posttreatment. Safety was based on the rates of moderate and severe thalamotomy-related adverse events. Treatment outcomes in relation to various patient- and sonication-related parameters were analyzed in a large cohort of patients with ET.

RESULTS: In total, 250 patients were included in the present analysis. Improvement was sustained throughout the 12-month follow-up period, and 184 (73.6%) of 250 patients had minimal or no disability due to tremor (CRST subscore < 10) at the 12-month follow-up. Younger age and higher focal temperature (Tmax) correlated with tremor improvement in the multivariate analysis (OR 0.948, p = 0.013; OR 1.188, p = 0.025; respectively). However, no single statistically significant factor correlated with Tmax in the multivariate analysis. The cutoff value of Tmax in predicting a CRST subscore < 10 was 55.8°C. Skull density ratio (SDR) was positively correlated with heating efficiency (β = 0.005, p < 0.001), but no significant relationship with tremor improvement was observed. In the low-temperature group, 1-3 repetitions to the right target with 52°C ≤ Tmax ≤ 54°C was sufficient to generate sustained tremor suppression within the investigated follow-up period. The high-temperature group had a higher rate of balance disturbances than the low-temperature group (p = 0.04).

CONCLUSIONS: The authors analyzed the data of 250 patients with the aim of improving practices for patient screening and determining treatment endpoints. These results may improve the safety, efficacy, and efficiency of MRgFUS thalamotomy for ET.

PMID:34020416 | DOI:10.3171/2020.11.JNS202580

Food Chem. 2021 May 11;360:130056. doi: 10.1016/j.foodchem.2021.130056. Online ahead of print.

ABSTRACT

Metabolomics of complex biological matrices conducted by means of ¹H NMR leads to spectra suffering from severe signal overlapping. Previously, we have developed a high-resolution spectral treatment method to help solving this issue in ¹H NMR of triacylglycerols. In this work, we tested the potential of the developed method in the characterization and authentication of food products from animal origin using egg yolk as a model matrix. The approach consisted in a spectral deconvolution guided by the precision obtained on the deconvoluted peaks after reference lineshape adjustment of spectra. Thus, 135 peaks were quantitated and successfully used as biomarkers of origin, of hens breed, and of farming system. This required multivariate statistical analyses for classification. The same pool of variables allowed construction of multivariate quantitation models for individual fatty acids. Furthermore, minute amounts of conjugated fatty acids were quantitated and used as fingerprints of samples from backyard and free-range farming.

PMID:34020363 | DOI:10.1016/j.foodchem.2021.130056

Seizure. 2021 May 9;89:65-72. doi: 10.1016/j.seizure.2021.04.025. Online ahead of print.

ABSTRACT

OBJECTIVE: The differential diagnosis between epileptic and psychogenic nonepileptic seizures (PNES) is challenging, yet suspicion of PNES is crucial to rethink treatment strategies and select patients for diagnostic confirmation through video EEG (VEEG). We developed a novel scale to prospectively suspect PNES.

METHODS: First, we developed a 51-item scale in two steps, based upon literature review and panel expert opinion. A pilot study verified the applicability of the instrument, followed by a prospective evaluation of 158 patients (66.5% women, mean age 33 years) who were diagnosed for prolonged VEEG. Only epileptic seizures were recorded in 103 patients, and the other 55 had either isolated PNES or both types of seizures. Statistical procedures identified 15 items scored between 0 and 3 that best discriminated patients with and without PNES, with a high degree of consistency.

RESULTS: Internal consistency reliability of the scale for suspicion of PNES was 0.77 with Cronbach’s Alpha Coefficient and 0.95 with Rasch Item Reliability Index, and performance did not differ according to the patient’s gender. For a cut-off score of 20 (of 45) points, area under the curve was 0.92 (95% IC: 0.87-0.96), with an accuracy of 87%, sensitivity of 89%, specificity of 85%, positive predictive value of 77%, and negative predictive value of 94% (95% IC) for a diagnosis of PNES.

CONCLUSIONS: The scale for suspicion of PNES (SS-PNES) has high accuracy to a reliable suspicion of PNES, helping with the interpretation of apparent seizure refractoriness, reframing treatment strategies, and streamlining referral for prolonged VEEG.

PMID:34020344 | DOI:10.1016/j.seizure.2021.04.025

Soc Sci Med. 2021 May 6;280:113946. doi: 10.1016/j.socscimed.2021.113946. Online ahead of print.

ABSTRACT

INTRODUCTION: Many adolescents living with HIV in sub-Saharan Africa (SSA) experience poverty and have access to limited resources, which can impact HIV and mental health outcomes. Few studies have analyzed the impact of economic empowerment interventions on the psychosocial wellbeing of adolescents living with HIV in low resource communities, and this study aims to examine the mediating mechanism(s) that may explain the relationship between a family economic empowerment intervention (Suubi + Adherence) and mental health outcomes for adolescents (ages 10-16 at enrollment) living with HIV in Uganda.

METHOD: We utilized data from Suubi + Adherence, a large-scale six-year (2012-2018) longitudinal randomized controlled trial (N = 702). Generalized structural equation models (GSEMs) were conducted to examine 6 potential mediators (HIV viral suppression, food security, family assets, and employment, HIV stigma, HIV status disclosure comfort level, and family cohesion) to determine those that may have driven the effects of the Suubi + Adherence intervention on adolescents’ mental health.

RESULTS: Family assets and employment were the only statistically significant mediators during follow-up (β from -0.03 to -0.06), indicating that the intervention improved family assets and employment which, in turn, was associated with improved mental health. The proportion of the total effect mediated by family assets and employment was from 42.26% to 71.94%.

CONCLUSIONS: Given that mental health services provision is inadequate in SSA, effective interventions incorporating components related to family assets, employment, and financial stability are crucial to supporting the mental health needs of adolescents living with HIV in under-resourced countries like Uganda. Future research should work to develop the sustainability of such interventions to improve long-term mental health outcomes among this at-risk group.

PMID:34020312 | DOI:10.1016/j.socscimed.2021.113946

J Environ Manage. 2021 May 18;292:112739. doi: 10.1016/j.jenvman.2021.112739. Online ahead of print.

ABSTRACT

Climate change is affecting the growth and distribution of trees in the Chinese boreal forest. Such changes in China, the southern terminus of the extensive Eurasian boreal forests, reflect on the changes that could occur further north under a warming climate. Most studies have found that tree growth increases with increasing temperature and precipitation in boreal forests, but there is little observational evidence of the climate thresholds that might slow these growth rates at the more extreme temperatures which are predicted to occur under future global warming. Here, we examine growth responses of this dominant boreal tree species (Larix gmelinii) to climate based on the data from plantation sample plots across a broad region (40° 51′-52° 58’N, 118° 12’E-133° 42’E) in northeast China. From statistically significant fits to quadratic equations, temperature and precipitation are the important climatic factors determining tree growth in L. gmelinii plantations at two age classes (<10 year and 10-30 year-old stands). The maximum rates of tree height and diameter at breast height (DBH) were about 0.53 m/year and 0.46 cm/year at <10 year stands, and about 0.63 m/year and 0.60 cm/year at 10-30 year stands, respectively. For stands with the highest values of mean annual increment (MAI), the corresponding optimal mean annual temperature (MAT_opt) focused between 0.66 °C and 1.57 °C. The optimal mean annual precipitation (MAP_opt) between 663 mm and 708 mm produced the maximal growth increments. With mean annual temperature of -2.4 °C and precipitation of 470 mm averaged over 1954-2005 in Chinese boreal forest region as baseline, we conservatively estimated that trees in Chinese boreal forest appear to have higher growth potentials with the maximum temperature increase of 3.6 °C and precipitation increase of 40%.

PMID:34020307 | DOI:10.1016/j.jenvman.2021.112739

J Environ Manage. 2021 May 18;292:112733. doi: 10.1016/j.jenvman.2021.112733. Online ahead of print.

ABSTRACT

Timely and accurate monitoring of the spatiotemporal changes in drought is very important for the reduction in the social losses caused by drought. The Optimized Meteorological Drought Index (OMDI), originally established in southwestern China, showed great potential for drought monitoring over large regions on a large scale. However, the applicability of the index requires further evaluation, especially when used throughout China, which has a different agricultural divisions, variable climatic conditions, complex terrain and diverse land cover. In addition, the OMDI model relies on training data to construct local parameters for the model. On a large scale, it is of great significance to use multisource remote sensing data sets to construct OMDI model parameters. In this paper, the constrained optimization method was used to establish weights for the MODIS-derived Vegetation Conditional Index (VCI), TRMM-derived Precipitation Condition Index (PCI), and GLDAS-derived Soil Moisture Condition Index (SMCI) and calculate the OMDI based on the Standard Precipitation Index (SPI), Standardized Precipitation Evapotranspiration Index (SPEI) and weather stations. The accuracy of the OMDI model was evaluated by using the correlation coefficient. Moreover, the spatiotemporal changes in drought were also analyzed through trend analysis, Mann-Kendall (MK) statistics and the Hurst index on the monthly and annual scales. The results showed that (1) the highest positive correlation between the OMDI and the SPI was SPI-1, which was higher than that for any other month interval, such as 3 months, 6 months, 9 months and 12 months of the SPI. The results indicated that the OMDI was suitable to monitor meteorological drought. (2) In the nine agricultural subareas in China, the degree of drought in the Yangtze River (DYR) area had the most severe evolution and change frequency. This region was very sensitive to drought in the past two decades. (3) The area with OMDI variation coefficient less than 0.1 accounted for 94%, indicating that the degree of drought fluctuates little; The linear tendency rate is 0.0004, and the area greater than 0 reaches 66.44%, indicating that the drought is developing in a lightning trend. (4) The Hurst index value is mostly higher than 0.5 (the area ratio is 56.31%), and the area of “Positive-Consistent” and “Negative- Opposite” accounted for 54.02%, indicating that more than half of China’s area drought changes will show a trend of mitigation in the future.

PMID:34020305 | DOI:10.1016/j.jenvman.2021.112733

Environ Int. 2021 May 18;156:106643. doi: 10.1016/j.envint.2021.106643. Online ahead of print.

ABSTRACT

Particulate radioactivity, a characteristic of particulate matter, is primarily determined by the abundance of radionuclides that are bound to airborne particulates. Exposure to high levels of particulate radioactivity has been associated with negative health outcomes. However, there are currently no spatially and temporally resolved particulate radioactivity data for exposure assessment purposes. We estimated the monthly distributions of gross beta particulate radioactivity across the contiguous United States from 2001 to 2017 with a spatial resolution of 32 km, via a multi-stage ensemble-based model. Particulate radioactivity was measured at 129 RadNet monitors across the contiguous U.S. In stage one, we built 264 base learning models using six methods, then selected nine base models that provide different predictions. In stage two, we used a non-negative geographically and temporally weighted regression method to aggregate the selected base learner predictions based on their local performance. The results of block cross-validation analysis suggested that the non-negative geographically and temporally weighted regression ensemble learning model outperformed all base learning model with the smallest rooted mean square error (0.094 mBq/m³). Our model provided an accurate estimation of particulate radioactivity, thus can be used in future health studies.

PMID:34020300 | DOI:10.1016/j.envint.2021.106643

J Forensic Leg Med. 2021 May 13;81:102184. doi: 10.1016/j.jflm.2021.102184. Online ahead of print.

ABSTRACT

The purpose of this study was to investigate overkill in the Greek population from a criminological and victimological point of view and explore possible correlations of the phenomenon with socio-cultural or psychiatric factors. Overall, 158 autopsies of overkill victims were identified throughout the 15-year records of the national forensic laboratories throughout the northern Greek mainland. The pattern that has emerged from the statistical results of the present study on the victims of overkill within the Greek borders was generally in line with global statistics on homicide victims, but also presented differences. The phenomenon correlated more with homicides in the context of mental disorders (within schizophrenia spectrum), other crimes (such as burglary) as well as domestic violence. Overall, males outnumbered females both as victims (approximately threefold) and as perpetrators in overkill homicide cases, but regarding domestic violence, the sad majority of overkill victims stood for females murdered with excessive violence by male relatives. Close female relatives (especially mothers and grandmothers) were also victimized by psychiatrically ill offenders. Female perpetrators tended to attack male individuals with whom they shared a relationship (intimate partners). An important finding was the fact that less than half the offenders’ population with major mental disorders were diagnosed at the time of the offense. Overkill victims were found, on average, to be older than average homicide victims, being probably associated with the entailed difference in the physical strength ratio between the victim and the perpetrator.

PMID:34020236 | DOI:10.1016/j.jflm.2021.102184

J Infect Public Health. 2021 Apr 20;14(6):702-708. doi: 10.1016/j.jiph.2021.03.013. Online ahead of print.

ABSTRACT

BACKGROUND: To this end, the influence of COVID-19 on pregnant women and their neonates is not completely clear. Therefore, the main aim of this study is to investigate maternal and neonatal clinical outcomes with confirmed COVID-19 infection. Besides, it investigates the likelihood of vertical transmission of COVID-19 infection from pregnant women to their neonates.

METHODS: A retrospective descriptive study was conducted in three medical centers during the period from March to November 2020. Data were collected from the available medical records in the respective hospitals using a standardized questionnaire on maternal and neonatal clinical outcomes. All pregnant women with confirmed COVID-19 infection across the three hospitals and their neonates were eligible to participate in this study. Descriptive statistics were presented as a median and interquartile range (IQR) or frequencies and percentages as appropriate using SPSS 24.0 software.

RESULTS: This study has identified a total of 288 pregnant women with confirmed COVID-19 infection over the study period of a median age of 30 years and median GA at diagnosis 38 weeks (IQR: 39 -33) as well as 27% of them were obese (n=78). The majority of pregnant women were symptomatic with cough (n=92, 31.9%) being the most frequent COVID-19 symptom followed by fever and dyspnea (n=36, 12.5%). Two-hundred and four pregnant delivered (70.84%) and caesarean sections were prevalent among 35.8% of them. The most common adverse pregnancy outcome was premature (n=31, 15.5%), followed by fetal distress (n=13, 6.5%), preeclampsia (n=4, 2.0%), and one pregnant woman died. The laboratory results exhibit that temperature higher than 38 (n=27), leukopenia (n=19), neutropenia (n=54), ALT (n=12), AST (n=31), and thrombocytopenia (n=35) were less frequent among pregnant women while lymphopenia (n=126), hemoglobin levels lower than 13.0 (n=218), deceased albumin levels (n=195) were most frequent among them. However, a small proportion of pregnant women were admitted to the ICU (3.8%). The most frequent maternal treatments were antibiotics (n=81), antiviral (n=49), and corticosteroid (n=24). Of 204 neonates, four had died and all the remaining neonates were alive. The median gestational age at delivery was 39 weeks (IQR: 35-40). Most neonates had normal laboratory results. However, 14 had lymphopenia (7.0%), 22 had neutropenia (11.0%), and 11 had thrombocytopenia (5.5%). Four infants had low hemoglobin levels of less than 13.0 (2.0%) and 81 had hyperbilirubinemia (e.g., total bilirubin of higher than 23; 40.5%). Approximately less than one-half of neonates required admission to the NICU (n=86, 43%), 7% of them required respiratory support of mechanical ventilation, and none of them get infected with COVID-19 disease.

CONCLUSION: This multicenter study suggests that the majority of pregnant women had mild or moderate disease symptoms. Nevertheless, this study did not find any evidence of possible vertical transmission of COVID-19 infection from mothers to their babies. This study may provide a baseline for further studies focusing on investigating long-term maternal and neonate’s outcomes and possible vertical transmission of COVID-19 from mothers to their newborn babies.

PMID:34020209 | DOI:10.1016/j.jiph.2021.03.013

Accid Anal Prev. 2021 May 18;157:106190. doi: 10.1016/j.aap.2021.106190. Online ahead of print.

ABSTRACT

Ranking sites with promise is an essential step for cost-effective engineering improvement on roadway traffic safety. This study proposes a Bayesian multivariate spatio-temporal interaction model based approach for ranking sites. The severity-weighted crash frequency and crash rate are used as the decision parameters. The posterior expected rank and posterior mean of the decision parameters are adopted as the statistical criteria. The proposed approach is applied to rank road segments on Kaiyang Freeway in China, which is conducted via programming in the freeware WinBUGS. The results of Bayesian estimation and assessment indicate that incorporating spatio-temporal correlations and interactions into the crash frequency model significantly improves the overall goodness-of-fit performance and affects the identified crash-contributing factors and the estimated safety effects for each severity level. With respect to the ranking results, significant differences are found between those generated from the proposed approach and those generated from the naïve ranking approach and a Bayesian approach based on the multivariate Poisson-lognormal model. Besides, the ranks under the posterior mean criterion are found generally consistent with those under the posterior expected rank criterion.

PMID:34020182 | DOI:10.1016/j.aap.2021.106190