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Background: Neurosurgery is a high-risk specialty with a low margin of error. We aim to assess the risk of neurosurgeons being involved in medicolegal cases in Canada. Methods: This retrospective descriptive study evaluated ten years (2012-2021) of closed legal cases, college cases, and hospital complaints against neurosurgeons with data from the CMPA. Included cases were cranial cases, VP shunts, or cases where a catheter or wire was inserted into the brain. Cases excluded angiography, radiation, ultrasound, or percutaneous procedures. Results: We identified 77 cases (66 urgent or emergent). Neurosurgeons had a significantly higher medicolegal risk than the CMPA surgeon membership, however lower risk compared to all physician specialties. Legal cases accounted for 69% with favourable outcomes in 52%. Forty-one cases involved post-operative complications and 16 cases involved VP shunts. Multiple surgeons or residents could be involved spanning age groups and years in practice. Thirty-four cases had a harmful incident, 41% of these severe. The majority of cases occurred at urban centers. The average case duration was 41 months. Conclusions: This study provides a recent medicolegal analysis of cranial neurosurgery in Canada. We identified areas of common complaints and hope the data can be used to mitigate risk surgical risk in the future.
Accumulating evidence suggests that positive and negative emotions, as well as emotion regulation, play key roles in human health and disease. Recent work has shown the gut microbiome is important in modulating mental and physical health through the gut–brain axis. Yet, its association with emotions and emotion regulation are understudied. Here we examined whether positive and negative emotions, as well as two emotion regulation strategies (i.e. cognitive reappraisal and suppression), were associated with the gut microbiome composition and functional pathways in healthy women.
Participants were from the Mind-Body Study (N = 206, mean age = 61), a sub-study of the Nurses' Health Study II cohort. In 2013, participants completed measures of emotion-related factors. Two pairs of stool samples were collected, 6 months apart, 3 months after emotion-related factors measures were completed. Analyses examined associations of emotion-related factors with gut microbial diversity, overall microbiome structure, and specific species/pathways and adjusted for relevant covariates.
Alpha diversity was negatively associated with suppression. In multivariate analysis, positive emotions were inversely associated with the relative abundance of Firmicutes bacterium CAG 94 and Ruminococcaceae bacterium D16, while negative emotions were directly correlated with the relative abundance of these same species. At the metabolic pathway level, negative emotions were inversely related to the biosynthesis of pantothenate, coenzyme A, and adenosine.
These findings offer human evidence supporting linkages of emotions and related regulatory processes with the gut microbiome and highlight the importance of incorporating the gut microbiome in our understanding of emotion-related factors and their associations with physical health.
Physical activity (PA) may help maintain brain structure and function in aging. Since the intensity of PA needed to effect cognition and cerebrovascular health remains unknown, we examined associations between PA and cognition, regional white matter hyperintensities (WMH), and regional cerebral blood flow (CBF) in older adults.
Forty-three older adults without cognitive impairment underwent magnetic resonance imaging (MRI) and comprehensive neuropsychological assessment. Waist-worn accelerometers objectively measured PA for approximately one week.
Higher time spent in moderate to vigorous PA (MVPA) was uniquely associated with better memory and executive functioning after adjusting for all light PA. Higher MVPA was also uniquely associated with lower frontal WMH volume although the finding was no longer significant after additionally adjusting for age and accelerometer wear time. MVPA was not associated with CBF. Higher time spent in all light PA was uniquely associated with higher CBF but not with cognitive performance or WMH volume.
Engaging in PA may be beneficial for cerebrovascular health, and MVPA in particular may help preserve memory and executive function in otherwise cognitively healthy older adults. There may be differential effects of engaging in lighter PA and MVPA on MRI markers of cerebrovascular health although this needs to be confirmed in future studies with larger samples. Future randomized controlled trials that increase PA are needed to elucidate cause-effect associations between PA and cerebrovascular health.
This study aimed to explore the utility of the eosinophil percentage in peripheral blood for guiding post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps.
Forty-four patients with chronic rhinosinusitis with nasal polyps underwent functional endoscopic sinus surgery and were randomly divided into two groups. Patients in the standard treatment group used oral and nasal spray glucocorticoids. In the biomarker treatment group, patients with peripheral blood eosinophil percentage values less than 3.05 per cent did not receive glucocorticoid treatment, whereas patients with values 3.05 per cent or above were part of the standard treatment group. Visual Analogue Scale, Sino-Nasal Outcome Test-22 scores, endoscopic Lund–Kennedy scores, eosinophils, interleukin-5 and eosinophil cationic protein in peripheral blood, and nasal secretions were measured.
After functional endoscopic sinus surgery, the Visual Analogue Scale, Sino-Nasal Outcome Test-22 and Lund–Kennedy scores were significantly reduced in both groups; there were no significant differences in those indicators between the groups during the three follow-up visits.
Peripheral blood eosinophil percentage offers a potential biomarker to guide post-operative glucocorticoid therapy in patients with chronic rhinosinusitis with nasal polyps.
Despite an elevated risk of psychopathology stemming from COVID-19-related stress, many essential workers stigmatise and avoid psychiatric care. This randomised controlled trial was designed to compare five versions of a social-contact-based brief video intervention for essential workers, differing by protagonist gender and race/ethnicity.
We examined intervention efficacy on treatment-related stigma (‘stigma’) and openness to seeking treatment (‘openness’), especially among workers who had not received prior mental healthcare. We assessed effectiveness and whether viewer/protagonist demographic concordance heightened effectiveness.
Essential workers (N = 2734) randomly viewed a control video or brief video of an actor portraying an essential worker describing hardships, COVID-related anxiety and depression, and psychotherapy benefits. Five video versions (Black/Latinx/White and male/female) followed an identical 3 min script. Half the intervention group participants rewatched their video 14 days later. Stigma and openness were assessed at baseline, post-intervention, and at 14- and 30-day follow-ups. Trial registration: NCT04964570.
All video intervention groups reported immediately decreased stigma (P < 0.0001; Cohen's d = 0.10) and increased openness (P < 0.0001; d = 0.23). The initial increase in openness was largely maintained in the repeated-video group at day 14 (P < 0.0001; d = 0.18), particularly among viewers without history of psychiatric treatment (P < 0.0001; d = 0.32). Increases were not sustained at follow-up. Female participants viewing a female protagonist and Black participants viewing a Black protagonist demonstrated greater openness than other demographic pairings.
Brief video-based interventions improved immediate stigma and openness. Greater effects among female and Black individuals viewing demographically matched protagonists emphasise the value of tailored interventions, especially for socially oppressed groups. This easily disseminated intervention may proactively increase care-seeking, encouraging treatment among workers in need. Future studies should examine intervention mechanisms and whether linking referrals to psychiatric services generates treatment-seeking.
Baseline data on local status of threatened species are often limited, and alternative information sources such as local ecological knowledge (LEK) have potential to provide conservation insights but require critical evaluation. We assess the usefulness of LEK to generate conservation evidence for the Hainan Peacock-pheasant Polyplectron katsumatae, a poorly known threatened island galliform. Interview surveys in rural communities across eight forested landscapes on Hainan provided a new dataset of sightings of Peacock-pheasants and other galliforms. Fewer respondents had seen Peacock-pheasants compared to other species across most landscapes, although Peacock-pheasant sightings showed significant across-landscape variation, with substantially more total and recent sightings from Yinggeling National Nature Reserve. However, validation of interview data with camera trapping data from Houmiling Provincial Nature Reserve, a landscape with few reported sightings, suggests a more optimistic possible status for Peacock-pheasants, which were detected as frequently as Red Junglefowl Gallus gallus and Silver Pheasant Lophura nycthemera during systematic camera trap placement. Hainan Peacock-pheasant sighting rates might be influenced by various factors (e.g. restricted local access to forests), with absolute abundance possibly greater than expected from limited sightings. Conversely, relative across-landscape abundance patterns from LEK are likely to be valid, as similar detection biases exist across surveyed landscapes.
The great demographic pressure brings tremendous volume of beef demand. The key to solve this problem is the growth and development of Chinese cattle. In order to find molecular markers conducive to the growth and development of Chinese cattle, sequencing was used to determine the position of copy number variations (CNVs), bioinformatics analysis was used to predict the function of ZNF146 gene, real-time fluorescent quantitative polymerase chain reaction (qPCR) was used for CNV genotyping and one-way analysis of variance was used for association analysis. The results showed that there exists CNV in Chr 18: 47225201-47229600 (5.0.1 version) of ZNF146 gene through the early sequencing results in the laboratory and predicted ZNF146 gene was expressed in liver, skeletal muscle and breast cells, and was amplified or overexpressed in pancreatic cancer, which promoted the development of tumour through bioinformatics. Therefore, it is predicted that ZNF146 gene affects the proliferation of muscle cells, and then affects the growth and development of cattle. Furthermore, CNV genotyping of ZNF146 gene was three types (deletion type, normal type and duplication type) by Real-time fluorescent quantitative PCR (qPCR). The association analysis results showed that ZNF146-CNV was significantly correlated with rump length of Qinchuan cattle, hucklebone width of Jiaxian red cattle and heart girth of Yunling cattle. From the above results, ZNF146-CNV had a significant effect on growth traits, which provided an important candidate molecular marker for growth and development of Chinese cattle.
We report the experimental results of the commissioning phase in the 10 PW laser beamline of the Shanghai Superintense Ultrafast Laser Facility (SULF). The peak power reaches 2.4 PW on target without the last amplifying during the experiment. The laser energy of 72 ± 9 J is directed to a focal spot of approximately 6 μm diameter (full width at half maximum) in 30 fs pulse duration, yielding a focused peak intensity around 2.0 × 1021 W/cm2. The first laser-proton acceleration experiment is performed using plain copper and plastic targets. High-energy proton beams with maximum cut-off energy up to 62.5 MeV are achieved using copper foils at the optimum target thickness of 4 μm via target normal sheath acceleration. For plastic targets of tens of nanometers thick, the proton cut-off energy is approximately 20 MeV, showing ring-like or filamented density distributions. These experimental results reflect the capabilities of the SULF-10 PW beamline, for example, both ultrahigh intensity and relatively good beam contrast. Further optimization for these key parameters is underway, where peak laser intensities of 1022–1023 W/cm2 are anticipated to support various experiments on extreme field physics.
Background: Despite a higher prevalence of traumatic spinal cord injury (TSCI) amongst Canadian Indigenous peoples, there is a paucity of studies focused on Indigenous TSCI. We present the first Canada-wide study comparing TSCI amongst Canadian Indigenous and non-Indigenous peoples. Methods: This study is a retrospective analysis of prospectively-collected TSCI data from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2004-2019. We divided participants into Indigenous and non-Indigenous cohorts and compared them with respect to demographics, injury mechanism, level, severity, and outcomes. Results: Compared with non-Indigenous patients, Indigenous patients were younger, more female, less likely to have higher education, and less likely to be employed. The mechanism of injury was more likely due to assault or transportation-related trauma in the Indigenous group. The length of stay for Indigenous patients was longer. Indigenous patients were more likely to be discharged to a rural setting, less likely to be discharged home, and more likely to be unemployed following injury. Conclusions: Our results suggest that more resources need to be dedicated for transitioning Indigenous patients sustaining a TSCI to community living and for supporting these patients in their home communities. A focus on resources and infrastructure for Indigenous patients by engagement with Indigenous communities is needed.
Background: Chordomas are rare malignant skull-base/spine cancers with devastating neurological morbidities and mortality. Unfortunately, no reliable prognostic factors exist to guide treatment decisions. This work identifies DNA methylation-based prognostic chordoma subtypes that are detectable non-invasively in plasma. Methods: Sixty-eight tissue samples underwent DNA methylation profiling and plasma methylomes were obtained for available paired samples. Immunohistochemical staining and publicly available methylation and gene expression data were utilized for validation. Results: Unsupervised clustering identified two prognostic tissue clusters (log-rank p=0.0062) predicting disease-specific survival independent of clinical factors (Multivariable Cox: HR=16.5, 95%CI: 2.8-96, p=0.0018). The poorer-performing cluster showed immune-related pathway promoter hypermethylation and higher immune cell abundance within tumours, which was validated with external RNA-seq data and immunohistochemical staining. The better-performing cluster showed higher tumour cellularity. Similar clusters were seen in external DNA methylation data. Plasma methylome-based models distinguished chordomas from differential diagnoses in independent testing sets (AUROC=0.84, 95%CI: 0.52-1.00). Plasma methylomes were highly correlated with tissue-based signals for both clusters (r=0.69 & 0.67) and leave-one-out models identified the correct cluster in all plasma cases. Conclusions: Prognostic molecular chordoma subgroups are for the first time identified, characterized, and validated. Plasma methylomes can detect and subtype chordomas which may transform chordoma treatment with personalized approaches tailored to prognosis.
In this study, an active defence cooperative guidance (ADCG) law that enables cheap and low-speed airborne defence missiles with low manoeuverability to accurately intercept fast and expensive attack missiles with high manoeuverability was designed to enhance the capability of aircraft for active defence. This guidance law relies on the line-of-sight (LOS) guidance method, and it realises active defence by adjusting the geometric LOS relationship involving an attack missile, a defence missile and an aircraft. We use a nonlinear integral sliding surface and an improved second-order sliding mode reaching law to design the guidance law. This can not only reduce the chattering phenomenon in the guidance command, but it can also ensure that the system can reach the sliding surface from any initial position in a finite time. Simulations were carried out to verify the proposed law using four cases: different manoeuvering modes of the aircraft, different speed ratios of the attack and defence missiles, different reaching laws applied to the ADCG law and a robustness analysis. The results show that the proposed guidance law can enable a defence missile to intercept an attack missile by simultaneously using information about the relative motions of the attack missile and the aircraft. It is also highly robust in the presence of errors and noise.
Large-eddy simulations of turbulent flow in partially filled pipes are conducted to investigate the effect of secondary currents on the friction factor, first- and second-order statistics and large-scale turbulent motion. The method is validated first and simulated profiles of the mean streamwise velocity, normal stresses and turbulent kinetic energy (TKE) are shown to be in good agreement with experimental data. The secondary flow is stronger in half- and three-quarters full pipes compared with quarter full or fully filled pipe flows, respectively. The origin of the secondary flow is examined by both the TKE budget and the steamwise vorticity equation, providing evidence that secondary currents originate from the corner between the free surface and the pipe walls, which is where turbulence production is larger than the sum of the remaining terms of the TKE budget. An extra source of streamwise vorticity production is found at the free surface near the centreline bisector, due to the two-component asymmetric turbulence there. The occurrence of dispersive stresses (due to secondary currents) reduces the contribution of the turbulent shear stress to the friction factor, which results in a reduction of the total friction factor of flows in half and three-quarters full pipes in comparison to a fully filled pipe flow. Furthermore, the presence of significant secondary currents inhibits very-large-scale motion (VLSM), which in turn reduces the strength and scales of near-wall streaks. Subsequently, near-wall coherent structures generated by streak instability and transient growth are significantly suppressed. The absence of VLSM and less coherent near-wall turbulence structures is supposedly responsible for the drag reduction in partially filled pipe flows relative to a fully filled pipe flow at an equivalent Reynolds number.
Experiments are conducted in a wave tank to investigate wave scattering by a three-dimensional submerged horizontal rectangular plate in a channel. The free-surface elevation around the plate is presented for various water depths and depths of submergence of the plate. The wave forces and moments are obtained using an underwater load measuring system. The numerical simulations are performed with a parallelized three-dimensional boundary element method. The numerical set-up follows closely the set-up of the laboratory experiments. The numerical results are compared with the experimental results for non-breaking waves. In most cases a good agreement is found for the free-surface elevation, the vertical force and the moment. A physical interpretation of the flow around the plate is provided. The pressure distribution on the lower surface of the plate differs from the linear distribution from the leading edge to the trailing edge that is obtained in the equivalent two-dimensional problem. The reflection by the lateral walls is investigated.
Weapon target allocation (WTA) is an effective method to solve the battlefield fire optimisation problem, which plays an important role in intelligent automated decision-making. We researched the multitarget allocation problem to maximise the attack effectiveness when multiple interceptors cooperatively attack multiple ground targets. Firstly, an effective and reasonable fitness function is established, based on the situation between the interceptors and targets, by comprehensively considering the relative range, relative angle, speed, capture probability and radiation source matching performance and thoroughly evaluating them based on the advantage of the attack effectiveness. Secondly, the optimisation performance of the particle swarm optimisation (PSO) algorithm is adaptively improved. We propose an adaptive simulated annealing-particle swarm optimisation (SA-PSO) algorithm by introducing the simulated annealing algorithm into the adaptive PSO algorithm. The proposed algorithm can enhance the convergence speed and overcome the disadvantage of the PSO algorithm easily falling into a local extreme point. Finally, a simulation example is performed in a scenario where ten interceptors cooperate to attack eight ground targets; comparative experiments are conducted between the adaptive SA-PSO algorithm and PSO algorithm. The simulation results indicate that the proposed adaptive SA-PSO algorithm demonstrates great performance in convergence speed and global optimisation capabilities, and a maximised attack effectiveness can be guaranteed.
The epidemic of tuberculosis has posed a serious burden in Qinghai province, it is necessary to clarify the epidemiological characteristics and spatial-temporal distribution of TB for future prevention and control measures. We used descriptive epidemiological methods and spatial statistical analysis including spatial correlation and spatial-temporal analysis in this study. Furthermore, we applied an exponential smoothing model for TB epidemiological trend forecasting. Of 43 859 TB cases, the sex ratio was 1.27:1 (M:F), and the average annual TB registered incidence was 70.00/100 000 of 2009–2019. More cases were reported in March and April, and the worst TB stricken regions were the prefectures of Golog and Yushu. High TB registered incidences were seen in males, farmers and herdsmen, Tibetans, or elderly people. 7132 cases were intractable, which were recurrent, drug resistant, or co-infected with other infections. Three likely cases clusters with significant high risk were found by spatial-temporal scan on data of 2009–2019. The exponential smoothing winters' additive model was selected as the best-fitting model to forecast monthly TB cases in the future. This research indicated that TB in Qinghai is still a serious threaten to the local residents' health. Multi-departmental collaboration and funds special for TB treatments and control are still needed, and the exponential smoothing model is promising which could be applied for forecasting of TB epidemic trend in this high-altitude province.
Background: We describe an infant with a diagnosis of GM3 synthase deficiency, presenting with severe neuroirritability from birth. He required multiple admissions due to extreme agitation and caregiver burnout. Multiple pharmacological agents were tried, and the effect of each medication was modest and short-lasting at best. The literature on the management of neuroirritability in children with progressive genetic and metabolic conditions is sparse, and a neuroirritability management protocol has yet to be developed at our institution. Methods: We searched for relevant primary research and articles on PubMed. We reviewed the evidence of each pharmacological agent and added non-pharmacological strategies. We developed management guidelines for neuroirritability at our hospital. This protocol was reviewed by several pediatric neurologists and pediatric palliative care specialists at the Stollery and SickKids Hospitals. Results: We present the Pediatric Neuroirritability Management Protocol for the Stollery Children’s Hospital. Conclusions: Further study is required to assess whether this protocol can be adapted to treat irritability in the context of other neurological conditions such as hypoxic-ischemic encephalopathy and non-accidental injury. In addition, we will expand our guidelines to include other symptoms such as spasticity, dystonia, and autonomic dysfunction.
Background: Epilepsy, a common neurologic condition, instigates a large number of emergency room (ER) visits annually. This project aims to retrospectively review the patterns and characteristics of Alberta ER visits by pediatric epilepsy patients. Methods: Methods: Alberta Health administrative databases, including the Inpatient Discharge Abstract Database, the National Ambulatory Care Reporting System, Diagnostic Imaging and Medical Laboratory, were used to identify ER utilization patterns among children with epilepsy in Alberta, Canada between 2012–2018. Results: Results: Of 5,419 pediatric epilepsy ER patients between 2012–2018 in Alberta, 59% were developmentally delayed children. Children in this particular group, when compared to developmentally normal children with epilepsy, had the following characteristics: they were significantly more likely to utilize ERs in children’s hospitals versus other hospitals; they presented at a significantly younger age; they had a significantly longer length of stay; they had higher triage scores; they were subjected to significantly more investigations; and they had significantly more hospital admissions for epilepsy. Conclusions: Discussion: This novel Alberta-wide study of resource utilization of pediatric epilepsy patients shows that developmentally delayed children with epilepsy use significantly higher resources compared to developmentally normal children with epilepsy. Whether this is justified or not requires further study.