Subject(s)
Lymph Nodes , Humans , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Lymph Node Excision , Pharynx , Male , Lymphatic MetastasisABSTRACT
Irreversible adsorption, or heel buildup, negatively impacts activated carbon performance and shortens its lifetime. This study elucidates the interconnections between flow rate and the oxygen impurity of desorption purge gas with heel buildup on beaded activated carbon (BAC). Nine thermal desorption scenarios were explored, varying nitrogen purge gas oxygen impurity levels (<5 ppmv, 10,000 ppmv, 210,000 ppm (21 %)) and flow rates (0.1, 1, 10 SLPM or 1 %, 10 %, 100 % of adsorption flow rate) during thermal desorption. Results reveal that increasing purge gas flow rate improves adsorption capacity recovery and mitigates adverse effects of purge gas oxygen impurity. Cumulative heel increased with higher purge gas oxygen impurity and lower flow rates. In the least effective regeneration scenario (0.1 SLPM N2, 21 % O2), a 32.8 wt% cumulative heel formed on BAC after five cycles, while the best-case scenario (10 SLPM N2, <5 ppmv O2) resulted in only 0.3 wt%. Comparing the pore size distributions of virgin and used BAC shows that heel initially forms in narrow micropores (<8.5Å) and later engages mesopores. Thermogravimetric analysis (TGA) showed that oxygen impurity creates high boiling point and/or strongly bound heel species. TGA confirmed that higher purge gas flow rates reduce heel amounts but encourage chemisorbed heel formation in oxygen's presence. These findings can guide optimization of regeneration conditions, enhancing activated carbon's long-term performance in cyclic adsorption processes.
ABSTRACT
Treatment of squamous cell carcinoma of the tonsil involves primary radiation therapy (RT) or surgical resection. Historically, if RT was the primary or adjuvant treatment modality, most of the bilateral retropharyngeal lymph nodes (RPLNs) were treated electively with a therapeutic dose for subclinical disease, regardless of whether radiographically pathologic lymph nodes were seen on initial diagnostic imaging. De-escalation strategies include the incorporation of transoral surgery with the goal to either eliminate or reduce the dose of adjuvant RT or chemotherapy. Transoral surgery does not include elective removal of the RPLNs, and no guideline or outcome paper recommends adjuvant RT specifically to electively treat RPLNs. In this Topic Discussion, we discuss pertinent literature and suggest management decisions. The management decisions discussed in this Topic Discussion pertain to only tonsillar primaries and not those of the soft palate or base of the tongue.
ABSTRACT
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) produces an electrophysiological signature called evoked resonant neural activity (ERNA); a high-frequency oscillation that has been linked to treatment efficacy. However, the single-neuron and synaptic bases of ERNA are unsubstantiated. This study proposes that ERNA is a subcortical neuronal circuit signature of DBS-mediated engagement of the basal ganglia indirect pathway network. In people with Parkinson's disease, we: (i) showed that each peak of the ERNA waveform is associated with temporally-locked neuronal inhibition in the STN; (ii) characterized the temporal dynamics of ERNA; (iii) identified a putative mesocircuit architecture, embedded with empirically-derived synaptic dynamics, that is necessary for the emergence of ERNA in silico; (iv) localized ERNA to the dorsal STN in electrophysiological and normative anatomical space; (v) used patient-wise hotspot locations to assess spatial relevance of ERNA with respect to DBS outcome; and (vi) characterized the local fiber activation profile associated with the derived group-level ERNA hotspot.
Subject(s)
Deep Brain Stimulation , Parkinson Disease , Subthalamic Nucleus , Humans , Parkinson Disease/therapy , Deep Brain Stimulation/methods , Subthalamic Nucleus/physiology , Basal Ganglia/physiology , Neurons/physiologyABSTRACT
PURPOSE: Stereotactic radiosurgery (SRS) is a method of delivering conformal radiation, which allows minimal radiation damage to surrounding healthy tissues. Adjuvant radiation therapy has been shown to improve local control in a variety of intracranial neoplasms, such as brain metastases, gliomas, and benign tumors (i.e., meningioma, vestibular schwannoma, etc.). For brain metastases, adjuvant SRS specifically has demonstrated positive oncologic outcomes as well as preserving cognitive function when compared to conventional whole brain radiation therapy. However, as compared with neoadjuvant SRS, larger post-operative volumes and greater target volume uncertainty may come with an increased risk of local failure and treatment-related complications, such as radiation necrosis. In addition to its role in brain metastases, neoadjuvant SRS for high grade gliomas may enable dose escalation and increase immunogenic effects and serve a purpose in benign tumors for which one cannot achieve a gross total resection (GTR). Finally, although neoadjuvant SRS has historically been delivered with photon therapy, there are high LET radiation modalities such as carbon-ion therapy which may allow radiation damage to tissue and should be further studied if done in the neoadjuvant setting. In this review we discuss the evolving role of neoadjuvant radiosurgery in the treatment for brain metastases, gliomas, and benign etiologies. We also offer perspective on the evolving role of high LET radiation such as carbon-ion therapy. METHODS: PubMed was systemically reviewed using the search terms "neoadjuvant radiosurgery", "brain metastasis", and "glioma". ' Clinicaltrials.gov ' was also reviewed to include ongoing phase III trials. RESULTS: This comprehensive review describes the evolving role for neoadjuvant SRS in the treatment for brain metastases, gliomas, and benign etiologies. We also discuss the potential role for high LET radiation in this setting such as carbon-ion radiotherapy. CONCLUSION: Early clinical data is very promising for neoadjuvant SRS in the setting of brain metastases. There are three ongoing phase III trials that will be more definitive in evaluating the potential benefits. While there is less data available for neoadjuvant SRS for gliomas, there remains a potential role, particularly to enable dose escalation and increase immunogenic effects.
Subject(s)
Brain Neoplasms , Glioma , Radiosurgery , Humans , Neoadjuvant Therapy , Radiosurgery/adverse effects , Radiosurgery/methods , Brain Neoplasms/radiotherapy , Brain Neoplasms/secondary , Glioma/surgery , Carbon , Retrospective StudiesABSTRACT
There is a requirement for an objective method to determine a safe level of low-level military occupational blast, having recognised it can lead to neurological damage. The purpose of the current study was to evaluate the effect of artillery firing training on the neurochemistry of frontline soldiers using two-dimensional (2D) COrrelated SpectroscopY (2D COSY) in a 3-T clinical MR scanner. Ten men considered to be of sound health were evaluated before and after a week-long live firing exercise in two ways. Prior to the live fire exercise, all participants were screened by a clinical psychologist using a combination of clinical interviews and psychometric tests, and were then scanned with 3-T MRI. The protocols included T1- and T2-weighted images for diagnostic reporting and anatomical localisation and 2D COSY to record any neurochemical effects from the firing. No changes to the structural MRI were recorded. Nine substantive and statistically significant changes in the neurochemistry were recorded as a consequence of firing training. Glutamine and glutamate, glutathione, and two of the seven fucose-α (1-2)-glycans were significantly increased. N-acetyl aspartate, myo-inositol + creatine, and glycerol were also increased. Significant decreases were recorded for the glutathione cysteine moiety and tentatively assigned glycan with a 1-6 linkage (F2: 4.00, F1: 1.31 ppm). These molecules are part of three neurochemical pathways at the terminus of the neurons providing evidence of early markers of disruption to neurotransmission. Using this technology, the extent of deregulation can now be monitored for each frontline defender on a personalised basis. The capacity to monitor early a disruption in neurotransmitters, using the 2D COSY protocol, can observe the effect of firing and may be used to prevent or limit these events.
ABSTRACT
Data assimilation techniques for state and parameter estimation are frequently applied in the context of computational neuroscience. In this work, we show how an adaptive variant of the unscented Kalman filter (UKF) performs on the tracking of a conductance-based neuron model. Unlike standard recursive filter implementations, the robust adaptive unscented Kalman filter (RAUKF) jointly estimates the states and parameters of the neuronal model while adjusting noise covariance matrices online based on innovation and residual information. We benchmark the adaptive filter's performance against existing nonlinear Kalman filters and explore the sensitivity of the filter parameters to the system being modelled. To evaluate the robustness of the proposed solution, we simulate practical settings that challenge tracking performance, such as a model mismatch and measurement faults. Compared to standard variants of the Kalman filter the adaptive variant implemented here is more accurate and robust to faults.
Subject(s)
Algorithms , Models, NeurologicalABSTRACT
Conductance-based models have played an important role in the development of modern neuroscience. These mathematical models are powerful "tools" that enable theoretical explorations in experimentally untenable situations, and can lead to the development of novel hypotheses and predictions. With advances in cell imaging and computational power, multi-compartment models with morphological accuracy are becoming common practice. However, as more biological details are added, they make extensive explorations and analyses more challenging largely due to their huge computational expense. Here, we focus on oriens-lacunosum/moleculare (OLM) cell models. OLM cells can contribute to functionally relevant theta rhythms in the hippocampus by virtue of their ability to express spiking resonance at theta frequencies, but what characteristics underlie this is far from clear. We converted a previously developed detailed multi-compartment OLM cell model into a reduced single compartment model that retained biophysical fidelity with its underlying ion currents. We showed that the reduced OLM cell model can capture complex output that includes spiking resonance in in vivo-like scenarios as previously obtained with the multi-compartment model. Using the reduced model, we were able to greatly expand our in vivo-like scenarios. Applying spike-triggered average analyses, we were able to to determine that it is a combination of hyperpolarization-activated cation and muscarinic type potassium currents that specifically allow OLM cells to exhibit spiking resonance at theta frequencies. Further, we developed a robust Kalman Filtering (KF) method to estimate parameters of the reduced model in real-time. We showed that it may be possible to directly estimate conductance parameters from experiments since this KF method can reliably extract parameter values from model voltage recordings. Overall, our work showcases how the contribution of cellular biophysical current details could be determined and assessed for spiking resonance. As well, our work shows that it may be possible to directly extract these parameters from current clamp voltage recordings.
Subject(s)
Hippocampus , Interneurons , Interneurons/physiology , Hippocampus/physiology , Biophysics , Models, Theoretical , Theta Rhythm/physiologyABSTRACT
The risk for future suicidal behaviours is elevated following suicide attempts, particularly for those with complex needs or those who are disconnected from healthcare systems. The PAUSE program was designed to address this gap using peer workers to provide continuity and coordination of care following suicide-related emergency presentations. This study aimed to evaluate the pilot program's effect on suicidal ideation and hope, and to explore the acceptability and participants' experiences. A mixed-methods design was employed with pre- and post-evaluation questionnaires, including the GHQ-28-SS (general health questionnaire suicide scale), AHS (adult hope scale), and K10 (Kessler psychological distress scale). Participant engagement rates and semi-structured interviews were used to explore program acceptability. In total, 142 people were engaged with the PAUSE pilot between 24 August 2017 and 11 January 2020. There were no significant gender differences in engagement. The suicidal ideation scores decreased, and the hope scores increased after participation in PAUSE. A thematic analysis revealed that participants identified that the key program mechanisms were holistic and responsive support, ongoing social connectedness, and having peer workers who understood their experiences and treated them like people rather than clients. The small number of participants and lack of a control group limited the result generalizability. The findings suggest that PAUSE was an effective and acceptable model for supporting people following suicide-related hospitalisations in this pilot sample.
Subject(s)
Suicide Prevention , Suicide, Attempted , Adult , Humans , Pilot Projects , Suicidal Ideation , Emergency Service, HospitalABSTRACT
BACKGROUND: Following the 2010-2011 floods and cyclones that affected 78% of Queensland, Australia, a State-wide mental health response was established. The response plan included a 24-hour access line. This study examines the effectiveness of the mental health screening program conducted via the State-wide health call center (13HEALTH) in 2012. METHODS: Callers to the 13HEALTH line were screened to assess the impact of the disaster. The 13HEALTH clinicians administered the Primary Care-Posttraumatic Stress Disorder Scale (PC-PTSD) screening measure. Those scoring more than two on the PC-PTSD Scale were provided information on the emotional impact of disasters and a referral to the post-disaster specialist mental health program (SMHP). For calls related to those under 18, a single-item question assessed behavioral or emotional changes since the natural disasters. Those with identified changes were offered a referral to a post-disaster SMHP.The study evaluates the relationship between disaster exposure and the likelihood of 13HEALTH callers experiencing physical health concerns and unacknowledged mental health symptoms. The program's cost for the 12 months of 2012 was assessed using data from the financial contract. RESULTS: In 2012, there were 205,064 calls to 13HEALTH: 19,708 identified as residing in a flood or cyclone-affected area, 7,315 adults indicated they were personally affected, and 907 scored more than two on the PC-PTSD Scale. Only 700 agreed to a referral to the SMHP. There were 290 children under 18 assessed as at risk; 207 accepted a referral to a SMHP.Regions that experienced a greater impact from the floods and cyclones were 1.3-2.3 times more likely to report being personally affected by the floods and cyclones. Similarly, these regions had more callers scoring more than two on the PC-PTSD Scale. The total cost of the 13HEALTH program for 2012 was $53,284 (AU) across all age groups. CONCLUSION: The 13HEALTH general health post-disaster screening program demonstrates opportunistic screening may assist identification of those with unmet mental health needs. The data indicate an increased likelihood of personal exposure in the more affected regions with an increased risk of unrecognized psychological symptoms as assessed by the PC-PTSD Scale. However, more than 20% declined referral to a SMHP.
Subject(s)
Cyclonic Storms , Disasters , Stress Disorders, Post-Traumatic , Adult , Child , Humans , Floods , Queensland/epidemiology , Mental Health , Australia , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychologyABSTRACT
Purpose: To demonstrate the clinical applications and feasibility of online adaptive magnetic resonance image guided radiotherapy (MRgRT) in the pediatric, adolescent and young adult (AYA) population. Methods: This is a retrospective case series of patients enrolled onto a prospective study. All pediatric (age < 18) and AYA patients (age< 30), treated on the Elekta Unity MR linear accelerator (MRL) from 2019 to 2021 were enrolled onto a prospective registry. Rationale for MRgRT included improved visualization of and alignment to the primary tumor, re-irradiation in a critical area, ability to use smaller margins, and need for daily adaptive replanning to minimize dose to adjacent critical structures. Step-and-shoot intensity-modulated radiation treatment (IMRT) plans were generated for all Unity patients with a dose grid of 3 mm and a statistical uncertainty of < 1% per plan. Results: A total of 15 pediatric and AYA patients have been treated with median age of 13 years (range: 6 mos - 27 yrs). Seven patients were <10 yo. The clinical applications of MRgRT included Wilms tumor with unresectable IVC thrombus (n=1), Ewing sarcoma (primary and metastatic, n=3), recurrent diffuse intrinsic pontine glioma (DIPG, n=2), nasopharyngeal carcinoma (n=1), clival chordoma (n=1), primitive neuroectodermal tumor of the pancreas (n=1), recurrent gluteo-sacral germ cell tumor (n=1), C-spine ependymoma (n=1), and posterior fossa ependymoma (n=1). Two children required general anesthesia. One AYA patient could not complete the MRgRT course due to tumor-related pain exacerbated by longer treatment times. Two AYA patients experienced anxiety related to treatment on the MRL, one of which required daily Ativan. No patient experienced treatment interruptions or unexpected toxicity. Conclusion: MRgRT was well-tolerated by pediatric and AYA patients. There was no increased use of anesthesia outside of our usual practice. Dosimetric advantages were seen for patients with tumors in critical locations such as adjacent to or involving optic structures, stomach, kidney, bowel, and heart.
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INTRODUCTION: Following natural disasters, rural general practitioners (GPs) are expected to undertake several roles, including identifying those experiencing psychological distress and providing evidence-informed mental health care. This paper reports on a collaborative mental health program developed to support a rural GP practice (population <1,500) and a disaster response service. METHODS: The program provided specialized disaster mental health care via the placement of a clinician in the GP facility. In collaboration with the GP practice, the program offered opportunistic screening using the Primary Care Posttraumatic Stress Disorder (PTSD) Scale (PC-PTSD) for probable PTSD as the primary measure and the Kessler 6 (K6) as a secondary measure. Those scoring higher than two on the PC-PTSD scale were referred to the mental health clinician (MHC) for further assessment and treatment. RESULTS: Sixty screening assessments were completed. Fourteen patients (male = 3; female = 11) scored higher than two on the PC-PTSD. The referred group PC-PTSD mean score was 3.14 and K6 mean score of 19. Those not referred had a PC-PTSD mean score = 0.72 and K6 mean score = 7.30. The treatment and non-treatment groups differed significantly (PC-PTSD: P <.00001 and K6: P <.00001). A prior history of trauma exposure was notable in the intervention group. Eight reported a history of domestic violence, seven histories of sexual abuse, five childhood sexual abuse, and eight intimate partner violence (IPV). CONCLUSION: A post-disaster integrated GP and mental health program in a rural community can assist in identifying individuals experiencing post-disaster psychological distress using opportunistic psychological screening. The findings indicate that collaborative mental health programs may effectively support rural communities post-disaster.
Subject(s)
Disasters , Domestic Violence , Stress Disorders, Post-Traumatic , Child , Female , Humans , Male , Mental Health , Primary Health Care , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapyABSTRACT
Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries' COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries' income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.
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INTRODUCTION: Glioblastomas (GBMs) are highly aggressive tumors. A common clinical challenge after standard of care treatment is differentiating tumor progression from treatment-related changes, also known as pseudoprogression (PsP). Usually, PsP resolves or stabilizes without further treatment or a course of steroids, whereas true progression (TP) requires more aggressive management. Differentiating PsP from TP will affect the patient's outcome. This study investigated using deep learning to distinguish PsP MRI features from progressive disease. METHOD: We included GBM patients with a new or increasingly enhancing lesion within the original radiation field. We labeled those who subsequently were stable or improved on imaging and clinically as PsP and those with clinical and imaging deterioration as TP. A subset of subjects underwent a second resection. We labeled these subjects as PsP, or TP based on the histological diagnosis. We coregistered contrast-enhanced T1 MRIs with T2-weighted images for each patient and used them as input to a 3-D Densenet121 model and using five-fold cross-validation to predict TP vs PsP. RESULT: We included 124 patients who met the criteria, and of those, 63 were PsP and 61 were TP. We trained a deep learning model that achieved 76.4% (range 70-84%, SD 5.122) mean accuracy over the 5 folds, 0.7560 (range 0.6553-0.8535, SD 0.069) mean AUROCC, 88.72% (SD 6.86) mean sensitivity, and 62.05% (SD 9.11) mean specificity. CONCLUSION: We report the development of a deep learning model that distinguishes PsP from TP in GBM patients treated per the Stupp protocol. Further refinement and external validation are required prior to widespread adoption in clinical practice.
Subject(s)
Brain Neoplasms , Deep Learning , Glioblastoma , Disease Progression , Humans , Magnetic Resonance Imaging , Retrospective StudiesABSTRACT
Determining the long-term performance of adsorbents is crucial for the design of air treatment systems. Heel buildup i.e., the accumulation of non-desorbed/ non-desorbable adsorbates and their reaction byproducts, on the surface/pores of the adsorbent is a primary cause of adsorption performance deterioration. However, due to the complexity of heel buildup mechanisms, theoretical models have yet to be developed to map the extent of heel buildup to the adsorption/desorption parameters. In this work, two machine learning (ML) algorithms (XGBoost and neural network (NN)) were applied to predict volatile organic compounds (VOCs) cyclic heel buildup on activated carbons (ACs) by considering the adsorbent characteristics, adsorbate properties and regeneration conditions. The NN algorithm showed better performance in prediction of cyclic heel buildup (R2 = 0.94) than XGBoost (R2 = 0.81). To analyze interaction between heel buildup and adsorbent characteristics, adsorbate properties, and regeneration conditions, partial dependency plots were generated. The proposed ML-based heel prediction methods can be ultimately used to: (i) optimize adsorption/desorption operating conditions to minimize heel buildup on activated carbon in cyclic adsorption/desorption processes and (ii) quickly screen various adsorbents for efficient adsorption/desorption of a particular family of VOCs by excluding adsorbents prone to high heel formation.
Subject(s)
Charcoal , Volatile Organic Compounds , Adsorption , Machine LearningABSTRACT
Adsorbents with high surface area, thermal stability and microwave absorption ability are highly desired for cyclic adsorption and microwave regeneration processes. However, most polymeric adsorbents are transparent to microwaves. Herein, porous hyper-crosslinked polymers (HCP) of (4,4'-bis((chloromethyl)-1,1'-biphenyl-benzyl chloride)) with different carbon black (CB) contents were synthesized via the Friedel-Crafts reaction. CB was selected as the filler due to its low cost and high dielectric loss and was embedded inside the polymer structure during polymerization. CB-containing composites showed enhanced thermal stability at elevated temperatures, and more than a 90-times increase in the dielectric loss factor, which is favorable for microwave regeneration. Nitrogen physisorption analysis by the Bruner-Emmett-Teller isotherms demonstrated that CB presence in the polymer structure nonlinearly decreases the surface area and total pore volume (by 38% and 26%, respectively at the highest CB load). Based on the characterization testing, 4 wt% of CB was found to be an optimum filler content, having the highest MW absorption and minimal effect on the adsorbent porosity. HCP with 4 wt% CB allowed a substantial increase in the desorption temperature and yielded more than a 450% enhancement in the desorption efficiency compared to HCP without CB.
Subject(s)
Microwaves , Volatile Organic Compounds , Adsorption , Carbon , Polymers , Porosity , SootABSTRACT
Choosing proper formulas for estimating different variables is imperative when modeling a fluidized bed using two-phase theory. In this study, a two-phase model was used to model the adsorption of volatile organic compounds (VOC) in a multistage fluidized bed adsorber. Two different approaches were used to describe gas flow and mixing in the emulsion phase, perfectly mixed (EGPM: Emulsion Gas - Perfectly Mixed) and plug flow (EGPF: Emulsion Gas - Plug flow). The impact of different formulas for estimating bubble size, bed porosity at minimum fluidization velocity, adsorption and interphase mass transfer coefficients, as well as tortuosity on the performance of the model was determined by comparing the model outcomes with experimental data. Finally, using a large dataset obtained from fluidized bed adsorption systems with different adsorbents, adsorbates, bed sizes, and operating conditions, a broadly-applicable set of formulas was suggested which could be used to describe the behavior of different countercurrent fluidized bed adsorbers. From the results, the two-phase model could successfully predict the experimental data, with EGPF showing better performance than EGPM. Proper use of formulas, especially those describing bed voidage and interphase mass transfer coefficient, could markedly improve the performance of the two-phase model. The two-phase model using the set of formulas proposed here was able to accurately replicate a large dataset of fluidized bed adsorption experiments over a wide range of operating conditions.
ABSTRACT
Aims: We aimed to determine whether there has been a change in the number of suicides occurring in three Australian states overall, and in age and sex subgroups, since the COVID-19 pandemic began, and to see if certain risk factors for suicide have become more prominent as likely underlying contributing factors for suicide. Method: Using real-time data from three state-based suicide registers, we ran multiple unadjusted and adjusted interrupted time series analyses to see if trends in monthly suicide counts changed after the pandemic began and whether there had been an increase in suicides where relationship breakdown, financial stressors, unemployment and homelessness were recorded. Results: Compared with the period before COVID-19, during the COVID-19 period there was no change in the number of suicides overall, or in any stratum-specific estimates except one. The exception was an increase in the number of young males who died by suicide in the COVID-19 period (adjusted RR 1.89 [95% CI 1.11-3.23]). The unadjusted analysis showed significant differences in suicide in the context of unemployment and relationship breakdown during the COVID-19 compared to the pre-COVID-19 period. Analysis showed an increase in the number of suicides occurring in the context of unemployment in the COVID-19 period (unadjusted RR 1.53 [95% CI 1.18-1.96]). In contrast, there was a decrease in the number of suicides occurring in the context of relationship breakdown in the COVID-19 period (unadjusted RR 0.82 [95% CI 0.67-0.99]). However, no significant changes were identified when the models were adjusted for possible over-dispersion, seasonality and non-linear trend. Conclusion: Although our analysis found no evidence of an overall increase in suicides after the pandemic began, the picture is complex. The identified increase in suicide in young men indicates that the impact of the pandemic is likely unevenly distributed across populations. The increase in suicides in the context of unemployment reinforces the vital need for mitigation measures during COVID-19, and for ongoing monitoring of suicide as the pandemic continues.
ABSTRACT
To characterise the demographic and clinical characteristics of women who died by suicide in the perinatal period to inform and improve suicide prevention strategies. Retrospective analysis of maternal suicides during and within 1 year after the end of pregnancy in Queensland between January 2004 and December 2017. Outcomes measured included timing of death in relation to pregnancy, sociodemographic and clinical characteristics and health service use prior to death. There were 65 deaths by suicide in the study period; six occurred during pregnancy, 30 occurred after a live birth, 22 occurred after a termination of pregnancy and seven followed a miscarriage or stillbirth. Most suicides were late maternal deaths. Women were younger, and more likely to identify as Aboriginal or Torres Strait Islander, when compared to all women giving birth for the same time period. Most women had a prior mental health diagnosis, most commonly depression. Over half of women had recent relationship separation or conflict prior to death. Perinatal women had higher rates of death by violent means than all women in Queensland who died by suicide during the same time period. The demographic, psychosocial and clinical characteristics of a group of women who died by suicide have been described, and this shows a high proportion of women with a prior mental health diagnosis. To reduce maternal mortality, psychosocial screening must be implemented broadly and continued until the end of the first year postpartum. Similar screening attention is needed for women who had a termination of pregnancy, miscarriage or stillbirth.
Subject(s)
Maternal Death , Suicide , Australia/epidemiology , Female , Humans , Maternal Mortality , Pregnancy , Queensland/epidemiology , Retrospective StudiesABSTRACT
BACKGROUND: Sphenoid wing meningiomas are a challenging surgical disease with relatively high perioperative morbidity. Most studies to date have focused on resection strategies as it relates to disease recurrence. Few have examined the optimal strategy as it relates to overall patient survival. We retrospectively reviewed our case series and evaluated extent of resection and perioperative stroke as it relates to all cause and disease-specific survival. PATIENTS/METHODS: Ninety-four patients were included in the study. Demographics, clinical features, operative features and clinical course, and time to mortality evaluation were collected. Extent of resection (EOR) was defined as gross total (GTR, 100%), near total (NTR, ≥ 95%), and subtotal (STR,<95%). RESULTS: The overall mean EOR was 94.5% with 70.2% of cases achieving GTR, 12.8% achieved NTR, and 17% achieved STR. Postoperative stroke only occurred with GTR or NTR (p=0.041). Age alone was significant on Cox regression analysis for all cause mortality (p=0.042, HR 1.054 [95% CI 1.002 - 1.109]). Postoperative stroke was associated with worse disease-specific mortality (p=0.046, HR 23.337 [95% CI 1.052 - 517.782) with no impact from extent of resection (p=0.258). CONCLUSIONS: Although maximizing resection and minimizing recurrence is ideal, GTR or NTR confer a significantly higher stroke risk. Most patients do not die from their meningioma, as all cause mortality was associated only with age. However, perioperative stroke conferred decreased survival throughout follow up. This series demonstrates that an overly aggressive surgical philosophy negatively impacted disease specific survival.