ABSTRACT
OBJECTIVE: Anterior capsulotomy (AC) is a therapeutic option for patients with severe, treatment-resistant obsessive-compulsive disorder (OCD). The procedure can be performed via multiple techniques, with stereotactic radiosurgery (SRS) gaining popularity because of its minimally invasive nature. The risk-benefit profile of AC performed specifically with SRS has not been well characterized. Therefore, the primary objective of this study was to characterize outcomes following stereotactic radiosurgical AC in OCD patients. METHODS: Studies assessing mean Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores before and after stereotactic radiosurgical AC for OCD were included in this analysis. Inverse-variance fixed-effect modeling was used for pooling, and random-effects estimate of the ratio of means and standard mean differences were calculated at 6 months, 12 months, and the last follow-up for Y-BOCS scores, as well as the last follow-up for the Beck Depression Inventory (BDI)/BDI-II scores. A generalized linear mixed model was used to generate fixed- and random-effects models for categorical outcomes. Univariate random-effects meta-regression was used to evaluate associations between postoperative Y-BOCS scores and study covariates. Adverse events were summed across studies. Publication bias was assessed with Begg's test. RESULTS: Eleven studies with 180 patients were eligible for inclusion. The mean Y-BOCS score decreased from 33.28 to 17.45 at the last-follow up (p < 0.001). Sixty percent of patients were classified as responders and 10% as partial responders, 18% experienced remission, and 4% had worsened Y-BOCS scores. The degree of improvement in the Y-BOCS score correlated with time since surgery (p = 0.046). In the random-effects model, the mean BDI at the last follow-up was not significantly different from that preoperatively. However, in an analysis performed with available paired pre- and postoperative BDI/BDI-II scores, there was significant improvement in the BDI/BDI-II scores postoperatively. Adverse events numbered 235, with headaches, weight change, mood changes, worsened depression/anxiety, and apathy occurring most commonly. CONCLUSIONS: Stereotactic radiosurgical AC is an effective technique for treating OCD. Its efficacy is similar to that of AC performed via other lesioning techniques.
ABSTRACT
COVID-19 has radically transformed urban travel behavior throughout the world. Agencies have had to provide adequate service while navigating a rapidly changing environment with reduced revenue. As COVID-19-related restrictions are lifted, transit agencies are concerned about their ability to adapt to changes in ridership behavior and public transit usage. To aid their becoming more adaptive to sudden or persistent shifts in ridership, we addressed three questions: To what degree has COVID-19 affected fixed-line public transit ridership and what is the relationship between reduced demand and -vehicle trips? How has COVID-19 changed ridership patterns and are they expected to persist after restrictions are lifted? Are there disparities in ridership changes across socioeconomic groups and mobility-impaired riders? Focusing on Nashville and Chattanooga, TN, ridership demand and vehicle trips were compared with anonymized mobile location data to study the relationship between mobility patterns and transit usage. Correlation analysis and multiple linear regression were used to investigate the relationship between socioeconomic indicators and changes in transit ridership, and an analysis of changes in paratransit demand before and during COVID-19. Ridership initially dropped by 66% and 65% over the first month of the pandemic for Nashville and Chattanooga, respectively. Cellular mobility patterns in Chattanooga indicated that foot traffic recovered to a greater degree than transit ridership between mid-April and the last week in June, 2020. Education-level had a statistically significant impact on changes in fixed-line bus transit, and the distribution of changes in demand for paratransit services were similar to those of fixed-line bus transit.
