Evaluating the Current State of Epilepsy Care in the Province of Ontario.

There are numerous challenges pertaining to epilepsy care across Ontario, including Epilepsy Monitoring Unit (EMU) bed pressures, surgical access and community supports. We sampled the current clinical, community and operational state of Ontario epilepsy centres and community epilepsy agencies post COVID-19 pandemic. A 44-item survey was distributed to all 11 district and regional adult and paediatric Ontario epilepsy centres. Qualitative responses were collected from community epilepsy agencies. Results revealed ongoing gaps in epilepsy care across Ontario, with EMU bed pressures and labour shortages being limiting factors. A clinical network advising the Ontario Ministry of Health will improve access to epilepsy care.

Correction: Mucci et al. WORKbiota: A Systematic Review about the Effects of Occupational Exposure on Microbiota and Workers' Health. Int. J. Environ. Res. Public Health 2022, 19, 1043.

Eleonora Tommasi was not included as an author in the original publication [...].

WORKbiota: A Systematic Review about the Effects of Occupational Exposure on Microbiota and Workers' Health.

The characterization of human microbiota and the impact of its modifications on the health of individuals represent a current topic of great interest for the world scientific community. Scientific evidence is emerging regarding the role that microbiota has in the onset of important chronic illnesses. Since individuals spend most of their life at work, occupational exposures may have an impact on the organism's microbiota. The purpose of this review is to explore the influence that different occupational exposures have on human microbiota in order to set a new basis for workers' health protection and disease prevention. The literature search was performed in PubMed, Cochrane, and Scopus. A total of 5818 references emerged from the online search, and 31 articles were included in the systematic review (26 original articles and 5 reviews). Exposure to biological agents (in particular direct contact with animals) was the most occupational risk factor studied, and it was found involved in modifications of the microbiota of workers. Changes in microbiota were also found in workers exposed to chemical agents or subjected to work-related stress and altered dietary habits caused by specific microclimate characteristics or long trips. Two studies evaluated the role of microbiota changes on the development of occupational lung diseases. Occupational factors can interface with the biological rhythms of the bacteria of the microbiota and can contribute to its modifications and to the possible development of diseases. Future studies are needed to better understand the role of the microbiota and its connection with occupational exposure to promote projects for the prevention and protection of global health.

Neurobehavioral Alterations from Noise Exposure in Animals: A Systematic Review.

Ecosystems are increasingly involved and influenced by human activities, which are ever-increasing. These activities are mainly due to vehicular, air and sea transportation, thus causing possible repercussions on the fauna that exists there. The aim of this systematic review is to investigate the possible consequences that these activities may have in the field of animal neurobehavior, with special emphasis on the species involved, the most common environment concerned, the noise source and the disturbance that is caused. This research includes articles published in the major databases (PubMed, Cochrane Library, Scopus, Embase, Web of Sciences); the online search yielded 1901 references. After selection, 49 articles (14 reviews and 35 original articles) were finally scrutinized. The main problems that were reported were in relation to movement, reproduction, offspring care and foraging. In live experiments carried out, the repercussions on the marine environment mainly concerned altered swimming, shallower descents, less foraging and an escape reaction for fear of cetaceans and fish. In birds, alterations in foraging, vocalizations and nests were noted; laboratory studies, on the other hand, carried out on small mammals, highlighted spatio-temporal cognitive alterations and memory loss. In conclusion, it appears that greater attention to all ecosystems should be given as soon as possible so as to try to achieve a balance between human activity and the well-being of terrestrial fauna.

Linear conjugacy of chemical kinetic systems.

Two networks are said to be linearly conjugate if the solution of their dynamic equations can be transformed into each other by a positive linear transformation. The study on dynamical equivalence in chemical kinetic systems was initiated by Craciun and Pantea in 2008 and eventually led to the Johnston-Siegel Criterion for linear conjugacy (JSC). Several studies have applied Mixed Integer Linear Programming (MILP) approach to generate linear conjugates of MAK (mass action kinetic) systems, Bio-CRNs (which is a subset of Hill-type kinetic systems when the network is restricted to digraphs), and PL-RDK (complex factorizable power law kinetic) systems. In this study, we present a general computational solution to construct linear conjugates of any "rate constant-interaction function decomposable" (RID) chemical kinetic systems, wherein each of its rate function is the product of a rate constant and an interaction function. We generate an extension of the JSC to the complex factorizable (CF) subset of RID kinetic systems and show that any non-complex factorizable (NF) RID kinetic system can be dynamically equivalent to a CF system via transformation. We show that linear conjugacy can be generated for any RID kinetic systems by applying the JSC to any NF kinetic system that are transformed to CF kinetic system.

Clinical outcome of adjuvant treatment of endometrial cancer using aperture-based intensity-modulated radiotherapy.

PURPOSE: To assess disease control and acute and chronic toxicity with aperture-based intensity-modulated radiotherapy (AB-IMRT) for postoperative pelvic irradiation of endometrial cancer. METHODS AND MATERIALS: Between January and July 2005, after hysterectomy for endometrial cancer, 15 patients received 45 Gy to the pelvis using AB-IMRT. The AB-IMRT plans were generated by an in-house treatment planning system (Ballista). The AB-IMRT plans were used for treatment and were dosimetrically compared with three other approaches: conventional four-field, enlarged four-field, and beamlet-based IMRT (BB-IMRT). Disease control and toxicity were prospectively recorded and compared with retrospective data from 30 patients treated with a conventional four-field technique. RESULTS: At a median follow-up of 27 months (range, 23-30), no relapse was noted among the AB-IMRT group compared with five relapses in the control group (p = 0.1). The characteristics of each group were similar, except for the mean body mass index, timing of brachytherapy, and applicator type used. Patients treated with AB-IMRT experienced more frequent Grade 2 or greater gastrointestinal acute toxicity (87% vs. 53%, p = 0.02). No statistically significant difference was noted between the two groups regarding the incidence or severity of chronic toxicities. AB-IMRT plans significantly improved target coverage (93% vs. 76% of planning target volume receiving 45 Gy for AB-IMRT vs. conventional four-field technique, respectively). The sparing of organs at risk was similar to that of BB-IMRT. CONCLUSION: The results of our study have shown that AB-IMRT provides excellent disease control with equivalent late toxicity compared with the conventional four-field technique. AB-IMRT provided treatment delivery and quality assurance advantages compared with BB-IMRT and could reduce the risk of second malignancy compared with BB-IMRT.

Postoperative irradiation of gynecologic malignancies: improving treatment delivery using aperture-based intensity-modulated radiotherapy.

PURPOSE: To evaluate dosimetric and treatment delivery advantages of aperture-based intensity-modulated radiotherapy (AB-IMRT) for the treatment of patients receiving whole pelvic radiotherapy for gynecologic malignancies. METHODS AND MATERIALS: Nineteen patients undergoing pelvic radiotherapy after resection of endometrial cancers were selected. A 45-Gy dose was prescribed to the target volume delineated on a planning CT scan. An in-house inverse planning system, Ballista, was used to develop a treatment plan using aperture-based multileaf collimator segments. This approach was compared with conventional four-field, enlarged four-field, and static beamlet-based IMRT (BB-IMRT) techniques in terms of target coverage, dose-volume histogram statistics for surrounding normal tissues, and numbers of segments and monitor units (MU). RESULTS: Three quarters (76.4%) of the planning target volume received the prescription dose with conventional four-field plans. With adequate target coverage, the Ballista plans significantly reduced the volume of bowel and bladder irradiated at the prescribed dose (p < 0.001), whereas the two approaches provided equivalent results for the rectum (p = 0.5). On the other hand, AB-IMRT and BB-IMRT plans showed only small differences in dose-volume histogram statistics of unknown clinical impact, whereas Ballista plan delivery required on average 73% and 59% fewer segments and MU, respectively. CONCLUSION: With respect to conventional techniques, AB-IMRT for the treatment of gynecologic malignancies provides dosimetric advantages similar to those with BB-IMRT but with clear treatment delivery improvements.

Assessment of statistical change criteria used to define significant change in neuropsychological test performance following cardiac surgery.

OBJECTIVE: This paper compares four techniques used to assess change in neuropsychological test scores before and after coronary artery bypass graft surgery (CABG), and includes a rationale for the classification of a patient as overall impaired. METHODS: A total of 55 patients were tested before and after surgery on the MicroCog neuropsychological test battery. A matched control group underwent the same testing regime to generate test-retest reliabilities and practice effects. Two techniques designed to assess statistical change were used: the Reliable Change Index (RCI), modified for practice, and the Standardised Regression-based (SRB) technique. These were compared against two fixed cutoff techniques (standard deviation and 20% change methods). RESULTS: The incidence of decline across test scores varied markedly depending on which technique was used to describe change. The SRB method identified more patients as declined on most measures. In comparison, the two fixed cutoff techniques displayed relatively reduced sensitivity in the detection of change. CONCLUSIONS: Overall change in an individual can be described provided the investigators choose a rational cutoff based on likely spread of scores due to chance. A cutoff value of > or =20% of test scores used provided acceptable probability based on the number of tests commonly encountered. Investigators must also choose a test battery that minimises shared variance among test scores.

Health Outcomes of Exposure to Biological and Chemical Components of Inhalable and Respirable Particulate Matter.

Particulate matter (PM) is a key indicator of air pollution and a significant risk factor for adverse health outcomes in humans. PM is not a self-contained pollutant but a mixture of different compounds including chemical and biological fractions. While several reviews have focused on the chemical components of PM and associated health effects, there is a dearth of review studies that holistically examine the role of biological and chemical components of inhalable and respirable PM in disease causation. A literature search using various search engines and (or) keywords was done. Articles selected for review were chosen following predefined criteria, to extract and analyze data. The results show that the biological and chemical components of inhalable and respirable PM play a significant role in the burden of health effects attributed to PM. These health outcomes include low birth weight, emergency room visit, hospital admission, respiratory and pulmonary diseases, cardiovascular disease, cancer, non-communicable diseases, and premature death, among others. This review justifies the importance of each or synergistic effects of the biological and chemical constituents of PM on health. It also provides information that informs policy on the establishment of exposure limits for PM composition metrics rather than the existing exposure limits of the total mass of PM. This will allow for more effective management strategies for improving outdoor air quality.

Serous papillary carcinoma of the endometrium arising from endometrial polyps: a clinical, histological, and immunohistochemical study of 13 cases.

Serous papillary carcinoma is an aggressive tumor. Point mutations in the p53 suppressor gene might explain in part the rapid growth of this malignant tumor and its unfavorable outcome. The aims of this study were to evaluate the behavior of serous papillary carcinoma developing in endometrial polyps and to assess the p53 protein overexpression. Patients included in this study were treated in our institution between 1982 and 2003. All clinical and pathological materials were examined. A p53 protein immunohistochemical analysis was performed on paraffin-embedded tissues. Thirteen serous papillary carcinomas arising from benign polyps of the endometrium were identified. The patients' age averaged 73 years. All patients were treated surgically. After an average follow-up of 22 months, 54% of the patients were dead or alive with disease. Of 10 serous papillary carcinomas, 8 (80%) for which paraffin blocks were available overexpressed the p53 protein. A serous papillary carcinoma arising from benign polyps of the endometrium remains a malignant neoplasia with an unfavorable outcome even if the primary tumor is limited to the polyp. The high rate of protein p53 overexpression suggests that a p53 gene mutation occurs early in the disease and might explain the rapid growth of the tumor.

Getting the basics right: choosing paper hand towels for use in one trust.

Hand towels that are effective and pleasant to use are an important element of a good infection control practice and are purchased in enormous quantities by NHS trusts. A balance between clinical and cost effectiveness was achieved at one trust following the audit and introduction of a new paper towel product.

Investigation of factors relating to neuropsychological change following cardiac surgery.

BACKGROUND: An analysis of neuropsychological impairment following cardiopulmonary bypass was performed in 55 patients undergoing elective coronary artery bypass grafting. METHODS: Neurocognitive function was measured preoperatively using the MicroCog: Assessment of Cognitive Functioning computer-based testing tool. Testing was repeated in the postoperative period immediately prior to discharge from hospital. Analysis of significant score decline was performed using the standardised regression-based technique. A patient was classified as overall impaired when > or = 20% of test scores were significantly impaired. The proposed marker of neurological damage S-100beta was also used. Prothrombin Fragment 1+2 (F1+2) was measured as a marker of thrombin development to test the hypothesis that excessive haemostatic activation may lead to thromboembolic damage to the brain. RESULTS AND CONCLUSIONS: 32.7% of patients were classified as significantly impaired. No relationship was detected between F1+2 and any neuropsychological test score; however, the study was limited due to small sample size. F1+2 levels were higher in patients undergoing prolonged bypass times. Neuropsychological decline was significantly correlated with patient age, suggesting a degree of caution is warranted when operating on an elderly cohort. An unexpected relationship was detected between higher heparin concentrations and increased risk of neuropsychological impairment; however, this requires re-evaluation.

Test-retest norms and reliable change indices for the MicroCog Battery in a healthy community population over 50 years of age.

The increasing availability of computerized test batteries used to assess neuropsychological changes requires the availability of suitable test-retest normative data. Reliable change indices can then be used to evaluate significance of change in an individual's performance on retesting. We tested (N = 40) neurologically normal adults on three occasions (initially, two weeks, and three months) on the MicroCog: Assessment of Cognitive Functioning computerized testing instrument. Normative retest data are presented for two analytic techniques: the Reliable Change Index adjusted for practice and the Standardized Regression-Based technique. At two weeks, the correlation coefficients ranged from .49 to .84, with all scores demonstrating significant practice effects. At 3 months, coefficients ranged from .50 to .83, with all scores except Attention / Mental Control demonstrating significant practice compared to baseline. Regression equations were generated for all scores using age, sex, education level, and score at Time 1 as predictors. For all measures the only significant predictor was the Time 1 score. The reliable change indices and regression equations presented here can be used to determine the significance of change from predicted retest scores in a matched interventional cohort.