Cluster analysis of behavioural and event-related potentials during a contingent negative variation paradigm in remitting-relapsing and benign forms of multiple sclerosis

<p>Abstract</p> <p>Background</p> <p>Event-related potentials (ERPs) may be used as a highly sensitive way of detecting subtle degrees of cognitive dysfunction. On the other hand, impairment of cognitive skills is increasingly recognised as a hallmark of patients suffering from multiple sclerosis (MS). We sought to determine the psychophysiological pattern of information processing among MS patients with the relapsing-remitting form of the disease and low physical disability considered as two subtypes: 'typical relapsing-remitting' (RRMS) and 'benign MS' (BMS). Furthermore, we subjected our data to a cluster analysis to determine whether MS patients and healthy controls could be differentiated in terms of their psychophysiological profile.</p> <p>Methods</p> <p>We investigated MS patients with RRMS and BMS subtypes using event-related potentials (ERPs) acquired in the context of a Posner visual-spatial cueing paradigm. Specifically, our study aimed to assess ERP brain activity in response preparation (contingent negative variation -CNV) and stimuli processing in MS patients. Latency and amplitude of different ERP components (P1, eN1, N1, P2, N2, P3 and late negativity -LN) as well as behavioural responses (reaction time -RT; correct responses -CRs; and number of errors) were analyzed and then subjected to cluster analysis.</p> <p>Results</p> <p>Both MS groups showed delayed behavioural responses and enhanced latency for long-latency ERP components (P2, N2, P3) as well as relatively preserved ERP amplitude, but BMS patients obtained more important performance deficits (lower CRs and higher RTs) and abnormalities related to the latency (N1, P3) and amplitude of ERPs (eCNV, eN1, LN). However, RRMS patients also demonstrated abnormally high amplitudes related to the preparation performance period of CNV (cCNV) and post-processing phase (LN). Cluster analyses revealed that RRMS patients appear to make up a relatively homogeneous group with moderate deficits mainly related to ERP latencies, whereas BMS patients appear to make up a rather more heterogeneous group with more severe information processing and attentional deficits.</p> <p>Conclusions</p> <p>Our findings are suggestive of a slowing of information processing for MS patients that may be a consequence of demyelination and axonal degeneration, which also seems to occur in MS patients that show little or no progression in the physical severity of the disease over time.</p

Subjective and objective measures

One of the greatest challenges in the study of emotions and emotional states is their measurement. The techniques used to measure emotions depend essentially on the authors’ definition of the concept of emotion. Currently, two types of measures are used: subjective and objective. While subjective measures focus on assessing the conscious recognition of one’s own emotions, objective measures allow researchers to quantify and assess the conscious and unconscious emotional processes. In this sense, when the objective is to evaluate the emotional experience from the subjective point of view of an individual in relation to a given event, then subjective measures such as self-report should be used. In addition to this, when the objective is to evaluate the emotional experience at the most unconscious level of processes such as the physiological response, objective measures should be used. There are no better or worse measures, only measures that allow access to the same phenomenon from different points of view. The chapter’s main objective is to make a survey of the main measures of evaluation of the emotions and emotional states more relevant in the current scientific panorama.info:eu-repo/semantics/acceptedVersio

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Extreme heat alerts and impacts across Mozambique 2016 - 2022: Gathering evidence from media articles

Heatwaves are increasing around the world and cause a range of devastating societal impacts. Effective communication during a heatwave enables the general public to prepare and, if possible, take the necessary actions. In many African countries, the recognition of heatwaves and appropriate action to reduce heat risk remains absent. In this study, extreme heat and heat-related impacts across Mozambique were analyzed across space and time by using text from media sources. Alerts were obtained by performing a broad word search across four popular media outlets (Club of Mozambique, Rádio Moçambique, O País, and Televisão de Moçambique). Between 2016 and 2022, 79 heat alerts and 12 posts on impacts were found. When mapped, a disproportionate number of articles were found for Southern provinces compared to Northern provinces. Communication of heat alerts were consistent across media outlets and included the maximum temperature forecasted and geographic locations affected. A majority of the messages (91%) did not include information on how to respond and the type of actions to take to reduce risk. Our findings provide spatio-temporal insights into extreme heat and impacts, and highlight the urgent need for an improved heatwave early warning system across Mozambique

Remote central effects of botulinum toxin type A as adjuvant to intense occupational therapy in the early stage of stroke: A Type II fMRI randomised controlled trial

Introduction: Improvements in motor function following interventions incorporating botulinum toxin type A (BTX-A) remain controversial, with existing studies yielding contrasting results.1-3 The mechanisms underlying BTX-A remote central effects are still under investigation. It is hypothesized that the toxin administration strategy may play a role in producing such differing outcomes. We tested a strategy based on modulating muscle synergies. Aim: The aim of the study was to investigate the clinical and remote central effects of an occupational therapy intervention combined with adjunctive BTX-A compared to the same occupational therapy without the adjuvant application of the toxin. Methods: A two-group, parallel, pre-post, randomized controlled trial was performed. The clinical effects of occupational therapy when performed following BTX-A injections to disinhibit finger flexors (n=5) was compared to those of an equal dose of occupational therapy alone (n=6). Motor dexterity and function were assessed using the Fugl-Meyer Scale, Motor Index, Arm Activity Measure, 9-Hole Peg Test, and Box and Block Test, and differences were analysed using ANCOVA. Brain activity was examined using functional magnetic resonance imaging (fMRI), and between-group differences were analysed using contrast statistical parametric mapping. Results: Both groups started in statistically similar conditions. Both treatments provided significant clinical improvements compared to baseline. The total differences in change score on the Fugl-Meyer Scale and Motor Index were larger, though not significantly, in the toxin-treated group than in the control group (Figure). When the toxin is administered, activity in the brain is more localised and appears more in the right hemisphere in subjects in the toxin-treated group and more in the left in those in the control group. Conclusions: Functional improvements were observed in the toxin-treated group, but the effect size compared to the control group was too small to provide definitive results. Post-treatment contrast analysis of the fMRI scans suggests that the toxin reduces cortical and cerebellar overexcitation. Findings are limited by the small cohort size. Funding: FOE received Mexican Research Council CONACYT CB-2014-01-237251