Full Assessment Research Articles

Healthcare Providers’ Knowledge, Attitudes and Practices towards Exercise during Pregnancy: A Cross-sectional Study

Background: Exercising during pregnancy can provide physical and mental health benefits for expectant mothers. Purpose: To assess healthcare providers’ knowledge, attitudes and practices regarding exercise during pregnancy in hospitals. Methods: A cross-sectional design was used. A convenience sample comprised (142) healthcare providers who work in four public hospitals in the southern region of Jordan. Descriptive analysis and inferential statistics were used to answer the research questions. Results: The results showed that some of the participants (39.4%) were familiar with the American College of Obstetricians and Gynaecologists guidelines for exercise during pregnancy, while the majority of participants were knowledgeable about the benefits of exercise during pregnancy. Healthcare providers’ attitudes were positive. Regarding the level of practice, the findings showed that approximately 50.7% of the participants provided advice about exercise. Demographic characteristics had no significant correlation with healthcare providers’ attitudes. Conclusion: Although healthcare providers' attitudes towards exercise during pregnancy were positive, not everyone knew of the American College of Obstetricians and Gynaecologists’ guidelines. Implications for Nursing: Healthcare Providers should undertake workshops and lectures and then highlight the need to practice exercise during pregnancy, also they should start by making a full and comprehensive assessment of the pregnant woman and then provide appropriate advice as advocated by the WHO and ACOG guidelines. Educational programmes, booklets and pamphlets should be available for free in all the hospitals and maternal healthcare centres to increase awareness among women in the community. Keywords: Attitudes, Exercise, Healthcare providers, Knowledge, Practices, Pregnancy

Saliency and Depth-Aware Full Reference 360-Degree Image Quality Assessment

With the widespread adoption of virtual reality and 360-degree video, there is a pressing need for objective metrics to assess quality in this immersive panoramic format reliably. However, existing image quality assessment models developed for traditional fixed-viewpoint content do not fully consider the specific perceptual issues involved in 360-degree viewing. This paper proposes a 360-degree image full-reference quality assessment (FR-IQA) methodology based on a multi-channel architecture. The proposed 360-degree FR-IQA method further optimizes and identifies the distorted image quality using two easily obtained useful saliency and depth-aware image features. The convolutional neural network (CNN) is designed for training. Furthermore, the proposed method accounts for predicting user viewing behaviors within 360-degree images, which will further benefit the multi-channel CNN architecture and enable the weighted average pooling of the predicted FR-IQA scores. The performance is evaluated on publicly available databases to demonstrate the advantages brought by the proposed multi-channel model in performance evaluation and cross-database evaluation experiments, where it outperforms other state-of-the-art ones. Moreover, an ablation study exhibits good generalization ability and robustness.

Assessment of association between interleukin 6 gene variant and its serum level in chronic obstructive pulmonary disease in a sample of Egyptian population

Abstract Background Researches in chronic obstructive pulmonary disease (COPD) had shown signs of inflammation with inflammatory markers that had pivotal role in COPD. some studies proposed that elevated serum interleukin-6 (IL-6) is associated with negative impact on lung functions but up to our knowledge, no studies were performed to correlate the genotypes of IL-6 with COPD patients in Egyptian and middle east populations. Objectives To study both the correlation of serum level of IL-6 as well as its gene variant (also known as G174C)) as possible genetic marker for COPD patients in Egyptian patients. Materials and methods This study is case-control that enrolled ninety participants; it consisted of two groups. Group I included 45 patients who were diagnosed as stable COPD; Group II included 45 healthy participants. After full clinical and pulmonary functions assessment of all participants, blood samples were collected from both groups for the detection serum level of IL-6 by ELISA and the detection of IL6 variant by TaqMan Real-Time PCR. Results Our study revealed that there was statistically significant increase in serum level of interleukin-6 in COPD patients compared to normal individuals (P value <0.001) and the presence of G/G variant of interleukin 6 gene in COPD patients more than normal subjects with frequency of 84.4% and 53.3% for COPD patients and healthy controls respectively. There was significant correlation between the serum level of interleukin-6 and COPD staging (P value <0.007). Conclusion The genotype GG variant of IL6 contributes to the prediction of COPD and may be used as a marker for the prediction of COPD risk in Egyptian population. Serum level of IL6 is markedly higher in COPD patients and can be used as a parameter of correlation with COPD stages.

FNDC5 genetic polymorphism in patients with peripartum cardiomyopathy.

Late in pregnancy or soon after delivery, peripartum cardiomyopathy (PPCM) which is an uncommon type of cardiomyopathy, can develop. To assess the association between the level of irisin expression and (FNDC5) (rs3480) gene polymorphism with peripartum cardiomyopathy. This is a case control study included a thirty female patients with new-onset PPCM and sixty healthy females at the at the peripartum period in same time window for PPCM as a control. For each patient, comprehensive medical history was taken, full clinical assessment was done, ECHO., FNDC5 (rs3480) & Irisin assay. The left ventricle end diastolic dimensions &left atrium diameters were statistically significant higher in patients' group than controls' group (P=0.000 for all), Also left ventricular ejection fraction (%) was statistically significant lower in patients than controls and as regards irisin, its Mean ±SD was lower in patient group than control group (8.44±1.1 vs 10.65±2.31) with (p <0.001) which is considered a significant difference statistically. Irisin level was lower in peripartum cardiomyopathic patients when compared with normal individuals and regarding its genotype, the homotype A/A was higher than homotype G/G.

Boundaries of management performance measures (MPMs) disclosed in primary financial statements prepared in accordance with new standard planned to supersede IAS 1

Abstract We outline the management performance measures (MPMs)' boundaries based on the upcoming introduction of MPM's definition to International Financial Reporting Standards (IFRS). The literature investigates business performance measures concentrating on managers' needs, while IFRS aims to provide financial information to external users who provide resources to the entity. This indicates a gap between how performance metrics have been investigated so far and how IFRS will adopt them. We used analysis of the exposure draft of the planned standard together with working materials developed in the consultation process. Further, a case study is presented. Results show that the scope of MPM to be introduced to IFRS is limited compared to the broad spectrum of performance measures presented in the literature. We contribute by showing the avenues for future performance measures research using signalling and agency theory and by indicating the limited scope of MPMs and thus bound prospects for using them for a full assessment of the entity‘s performance.

Rapid Assessment for Emergency Infrastructures in Responding Flood related to Mining Activity: Case Study of Banjarasri and Kedungbanteng Flood, Sidoarjo, Indonesia

Flooding has become the most frequent and impactful disaster events in the Indonesian cities. The Indonesian disaster board also noted that flood events has increasing pattern for today and future time. One of the strategic ways to decrease the impact of flooding is delivering the emergency infrastructures to the needs immediately. The faster delivery makes less impact of disaster events. Therefore, this paper synthesizes a rapid model of assessment from the full assessment of emergency infrastructure need in Sidoarjo Flooding 2020. During the synthesize, the model can reduce duration of assessment from 148 days to four days only. Within the time, eight main steps include finding relevant emergency infrastructures, determining emergency infrastructures needed, assessing emergency infrastructures needed and confirming the actual emergency infrastructure needed. Those eight steps should be taken by encouraging more FGD and in-depth interviews for key relevant stakeholders, guided by specific checklist and filling the gap forms. Strict forms and guidelines provided to help the process in achieving four days assessment period. Consequently, the authorities can use the output assessment for emergency infrastructure program delivery starting from the fifth days after the events.

METHODOLOGICAL APPROACHES TO ASSESSING THE LEVEL OF ECONOMIC SECURITY OF THE ENTERPRISE

The article is devoted to the problem of assessing the level of economic security of enterprises in modern conditions. The authors define economic security as an important aspect of the functioning and development of enterprises in a dynamic economic environment. The authors point out the urgency of the problem of finding criteria and tools for assessing this indicator, given the variety of approaches to determining the economic security of an enterprise in the literature. The methodology uses general scientific and special methods, such as analysis, synthesis, logical, terminological, financial, systemic and structural analysis, systematization and generalization, to confirm the reliability of the results obtained. The approaches and methods for assessing the level of economic security of an enterprise depend on the diversity of interpretations of the very concept of «economic security of an enterprise», which leads to the absence of a single indicator for a full assessment of this phenomenon. Different approaches to assessing the economic security of an enterprise are presented through resource-functional, indicator, profit and investment, three-dimensional, program-target, bankruptcy forecasting, economic and mathematical, systemic and economic risk theory. Each of these approaches uses different methods and criteria to determine the level of economic security of an enterprise. It is noted that economic security assessment can be carried out using various methods, such as expert assessments, regression and variance analysis, exponential smoothing, fuzzy systems theory and multivariate statistical analysis. The author emphasizes the importance of a systematic approach that takes into account internal and external relations, interdependence and subordination of the functional components of an enterprise when assessing the level of its economic security. For a comparative analysis of the levels of functional components of the economic security of enterprise, the authors use the calculation of the rates of change of indicators. The general methodology for calculating indicators of the levels of functional components includes analysis and evaluation of the dynamics of indicators, which indicates trends and changes in various areas of economic security of enterprise.

Persepsi Simetode Mengajar Guru Pendidikan Agama Islam pada Siswa SMPN 3 Tanjung Medan

This test expects to figure out understudies' perspectives on PAI teachers' presentation methods for understudies at SMPN 3 Tanjung Medan. This investigation method utilizes a realistic quantitative procedure. The populace in this study was 81 Muslim understudies at SMPN 3 Tanjung Medan. The assessment technique utilizes a full scale assessment, so the populace and test takers have similar number, to be specific 81 understudies. Data was gathered utilizing an open survey and a proportion of understudies' impressions of the teacher's exhibition procedure assessed utilizing a Likert scale. The data checking system utilized is realistic examination. Based on the consequences of data testing, the query items show that understudy appraisals are named 39.5% satisfied, 23.5% extremely fulfilled, 21% frustrated, and 16% exceptionally disheartened. Hence, one might say that the most predominant gathering of understudies' comprehension was satisfied at 39.5% and the gathering with the least understanding was exceptionally disheartened at 16%.

Lung Ultrasound Findings in the Diagnosis of Transient Tachypnea of Newborn in Late Preterm and Term Neonates

Background: Transient tachypnea of the newborn (TTN) is a prevalent etiology of respiratory distress (RD) in neonates. The condition is a result of the accumulation of fetal lung fluid owing to defective processes responsible for its removal. However, differentiating TTN from various etiologies of RD may provide challenges. Lung ultrasound (LUS) has effectively been used to diagnose and differentiate infant RD. The objective of this research was to evaluate the ultrasonographic findings in the diagnosis of TTN in late preterm and full-term neonates.&#x0D; Methods: All neonates had been exposed to full taking of history, full clinical assessment, chest X-ray, routine laboratory tests, and LUS assessment was performed on 80 late preterm and full-term neonates diagnosed with TTN by clinical and radiological findings and performed on control group.&#x0D; Results: Among 80 neonates who were diagnosed to have TTN, double lung point sign (DLP) was present in 62 (77. 5 %), pleural line abnormalities had been observed in 80 (100%), alveolar interstitial syndrome (AIS) was observed in 68 (85.0%), while white lung was present only in 12 TTN cases (15%), and no pleural effusion was found in any of the patients. While these findings weren’t detected in the control group.&#x0D; Conclusion: LUS could be accurately and reliably used in the diagnosis and screening of TTN. Most common findings in TTN were pleural line abnormalities followed by AIS and DLP.

Sustainable regeneration of waste polystyrene foam as cooling coating: Building cooling energy saving, CO2 emission reduction and cost-benefit prospective

Passive radiative cooling technology provides a green and energy-free approach for large-scale building cooling. Developing low-cost raw materials, green production process and entire-process evaluation is keys for the commercialization of cooling materials. This work proposes quickly converting abundant waste polystyrene foam into cooling coating via closed-loop solvent extraction strategy to satisfy scale and clean production requirements of building cooling envelope. Residential building thermodynamic model and outdoor cooling experiment are established to evaluate the application in building energy-saving and CO2 reduction. In addition, this work conducts a full lifecycle assessment to explore the advantages and disadvantages of the coating. Results demonstrate the coating has a randomly porous structure thus reflecting ∼97% solar radiation and emit ∼94% thermal radiation. About 8 °C of net and ∼7.5 °C/1000 cm3 building space cooling capacity can be achieved even under ∼1500 W/m2 of solar radiation. The coating is evaluated to reduce 5.09 kW h·m−2 electrical energy and ∼2 kg/m2 CO2 emission annually in Nanjing. Benefiting from the low-cost raw materials and closed-loop preparation process, the payback time and total environmental impact are reduced 54.96% and 28.29%–54.19% compared to commercial one, respectively. This work will effectively inspire the development of large-scale and low environmental impact building cooling envelopes.

A Velocity Stretch Reflex Threshold Based on Muscle-Tendon Unit Peak Acceleration to Detect Possible Occurrences of Spasticity during Gait in Children with Cerebral Palsy.

Spasticity might affect gait in children with cerebral palsy. Quantifying its occurrence during locomotion is challenging. One approach is to determine kinematic stretch reflex thresholds, usually on the velocity, during passive assessment and to search for their exceedance during gait. These thresholds are determined through EMG-Onset detection algorithms, which are variable in performance and sensitive to noisy data, and can therefore lack consistency. This study aimed to evaluate the feasibility of determining the velocity stretch reflex threshold from maximal musculotendon acceleration. Eighteen children with CP were recruited and underwent clinical gait analysis and a full instrumented assessment of their soleus, gastrocnemius lateralis, semitendinosus, and rectus femoris spasticity, with EMG, kinematics, and applied forces being measured simultaneously. Using a subject-scaled musculoskeletal model, the acceleration-based stretch reflex velocity thresholds were determined and compared to those based on EMG-Onset determination. Their consistencies according to physiological criteria, i.e., if the timing of the threshold was between the beginning of the stretch and the spastic catch, were evaluated. Finally, two parameters designed to evaluate the occurrence of spasticity during gait, i.e., the proportion of the gait trial time with a gait velocity above the velocity threshold and the number of times the threshold was exceeded, were compared. The proposed method produces velocity stretch reflex thresholds close to the EMG-based ones. For all muscles, no statistical difference was found between the two parameters designed to evaluate the occurrence of spasticity during gait. Contrarily to the EMG-based methods, the proposed method always provides physiologically consistent values, with median electromechanical delays of between 50 and 130 ms. For all subjects, the semitendinosus velocity during gait usually exceeded its stretch reflex threshold, while it was less frequent for the three other muscles. We conclude that a velocity stretch reflex threshold, based on musculotendon acceleration, is a reliable substitute for EMG-based ones.

Regulation of genetically modified organisms, food and feed in the EU with particular reference to Poland – protection of consumers and the environment or merely a response to public expectations?

This article aims to establish the rationale for its introduction within the European Union and subsequent changes to the legal regulation of its release into the environment, genetically modified organisms (GMOs), and the placement of genetically modified food and feed on the market. Following the presentation of the original regulation, public reactions to GMOs and the resulting changes in the European Union and national regulations are discussed based on cases before the European Court of Justice. The analysis leads to the conclusion that in the case of GMOs and genetically modified food and feed, the legislature has acted mainly based on public expectations, while neglecting a full scientific assessment of the solutions adopted to protect consumers and the environment.

ETIOLOGY OF REGENERATIVE ANEMIA IN DOGS AND CATS

The study was conducted between March 2020 – December 2022 on 129 dogs and 63 cats, different breeds and age, both males and females, clinically diagnosed with anemia. All individuals were subjected to a full hematology test including blood analysis and blood smear assessment where regenerative reaction was confirmed in 22 dogs and 9 cats. To understand the ability of the hematogenous bone marrow to respond and develop new red blood cells (RBCs) and the effectiveness of the therapy is important to recognize the main causes of anemia that lead to the destruction, loss or deficit in production. The research highlighted post-hemorrhagic anemia as the most important cause of regenerative reaction in dogs (68,2%) while in cats, hemolytic anemia was the primary reason of reticulocytosis (55,6%). Correctly identifying the type of anemia in terms of hematogenous bone marrow responsiveness is of utmost importance in tailoring the treatment, preventing complications or monitoring the progress of the patient and one of main tools used to assess and differentiate between the RBCs disorders

Assessing nutrition status, sarcopenia, and frailty in adult transplant recipients.

The assessment of nutrition status, sarcopenia, and frailty holds significant relevance in the context of adult transplantation, as these factors are associated with an unfavorable prognosis; thus, transplant candidates must undergo a full nutrition assessment. Screening tools may be used to prioritize patients, this can be done using the Nutrition Risk Screening 2002 or Royal Free Hospital-Nutritional Prioritizing Tool. Subsequently, a thorough nutrition-focused physical examination should be conducted to evaluate clinical signs of nutrition deficiencies, fat and muscle loss, and fluid overload; dietary history and current intake must also be assessed. Apart from physical examination, specific testing for sarcopenia and frailty are recommended. For sarcopenia assessment, specifically for muscle quantification, the gold standard is the cross-sectional measurement of the muscle at L3 obtained from a computed tomography scan or magnetic resonance imaging; dual-energy x-ray absorptiometry is also a good tool especially when appendicular skeletal muscle index is calculated. Other more readily available options include phase angle from bioelectrical impedance or bioimpedance spectroscopy. In the sarcopenia assessment, muscle function evaluation is required, handgrip strength stands as the primary test for this purpose; this test is also part of the subjective global assessment and is included in some frailty scores. Finally, for frailty assessment, the Short Physical Performance Battery is useful for evaluating physical frailty, and for a multidimensional evaluation, the Fried frailty phenotype can be used. Specifically for liver transplant candidates, the use of Liver Frailty Index is recommended.

Atopic Dermatitis in the Elderly Population.

Atopic dermatitis is a common inflammatory disease with a chronic and relapsing course. Although considered a childhood disease, it is now evident that atopic dermatitis is also common in adulthood and in the elderly population. Atopic dermatitis typically manifests with bilateral and symmetrical eczematous lesions on the face, trunk and skin folds. Itch is invariably present and may be very severe, markedly affecting daily life and sleep. In older adults, atopic dermatitis may have a high level of impact on quality of life, frequently burdening an already complex comorbid situation. The full assessment of disease burden (localizations, itch severity, sleep alterations, impact on quality of life, disease history, comorbidities) is crucial to identify the most appropriate treatment. In many cases, moderate-to-severe atopic dermatitis in the elderly population can be successfully and safely treated with biological agents inhibiting the interleukin-4/-13 pathway, whereas the use of Janus kinase inhibitors may pose concerns about the safety profile.

ANALYSIS OF METHODS FOR DETERMINING THE QUALITY OF FUNCTIONING OF TELECOMMUNICATION SYSTEMS

The rapid development and spread of information and communication technologies is taking on the character of a global information revolution today. Users have a need for communication services that can be flexibly configured. Next Generation Networks (NGN) - the modern stage of development of telecommunication networks (TCN) - represent a single transport platform on the basis of which various types of services are combined. One of the main aspects that should be taken into account when designing NGN is the provision of appropriate quality of service. With the introduction of multi-service networks, the approach to the task of service level based on the requirements of the users themselves for the quality of services becomes predominant, which requires the improvement of methods of managing the quality of services in TCN. The analysis of the works of domestic and foreign scientists regarding service quality management in TCN indicates the need to improve service quality management methods. It should be noted that in the works on the quality management of telecommunication services (TCS), attention is mainly paid to the technical indicators of the quality of services, while the development of effective methods of taking into account the user's opinion in managing the quality of services is currently relevant. The existing subjective methods of assessing the quality of TCS take into account the quality of the transmitted media information based on expert assessments, but do not provide a full assessment of the quality of the service by the user. The ITU-T recommendations describe different points of view on the quality of service, but do not provide specific methods for evaluating and managing the quality of TCS taking into account the opinion of the user. It is the unsolved task of comprehensive assessment of the quality of services in next-generation TCN that determined the purpose of this work.

Drivers of success, speed and performance in fisheries moving towards Marine Stewardship Council certification

AbstractWith growing concerns about global overfishing, market‐based eco‐certification programs like the Marine Stewardship Council (MSC) can incentivise adoption of sustainable practices. Several studies investigated drivers of improvement in market‐driven Fisheries Improvement Projects, but failed to use detailed, standardised measures of progress, or considered small samples. We considered the relative influence market, governance and fishery‐specific drivers have on MSC certification speed and success in 208 fisheries. To evaluate improvement we compared pre‐certification scores from MSC pre‐assessments—rapid high‐level audits against the MSC Standard—to scores from full MSC audits. Drivers considered included measures of pre‐assessment quality, as this initial advice might contribute to later certification success. National fishery management capacity, percentage of MSC catch and landed value were the strongest drivers of successful and rapid certification. Environmental improvements occurred for stock management, ecosystem health and governance aspects. While only 48% of fisheries with favourable pre‐assessment outcomes went on to be certified, improvements in many fisheries with lower pre‐assessment scores were observed in their lead‐up to full assessment. Random forest analyses allowed for considering multiple interacting variables simultaneously and revealed influential drivers under specific fishery contexts. For example, higher certification probability was associated with greater percentage of MSC catch under the full dataset, but not under subsets representing fisheries facing more challenging contexts for certification. Fisheries from lower/middle‐income countries had lower overall probability of certification, but this increased with higher management capacity. This suggests multiple drivers interact in instigating fisheries improvements, and MSC pre‐assessments provide valuable resources to understand this journey.

Stroke After Acute Type A Dissection Repair Using Right Axillary Cannulation First Approach

BackgroundThis study sought to analyze the details of strokes after acute type A dissection repair (ATAD) using a right axillary artery (RAX) first approach. MethodsA total of 356 consecutive ATAD repairs from 2005 to 2022 were analyzed on the basis of arterial cannulation site. Strokes were evaluated by head computed tomography. ResultsThe rate of RAX cannulation was 82.6% (n = 294), with a 38.2% rate of antegrade cerebral perfusion use, both of which had increased over the years. The non-RAX group had more cardiogenic shock (RAX, 16.3% vs non-RAX, 37.1%; P < .001), cerebral malperfusion (8.8% vs 25.8%, respectively; P < .001), and innominate artery dissection (45.9% vs 69.2%, respectively; P = .007). Eight patients died before undergoing a full neurologic assessment. The overall stroke rate was 8.4% (n = 30), and it was lower in the RAX group (5.1% vs 24.2%; P < .001). All strokes were ischemic, with concomitant hemorrhagic strokes occurring in 6 patients. Strokes diagnosed immediately after surgery (perioperative stroke) accounted for 70% (n = 21 of 30) of cases. Strokes predominantly affected the right anterior circulation (right anterior, 80% vs left anterior, 46.7% vs left posterior, 26.7%; P = .013), independent of arterial cannulation site. The proposed mechanism of perioperative strokes was not uniform (embolism, 33.3%; hypoperfusion, 42.8%; embolism and hypoperfusion, 14.3%; lacunar infarct, 10%), whereas most postoperative strokes were embolic (77.8%). The mean National Institutes of Health Stroke Scale score was 20.6 ± 9.9, and the modified Rankin score at discharge was 4.1±2.2. ConclusionsMost strokes in ATAD occurred perioperatively from various mechanisms predominantly affecting the right anterior circulation irrespective of the arterial cannulation site. This complication is most likely the result of unstable hemodynamics and dissection of the innominate artery (IA) or its downstream vessels.

Geography, taxonomy, extinction risk and exposure of fully migratory birds to droughts and cyclones

AbstractAimAnthropogenic climate change is predicted to drive unprecedented increases in the frequency and intensity of extreme climatic events, such as drought and cyclones. The impacts of these events on fully migratory species could be particularly severe and have cascading effects on the functioning of many ecosystems. We explore the relationships between geography, taxonomy, extinction risk and the exposure of fully migratory birds to drought and cyclones.LocationGlobal.Time Period1985–2014.Major Taxa Studied383 fully migratory bird species.MethodsWe assessed the exposure of fully migratory birds to cyclones and droughts, quantifying exposure by calculating the percentage of spatial overlap between a species' range and the extent of an extreme event within a given time series. We compared the level of cumulative exposure sustained by species among different taxonomic groups and within their breeding and wintering ranges; we also assessed whether species currently classed as ‘threatened’ are more cumulatively exposed than ‘non‐threatened’ species.ResultsWe identified fully migratory bird species highly exposed to extreme climatic events and global geographic hotspots of species exposure. 4% of species were found to be highly exposed to cyclones and droughts in both their wintering and breeding ranges. Wintering ranges were, on average, more cumulatively exposed to cyclones than breeding ranges; there was no discernible difference in drought exposure between ranges. Species currently classed as threatened were shown to experience higher exposure to droughts than non‐threatened ones in both ranges.Main ConclusionsThis exposure analysis provides the first step to a full global assessment of fully migratory bird species' vulnerability to extreme climatic events. Many species are at least as exposed to extreme events within their wintering ranges as in their breeding ranges, supporting calls for ‘full cycle’ assessment of migratory species' vulnerability to climate change. Our identification of hotspots of exposure may help to guide further monitoring, research and management.

Metabolic heterogeneity in different subtypes of malformations of cortical development causing epilepsy: a proton magnetic resonance spectroscopy study.

The most common subtypes of malformations of cortical development (MCDs) are gray matter heterotopia (GMH), focal cortical dysplasia (FCD), and polymicrogyria (PMG). This study aimed to characterize the possible neurometabolic abnormalities and heterogeneity in different MCDs subtypes using proton magnetic resonance spectroscopy (1H-MRS). In this prospective cross-sectional study, we recruited 29 patients with MCDs and epilepsy, including ten with GMH, ten with FCD, and nine with PMG, as well as 25 age- and sex-matched healthy controls (HC) from the Epilepsy Center of West China Hospital of Sichuan University between August 2018 and November 2021. Inclusion criteria for the patients were based upon typical magnetic resonance imaging (MRI) findings of MCDs and full clinical assessment for epilepsy. Single-voxel point-resolved spectroscopy was used to acquire data from both the lesion and the normal-appearing contralateral side (NACS) in patients and from the frontal lobe in HC. Metabolite measures, including N-acetyl aspartate (NAA), myoinositol (Ins), choline (Cho), creatine (Cr), and glutamate + glutamine (Glx) concentrations, were quantitatively estimated with linear combination model (LCModel) software and corrected for the partial volume effect of cerebrospinal fluid (CSF). The NAA concentration was lower and the Ins concentration was higher in the MCDs lesions than in the NACS and in HC (P=0.002-0.007), and the Cho and Cr concentrations were higher in MCDs lesions than in HC (P=0.001-0.016). Moreover, the Cho concentration was higher in NACS than in HC (P=0.015). In the GMH lesions, the only metabolic alteration was an NAA reduction (GMH_lesion vs. HC: P=0.001). In the FCD lesions, there were more metabolite abnormalities than in the other two subtypes, particularly a lower NAA and a higher Ins than in HC and NACS (P=0.012-0.042). In the PMG lesions, Cr (lesion vs. HC or NACS: P=0.017-0.021) and Glx (lesion vs. NACS: P=0.043) were increased, while NAA was normal. Correlation analysis revealed that the Cr concentration in MCDs lesions was positively correlated with seizure frequency (r=0.411; P=0.027). Based upon 1H-MRS, our study demonstrated that different MCDs subtypes exhibited variable metabolic features, which may be associated with distinct functional and cytoarchitectural properties.