Which outcomes should we measure in adult epilepsy trials? The views of people with epilepsy and informal carers

AbstractObjectiveSo that informed treatment decisions can be made, clinical trials need to evaluate treatments against domains that are important to people with epilepsy (PWE), their carers, and clinicians. Health professionals have identified domains of importance to them via the International League Against Epilepsy's Commission on Outcome Measurement (COME). However, patients and carers have not been systematically asked.MethodsVia the membership of the British Epilepsy Association, we recruited and surveyed 352 PWE and 263 of their informal carers. They were presented with 10 outcome domains (including the 5 identified by COME) and asked to rate their importance using a 9-point Likert scale. They were also asked to identify any additional domains of importance.ResultsThe patients' mean age was 49years, the median number of years since diagnosis was 20, and 65% had experienced seizures in the prior 12months. Most carers were the spouse or parent. Patients' and carers' mean ratings indicated that their outcome priorities were similar, as were those of patients who had and had not experienced recent seizures. There was consensus among patients that 6 domains were of critical importance. These included the 5 identified by COME (namely, and in order of importance, the effects of the treatment on “Seizure severity”, “Seizure frequency”, “Quality of life”, “Cognitive function”, and “Adverse events”), as well as one additional domain (“Independence/need for support”). There was consensus among carers that the 5 COME domains were also critically important. They, however, identified 3 further domains as critically important. These were the effects of the treatment on patient “Depression”, “Anxiety”, and “Independence/need for support”.ConclusionsOur study found some overlap between the priorities of PWE, carers, and health professionals. They, however, highlight additional areas of importance to patients and carers. Our results could inform a core outcome set for epilepsy that represents the domains that should be reported as a minimum by all trials. This could promote trials which produce meaningful results and consistency in measurement and reporting

Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender

This work was funded by a grant from the Engineering and Physical Sciences Research Council (EP/G030693/1) and supported by the Oxford British Heart Foundation Centre of Research Excellence and the National Institute for Health Research Oxford Biomedical Research Centr

Understanding why metal-on-metal hip arthroplasties fail: a comparison between patients with well-functioning and revised birmingham hip resurfacing arthroplasties. AAOS exhibit selection.

A large proportion of metal-on-metal hip arthroplasty failures are due to unexplained pain. The mechanism of failure has been thought to be associated with factors that increase material loss, including specific design features and surgical positioning of components. However, recent evidence suggests that there is not a simple dose-response relationship. An analysis of failed metal-on-metal hip arthroplasties involving a single design was performed in an attempt to help resolve this issue. Our aim was to identify the clinical and component variables associated with failure of metal-on-metal hip arthroplasties, particularly in patients undergoing revision arthroplasty because of unexplained hip pain, and to clarify the role of material loss

Mirasol3B: A Multimodal Autoregressive model for time-aligned and contextual modalities

One of the main challenges of multimodal learning is the need to combine heterogeneous modalities (e.g., video, audio, text). For example, video and audio are obtained at much higher rates than text and are roughly aligned in time. They are often not synchronized with text, which comes as a global context, e.g., a title, or a description. Furthermore, video and audio inputs are of much larger volumes, and grow as the video length increases, which naturally requires more compute dedicated to these modalities and makes modeling of long-range dependencies harder. We here decouple the multimodal modeling, dividing it into separate, focused autoregressive models, processing the inputs according to the characteristics of the modalities. We propose a multimodal model, called Mirasol3B, consisting of an autoregressive component for the time-synchronized modalities (audio and video), and an autoregressive component for the context modalities which are not necessarily aligned in time but are still sequential. To address the long-sequences of the video-audio inputs, we propose to further partition the video and audio sequences in consecutive snippets and autoregressively process their representations. To that end, we propose a Combiner mechanism, which models the audio-video information jointly within a timeframe. The Combiner learns to extract audio and video features from raw spatio-temporal signals, and then learns to fuse these features producing compact but expressive representations per snippet. Our approach achieves the state-of-the-art on well established multimodal benchmarks, outperforming much larger models. It effectively addresses the high computational demand of media inputs by both learning compact representations, controlling the sequence length of the audio-video feature representations, and modeling their dependencies in time

Postdischarge interventions for children hospitalized with severe acute malnutrition: a systematic review and meta-analysis.

BACKGROUND: Children hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment. OBJECTIVES: This systematic review and meta-analysis aimed to examine whether postdischarge interventions can improve outcomes in children recovering from complicated SAM. METHODS: Systematic searches of 4 databases were undertaken to identify studies of interventions delivered completely or partially after hospital discharge in children aged 6-59 mo, following inpatient treatment of SAM. The main outcome of interest was mortality. Random-effects meta-analysis was undertaken where ≥2 studies were sufficiently similar in intervention and outcome. RESULTS: Ten studies fulfilled the inclusion criteria, recruiting 39-1781 participants in 7 countries between 1975 and 2015. Studies evaluated provision of zinc (2 studies), probiotics or synbiotics (2 studies), antibiotics (1 study), pancreatic enzymes (1 study), and psychosocial stimulation (4 studies). Six studies had unclear or high risk of bias in ≥2 domains. Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05). In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049). Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies. There was no evidence that zinc reduced mortality in the single study reporting deaths. Antibiotics reduced infectious morbidity but did not reduce mortality. CONCLUSIONS: Several biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials. This study was registered with PROSPERO as CRD42018111342 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342)