Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial

Epilepsy affects up to 1% of people in the UK and some would like to know more about living with epilepsy and managing their seizures. To help people who have epilepsy and a lot of seizures, we tested a group course called Self-Management education for adults with poorly controlled epILEpsy or SMILE (UK). The study had 404 people with epilepsy. People were asked questions about their general well-being (‘quality of life’), health, whether or not they felt worried or depressed, and how epilepsy had an impact on their lives. The study also aimed to find out what people thought about the course and whether or not it could lower the costs of epilepsy care. The results showed that people who were less happy with their general well-being may also feel depressed and worried, feel that others treat them differently and feel less able to control their epilepsy. They may not take their medicine as they should and they may have other health problems or a lot of seizures. At the end of the study, general well-being was the same between the people who took the course and those who did not. The course was not found to save costs for epilepsy treatment, but people said that learning in a group helped them feel less alone and let them open up to discuss feelings. They were also more confident, which improved their outlook and coping with epilepsy. However, some said that they had trouble recalling parts of the course because of memory problems. The study testing SMILE (UK) for people with epilepsy in groups did not find any difference in general well-being in people 1 year after attending the course. But the course gave people the chance to learn from experts and, by talking with others, they felt less alone and more confident

Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal

Background: Peripheral quantitative computed tomography (pQCT) is an established technology that allows for the measurement of the material properties of bone. Alterations to bone architecture are associated with an increased risk of fracture. Further pQCT research is necessary to identify regions of interest that are prone to fracture risk in people with chronic diseases. The second metatarsal is a common site for the development of insufficiency fractures, and as such the aim of this study was to assess the reproducibility of a novel scanning protocol of the second metatarsal using pQCT. Methods. Eleven embalmed cadaveric leg specimens were scanned six times; three times with and without repositioning. Each foot was positioned on a custom-designed acrylic foot plate to permit unimpeded scans of the region of interest. Sixty-six scans were obtained at 15% (distal) and 50% (mid shaft) of the second metatarsal. Voxel size and scan speed were reduced to 0.40 mm and 25 mm.sec-1. The reference line was positioned at the most distal portion of the 2nd metatarsal. Repeated measurements of six key variables related to bone properties were subject to reproducibility testing. Data were log transformed and reproducibility of scans were assessed using intraclass correlation coefficients (ICC) and coefficients of variation (CV%). Results: Reproducibility of the measurements without repositioning were estimated as: trabecular area (ICC 0.95; CV% 2.4), trabecular density (ICC 0.98; CV% 3.0), Strength Strain Index (SSI) - distal (ICC 0.99; CV% 5.6), cortical area (ICC 1.0; CV% 1.5), cortical density (ICC 0.99; CV% 0.1), SSI - mid shaft (ICC 1.0; CV% 2.4). Reproducibility of the measurements after repositioning were estimated as: trabecular area (ICC 0.96; CV% 2.4), trabecular density (ICC 0.98; CV% 2.8), SSI - distal (ICC 1.0; CV% 3.5), cortical area (ICC 0.99; CV%2.4), cortical density (ICC 0.98; CV% 0.8), SSI - mid shaft (ICC 0.99; CV% 3.2). Conclusions: The scanning protocol generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the 2 nd metatarsal. This protocol extends the capabilities of pQCT to evaluate bone quality in people who may be at an increased risk of metatarsal insufficiency fractures

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Optimal allocations of agricultural intensity reveal win-no loss solutions for food production and biodiversity

publication en ligne 23 avril 2016Reconciling biodiversity conservation and food production may require the fine-tuning of both agricultural intensity and its spatial allocation. Here, we explored whether the optimization of allocation of intensity could improve food production and biodiversity outcomes. We developed a spatially explicit, multi-criteria optimization model for agricultural intensity allocation at the scale of France and at the resolution of small agricultural regions (SARs) with a mean area of 669.6 km2. Three thousand allocations were randomly simulated and then optimized under three scenarios: intensification, extensification, and reallocation. Optimization was based on food production and biodiversity outcomes using several metrics, such as habitat specialization and trophic level, that reflect the composition of farmland bird communities. The optimization was based on derived statistical relationships between intensity and the production and biodiversity metrics at the SAR scale using national agricultural statistics and bird census data. Simulations showed that optimal allocations modulated the trade-off among criteria and led to increased efficiency, with optimal extensification increasing biodiversity and minimizing production losses. Furthermore, we revealed “win-no loss” solutions. For example, optimal intensification increased production with almost no biodiversity loss and optimal reallocation benefited biodiversity with almost no cost to production. A variety of agricultural intensity levels were necessary to maintain a diversity of farmland bird communities at the national scale. Although we demonstrate that optimal allocation of intensity can be a powerful means of reconciling diverse criteria at the national scale, its implementation will require new mechanisms for spatially targeted and coordinated policies