Provision of care to people with epilepsy: standards and mortality.

Background: Audits of service provision for people with epilepsy in the UK have shown care to be substandard. People with epilepsy may die prematurely, and substandard care may contribute to this.;Methods: The Chiltern audit is a records audit of people taking anti-epileptic drugs in 12 general practices in Buckinghamshire. The National Sentinel Clinical Audit of Epilepsy-related death is an audit of deaths certified as being epilepsy-related in one year in the UK the primary and specialist care sections were further explored in this thesis. In both audits documented care was compared with published standards. Data from an incident cohort of people with epilepsy were examined to investigate which details predicted inclusion of epilepsy on the death certificate. The standardised mortality ratio (SMR) for epilepsy in England and Wales was calculated from death certificates including epilepsy. A re-analysis of a previously published meta-analysis of suicide in epilepsy was performed.;Results: The primary care audits found evidence of recent epilepsy review in fewer than two thirds of people with epilepsy. These audits suffered from lack of evidence in the clinical records. The overall standard of specialist care was adequate in under half, but there was no evidence of different standards of care in people with and without learning disability. Epilepsy is indicated in seven percent of death certificates of people with epilepsy, confirming that they do not provide appropriate case ascertainment for studying death in people with epilepsy. The investigation of suicide in England and Wales shows that they are similarly unsuitable for investigating deaths from suicide in people with epilepsy. The SMR for suicide in epilepsy is significantly increased.;Conclusion: Poor record keeping hampers assessment of care by audit. Epilepsy care may often be substandard, but death as outcome is far removed from delivery of care other outcomes are considered

Cause of death and predictors of mortality in a community-based cohort of people with epilepsy.

OBJECTIVE: The risk of premature mortality is increased in people with epilepsy. The reasons for this and how it may relate to epilepsy etiology remain unclear. METHODS: The National General Practice Study of Epilepsy is a prospective, community-based cohort that includes 558 people with recurrent unprovoked seizures of whom 34% died during almost 25 years of follow-up. We assessed the underlying and immediate causes of death and their relationship to epilepsy etiology. Psychiatric and somatic comorbidities of epilepsy as predictors of mortality were scrutinized using adjusted Cox proportional hazards models. RESULTS: The 3 most common underlying causes of death were noncerebral neoplasm, cardiovascular, and cerebrovascular disease, accounting for 59% (111/189) of deaths, while epilepsy-related causes (e.g., sudden unexplained death in epilepsy) accounted for 3% (6/189) of deaths. In 23% (43/189) of individuals, the underlying cause of death was directly related to the epilepsy etiology; this was significantly more likely if death occurred within 2 years of the index seizure (percent ratio 4.28 [95% confidence interval 2.63-6.97]). Specific comorbidities independently associated with increased risk of mortality were neoplasms (primary cerebral and noncerebral neoplasm), certain neurologic diseases, and substance abuse. CONCLUSIONS: Comorbid diseases are important causes of death, as well as predictors of premature mortality in epilepsy. There is an especially strong relationship between cause of death and epilepsy etiology in the first 2 years after the index seizure. Addressing these issues may help stem the tide of premature mortality in epilepsy

A randomized controlled trial: the effect of inulin on weight management and ectopic fat in subjects with prediabetes.

BACKGROUND: Fat infiltration of the liver, muscle and pancreas is associated with insulin resistance and risk of diabetes. Weight loss reduces ectopic fat deposition and risk of diabetes, but is difficult to sustain to due to compensatory increases in appetite. Fermentable carbohydrates have been shown to decrease appetite and food intake, and promote weight loss in overweight subjects. In animal studies, fermentable carbohydrate reduces ectopic fat independent of weight loss. We aimed to investigate the effect of the fermentable carbohydrate inulin on weight maintenance, appetite and ectopic fat in subjects with prediabetes. METHODS: Forty-four subjects with prediabetes were randomized to 18 weeks' inulin or cellulose supplementation. During weeks 1-9 (weight loss phase) all subjects had four visits with a dietitian to guide them towards a 5 % weight loss. During weeks 10-18 (weight maintenance phase) subjects continued taking their assigned supplementation and were asked to maintain the weight they had lost but were offered no further support. All subjects attended study sessions at baseline, 9 and 18 weeks for measurement of weight; assessment of adipose tissue and ectopic fat content by magnetic resonance imaging and magnetic resonance spectroscopy; glucose, insulin and GLP-1 levels following a meal tolerance test; and appetite by ad libitum meal test and visual analogue scales. RESULTS: Both groups lost approximately 5 % of their body weight by week nine (-5.3 ± 0.1 % vs -4.3 ± 0.4 %, p = 0.13, but the inulin group lost significantly more weight between 9 and 18 weeks (-2.3 ± 0.5 % vs -0.6 ± 0.4 %, p = 0.012). Subjects taking inulin had lower hepatic (p = 0.02) and soleus muscle (p < 0.05) fat content at 18 weeks compared to control even after controlling for weight loss and consumed less at the ad libitum meal test (p = 0.027). Fasting glucose significantly decreased at week nine only (p = 0.005), insulin concentrations did not change, and there was a significant increase in GLP-1 in the cellulose group at 9 and 18 weeks (p < 0.03, p < 0.00001). CONCLUSION: Inulin may have a two-pronged effect on the risk of diabetes by 1) promoting weight loss 2) reducing intrahepatocellular and intramyocellular lipid in people with prediabetes independent of weight loss

Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?

Background: Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy. Methods: The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery). Results: There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8). Conclusion: Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.<br/

Cortical Processing of Global Form, Motion and Biological Motion Under Low Light Levels

Advances in potential treatments for rod and cone dystrophies have increased the need to understand the contributions of rods and cones to higher-level cortical vision. We measured form, motion and biological motion coherence thresholds and EEG steady-state visual evoked potentials (SSVEP) responses under light conditions ranging from photopic to scotopic. Low light increased thresholds for all three kinds of stimuli; however, global form thresholds were relatively more impaired than those for global motion or biological motion. SSVEP responses to coherent global form and motion were reduced in low light, and motion responses showed a shift in topography from the midline to more lateral locations. Contrast sensitivity measures confirmed that basic visual processing was also affected by low light. However, comparison with contrast sensitivity function (CSF) reductions achieved by optical blur indicated that these were insufficient to explain the pattern of results, although the temporal properties of the rod system may also play a role. Overall, mid-level processing in extra-striate areas is differentially affected by light level, in ways that cannot be explained in terms of low-level spatiotemporal sensitivity. A topographical shift in scotopic motion SSVEP responses may reflect either changes to inhibitory feedback mechanisms between V1 and extra-striate regions or a reduction of input to the visual cortex. These results provide insight into how higher-level cortical vision is normally organised in absence of cone input, and provide a basis for comparison with patients with cone dystrophies, before and after treatments aiming to restore cone function

Verificación de un equipo FDR para la medida del contenido de agua del suelo en dos sistemas de cultivo

[ES] Se ha estudiado el comportamiento de un equipo FDR (sonda multisensor EnviroSCAN, Sentek PTY LTD, Adelaine, South Autralia) para su uso en la programación de riegos de dos sistemas de explotación diferentes (plantación de olivar regada por goteo y parcela de trigo regada por aspersión). En cada una de ellas se instaló un equipo EnviroSCAN con varias sondas de medida del contenido de agua en profundidad, y varios tubos de acceso de sonda de neutrones. En primer lugar, se compararon los contenidos de agua calculados a partir de las medidas realizadas con ambos sistemas de medida. Se encontraron buenos ajustes lineales (R2 mayores de 0.70), salvo para los sensores más profundos, es decir, con pequeñas variaciones de humedad (valores entre 0.043 a 0.054 cm3/cm3), y en las parcelas no regadas. Además, era apreciable la descalibración del sistema de medida EnviroSCAN, consecuencia de la utilización de la recta de calibración facilitada por el fabricante. Por último, se calibró el sistema EnviroSCAN utilizando los datos del primer año de medida para corregir los del segundo. Así, se encontró que aunque no se mejoraron las regresiones realizadas, el RMSE se mejoró considerablemente tanto para las medidas superficiales, como para los contenidos de humedad medios del perfil de profundidad determinada.Moreno-Pérez, M.; Villalobos Martín, F.; Fereres Castiel, E. (2005). Verificación de un equipo FDR para la medida del contenido de agua del suelo en dos sistemas de cultivo. Ingeniería del agua. 12(4):345-359. https://doi.org/10.4995/ia.2005.2570OJS345359124Baumhardt, R.L; Lascano, R.J.; Evett, S.R. (2000). Soil material, temperature, and salinity effects on calibration of multisensor capacitance probes. Soil Sci. Soc. Am. J. Nov/Dec 2000. v. 64 (6) p. 1940-1946.Bell, J.P.; Dean, T.J.; Hodnett, M.G. (1987). Soil moisture measurement by an improved capacitance technique. II: field techniques, evaluation and calibration, J. 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The role of insulin receptor substrate 2 in hypothalamic and β cell function

Insulin receptor substrate 2 (Irs2) plays complex roles in energy homeostasis. We generated mice lacking Irs2 in β cells and a population of hypothalamic neurons (RIPCreIrs2KO), in all neurons (NesCreIrs2KO), and in proopiomelanocortin neurons (POMCCreIrs2KO) to determine the role of Irs2 in the CNS and β cell. RIPCreIrs2KO mice displayed impaired glucose tolerance and reduced β cell mass. Overt diabetes did not ensue, because β cells escaping Cre-mediated recombination progressively populated islets. RIPCreIrs2KO and NesCreIrs2KO mice displayed hyperphagia, obesity, and increased body length, which suggests altered melanocortin action. POMCCreIrs2KO mice did not display this phenotype. RIPCreIrs2KO and NesCreIrs2KO mice retained leptin sensitivity, which suggests that CNS Irs2 pathways are not required for leptin action. NesCreIrs2KO and POMCCreIrs2KO mice did not display reduced β cell mass, but NesCreIrs2KO mice displayed mild abnormalities of glucose homeostasis. RIPCre neurons did not express POMC or neuropeptide Y. Insulin and a melanocortin agonist depolarized RIPCre neurons, whereas leptin was ineffective. Insulin hyperpolarized and leptin depolarized POMC neurons. Our findings demonstrate a critical role for IRS2 in β cell and hypothalamic function and provide insights into the role of RIPCre neurons, a distinct hypothalamic neuronal population, in growth and energy homeostasis

Optimal States for Bell inequality Violations using Quadrature Phase Homodyne Measurements

We identify what ideal correlated photon number states are to required to maximize the discrepancy between local realism and quantum mechanics when a quadrature homodyne phase measurement is used. Various Bell inequality tests are considered.Comment: 6 pages, 5 Figure