Predictors of health-related quality of life and costs in adults with epilepsy: A systematic review

Purpose: Given the high burden of epilepsy on both health‐related quality of life (HRQoL) and costs, identification of factors that are predictive of either reduced HRQoL or increased expenditure is central to the better future targeting and optimization of existing and emerging interventions and management strategies for epilepsy. Methods: Searches of Medline, Embase, and Cochrane Library (up to July 2010) to identify studies examining the association between demographic, psychosocial, and condition‐related factors and HRQoL, resource utilization or costs in adults with epilepsy. For each study, predictor factor associations were summarized on the basis of statistical significance and direction; the results were then combined across studies. Key Findings: Ninety‐three HRQoL and 16 resource utilization/cost studies were included. Increases in seizure frequency, seizure severity, level of depression, and level of anxiety and presence of comorbidity were strongly associated with reduced HRQoL. The majority of studies were cross‐sectional in design and had an overall methodologic quality that was judged to be “moderate” for HRQoL studies and “poor” for health care resource or costs studies. In the 53 multivariate studies, age, gender, marital status, type of seizure, age at diagnosis, and duration of epilepsy did not appear to be associated with HRQoL, whereas the predictive influence of educational and employment status, number of antiepileptic drugs (AEDs) and AED side effects was unclear. The association between predictive factors and HRQoL appeared to be consistent across individuals whether refractory or seizures controlled or managed by AEDs. There were insufficient multivariate studies (five) to reliably comment on the predictors of resource utilization or cost in epilepsy. Significance: In addition to seizure control, effective epilepsy management requires the early detection of those most at risk of psychological dysfunction and comorbidity, and the targeting of appropriate interventions. There is need for more rigorous studies with appropriate multivariate statistical methods that prospectively investigate the predictors of HRQoL, resource utilization, and costs in epilepsy

Bulgaria: sea-level change and submerged settlements on the Black Sea

The Black Sea is recognised as having great potential for the preservation of submerged prehistoric sites because of the large area of land exposed on the continental shelf at lowest sea levels, especially along its western and north-western coastlines. However, very few have been discovered to date, and those that are known are located in Bulgaria. Because of the complexities associated with the periodic isolation of the Black Sea from the Mediterranean and its reconnection, offshore research has tended to focus on geological and geophysical investigation of inundation history, with unresolved and strongly-held disagreements about the timing and rapidity of sea level rise at the end of the Last Glacial and its potential human impact. In Bulgaria, a rich concentration of underwater prehistoric sites has been discovered thanks to dredging activities earlier in the 20th century and a long tradition of underwater archaeological investigations going back to the 1970s. These demonstrate the presence of substantial in situ village settlements of Eneolithic and Early Bronze Age date in shallow water (< 10 m), with excellent preservation of large ceramic assemblages, wooden structures, and faunal and palynological data on palaeodiet and palaeoeconomy. More recently, large scale marine-geological and archaeological projects have begun, aimed at integrating shallow-water inshore investigations with offshore survey in deeper water

Adenosine Signaling in the Tumor Microenvironment

Adenosine, deriving from ATP released by dying cancer cells and then degradated in the tumor environment by CD39/CD73 enzyme axis, is linked to the generation of an immunosuppressed niche favoring the onset of neoplasia. Signals delivered by extracellular adenosine are detected and transduced by G-protein-coupled cell surface receptors, classified into four subtypes: A1, A2A, A2B, and A3. A critical role of this nucleoside is emerging in the modulation of several immune and nonimmune cells defining the tumor microenvironment, providing novel insights about the development of novel therapeutic strategies aimed at undermining the immune-privileged sites where cancer cells grow and proliferate