‘Destination’ Berlin revisited. From (new) tourism towards a pentagon of mobility and place consumption

This article is concerned with the increasing role and relevance of tourism in processes of urban change as well as its overlap and interplay with other mobilities and place consumption practices. It responds to recent debates surrounding the extension and intensification of ‘touristification’ processes in urban areas and uses the case of Berlin to draw attention to a number of intricacies and complexities that complicate their interpretation. The main argument the article advances is that developments in Berlin which are currently discussed under the rubric of ‘touristification’ can by no means be exclusively attributed to tourism, however conceived, and instead illustrate the need to adopt new ways of approaching and understanding what is perceived as tourism-induced urban change. To this end, the article will present a preliminary heuristic portrayal of (tourism) mobility and place consumption as a pentagon with five interrelated but distinct dimensions and present several salient issues and questions that warrant further investigation. The paper will conclude with some brief reflections concerning the wider implications of the increased centrality of mobility flows and place consumption practices in today's cities. These, it will be argued, not only challenge the way we think about tourism. Rather, they also raise fundamental questions concerning our understanding of cities and neighbourhoods, the ‘legitimacy’ of particular claims over them, as well as several traditional precepts of modern urban planning and management

Urban tourism as a bone of contention. Four explanatory hypotheses and a caveat

This commentary responds to recent debates surrounding the observable proliferation and intensification of controversies and disputes surrounding urban tourism. It argues that coming to terms with conflicts about and around tourism in cities represents an important frontier for research and puts forth some observations about its causes and characteristics, the debates they have sparked, and our scholarly engagement with them so far. In particular, the commentary will address (i) the role of urban tourism’s massive and often rapid growth; (ii) the fact that backlashes in cities are often less directed against tourism in its entirety than against particular kinds of tourism (or tourists); (iii) the need to look at contestations surrounding urban tourism not in isolation from, but in firm connection to the more general rise of struggles and protests in and about urban space unfolding in cities worldwide ; (iv) the extent to which contestations are are linked to the ongoing, and, it seems, accelerating, geographical spread of tourism; and, lastly, (v) the need to critically engage with the notion of tourism itself and move beyond essentialising narratives that portray tourism as an alltogether distinct, easily separable social phenomenon

Urban tourism as a bone of contention. Four explanatory hypotheses and a caveat

This commentary responds to recent debates surrounding the observable proliferation and intensification of controversies and disputes surrounding urban tourism. It argues that coming to terms with conflicts about and around tourism in cities represents an important frontier for research and puts forth some observations about its causes and characteristics, the debates they have sparked, and our scholarly engagement with them so far. In particular, the commentary will address (i) the role of urban tourism’s massive and often rapid growth; (ii) the fact that backlashes in cities are often less directed against tourism in its entirety than against particular kinds of tourism (or tourists); (iii) the need to look at contestations surrounding urban tourism not in isolation from, but in firm connection to the more general rise of struggles and protests in and about urban space unfolding in cities worldwide ; (iv) the extent to which contestations are are linked to the ongoing, and, it seems, accelerating, geographical spread of tourism; and, lastly, (v) the need to critically engage with the notion of tourism itself and move beyond essentialising narratives that portray tourism as an alltogether distinct, easily separable social phenomenon

Recurrence of status epilepticus: Prognostic role and outcome predictors.

OBJECTIVE: Predictors of morbidity and mortality after status epilepticus (SE) have been studied extensively in hospital- and population-based cohorts. However, little attention has been directed toward SE recurrence after an incident episode. We investigated clinical and demographic characteristics of patients presenting SE recurrence and its specific prognostic role. METHODS: In this observational cohort study, we screened our prospective registry of consecutive adults with SE between April 2006 and February 2014. Demographic and clinical data were compared between incident and recurrent SE episodes; risk of SE recurrence was assessed through survival analysis, and the prognostic role of SE recurrence with multivariable logistic regressions. RESULTS: Of the incident cohort (509 patients), 68 (13%) experienced recurrent SE. The cumulative recurrence rate over 4 years was 32%. Recurrence risk was significantly reduced after an acute SE etiology (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.31-0.82; p = 0.005), and was borderline increased in women (HR 1.59, 95% CI 0.97-2.65; p = 0.06). Although recurrent SE episodes showed lower morbidity and mortality, prognosis was independently related to Status Epilepticus Severity Score (STESS) and potentially fatal etiology, but not to SE recurrence. SIGNIFICANCE: This study provides class III evidence that SE recurrence involves a significant proportion of patients, and that recurrence risk is independently associated with chronic etiology and to a lesser extent with female gender. However, contrary to underlying cause and SE severity, SE recurrence per se does not independently correlate with outcome. Early identification of patients at higher risk of SE recurrence may influence their management during follow-up

Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents.

Newer antiepileptic drugs (AEDs) are increasingly prescribed; however, relatively limited data are available regarding their use in status epilepticus (SE) and the impact on outcome. The aim of this study was to explore the evolution in prescription patterns of newer and traditional AEDs in this clinical setting, and their association with prognosis. We analyzed our prospective adult SE registry over a 10-year period (2007-2016) and assessed the yearly use of newer and traditional AEDs and their association with mortality, return to baseline conditions at discharge, and SE refractoriness, defined as treatment resistance to two AEDs, including benzodiazepines. In 884 SE episodes, corresponding to 719 patients, the prescription of at least one newer AED increased from 0.38 per SE episode in 2007 to 1.24 per SE episode in 2016 (mostly due to the introduction of levetiracetam and lacosamide). Traditional AEDs (excluding benzodiazepines) decreased over time from 0.74 in 2007 to 0.41 in 2016, correlating with the decreasing use of phenytoin. The prescription of newer AEDs was independently associated with a lower chance of return to baseline conditions at discharge (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.40-0.84) and a higher rate of SE refractoriness (OR 19.84, 95% CI 12.76-30.84), but not with changes in mortality (OR 1.08, 95% CI 0.58-2.00). We observed a growing trend in the prescription of newer AEDs in SE over the last decade; however, our findings might suggest an associated increased risk of SE refractoriness and new disability at hospital discharge. Pending prospective, comparative studies, this may justify some caution in the routine use of newer AEDs in SE

Age, Comorbidity, Frailty in Observational and Analytic Studies of Neurological Diseases

BACKGROUND: Comorbidities are rarely taken into account in studies of neurological conditions although they may be a confounder of the outcome and treatment. The relationship between comorbidities and neurological conditions is also problematic as comorbidities may be symptoms of the underlying cause of the neurologic condition or long-term adverse effects of the treatment. SUMMARY: There is evidence that several common neurological conditions have an increased burden of somatic and psychiatric comorbidities compared with matched samples from the general population. Depression is probably the most common comorbidity. Both psychiatric and somatic comorbidities have been shown to account for some of the premature mortality encountered in these neurological conditions. Comorbidities and age can also be important factors in the response and tolerance to treatment, and can alter the general outcome of a disease. KEY MESSAGES: Age and comorbidities should not be overlooked in the observation and assessment of neurological conditions and their treatment

EEG reactivity to pain in comatose patients: Importance of the stimulus type.

INTRODUCTION: Electroencephalogram (EEG) background reactivity is a potentially interesting outcome predictor in comatose patients, especially after cardiac arrest, but recent studies report only fair interrater reliability. Furthermore, there are no definite guidelines for its testing. We therefore investigated the EEG effect of standardized noxious stimuli in comatose patients not reactive to auditory stimuli. METHODS: In this prospective study we applied a protocol using three different painful stimuli (bilateral nipple pinching, pinprick at the nose base, finger-nail compression on each side), grouped in three distinct clusters with an alternated sequence, during EEG recordings in comatose patients. We only analyzed recordings showing any reactivity to pain. Fisher and χ2 tests were used as needed to assess contingency tables. RESULTS: Of 42 studies, 12 did not show any background reactivity, 2 presented SIRPIDs, and 2 had massive artefacts; we thus analyzed 26 EEGs recorded in 17 patients (4 women, 24%). Nipple pinching more frequently induced a change in EEG background activity (p<0.001), with a sensitivity of 97.4% for reactivity. Neither the order of the stimuli in the cluster (p=0.723), nor the cluster order (p=0.901) influenced the results. CONCLUSION: In this pilot study, bilateral, synchronous nipple pinching seems to be the most efficient method to test nociceptive EEG reactivity in comatose patients. This approach may enhance interrater reliability, but deserves confirmation in larger cohorts

FPGA based data acquisition system for COMPASS experiment

This paper discusses the present data acquisition system (DAQ) of the COMPASS experiment at CERN and presents development of a new DAQ. The new DAQ must preserve present data format and be able to communicate with FPGA cards. Parts of the new DAQ are based on state machines and they are implemented in C++ with usage of the QT framework, the DIM library, and the IPBus technology. Prototype of the system is prepared and communication through DIM between parts was tested. An implementation of the IPBus technology was prepared and tested. The new DAQ proved to be able to fulfill requirements.Comment: 8 pages, CHEP 201

Yield of Outpatient Sleep EEG for Epileptiform Alterations' Detection in Children.

PURPOSE: Ambulatory EEGs in children are frequently ordered as sleep studies. However, the yield according to different clinical situations has received little attention to date. The authors aimed to quantify the added value in terms of detection of epileptiform features of an EEG containing sleep, as compared with only wakefulness, according to the referral diagnoses. METHODS: The authors retrospectively selected consecutive outpatients' EEG recordings of patients between 6 months to 16 years old, performed between January 2014 and February 2015. The authors excluded those lacking at least 10 minutes of waking and/or at least 5 minutes of behavioral sleep. Interictal epileptiform activity (IEA) in wakefulness and sleep was compared among referral suspected diagnoses. Additional yield of sleep was considered if at least one of the following was observed: appearance of interictal epileptiform activity or increase by >50%; interictal epileptiform activity change in localization or morphology, seizure occurrence. RESULTS: A total of 425 recordings (mean age 6.9 ± 4.7 years) were analyzed. Of them, 194 (45.6%) presented an additional yield during sleep, which was dependent on the occurrence of IEA during wakefulness: 77/251 (30.7%) in those without versus 117/174 (67.2%) in those with wakefulness IEA (P < 0.001, χ). The yield was markedly lower in studies performed for nonepileptic referral diagnoses (7% vs. 43% to 100%; P < 0.001, Fisher). CONCLUSIONS: When wakefulness EEG lacks epileptiform features, the yield of sleep EEG in our pediatric population appeared modest, especially in patients without a suspected epileptic syndrome. This information may be used to optimize the request of sleep EEG in children

Status epilepticus of inflammatory etiology: A cohort study.

OBJECTIVE: Inflammation-related epilepsy is increasingly recognized; however, studies on status epilepticus (SE) are very infrequent. We therefore aimed to determine the frequency of inflammatory etiologies in adult SE, and to assess related demographic features and outcomes. METHODS: This was a retrospective analysis of a prospective registry of adult patients with SE treated in our center, from January 2008 to June 2014, excluding postanoxic causes. We classified SE episodes into 3 etiologic categories: infectious, autoimmune, and noninflammatory. Demographic and clinical variables were analyzed regarding their relationship to etiologies and functional outcome. RESULTS: Among the 570 SE consecutive episodes, 33 (6%) were inflammatory (2.5% autoimmune; 3.3% infectious), without any change in frequency over the study period. Inflammatory SE episodes involved younger patients (mean age 53 vs 61 years, p = 0.015) and were more often refractory to initial antiepileptic treatment (58% vs 38%, odds ratio = 2.19, 95% confidence interval = 1.07-4.47, p = 0.041), despite similar clinical outcome. Subgroup analysis showed that, compared with infectious SE episodes, autoimmune SE involved younger adults (mean age 44 vs 60 years, p = 0.017) and was associated with lower morbidity (return to baseline conditions in 71% vs 32%, odds ratio = 5.41, 95% confidence interval = 1.19-24.52, p = 0.043) without any difference in mortality. CONCLUSIONS: Despite increasing awareness, inflammatory SE etiologies were relatively rare; their occurrence in younger individuals and higher refractoriness to treatment did not have any effect on outcome. Autoimmune SE episodes also occurred in younger patients, but tended to have better outcomes in survivors than infectious SE