Psychiatric Comorbidities in People With Epilepsy.

Purpose of Review: To review the latest evidence concerning the epidemiology, clinical implications, and management of psychiatric disorders in epilepsy. Recent Findings: People with epilepsy have a 2-5 times increased risk of developing any psychiatric disorder, and 1 in 3 patients with epilepsy have a lifetime psychiatric diagnosis. Psychiatric comorbidities represent a poor prognostic marker as they have been associated with a poor response to treatment (drugs and surgery), increased morbidity, and mortality. Validated screening instruments are available for mood and anxiety disorders in adults as well as attention-deficit hyperactivity disorder in children with epilepsy. Summary: All patients with epilepsy should be routinely screened for psychiatric disorder at the onset and at least once a year. Patients with epilepsy and their relatives should be informed of the risk of mental health problems and the implications

Chapter 08: Conclusions and Recommendations

Here we review brief summaries by chapter and then derive some integrated conclusions across chapters. Recommendations are presented with respect to further research, outreach and policy consideration. Because several years have passed between the end of our field work and publication of this synthesis volume, we end with an epilogue that highlights changes and key events that happened at San José Llanga (SJL) and with collaborating institutions in Bolivia between 1996-9.https://digitalcommons.usu.edu/sustaining_agropastoralism/1007/thumbnail.jp

Association of metabolic equivalent of task (MET) score in length of stay in hospital following radical cystectomy with urinary diversion:a multi-institutional study

PURPOSE: The Metabolic equivalent of task (MET) score is used in patients’ preoperative functional capacity assessment. It is commonly thought that patients with a higher MET score will have better postoperative outcomes than patients with a lower MET score. However, such a link remains the subject of debate and is yet unvalidated in major urological surgery. This study aimed to explore the association of patients’ MET score with their postoperative outcomes following radical cystectomy. METHODS: We used records-linkage methodology with unique identifiers (Community Health Index/hospital number) and electronic databases to assess postoperative outcomes of patients who had underwent radical cystectomies between 2015 and 2020. The outcome measure was patients’ length of hospital stay. This was compared with multiple basic characteristics such as age, sex, MET score and comorbid conditions. A MET score of less than four (< 4) is taken as the threshold for a poor functional capacity. We conducted unadjusted and adjusted Cox regression analyses for time to discharge against MET score. RESULTS: A total of 126 patients were included in the analysis. Mean age on date of operation was 66.2 (SD 12.2) years and 49 (38.9%) were female. A lower MET score was associated with a statistically significant lower time-dependent risk of hospital discharge (i.e. longer hospital stay) when adjusted for covariates (HR 0.224; 95% CI 0.077–0.652; p = 0.006). Older age (adjusted HR 0.531; 95% CI 0.332–0.848; p = 0.008) and postoperative complications (adjusted HR 0.503; 95% CI 0.323–0.848; p = 0.002) were also found to be associated with longer hospital stay. Other comorbid conditions, BMI, disease staging and 30-day all-cause mortality were statistically insignificant. CONCLUSION: A lower MET score in this cohort of patients was associated with a longer hospital stay length following radical cystectomy with urinary diversion. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11255-021-02813-x

Use of complementary and alternative medicine by those with a chronic disease and the general population - results of a national population based survey

<p>Abstract</p> <p>Background</p> <p>The use of complementary and alternative medicine (CAM) is becoming more common, but population-based descriptions of its patterns of use are lacking. This study aimed to determine the prevalence of CAM use in the general population and for those with asthma, diabetes, epilepsy and migraine.</p> <p>Methods</p> <p>Data from cycles 1.1, 2.1 and 3.1 of the Canadian Community Health Survey (CCHS) were used for the study. The CCHS is a national cross-sectional survey administered to 400,055 Canadians aged ≥12 between 2001-2005. Self-reported information about professionally diagnosed health conditions was elicited. CCHS surveys use a multistage stratified cluster design to randomly select a representative sample of Canadian household residents. Descriptive data on the utilization of CAM services was calculated and logistic regression was used to determine what sociodemographic factors predict CAM use.</p> <p>Results</p> <p>Weighted estimates show that 12.4% (95% Confidence Interval (CI): 12.2-12.5) of Canadians visited a CAM practitioner in the year they were surveyed; this rate was significantly higher for those with asthma 15.1% (95% CI: 14.5-15.7) and migraine 19.0% (95% CI: 18.4-19.6), and significantly lower for those with diabetes 8.0% (95% CI: 7.4-8.6) while the rate in those with epilepsy (10.3%, 95% CI: 8.4-12.2) was not significantly different from the general population.</p> <p>Conclusion</p> <p>A large proportion of Canadians use CAM services. Physicians should be aware that their patients may be accessing other services and should be prepared to ask and answer questions about the risks and benefits of CAM services in conjunction with standard medical care.</p

Cracking and Corrosion of Composite Tubes in Black Liquor Recovery Boiler Primary Air Ports

Black liquor recovery boilers are an essential part of kraft mills. Their design and operating procedures have changed over time with the goal of providing improved boiler performance. These performance improvements are frequently associated with an increase in heat flux and/or operating temperature with a subsequent increase in the demand on structural materials associated with operation at higher temperatures and/or in more corrosive environments. Improvements in structural materials have therefore been required. In most cases the alternate materials have provided acceptable solutions. However, in some cases the alternate materials have solved the original problem but introduced new issues. This report addresses the performance of materials in the tubes forming primary air port openings and, particularly, the problems associated with use of stainless steel clad carbon steel tubes and the solutions that have been identified

Does the type of silvicultural practice influence spruce budworm defoliation of seedlings?

Spruce budworm (Choristoneura fumiferana (Clem)) is the main defoliator in the boreal forest of North America, and its outbreaks have major ecological and economic consequences and represent a challenge for forest management. Numerous studies have addressed the effects of this defoliator on mature trees, whereas the effects of spruce budworm on regeneration remain elusive. Furthermore, intensive exploitation practices during the last decades have left a large area of the Canadian boreal forest in an early development stage. In this context, it becomes vital to understand those factors affecting the severity of spruce budworm-related defoliation on regeneration. Here, we determine the defoliation severity of black spruce and balsam fir seedlings in both mature pure black spruce and black spruce-balsam fir stands subjected to two different silvicultural treatments (clear-cutting and partial cutting). Defoliation intensity varied between stand types, silvicultural treatments, species, and height classes. Seedlings in black spruce-balsam fir stands experienced twice the defoliation of those in pure black spruce stands (black spruce seedlings 10% vs. 23%; balsam fir seedlings 29% vs. 47%, respectively). Harvesting methods also influenced seedling defoliation. Under clear-cutting, black spruce seedlings (24%) were three times as defoliated as black spruce seedlings in partial cutting stands (8%), whereas balsam fir seedlings in clear-cutting plots experienced twice the defoliation (42%) of balsam fir seedlings in partial cutting plots (20%). The level of defoliation also increased with seedling height. This study will help silvicultural strategies adapt to the effects of natural disturbance regimes. As the intensity and severity of defoliator outbreaks are expected to increase under climate change, these results will help guide forest management strategies to select harvesting methods that will limit the effects of defoliation on conifer regeneration