Timing matters: impact of anticonvulsant drug treatment and spikes on seizure risk in benign epilepsy with centrotemporal spikes

OBJECTIVE: Benign epilepsy with centrotemporal spikes (BECTS) is a common, self-limited epilepsy syndrome affecting school-age children. Classic interictal epileptiform discharges (IEDs) confirm diagnosis, and BECTS is presumed to be pharmacoresponsive. As seizure risk decreases in time with this disease, we hypothesize that the impact of IEDs and anticonvulsive drug (ACD) treatment on the risk of subsequent seizure will differ based on disease duration. METHODS: We calculate subsequent seizure risk following diagnosis in a large retrospective cohort of children with BECTS (n = 130), evaluating the impact of IEDs and ACD treatment in the first, second, third, and fourth years of disease. We use a Kaplan-Meier survival analysis and logistic regression models. Patients were censored if they were lost to follow-up or if they changed group status. RESULTS: Two-thirds of children had a subsequent seizure within 2 years of diagnosis. The majority of children had a subsequent seizure within 3 years despite treatment. The presence of IEDs on electroencephalography (EEG) did not impact subsequent seizure risk early in the disease. By the fourth year of disease, all children without IEDs remained seizure free, whereas one-third of children with IEDs at this stage had a subsequent seizure. Conversely, ACD treatment corresponded with lower risk of seizure early in the disease but did not impact seizure risk in later years. SIGNIFICANCE: In this cohort, the majority of children with BECTS had a subsequent seizure despite treatment. In addition, ACD treatment and IEDs predicted seizure risk at specific points of disease duration. Future prospective studies are needed to validate these exploratory findings.Published versio

Wind Signatures In The X-Ray Emission-Line Profiles Of The Late-O Supergiant Zeta Orionis

X-ray line-profile analysis has proved to be the most direct diagnostic of the kinematics and spatial distribution of the very hot plasma around O stars. The Doppler-broadened line profiles provide information about the velocity distribution of the hot plasma, while the wavelength-dependent attenuation across a line profile provides information about the absorption to the hot plasma, thus providing a strong constraint on its physical location. In this paper, we apply several analysis techniques to the emission lines in the Chandra High Energy Transmission Grating Spectrometer (HETGS) spectrum of the late-O supergiant zeta Ori (O9.7 Ib), including the fitting of a simple line-profile model. We show that there is distinct evidence for blueshifts and profile asymmetry, as well as broadening in the X-ray emission lines of zeta Ori. These are the observational hallmarks of a wind-shock X-ray source, and the results for zeta Ori are very similar to those for the earlier O star, zeta Pup, which we have previously shown to be well fit by the same wind-shock line-profile model. The more subtle effects on the line-profile morphologies in zeta Ori, as compared to zeta Pup, are consistent with the somewhat lower density wind in this later O supergiant. In both stars, the wind optical depths required to explain the mildly asymmetric X-ray line profiles imply reductions in the effective opacity of nearly an order of magnitude, which may be explained by some combination of mass-loss rate reduction and large-scale clumping, with its associated porosity-based effects on radiation transfer. In the context of the recent reanalysis of the helium-like line intensity ratios in both zeta Ori and zeta Pup, and also in light of recent work questioning the published mass-loss rates in OB stars, these new results indicate that the X-ray emission from zeta Ori can be understood within the framework of the standard wind-shock scenario for hot stars

Future Challenges in Psychotherapy Research for Personality Disorders

Purpose of Review Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. Recent Findings Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. Summary We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy

Wind signatures in the X-ray emission line profiles of the late O supergiant ζ\zeta Orionis

X-ray line profile analysis has proved to be the most direct diagnostic of the kinematics and spatial distribution of the very hot plasma around O stars. In this paper we apply several analysis techniques to the emission lines in the Chandra HETGS spectrum of the late-O supergiant zeta Ori (O9.7 Ib), including the fitting of a simple line-profile model. We show that there is distinct evidence for blue shifts and profile asymmetry, as well as broadening in the X-ray emission lines of zeta Ori. These are the observational hallmarks of a wind-shock X-ray source, and the results for zeta Ori are very similar to those for the earlier O star, zeta Pup, which we have previously shown to be well-fit by the same wind-shock line-profile model. The more subtle effects on the line-profile morphologies in zeta Ori, as compared to zeta Pup, are consistent with the somewhat lower density wind in this later O supergiant. In both stars, the wind optical depths required to explain the mildly asymmetric X-ray line profiles imply reductions in the effective opacity of nearly an order of magnitude, which may be explained by some combination of mass-loss rate reduction and large-scale clumping, with its associated porosity-based effects on radiation transfer. In the context of the recent reanalysis of the helium-like line intensity ratios in both zeta Ori and zeta Pup, and also in light of recent work questioning the published mass-loss rates in OB stars, these new results indicate that the X-ray emission from zeta Ori can be understood within the framework of the standard wind-shock scenario for hot stars.Comment: MNRAS, accepted; 16 pages, 5 figure

Targeting sexual health services in primary care: a systematic review of the psychosocial correlates of adverse sexual health outcomes reported in probability surveys of women of reproductive age

BACKGROUND: Women using primary care vary in need for sexually transmitted infections (STIs) testing and contraception. Psychosocial correlates of these needs may be useful for targeting services. We undertook a systematic review to identify psychosocial correlates of STI acquisition, unplanned pregnancy (UP), abortion and risky sexual behaviours in general population samples of women of reproductive age. METHODS: We searched bibliographic databases for probability surveys of women aged 16-44years in the European Union, USA, Canada, Australia, UK or New Zealand undertaken January 1994-January 2014. RESULTS: Eleven papers were included. Unplanned pregnancy was associated with smoking, depression, being single and sexual debut <16years. Abortion was associated with lack of closeness to parents, leaving home at an early age, and relationship break-up. Multiple partnerships were associated with intensity of marijuana and alcohol use, and smoking. STI diagnosis was associated with relationship break-up and younger partners. Non-use of contraception was associated with smoking, obesity, relationship status, sedentary lifestyles, fatalistic pregnancy attitudes and lower alcohol use. Condom non-use was higher (at first sex) with partners 5+years older and lower (at last sex) in less stable partnerships. CONCLUSION: Psychosocial variables, particularly relationship status and smoking, may help identify women in primary care for STI testing and contraception advice and supply

Tracking Changes in Neuropathic Pain After Acute Spinal Cord Injury

Neuropathic pain represents a primary detrimental outcome of spinal cord injury. A major challenge facing effective management is a lack of surrogate measures to examine the physiology and anatomy of neuropathic pain. To this end, we investigated the relationship between psychophysical responses to tonic heat stimulation and neuropathic pain rating after traumatic spinal cord injury. Subjects provided a continuous rating to 2 min of tonic heat at admission to rehabilitation and again at discharge. Adaptation, temporal summation of pain, and modulation profile (i.e., the relationship between adaptation and temporal summation of pain) were extracted from tonic heat curves for each subject. There was no association between any of the tonic heat outcomes and neuropathic pain severity at admission. The degree of adaptation, the degree of temporal summation of pain, and the modulation profile did not change significantly from admission to discharge. However, changes in modulation profiles between admission and discharge were significantly correlated with changes in neuropathic pain severity (p = 0.027; R2 = 0.323). The modulation profile may represent an effective measure to track changes in neuropathic pain severity from early to later stages of spinal cord injury

A statistically robust EEG re-referencing procedure to mitigate reference effect

Background: The electroencephalogram (EEG) remains the primary tool for diagnosis of abnormal brain activity in clinical neurology and for in vivo recordings of human neurophysiology in neuroscience research. In EEG data acquisition, voltage is measured at positions on the scalp with respect to a reference electrode. When this reference electrode responds to electrical activity or artifact all electrodes are affected. Successful analysis of EEG data often involves re-referencing procedures that modify the recorded traces and seek to minimize the impact of reference electrode activity upon functions of the original EEG recordings. New method: We provide a novel, statistically robust procedure that adapts a robust maximum-likelihood type estimator to the problem of reference estimation, reduces the influence of neural activity from the re-referencing operation, and maintains good performance in a wide variety of empirical scenarios. Results: The performance of the proposed and existing re-referencing procedures are validated in simulation and with examples of EEG recordings. To facilitate this comparison, channel-to-channel correlations are investigated theoretically and in simulation. Comparison with existing methods: The proposed procedure avoids using data contaminated by neural signal and remains unbiased in recording scenarios where physical references, the common average reference (CAR) and the reference estimation standardization technique (REST) are not optimal. Conclusion:The proposed procedure is simple, fast, and avoids the potential for substantial bias when analyzing low-density EEG data