Long-term outcome and prognosis of patients with emergent periodic lateralized epileptiform discharges (ePLEDs)

AbstractPurposeEmergent EEG (eEEG) is an EEG performed on a non-elective basis upon request from a clinician for a seemingly emergency indication. Little is known about the long-term prognosis of patients with emergent periodic lateralized epileptiform discharges (ePLEDs).MethodsWe analyzed the EEG and clinical records of patients with ePLEDs from January 2002 to December 2008.ResultsOut of 1948 eEEGs, 79 (4%) patients had ePLEDs. Sixty-three patients had ePLEDs and 16 had eBiPLEDs (emergent bilateral periodic lateralized epileptiform discharges). The etiology of ePLEDs was CNS infection and inflammation (35.4%), stroke (32.9%), and metabolic encephalopathy (11.4%). Of the surviving 52 (65.8%) patients with ePLEDs, 34 (65.4%) had persistent seizures during a mean follow-up of 28 months (range 12–72 months). Seizure as the initial presentation was more commonly seen in children as compared to adults (64% versus 31%, p=0.005). CNS infection and inflammation were also seen more frequently in the pediatric age group (50% versus 27%, p=0.04). At follow-up, patients with eBiPLEDs had more seizures than patients with ePLEDs (87.5% versus 61.3%).ConclusionePLEDs is associated with significant morbidity and mortality. However, the etiology of ePLEDs and brain dysfunction will influence the long-term outcome. This information is invaluable for prognostication and underscores the importance of rigorous management of patients with ePLEDs

Human migration to the forest frontier:implications for land use change and conservation management

Human migration is often considered an important driver of land use change and a threat to protected area integrity, but the reasons for in-migration, the effectiveness of conservation restrictions at stemming migration, and the extent to which migrants disproportionately contribute to land use change has been poorly studied, especially at fine spatial scales. Using a case study in eastern Madagascar (603 household surveys, mapping agricultural land for a subset of 167 households, and 49 focus group discussions and key informant interviews), we explore the patterns and drivers of migration within the lifetime of those currently alive. We investigate how this influences forest conversion on the border of established protected areas and sites without a history of conservation restrictions. We show that in-migration is driven, especially in sites with high migration, by access to land. There is a much higher proportion of migrant households at sites without a long history of conservation restrictions than around long-established protected areas, and migrants tend to be more educated and live closer to the forest edge than non-migrants. Our evidence supports the engulfment model (an active forest frontier later becoming a protected area); there is no evidence that protected areas have attracted migrants. Where there is a perceived open forest frontier, people move to the forest but these migrants are no more likely than local people to clear land (i.e., migrants are not “exceptional resource degraders”). In some parts of the tropics, out-migration from rural areas is resulting in forest regrowth; such a forest transition is unlikely to occur in Madagascar for some time. Those seeking to manage protected areas at the forest frontier will therefore need to prevent further colonisation; supporting tenure security for existing residents is likely to be an important step

Stroke mimics transported by emergency medical services to a comprehensive stroke center : the magnitude of the problem

Background: Despite the use of validated prehospital stroke screens, stroke mimics are frequent among patients transported by Emergency Medical Services to the Emergency Department. We aimed to describe the frequency and characteristics of neurological and non-neurological mimics transported to a comprehensive stroke center for acute stroke evaluation. Methods: This was a retrospective analysis of a database consisting of all consecutive patients with suspected stroke transported to the Emergency Department of a comprehensive stroke center during an 18-month period. Hospital charts and neuroimaging were utilized to adjudicate the final diagnosis (acute stroke, stroke mimic, and specific underlying diagnoses). Results: 950 patients were transported with suspected stroke, among whom 405 (42.6%) were stroke mimics (age 66.9±17.1 years; 54% male). Neurological mimics were diagnosed in 223 (55.1%) patients and mimics were non-neurological in 182. The most common neurological diagnoses were seizures (19.7%), migraines (18.8%) and peripheral neuropathies (11.2%). Cardiovascular (14.6%) and psychiatric (11.9%) diagnoses were common non-neurological mimics. Patients with neurological mimic were younger (64.1±17.3 years vs. 70.5±16.1 years, p<0.001) and had less vascular risk factors than non-neurological mimics. The proportion of non-neurological mimics remained high (38%) despite the use of a prehospital identification scale. Conclusion: Stroke mimics are common among patients transported by Emergency Medical Services to a comprehensive stroke center for suspected stroke, with a considerable proportion being non-neurological in origin. Studies refining triage and transport of suspected acute stroke may be warranted to minimize the number of mimics transported by to a comprehensive stroke center for acute stroke evaluation

Validation of an MRI-only planning workflow for definitive pelvic radiotherapy

Purpose: Previous work on Magnetic Resonance Imaging (MRI) only planning has been applied to limited treatment regions with a focus on male anatomy. This research aimed to validate the use of a hybrid multi-atlas synthetic computed tomography (sCT) generation technique from a MRI, using a female and male atlas, for MRI only radiation therapy treatment planning of rectum, anal canal, cervix and endometrial malignancies. Patients and methods: Forty patients receiving radiation treatment for a range of pelvic malignancies, were separated into male (n = 20) and female (n = 20) cohorts for the creation of gender specific atlases. A multi-atlas local weighted voting method was used to generate a sCT from a T1-weighted VIBE DIXON MRI sequence. The original treatment plans were copied from the CT scan to the corresponding sCT for dosimetric validation. Results: The median percentage dose difference between the treatment plan on the CT and sCT at the ICRU reference point for the male cohort was − 0.4% (IQR of 0 to − 0.6), and − 0.3% (IQR of 0 to − 0.6) for the female cohort. The mean gamma agreement for both cohorts was &gt; 99% for criteria of 3%/2 mm and 2%/2 mm. With dose criteria of 1%/1 mm, the pass rate was higher for the male cohort at 96.3% than the female cohort at 93.4%. MRI to sCT anatomical agreement for bone and body delineated contours was assessed, with a resulting Dice score of 0.91 ± 0.2 (mean ± 1 SD) and 0.97 ± 0.0 for the male cohort respectively; and 0.96 ± 0.0 and 0.98 ± 0.0 for the female cohort respectively. The mean absolute error in Hounsfield units (HUs) within the entire body for the male and female cohorts was 59.1 HU ± 7.2 HU and 53.3 HU ± 8.9 HU respectively. Conclusions: A multi-atlas based method for sCT generation can be applied to a standard T1-weighted MRI sequence for male and female pelvic patients. The implications of this study support MRI only planning being applied more broadly for both male and female pelvic sites. Trial registration This trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) (www.anzctr.org.au) on 04/10/2017. Trial identifier ACTRN12617001406392.</p

No one left behind: Using mixed-methods research to identify and learn from socially marginalised adolescents in low- and middle-income countries

This article describes the mixed-methods approach used by the Gender and Adolescence: Global Evidence (GAGE) research programme. It discusses how qualitative and quantitative methods can be used both in isolation and combined to learn about the lives of adolescents in low- and middle-income countries (LMICs), focusing on the methodological and ethical approaches used to reach socially marginalised adolescents (including adolescents with disabilities, adolescents not in school, adolescent refugees, adolescents living in urban slums, adolescents who married as children, and adolescent mothers). We reflect on the implementation of the GAGE conceptual framework, discussing its strengths and weaknesses, and the challenges to promoting inclusive and genuinely mixed-methods research practices. While these methods have been adapted in the countries where research was undertaken, the conceptual framework provides a common methodological approach, utilising an intersectional lens. We show how mixed-methods approaches can contribute to the knowledge base on research with socially marginalised adolescent girls and boys globally, serving as an important resource for future research with young people in LMICs

Nature’s contribution to poverty alleviation, human wellbeing and the SDGs

Millions of households globally rely on uncultivated ecosystems for their livelihoods. However, much of the understanding about the broader contribution of uncultivated ecosystems to human wellbeing is still based on a series of small-scale studies due to limited availability of large-scale datasets. We pooled together 11 comparable datasets comprising 232 settlements and 10,971 households in ten low-and middle-income countries, representing forest, savanna and coastal ecosystems to analyse how uncultivated nature contributes to multi-dimensional wellbeing and how benefits from nature are distributed between households. The resulting dataset integrates secondary data on rural livelihoods, multidimensional human wellbeing, household demographics, resource tenure and social-ecological context, primarily drawing on nine existing household survey datasets and their associated contextual information together with selected variables, such as travel time to cities, population density, local area GDP and land use and land cover from existing global datasets. This integrated dataset has been archived with ReShare (UK Data Service) and will be useful for further analyses on nature-wellbeing relationships on its own or in combination with similar datasets

Estudio de experiencias y buenas prácticas comunitarias vinculadas a sistemas de restauración de paisajes forestales, en dos microrregiones del Departamento De San Marcos, Guatemala, C.A.

El presente trabajo de graduación se desarrolló en el altiplano del departamento de San Marcos, en las microrregiones Esquichá y Ricardo Chávez de la parte alta de la cuenca del río Coatán y del río Suchiate respectivamente. Tuvo la finalidad de apuntalar los esfuerzos regionales de desarrollo humano y conservación de los recursos naturales, coordinados por el Mecanismo de Restauración de Bosques y Paisajes y en la mejora de los medios de vida de las comunidades locales; enfocado a la restauración del paisaje forestal, entiéndase los bienes y servicios ambientales asociados a éste. El objetivo primordial del diagnóstico de las microrregiones, consistió en conocer la coyuntura ambiental y social del paisaje forestal en el área. La determinación de los factores de degradación del paisaje y los componentes sociales y ambientales, permitieron conocer hacia dónde orientar las acciones para la restauración del paisaje forestal, haciendo de éste un proceso sostenible. En tal sentido, la investigación se orientó al estudio y documentación de las buenas prácticas y sistemas tradicionales vinculados a la restauración del paisaje forestal en el altiplano occidental. Se documentaron un total de 18 buenas prácticas, algunas de éstas se implementaron a través del establecimiento de 10 sitios demostrativos, los cuales constituyen parcelas modelo de cómo restaurar el paisaje en diferentes condiciones edafoclimáticas y ecológicas, características de la región. Se realizó una caracterización biofísica detallada de cada uno de éstos sitios, incluyendo un análisis microbiológico del suelo, el cual constituye un pilar fundamental en el estudio de la degradación de los suelos de las tierras forestales. Dentro de los principales ejes de trabajo del mecanismo se encuentran la sensibilización, el fortalecimiento de capacidades y la implementación de sitios demostrativos de prácticas y sistemas de restauración del paisaje forestal; en respuesta a estos tres objetivos generales se desarrollaron los servicios profesionales

The UK Lung Screen (UKLS): Demographic Profile of First 88,897 Approaches Provides Recommendations for Population Screening

The UK Lung Cancer Screening trial (UKLS) aims to evaluate low-dose computed tomography (LDCT) lung cancer population screening in the United Kingdom. In UKLS, a large population sample ages 50 to 75 years is approached with a questionnaire to determine lung cancer risk. Those with an estimated risk of at least 5% of developing lung cancer in the next 5 years (using the Liverpool Lung project risk model) are invited to participate in the trial. Here, we present demographic, risk, and response rate data from the first 88,897 individuals approached. Of note, 23,794 individuals (26.8% of all approached) responded positively to the initial questionnaire; 12% of these were high risk. Higher socioeconomic status correlated positively with response, but inversely with risk (P < 0.001). The 50- to 55-year age group was least likely to participate, and at lowest cancer risk. Only 5% of clinic attendees were ages ≤60 years (compared with 47% of all 88,897 approached); this has implications for cost effectiveness. Among positive responders, there were more ex-smokers than expected from population figures (40% vs. 33%), and fewer current smokers (14% vs. 17.5%). Of note, 32.7% of current smokers and 18.4% of ex-smokers were designated as high risk. Overall, 1,452 of 23,794 positive responders (6.1%) were deemed high risk and attended a recruitment clinic. UKLS is the first LDCT population screening trial, selecting high-risk subjects using a validated individual risk prediction model. Key findings: (i) better recruitment from ex- rather than current smokers, (ii) few clinic attendees ages early 50s, and (iii) representative number of socioeconomically deprived people recruited, despite lower response rates

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Nature’s contribution to poverty alleviation, human wellbeing and the SDGs

Millions of households globally rely on uncultivated ecosystems for their livelihoods. However, much of the understanding about the broader contribution of uncultivated ecosystems to human wellbeing is still based on a series of small-scale studies due to limited availability of large-scale datasets. We pooled together 11 comparable datasets comprising 232 settlements and 10,971 households in ten low-and middle-income countries, representing forest, savanna and coastal ecosystems to analyse how uncultivated nature contributes to multi-dimensional wellbeing and how benefits from nature are distributed between households. The resulting dataset integrates secondary data on rural livelihoods, multidimensional human wellbeing, household demographics, resource tenure and social-ecological context, primarily drawing on nine existing household surveys and their associated contextual information together with selected variables, such as travel time to cities, population density, local area GDP and land use and land cover from existing global datasets. This integrated dataset has been archived with ReShare (UK Data Service) and will be useful for further analyses on nature-wellbeing relationships on its own or in combination with similar datasets