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

Association is not causation: treatment effects cannot be estimated from observational data in heart failure

Aims: Treatment ‘effects’ are often inferred from non-randomized and observational studies. These studies have inherent biases and limitations, which may make therapeutic inferences based on their results unreliable. We compared the conflicting findings of these studies to those of prospective randomized controlled trials (RCTs) in relation to pharmacological treatments for heart failure (HF). Methods and results: We searched Medline and Embase to identify studies of the association between non-randomized drug therapy and all-cause mortality in patients with HF until 31 December 2017. The treatments of interest were: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists (MRAs), statins, and digoxin. We compared the findings of these observational studies with those of relevant RCTs. We identified 92 publications, reporting 94 non-randomized studies, describing 158 estimates of the ‘effect’ of the six treatments of interest on all-cause mortality, i.e. some studies examined more than one treatment and/or HF phenotype. These six treatments had been tested in 25 RCTs. For example, two pivotal RCTs showed that MRAs reduced mortality in patients with HF with reduced ejection fraction. However, only one of 12 non-randomized studies found that MRAs were of benefit, with 10 finding a neutral effect, and one a harmful effect. Conclusion: This comprehensive comparison of studies of non-randomized data with the findings of RCTs in HF shows that it is not possible to make reliable therapeutic inferences from observational associations. While trials undoubtedly leave gaps in evidence and enrol selected participants, they clearly remain the best guide to the treatment of patients

Talking to patients with heart failure about end of life

No abstract available

Redefining heart failure phenotypes based on ejection fraction

No abstract available

Unifying Gate Synthesis and Magic State Distillation

The leading paradigm for performing a computation on quantum memories can be encapsulated as distill-then-synthesize. Initially, one performs several rounds of distillation to create high-fidelity magic states that provide one good T gate, an essential quantum logic gate. Subsequently, gate synthesis intersperses many T gates with Clifford gates to realize a desired circuit. We introduce a unified framework that implements one round of distillation and multiquibit gate synthesis in a single step. Typically, our method uses the same number of T gates as conventional synthesis but with the added benefit of quadratic error suppression. Because of this, one less round of magic state distillation needs to be performed, leading to significant resource savings

The VISTA Science Archive

We describe the VISTA Science Archive (VSA) and its first public release of data from five of the six VISTA Public Surveys. The VSA exists to support the VISTA Surveys through their lifecycle: the VISTA Public Survey consortia can use it during their quality control assessment of survey data products before submission to the ESO Science Archive Facility (ESO SAF); it supports their exploitation of survey data prior to its publication through the ESO SAF; and, subsequently, it provides the wider community with survey science exploitation tools that complement the data product repository functionality of the ESO SAF. This paper has been written in conjunction with the first public release of public survey data through the VSA and is designed to help its users understand the data products available and how the functionality of the VSA supports their varied science goals. We describe the design of the database and outline the database-driven curation processes that take data from nightly pipeline-processed and calibrated FITS files to create science-ready survey datasets. Much of this design, and the codebase implementing it, derives from our earlier WFCAM Science Archive (WSA), so this paper concentrates on the VISTA-specific aspects and on improvements made to the system in the light of experience gained in operating the WSA.Comment: 22 pages, 16 figures. Minor edits to fonts and typos after sub-editting. Published in A&