Diagnosis and Management of Epilepsy Adult Patient

S. Afr. Med. J., 48, 841 (1974)

Gender-Specific Trajectories of Conduct Problems from Ages 3 to 11

Gender-specific pathways of conduct problems (CP) from toddlerhood have received little attention. Using a nationally representative sample of UK children born in 2000-2001 (6458 boys and 6340 girls), the current study (a) identified subgroups of CP pathways separately for boys and girls from ages 3 to 11 and (b) examined early precursors (pregnancy to 9 months) of these trajectories. Group-based trajectory models identified four distinct trajectories for both boys and girls: each characterized as 'low'; 'early-onset, desisting'; 'early-onset, persistent' and 'school-onset'. This suggests that the taxonomic framework developed to conceptualise childhood-onset CP among males is also applicable to females, though needing some revision to capture heterogeneity identified during early and middle childhood. We also found significant precursors of the different trajectory groups with some variation by gender. Early socioeconomic deprivation was a significant risk factor of the early-onset pathways among both genders, but played no significant role for 'school-onset'. Childhood-onset trajectories of boys, but not girls, were predicted by parenting attitudes and behaviour

Trends in parent- and teacher-rated mental health problems among 10- and 11-year-olds in Great Britain: 1999-2012

BACKGROUND: Previous evidence indicates that mental health problems are becoming more common for adolescents. Less is known about whether these trends have continued and there has been no study to date which has specifically focused on early adolescents over a sufficiently long period. This study examines changes in parent- and teacher-reported mental health problems among 10- and 11-year-olds in 1999, 2004 and 2012 in Great Britain. METHODS: Parent and teacher ratings of the Strengths and Difficulties Questionnaire were used to compare the prevalence of conduct problems, hyperactivity/inattention, emotional problems, peer problems and total difficulties among 10- and 11-year-olds in three nationally representative British samples assessed in 1999 (n = 1904), 2004 (n = 1348) and 2012 (n = 11,397). RESULTS: Teacher reports showed improving trends for boys' and girls' mental health from 1999 to 2012, particularly for externalizing behaviours (i.e. conduct problems and hyperactivity/inattention). Parent reports, on the other hand, identified only one area of sustained improvement between 1999 and 2012, namely hyperactivity/inattention among boys. Although parent reports of girls' mental health indicate improving trends from 1999 to 2004, they also suggest worsening mental health from 2004. CONCLUSIONS: These findings suggest that perceptions of emotional and behavioural problems vary by the gender of the adolescent, the context in which they are observed or by whom they are reported

Experiences of women with cardiac disease in pregnancy: A systematic review and metasynthesis

© Author(s) (or their employer(s)) 2018. Objective Cardiac disease in pregnancy is a leading cause of maternal death in high-income countries. Evidence-based guidelines to assist in planning and managing the healthcare of affected women is lacking. The objective of this research was to produce the first qualitative metasynthesis of the experiences of pregnant women with existing or acquired cardiac disease to inform improved healthcare services. Method We conducted a systematic search of peerreviewed publications in five databases to investigate the decision-making processes, supportive strategies and healthcare experiences of pregnant women with existing or acquired cardiac disease, or of affected women contemplating pregnancy. Identified publications were screened for duplication and eligibility against selection criteria, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We then undertook a thematic analysis of the data relating to women's experiences extracted from each publication to inform new healthcare practices and communication. Results Eleven studies from six countries were included in our meta-synthesis. Four themes were revealed. Women with congenital and acquired heart disease identified situations where they had either taken charge of decision-making, lacked control or experienced emotional uncertainty when making decisions. Some women were risk aware and determined to take care of themselves in pregnancy while others downplayed the risks. Women with heart disease acknowledged the importance of specific social support measures during pregnancy and after child birth, and reported a spectrum of healthcare experiences. Conclusions There is a lack of integrated and tailored healthcare services and information for women with cardiac disease in pregnancy. The experiences of women synthesised in this research has the potential to inform new evidencebased guidelines to support the decision-making needs of women with cardiac disease in pregnancy. Shared decisionmaking must consider communication across the clinical team. However, coordinated care is challenging due to the different specialists involved and the limited clinical evidence concerning effective approaches to managing such complex care

Assessment of the 2016 National Institute for Health and Care Excellence high-sensitivity troponin rule-out strategy.

OBJECTIVE: We aimed to evaluate the limit of detection of high-sensitivity troponin (hs-cTn) and Thrombolysis In Myocardial Infarction (TIMI) score combination rule-out strategy suggested within the 2016 National Institute for Health and Care Excellence (NICE) Chest Pain of Recent Onset guidelines and establish the optimal TIMI score threshold for clinical use. METHODS: A pooled analysis of adult patients presenting to the emergency department with chest pain and a non-ischaemic ECG, recruited into six prospective studies, from Australia, New Zealand and the UK. We evaluated the sensitivity of TIMI score thresholds from 0 to 2 alongside hs-cTnT or hs-cTnI for the primary outcome of major adverse cardiac events within 30 days. RESULTS: Data were available for 3159 patients for hs-cTnT and 4532 for hs-cTnI, of these 376 (11.9%) and 445 (9.8%) had major adverse cardiac events, respectively. Using a TIMI score of 0, the sensitivity for the primary outcome was 99.5% (95% CI 98.1% to 99.9%) alongside hs-cTnT and 98.9% (97.4% to 99.6%)%) alongside hs-cTnI, identifying 17.9% and 21.0% of patients as low risk, respectively. For a TIMI score ≤1 sensitivity was 98.9% (97.3% to 99.7%)%) alongside hs-cTnT and 98.4% (96.8% to 99.4%)%) alongside hs-cTnI, identifying 28.1% and 35.7% as low risk, respectively. For TIMI≤2, meta-sensitivity was <98% with either assay. CONCLUSIONS: Our findings support the rule-out strategy suggested by NICE. The TIMI score threshold suggested for clinical use is 0. The proportion of patients identified as low risk (18%-21%) and suitable for early discharge using this threshold may be sufficient to encourage change of practice. TRIAL REGISTRATION NUMBERS: ADAPT observational study/IMPACT intervention trial ACTRN12611001069943.ADAPT-ADP randomised controlled trial ACTRN12610000766011.EDACS-ADP randomised controlled trial ACTRN12613000745741.TRUST observational study ISRCTN no. 21109279

Supercooled-liquid and plastic-crystalline state in succinonitrile-glutaronitrile mixtures

We report a thorough characterization of the glassy phases of mixtures of succinonitrile and glutaronitrile via dielectric spectroscopy and differential scanning calorimetry. This system is revealed to be one of the rare examples where both glassy states of matter, a structurally disordered supercooled liquid and an orientationally disordered plastic crystal, can be prepared in the same material. Both disordered states can be easily supercooled, finally arriving at a structural-glass or a glassy-crystal state. Detailed investigations using broadband dielectric spectroscopy enable a comparison of the glassy dynamics in both phases. Just as previously demonstrated for supercooled-liquid and plastic-crystalline ethanol, our experiments reveal very similar relaxational behavior and glass temperatures of both disordered states. Thus the prominent role of orientational degrees of freedom in the glass transition, suggested on the basis of the findings for ethanol, is fully corroborated by the present work. Moreover, the fragilities of both phases are determined and compared for different mixtures. The findings can be well understood within an energy-landscape based explanation of fragility.Comment: 8 pages, 7 figure

Theory of Distinct Crystal Structures of Polymerized Fullerides AC60, A=K, Rb, Cs: the Specific Role of Alkalis

The polymer phases of AC60 form distinct crystal structures characterized by the mutual orientations of the (C60-)n chains. We show that the direct electric quadrupole interaction between chains always favors the orthorhombic structure Pmnn with alternating chain orientations. However the specific quadrupolar polarizability of the alkali metal ions leads to an indirect interchain coupling which favors the monoclinic structure I2/m with equal chain orientations. The competition between direct and indirect interactions explains the structural difference between KC60 and RbC60, CsC60.Comment: 4 pages, 2 figures, 1 tabl

Counting Complex Disordered States by Efficient Pattern Matching: Chromatic Polynomials and Potts Partition Functions

Counting problems, determining the number of possible states of a large system under certain constraints, play an important role in many areas of science. They naturally arise for complex disordered systems in physics and chemistry, in mathematical graph theory, and in computer science. Counting problems, however, are among the hardest problems to access computationally. Here, we suggest a novel method to access a benchmark counting problem, finding chromatic polynomials of graphs. We develop a vertex-oriented symbolic pattern matching algorithm that exploits the equivalence between the chromatic polynomial and the zero-temperature partition function of the Potts antiferromagnet on the same graph. Implementing this bottom-up algorithm using appropriate computer algebra, the new method outperforms standard top-down methods by several orders of magnitude, already for moderately sized graphs. As a first application, we compute chromatic polynomials of samples of the simple cubic lattice, for the first time computationally accessing three-dimensional lattices of physical relevance. The method offers straightforward generalizations to several other counting problems.Comment: 7 pages, 4 figure

Differential expression, function and response to inflammatory stimuli of 11β-hydroxysteroid dehydrogenase type 1 in human fibroblasts: a mechanism for tissue-specific regulation of inflammation

Stromal cells such as fibroblasts play an important role in defining tissue-specific responses during the resolution of inflammation. We hypothesized that this involves tissue-specific regulation of glucocorticoids, mediated via differential regulation of the enzyme 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). Expression, activity and function of 11β-HSD1 was assessed in matched fibroblasts derived from various tissues (synovium, bone marrow and skin) obtained from patients with rheumatoid arthritis or osteoarthritis. 11β-HSD1 was expressed in fibroblasts from all tissues but mRNA levels and enzyme activity were higher in synovial fibroblasts (2-fold and 13-fold higher mRNA levels in dermal and synovial fibroblasts, respectively, relative to bone marrow). Expression and activity of the enzyme increased in all fibroblasts following treatment with tumour necrosis factor-α or IL-1β (bone marrow: 8-fold and 37-fold, respectively, compared to vehicle; dermal fibroblasts: 4-fold and 14-fold; synovial fibroblasts: 7-fold and 31-fold; all P < 0.01 compared with vehicle). Treatment with IL-4 or interferon-γ was without effect, and there was no difference in 11β-HSD1 expression between fibroblasts (from any site) obtained from patients with rheumatoid arthritis or osteoarthritis. In the presence of 100 nmol/l cortisone, IL-6 production – a characteristic feature of synovial derived fibroblasts – was significantly reduced in synovial but not dermal or bone marrow fibroblasts. This was prevented by co-treatment with an 11β-HSD inhibitor, emphasizing the potential for autocrine activation of glucocorticoids in synovial fibroblasts. These data indicate that differences in fibroblast-derived glucocorticoid production (via the enzyme 11β-HSD1) between cells from distinct anatomical locations may play a key role in the predeliction of certain tissues to develop persistent inflammation

Training opportunities in thoracic ultrasound for respiratory trainees: are current guidelines practical?

Respiratory trainees in the UK face challenges in meeting current Royal College of Radiologists (RCR) Level 1 training requirements for thoracic ultrasound (TUS) competence, specified as attending 'at least one session per week over a period of no less than 3 months, with approximately five scans per session performed by the trainee (under supervision of an experienced practitioner)'. We aimed to clarify where TUS training opportunities currently exist for respiratory registrars.This is an Open Access article. Click on the Publisher URL to access the full-text