Attention-deficit/hyperactivity disorder medication and seizures

OBJECTIVE: Individuals with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of seizures, but there is uncertainty about whether ADHD medication treatment increases risk among patients with and without preexisting seizures. METHODS: We followed a sample of 801,838 patients with ADHD who had prescribed drug claims from the Truven Health MarketScan Commercial Claims and Encounters databases to examine whether ADHD medication increases the likelihood of seizures among ADHD patients with and without a history of seizures. First, we assessed overall risk of seizures among patients with ADHD. Second, within-individual concurrent analyses assessed odds of seizure events during months when a patient with ADHD received ADHD medication compared with when the same individual did not, while adjusting for antiepileptic medications. Third, within-individual long-term analyses examined odds of seizure events in relation to the duration of months over the previous 2 years patients received medication. RESULTS: Patients with ADHD were at higher odds for any seizure compared with non-ADHD controls (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 2.24-2.42 males; OR = 2.31, 95% CI = 2.22-2.42 females). In adjusted within-individual comparisons, ADHD medication was associated with lower odds of seizures among patients with (OR = 0.71, 95% CI = 0.60-0.85) and without (OR = 0.71, 95% CI = 0.62-0.82) prior seizures. Long-term within-individual comparisons suggested no evidence of an association between medication use and seizures among individuals with (OR = 0.87, 95% CI = 0.59-1.30) and without (OR = 1.01, 95% CI = 0.80-1.28) a seizure history. CONCLUSIONS: Results reaffirm that patients with ADHD are at higher risk of seizures. However, ADHD medication was associated with lower risk of seizures within individuals while they were dispensed medication, which is not consistent with the hypothesis that ADHD medication increases risk of seizures

Dynamic Ocean Management Increases the Efficiency and Efficacy of Fisheries Management

In response to the inherent dynamic nature of the oceans and continuing difficulty in managing ecosystem impacts of fisheries, interest in the concept of dynamic ocean management, or real-time management of ocean resources, has accelerated in the last several years. However, scientists have yet to quantitatively assess the efficiency of dynamic management over static management. Of particular interest is how scale influences effectiveness, both in terms of how it reflects underlying ecological processes and how this relates to potential efficiency gains. Here, we address the empirical evidence gap and further the ecological theory underpinning dynamic management. We illustrate, through the simulation of closures across a range of spatiotemporal scales, that dynamic ocean management can address previously intractable problems at scales associated with coactive and social patterns (e.g., competition, predation, niche partitioning, parasitism, and social aggregations). Furthermore, it can significantly improve the efficiency of management: as the resolution of the closures used increases (i.e., as the closures become more targeted), the percentage of target catch forgone or displaced decreases, the reduction ratio (bycatch/catch) increases, and the total time-area required to achieve the desired bycatch reduction decreases. In the scenario examined, coarser scale management measures (annual time-area closures and monthly full-fishery closures) would displace up to four to five times the target catch and require 100-200 times more square kilometer-days of closure than dynamic measures (grid-based closures and move-on rules). To achieve similar reductions in juvenile bycatch, the fishery would forgo or displace between USD 15-52 million in landings using a static approach over a dynamic management approach

Integrating engineering systems research and undergraduate education through a term-length case study

Introduction The MIT-Portugal Program (MPP) was launched in 2007 with the dual objectives of conducting innovative research and establishing leading academic degree programs through international collaboration across a range of technical disciplines. Among the first attempts to integrate the research and teaching objectives of the MPP was the Spring 2009 offering of Engineering System Design, a required course for third- and fourth-year undergraduates in MIT’s Department of Civil and Environmental Engineering. The course employed a semester-long case study, drawing heavily on active MPP transportation and engineering systems research for teaching and assignment content

Measurements of Forbush decreases at Mars: both by MSL on ground and by MAVEN in orbit

The Radiation Assessment Detector (RAD), on board Mars Science Laboratory's (MSL) Curiosity rover, has been measuring ground level particle fluxes along with the radiation dose rate at the surface of Mars since August 2012. Similar to neutron monitors at Earth, RAD sees many Forbush decreases (FDs) in the galactic cosmic ray (GCR) induced surface fluxes and dose rates. These FDs are associated with coronal mass ejections (CMEs) and/or stream/corotating interaction regions (SIRs/CIRs). Orbiting above the Martian atmosphere, the Mars Atmosphere and Volatile EvolutioN (MAVEN) spacecraft has also been monitoring space weather conditions at Mars since September 2014. The penetrating particle flux channels in the Solar Energetic Particle (SEP) instrument onboard MAVEN can also be employed to detect FDs. For the first time, we study the statistics and properties of a list of FDs observed in-situ at Mars, seen both on the surface by MSL/RAD and in orbit detected by the MAVEN/SEP instrument. Such a list of FDs can be used for studying interplanetary CME (ICME) propagation and SIR evolution through the inner heliosphere. The magnitudes of different FDs can be well-fitted by a power-law distribution. The systematic difference between the magnitudes of the FDs within and outside the Martian atmosphere may be mostly attributed to the energy-dependent modulation of the GCR particles by both the pass-by ICMEs/SIRs and the Martian atmosphere

Rofecoxib and cardiovascular adverse events in adjuvant treatment of colorectal cancer

Background Selective cyclooxygenase inhibitors may retard the progression of cancer, but they have enhanced thrombotic potential. We report on cardiovascular adverse events in patients receiving rofecoxib to reduce rates of recurrence of colorectal cancer. Methods All serious adverse events that were cardiovascular thrombotic events were reviewed in 2434 patients with stage II or III colorectal cancer participating in a randomized, placebo-controlled trial of rofecoxib, 25 mg daily, started after potentially curative tumor resection and chemotherapy or radiotherapy as indicated. The trial was terminated prematurely owing to worldwide withdrawal of rofecoxib. To examine possible persistent risks, we examined cardiovascular thrombotic events reported up to 24 months after the trial was closed. Results The median duration of active treatment was 7.4 months. The 1167 patients receiving rofecoxib and the 1160 patients receiving placebo were well matched, with a median follow-up period of 33.0 months (interquartile range, 27.6 to 40.1) and 33.4 months (27.7 to 40.4), respectively. Of the 23 confirmed cardiovascular thrombotic events, 16 occurred in the rofecoxib group during or within 14 days after the treatment period, with an estimated relative risk of 2.66 (from the Cox proportional-hazards model; 95% confidence interval [CI], 1.03 to 6.86; P = 0.04). Analysis of the Antiplatelet Trialists’ Collaboration end point (the combined incidence of death from cardiovascular, hemorrhagic, and unknown causes; of nonfatal myocardial infarction; and of nonfatal ischemic and hemorrhagic stroke) gave an unadjusted relative risk of 1.60 (95% CI, 0.57 to 4.51; P = 0.37). Fourteen more cardiovascular thrombotic events, six in the rofecoxib group, were reported within the 2 years after trial closure, with an overall unadjusted relative risk of 1.50 (95% CI, 0.76 to 2.94; P = 0.24). Four patients in the rofecoxib group and two in the placebo group died from thrombotic causes during or within 14 days after the treatment period, and during the follow-up period, one patient in the rofecoxib group and five patients in the placebo group died from cardiovascular causes. Conclusions Rofecoxib therapy was associated with an increased frequency of adverse cardiovascular events among patients with a median study treatment of 7.4 months’ duration. (Current Controlled Trials number, ISRCTN98278138.

The importance of both setting and intensity of physical activity in relation to non-clinical anxiety and depression

Physical activity is associated with good physical and mental health. Current recommendations suggest that people should achieve 30 minutes of moderate-intensity activity most days of the week to gain health benefits. This activity may be accumulated in leisure time, in active commuting, at work or in the home. Here we look at the cross-sectional relationship between physical activity and mental health as measured by the HADS anxiety and depression scores in a sample of 1,742 participants from a Scottish general population survey. The participants were men and women in three age cohorts aged around 24, 44 and 64 years who, in 1995, were interviewed face to face and also self-completed the HADS depression and anxiety scale. Respondents reported their levels of physical activity at work, in the home and in leisure time; the intensities of activity were also determined. Physical activity was related to depression scores but not to anxiety scores. There was no relationship between work physical activity and depression score. Among women, depression score increased with each additional episode of vigorous home activity. In both sexes, depression score decreased with each additional episode of vigorous leisure activity, but among men the decrease in depression score with moderate leisure activity was reversed if a lot of moderate activity was undertaken. We have found a variable relationship between depression scores and various settings for physical activity. Researchers, policymakers and practitioners who are interested in the relationship between physical activity and mental health should take into account the setting for activity as well as frequency, duration and intensity of activity

X-rays Studies of the Solar System

X-ray observatories contribute fundamental advances in Solar System studies by probing Sun-object interactions, developing planet and satellite surface composition maps, probing global magnetospheric dynamics, and tracking astrochemical reactions. Despite these crucial results, the technological limitations of current X-ray instruments hinder the overall scope and impact for broader scientific application of X-ray observations both now and in the coming decade. Implementation of modern advances in X-ray optics will provide improvements in effective area, spatial resolution, and spectral resolution for future instruments. These improvements will usher in a truly transformative era of Solar System science through the study of X-ray emission.Comment: White paper submitted to Astro2020, the Astronomy and Astrophysics Decadal Surve

Prognosis of sciatica and back-related leg pain in primary care: the ATLAS cohort

BACKGROUND CONTEXT: Evidence is lacking on the prognosis and prognostic factors of back-related leg pain and sciatica in patients seeing their primary care physicians. This evidence could guide timely appropriate treatment and referral decisions. PURPOSE: The present study aims to describe the prognosis and prognostic factors in primary care patients with low back-related leg pain and sciatica. STUDY DESIGN: This is a prospective cohort study. PATIENT SAMPLE: The present study included adults visiting their family doctor with back-related leg pain in the United Kingdom. OUTCOME MEASURES: Information about pain, function, psychological, and clinical variables, was collected. Good outcome was defined as 30% or more reduction in disability (Roland-Morris Disability Questionnaire). METHODS: Participants completed the questionnaires, underwent clinical assessments, received a magnetic resonance imaging scan, and were followed-up 12 months later. Mixed-effects logistic regression evaluated the prognostic value of six a priori defined variable sets (leg pain duration, pain intensity, neuropathic pain, psychological factors, clinical examination, and imaging variables). A combined model, including variables from all models, examined independent effects. The National Institute for Health Research funded the study. There are no conflicts of interest. RESULTS: A total of 609 patients were included. At 12 months, 55% of patients improved in both the total sample and the sciatica group. For the whole cohort, longer leg pain duration (odds ratio [OR] 0.41; confidence interval [CI] 0.19-0.90), higher identity score (OR 0.70; CI 0.53-0.93), and patient's belief that the problem will last a long time (OR 0.27; CI 0.13-0.57) were the strongest independent prognostic factors negatively associated with improvement. These last two factors were similarly negatively associated with improvement in the sciatica subgroup. CONCLUSIONS: The present study provides new evidence on the prognosis and prognostic factors of back-related leg pain and sciatica in primary care. Just over half of patients improved at 12 months. Patient's belief of recovery timescale and number of other symptoms attributed to the pain are independent prognostic factors. These factors can be used to inform and direct decisions about timing and intensity of available therapeutic options

Neuropsychological Assessment, Neuroimaging, and Neuropsychiatric Evaluation in Pediatric and Adult Patients with Sickle Cell Disease (SCD)

Traditionally, neuropsychological deficits due to Sickle Cell Disease (SCD) have been understudied in adults. We have begun to suspect, however, that symptomatic and asymptomatic Cerebrovascular Events (CVE) may account for an alarming number of deficits in this population. In the current brief review, we critically evaluated the pediatric and adult literatures on the neurocognitive effects of SCD. We highlighted the studies that have been published on this topic and posit that early detection of CVE via neurocognitive testing, neuropsychiatric evaluations, and neuroimaging may significantly reduce adult cognitive and functional morbidities