Safe Care for Seizure Patients on an Epilepsy Monitoring Unit

Seizure patients admitted to an Epilepsy Monitoring Unit located within an academic tertiary medical center have a high potential to impact patient safety. As a result, a unit based team identified a need for a higher level of training for both their staff and float companions to ensure safe and standardized care for this group of patients. The goal of this quality improvement project was to create an educational tool that would assist 100% of staff in better recognizing and responding to seizures. Baseline metrics and root cause analysis demonstrated a lack of consistent information being taught, a poorly identified target audience as well as educators. Several countermeasures were instituted to include an educational video that standardized seizure and response education. Data collected post rollout demonstrated several positive outcomes to include zero safety events involving this patient population, meeting the goal of 100% of staff educated, and education being mandatory for new staff. Some of the next steps include expanding training to staff caring for pediatric epilepsy patients as well as a tele-sitters video monitoring system request for FY20 budget year

Covariation in urban birds providing cultural services or disservices and people

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.1. The spatial distributions of biodiversity and people vary across landscapes, and are critical to the delivery of ecosystem services and disservices. The high densities of people, and often of birds, in urban areas lead to frequent human-avian interactions, which can be positive or negative for people’s well-being. The identities of the bird species providing these services or disservices tend to be quite different, however it is unclear how their abundance and richness covary with human population density, and hence with potential recipients of these services and disservices. 2. We surveyed bird populations in 106 tiles (500x500 m) across the 174 km2 of an extended urban area in southern England. From the literature, we identified two groups of species: those associated with positive interactions for human well-being, and those that display behaviours that are negative for human well-being. We estimated the abundance (adjusted for detection probability) and richness of each group, and modelled how they covary with human population density. 3. Aggregation of population estimates for the 35 service and nine disservice species observed revealed 593,128 (95% confidence interval: 541,817-657,046) and 225,491 (200,134-235,066) birds, respectively. Across the surveyed tiles there were 1.09 service, and 0.42 disservice birds per person. 4. There was a peaking quadratic relationship between service abundance and human population density, but a negative linear relationship between richness and human density. Conversely, there were positive linear relationships for both abundance and richness of disservice species with human density. The ratio of service to disservice birds shifted from 3.5 to 1 at intermediate human densities to 1 to 1 in more densely populated areas. 5. Synthesis and applications. Differences in the distributions of service and disservice species, and the extremely low ratios of birds to people particularly in socioeconomically deprived areas, mean that people there have few opportunities for contact with birds, and the contact that they do have is equally likely to be negative as positive for human well-being. We recommend spatial targeting of improvements in green infrastructure, combined with the targeted provisioning of food and nesting places for service species, to promote positive interactions between birds and people.We thank M. Evans and M. Gregory for their fieldwork, and J. Harris and R. Corstanje for their advice and logistical support. All authors were supported by the Fragments, Functions, Flows and Urban Ecosystem Services project, NERC grant NE/J015237/1, funded under the NERC Biodiversity and Ecosystem Service Sustainability programme. The authors declare no conflict of interest

The use of the ketogenic diet in the treatment of psychiatric disorders

Introduction: The ketogenic diet (KD) is a high-fat, low-carbohydrate, and moderate-protein diet that has shown benefit as a treatment in neurologic disorders and may serve as a therapeutic option in individuals with psychiatric disorders. Methods: A search was conducted using EBSCOhost and PubMed databases for studies relating to ketogenic or low-carbohydrate diets and psychiatric disorders. Results: A total of 32 experimental or observational studies were identified by initial search strategies, 14 of which met the criteria to be included in this analysis. Although specific diet formulations varied somewhat between studies, they all generally examined low-carbohydrate dietary intake with the goal of producing a ketotic state. The studies included in this review indicated the KD was beneficial in reducing symptoms associated with various psychiatric disorders. Discussion: This review summarizes the available evidence regarding the efficacy of the ketogenic diet in psychiatric disease states. Data from the studies analyzed demonstrated a positive response in individuals who were able to remain on the diet, regardless of the disease state. However, there is a need for more data to clearly define the specific benefits the KD may provide

Phase 1/2a trial of intravenous BAL101553, a novel controller of the spindle assembly checkpoint, in advanced solid tumours

Background: BAL101553 (lisavanbulin), the lysine prodrug of BAL27862 (avanbulin), exhibits broad anti-proliferative activity in human cancer models refractory to clinically relevant microtubule-targeting agents. Methods: This two-part, open-label, phase 1/2a study aimed to determine the maximum tolerated dose (MTD) and dose-limiting toxicities (DLTs) of 2-h infusion of BAL101553 in adults with advanced or recurrent solid tumours. The MTD was determined using a modified accelerated titration design in phase I. Patients received BAL101553 at the MTD and at lower doses in the phase 2a expansion to characterise safety and efficacy and to determine the recommended phase 2 dose (RP2D). Results: Seventy-three patients received BAL101553 at doses of 15–80 mg/m2 (phase 1, n = 24; phase 2a, n = 49). The MTD was 60 mg/m2; DLTs observed at doses ≥60 mg/m2 were reversible Grade 2–3 gait disturbance with Grade 2 peripheral sensory neuropathy. In phase 2a, asymptomatic myocardial injury was observed at doses ≥45 mg/m2. The RP2D for 2-h intravenous infusion was 30 mg/m2. The overall disease control rate was 26.3% in the efficacy population. Conclusions: The RP2D for 2-h infusion of BAL101553 was well tolerated. Dose-limiting neurological and myocardial side effects were consistent with the agent’s vascular-disrupting properties. Clinical trial registration: EudraCT: 2010-024237-23

A camera‐based method for estimating absolute density in animals displaying home range behaviour

1. The measurement of animal density may take advantage of recent technological achievements in wildlife video recording. Fostering the theoretical links between the patterns depicted by cameras and absolute density is required to exploit this potential. 2. We explore the applicability of the Hutchinson–Waser’s postulate (i.e. when animal density is stationary at a given temporal and spatial scale, the absolute density is given by the average number of animals counted per frame), which is a counterintuitive statement for most ecologists and managers who are concerned with counting the same individual more than once. We aimed to reconcile such scepticism for animals displaying home range behaviour. 3. The specific objectives of this paper are to generalize the Hutchinson–Waser’s postulate for animals displaying home range behaviour and to propose a Bayesian implementation to estimate density from counts per frame using video cameras. 4. Accuracy and precision of the method was evaluated by means of computer simulation experiments. Specifically, six animal archetypes displaying well-contrasted movement features were considered. The simulation results demonstrate that density could be accurately estimated after an affordable sampling effort (i.e. number of cameras and deployment time) for a great number of animals across taxa. 5. The proposed method may complement other conventional methods for estimating animal density. The major advantages are that identifying an animal at the individual level and precise knowledge on how animals move are not needed, and that density can be estimated in a single survey. The method can accommodate conventional camera trapping data. The major limitations are related to some implicit assumptions of the underlying model: the home range centres should be homogeneously distributed, the detection probability within the area surveyed by the camera should be known, and animals should move independently to one another. Further improvements for circumventing these limitations are discussed.Ministerio de Educación, Cultura y Deporte, Grant/Award Number: FPU13/01440; Ministerio de Economía y Competitividad Juan de la Cierva Postdoctoral Grant, Grant/Award Number: FJCI-2014-21 and CTM2015-69126-C2-1-R

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests