Premature mortality in refractory partial epilepsy: does surgical treatment make a difference?

Background: Epilepsy carries an increased risk of premature death. For some people with intractable focal epilepsy, surgery offers hope for a seizure-free life. The authors aimed to see whether epilepsy surgery influenced mortality in people with intractable epilepsy. Methods: The authors audited survival status in two cohorts (those who had surgery and those who had presurgical assessment but did not have surgery). Results: There were 40 known deaths in the non-surgical group (3365 person years of follow-up) and 19 in the surgical group (3905 person-years of follow-up). Non-operated patients were 2.4 times (95% CI 1.4 to 4.2) as likely to die as those who had surgery. They were 4.5 times (95% CI 1.9 to 10.9) as likely to die a probable epilepsy-related death. In the surgical group, those with ongoing seizures 1 year after surgery were 4.0 (95% CI 1.2 to 13.7) times as likely to die as those who were seizure-free or who had only simple partial seizures. Time-dependent Cox analysis showed that the yearly outcome group did not significantly affect mortality (HR 1.3, 95% CI 0.9 to 1.8). Conclusion: Successful epilepsy surgery was associated with a reduced risk of premature mortality, compared with those with refractory focal epilepsy who did not have surgical treatment. To some extent, the reduced mortality is likely to be conferred by inducing freedom from seizures. It is not certain whether better survival is attributable only to surgery, as treatment decisions were not randomised, and there may be inherent differences between the groups.<br/

Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework

Background: Scoping studies are increasingly common for broadly searching the literature on a specific topic, yet researchers lack an agreed-upon definition of and framework for the methodology. In 2005, Arksey and O'Malley offered a methodological framework for conducting scoping studies. In their subsequent work, Levac et al. responded to Arksey and O'Malley's call for advances to their framework. Our paper builds on this collective work to further enhance the methodology. Discussion: This paper begins with a background on what constitutes a scoping study, followed by a discussion about four primary subjects: (1) the types of questions for which Arksey and O'Malley's framework is most appropriate, (2) a contribution to the discussion aimed at enhancing the six steps of Arskey and O'Malley's framework, (3) the strengths and challenges of our experience working with Arksey and O'Malley's framework as a large, inter-professional team, and (4) lessons learned. Our goal in this paper is to add to the discussion encouraged by Arksey and O'Malley to further enhance this methodology. Summary: Performing a scoping study using Arksey and O'Malley's framework was a valuable process for our research team even if how it was useful was unexpected. Based on our experience, we recommend researchers be aware of their expectations for how Arksey and O'Malley's framework might be useful in relation to their research question, and remain flexible to clarify concepts and to revise the research question as the team becomes familiar with the literature. Questions portraying comparisons such as between interventions, programs, or approaches seem to be the most suitable to scoping studies. We also suggest assessing the quality of studies and conducting a trial of the method before fully embarking on the charting process in order to ensure consistency. The benefits of engaging a large, inter-professional team such as ours throughout every stage of Arksey and O'Malley's framework far exceed the challenges and we recommend researchers consider the value of such a team. The strengths include breadth and depth of knowledge each team member brings to the study and time efficiencies. In our experience, the most significant challenges presented to our team were those related to consensus and resource limitations. Effective communication is key to the success of a large group. We propose that by clarifying the framework, the purposes of scoping studies are attainable and the definition is enriched

The African Pollen Database (APD) and tracing environmental change: State of the Art

International audienc

Circulating emm types of Streptococcus pyogenes in Scotland: 2011-2015

No abstract available

FUEL POVERTY IN IRELAND: EXTENT, AFFECTED GROUPS AND POLICY ISSUES. ESRI WP262. October 2008

This paper provides updated estimates for the scale of fuel poverty in the Republic of Ireland using two measures: one based on fuel expenditure as a share of income and the other based on self-reported deprivation. It also presents modeling results as to the characteristics of households most vulnerable to fuel poverty, examines the potential effects of future fuel price changes, outlines policies in place in Ireland and other countries, and discusses policy issues

The Distributional Implications of a Carbon Tax in Ireland. ESRI WP250. July 2008

We study the effects of carbon tax and revenue recycling across the income distribution in the Republic of Ireland. In absolute terms, a carbon tax of €20/tCO2 would cost the poorest households less than €3/week and the richest households more than €4/week. A carbon tax is regressive, therefore. However, if the tax revenue is used to increase social benefits and tax credits, households across the income distribution can be made better off without exhausting the total carbon tax revenue

Statistical Models of Nuclear Fragmentation

A method is presented that allows exact calculations of fragment multiplicity distributions for a canonical ensemble of non-interacting clusters. Fragmentation properties are shown to depend on only a few parameters. Fragments are shown to be copiously produced above the transition temperature. At this transition temperature, the calculated multiplicity distributions broaden and become strongly super-Poissonian. This behavior is compared to predictions from a percolation model. A corresponding microcanonical formalism is also presented.Comment: 12 pages, 5 figure

LHCD during current ramp experiments on Alcator C-Mod

The lower hybrid current drive (LHCD) system on Alcator C-Mod is capable of sustaining fully non-inductive discharges for multiple current relaxation times (τcr ∼ 200 ms) at line averaged densities in the range of 5x1019 m-3. Some of these non-inductive discharges develop unstable MHD modes that can greatly reduce current drive performance, particularly in discharges with plasma current of 0.5 MA or less [1,2]. Avoiding these unstable MHD modes motivated an experiment to test if the stable current profile shape of a higher current non-inductive discharge could be achieved in a lower current discharge. Starting from a discharge at 0.8 MA, the plasma current was ramped down to 0.5 MA over 200 ms. The surface voltage of the plasma swings negative during the ramp, with the loop voltage reversal impacting the edge fast electron measurements immediately. Little change can be seen during the Ip ramp in the core fast electron measurements, indicating that the loop voltage reversal does not penetrate fully to the magnetic axis on the timescale of the current ramp. The resulting discharge did not exhibit deleterious MHD instabilities, however the existence of this one discharge does not necessarily represent a robust solution to the problem