The incidence of sudden unexpected death in epilepsy (sudep) in south dublin and wicklow

Patients with epilepsy have a mortality rate higher than that of the general population. Some of this excess mortality is attributable to sudden unexpected death (SUDEP). We examined the incidence of this phenomenon both retrospectively and prospectively in the population of South Dublin and Wicklow over the period May 1992–1995. Cases were ascertained by examination of post-mortem registers of hospitals serving the area studied. Information on cases was sought from hospital records, general practitioners and families. Fifteen cases (10 male, five female) were identified resulting in an overall incidence rate of SUDEP of 1:680/year for the 3 years of the study. This is the only study of incidence of SUDEP conducted in Ireland and our results are in keeping with incidence rates elsewhere in Europe and the USA

Preliminary joint X-ray and neutron protein crystallographic studies of ecDHFR complexed with folate and NADP\u3csup\u3e+\u3c/sup\u3e

A crystal of Escherichia coli dihydrofolate reductase (ecDHFR) complexed with folate and NADP+ of 4 x 1.3 x 0.7 mm (3.6 mm3) in size was obtained by sequential application of microseeding and macroseeding. A neutron diffraction data set was collected to 2.0 A resolution using the IMAGINE diffractometer at the High Flux Isotope Reactor within Oak Ridge National Laboratory. A 1.6 A resolution X-ray data set was also collected from a smaller crystal at room temperature. The neutron and X-ray data were used together for joint refinement of the ecDHFR–folate–NADP+ ternary-complex structure in order to examine the protonation state, protein dynamics and solvent structure of the complex, furthering understanding of the catalytic mechanism

Multi-model and multi-scenario assessments of Asian water futures: the Water Futures and Solutions (WFaS) initiative

This paper presents one of the first quantitative scenario assessments for future water supply and demand in Asia to 2050. The assessment, developed by the Water Futures and Solutions (WFaS) initiative, uses the latest set of global climate change and socioeconomic scenarios and state-of-the-art global hydrological models. In Asia, water demand for irrigation, industry and households is projected to increase substantially in the coming decades (30-40% by 2050 compared to 2010). These changes are expected to exacerbate water stress, especially in the current hotspots such as north India and Pakistan, and north China. By 2050, 20% of the land area in the Asia-Pacific region, with a population of 1.6-2 billion, is projected to experience severe water stress. We find that socioeconomic changes are the main drivers of worsening water scarcity in Asia, with climate change impacts further increasing the challenge into the 21st century. Moreover, a detailed basin-level analysis of the hydro-economic conditions of 40 Asian basins shows that although the coping capacity of all basins is expected to improve due to GDP growth, some basins continuously face severe water challenges. These basins will potentially be home to up to 1.6 billion people by mid-21st century

Improving Water Resources Management on Global and Region Scales – Evaluating Strategies for Water Futures with the IIASA’s Community Water Model

Half of the planet’s population is severely impacted by severe water issues including absent or unreliable water supply, sanitation, poor water quality, unmitigated floods and droughts, and degraded water environments. In recent years, global water security has been highlighted not only by the science community but also by business leaders as one of the greatest threats to sustainable human development for different generations. How can we ensure the well-being of people and ecosystems with limited water, technology and financial resources? To evaluate this, IIASA’s Water Futures and Solutions Initiative (WFaS) is identifying a portfolios of robust and cost-effective options across different economic sectors including agriculture, energy, manufacturing, households, and environment and ecosystems. Options to increase water supply and accessibility are evaluated together with water demand management and water governance options. To test these solution-portfolios in order to obtain a clear picture of the opportunities but also of the risks and the trade-offs we have developed the Community Water Model (CWATM) which joins IIASA’s integrated assessment modeling framework, coupling hydrology with hydro-economics (ECHO model), energy (MESSAGE model) and land use (GLOBIOM model). CWATM has been developed to work flexibly with varying spatial resolutions from global to regional levels. The model is open source and community-driven to promote our work amongst the wider water and other science community worldwide, with flexibility to link to other models and integrate newly developed modules such as water quality. In order to identify the solution portfolios, we present a global hotspots assessment of water-related risks with the ability to zoom in at regional scale using the example of the Lake Victoria basin in E. Africa. We show how socio-economic and climate change will alter spatial patterns of the hydrological cycle and have regional impacts on water availability. At the same time, we assess water needs for humans and environment to identify the population and regions that are vulnerable to changes linked to extremes such as water scarcity, droughts and floods. Different solution-portfolios to facilitate regional water management planning will be further discussed

Atopic eczema and cancer: parallel cohort studies in England and Denmark

IMPORTANCE: Associations between atopic eczema and cancer are unclear, with competing theories: that increased immune surveillance reduces cancer risk; and that immune stimulation increases risk. Establishing baseline cancer risk in people with atopic eczema is important prior to exploring the impact of new biologic drugs (for eczema) on cancer risk. OBJECTIVE: To investigate whether atopic eczema is associated with cancer. DESIGN: Matched cohort studies (England: 1998-2016; Denmark: 1982-2016). SETTING: English primary care, and nationwide Danish data. PARTICIPANTS: Individuals with atopic eczema (England: adults only; Denmark: any age) matched on age, sex, calendar period, and (in England only) primary care practice, to people without eczema. EXPOSURE: Atopic eczema MAIN OUTCOMES: We compared overall risk of cancer, and of 11 specific cancers, in people with and without eczema. RESULTS: We included 471,970 and 2,239,775 individuals with and without atopic eczema respectively in England; and 44,945 and 445,673 respectively in Denmark. We found little evidence of associations between atopic eczema and cancer overall (adjusted hazard ratios [HRs] [99%CI]: England 1.04 [1.02-1.06]; Denmark 1.05 [0.95-1.16]), or for most specific cancers. However, non-cutaneous lymphoma risk was raised in people with atopic eczema in England (adjusted HR [99%CI] 1.20 [1.07-1.34] for non-Hodgkin’s [NHL] and 1.48 [1.07-2.04] for Hodgkin’s). Lymphoma risk increased with greater eczema severity (NHL adjusted HR [99%CI] compared to without eczema: mild 1.06 [0.90-1.25], moderate 1.24 [1.04-1.48], severe 2.08 [1.42-3.04]). Danish point estimates also showed increased lymphoma in moderate-to-severe eczema compared to without (adjusted HR [99%CI]: NHL 1.31 [0.76-2.26]; Hodgkin’s 1.35 [0.65-2.28]), but confidence intervals were wide. CONCLUSIONS AND RELEVANCE: Our findings, from two large population-based studies in different settings, are largely reassuring as they do not support associations between eczema and most cancers. However, we observed an association between eczema and lymphoma that increased with eczema severity, which warrants further study with the introduction of new therapeutics that may impact cancer risk

Inflammatory skin diseases and the risk of chronic kidney disease: population-based case-control and cohort analyses.

BACKGROUND: Emerging evidence suggests an association between common inflammatory skin diseases and chronic kidney disease (CKD). OBJECTIVES: To explore the association between CKD stages 3-5 (CKD3-5) and atopic eczema, psoriasis, rosacea and hidradenitis suppurativa. METHODS: We undertook two complementary analyses; a prevalent case-control study and a cohort study using routinely collected primary care data [UK Clinical Practice Research Datalink (CPRD)]. We matched individuals with CKD3-5 in CPRD in March 2018 with up to five individuals without CKD for general practitioner practice, age and sex. We compared the prevalence of CKD3-5 among individuals with and without each inflammatory skin disease. We included individuals in CPRD with diabetes mellitus (2004-2018) in a cohort analysis to compare the incidence of CKD3-5 among people with and without atopic eczema and psoriasis. RESULTS: Our study included 56 602 cases with CKD3-5 and 268 305 controls. Cases were more likely than controls to have a history of atopic eczema [odds ratio (OR) 1·14, 99% confidence interval (CI) 1·11-1·17], psoriasis (OR 1·13, 99% CI 1·08-1·19) or hidradenitis suppurativa (OR 1·49, 99% CI 1·19-1·85), but were slightly less likely to have been diagnosed with rosacea (OR 0·92, 99% CI 0·87-0·97), after adjusting for age, sex, practice (matching factors), index of multiple deprivation, diabetes, smoking, harmful alcohol use and obesity. Results remained similar after adjusting for hypertension and cardiovascular disease. In the cohort with diabetes (N = 335 827), there was no evidence that CKD3-5 incidence was associated with atopic eczema or psoriasis. CONCLUSIONS: Atopic eczema, psoriasis and hidradenitis suppurativa are weakly associated with CKD3-5. Future research is needed to elucidate potential mechanisms and the clinical significance of our findings

Sources and export of nutrients in the Zambezi River basin: status and future trend

In the past decades, nutrient enrichment in African water bodies has been frequently reported and associated to long-term ecological and socio-economic consequences, such as species extinction, unsafe drinking water and compromised local livelihood. Meanwhile, rapid population growth and land-use change towards intensified food production are projected in Africa. As a result, substantial increases are expected in human-induced nutrient inputs (e.g. human waste and fertilizer) to the terrestrial and aquatic environments. This may potentially further deteriorate African water bodies. As part of the Integrated Solution for Water, Land and Energy (IS-WEL) project, this study aims to assess the status and projected changes of nutrient sources, inputs to rivers and export to seas, shading light on possible solutions to minimize further nutrient-induced deterioration of the water bodies and maximize the availability of water of suitable quality for different sectors. This study focuses on the Zambezi river basin, the fourth largest transboundary basin draining through eight southern African countries. Nutrient sources, inputs to rivers and export to sea are estimated using the MARINA model (Model to Assess River Inputs of Nutrients to seAs) under current conditions and future climate, land use and socio-economic projections up to 2050. Results show that for the current period (2005-2010), inputs of nutrients (nitrogen and phosphorus) to rivers and their export to sea are mainly attributed to natural sources. These sources include nitrogen fixation by the natural ecosystems, phosphorus weathering, and leaching of organic nitrogen and phosphorus from non-agricultural areas. By 2050, nutrient sources will be at least doubled due to anthropogenic inputs in the basin. Consequently, the fraction of human-induced nutrient export are projected to increase considerably, especially for dissolved inorganic phosphorus from domestic wastewater. Additionally, nutrient export to sea is strongly influenced by the intra- and inter-annual precipitation and discharge variabilities in the region. The study highlights the need to simultaneously consider source control, infrastructure development and climate adaptation to minimize further nutrient-induced deterioration of water bodies