Does in utero exposure of antiepileptic drugs lead to failure to reach full cognitive potential?

AbstractA clinical scenario of a young female on 800mg of sodium valproate (VPA) who has recently failed lamotrigine (LTG) and levetiracetam (LEV) and who is currently planning a pregnancy is presented. Currently available data pertaining to the longer-term development of children exposed to antiepileptic drugs (AEDs) are reviewed along with considerations around the methodology and interpretation of such research. There is an accumulation of data highlighting significant risks associated with prenatal exposed to VPA, with the level of risk being mediated by dose. The majority of published evidence does not find a significant risk associated with carbamazepine (CBZ) exposure in utero for global cognitive abilities however the evidence for more specific cognitive skills are unclear. Limited data indicate that LTG may be a preferred treatment to VPA in terms of foetal outcome but further evidence is required. Too little data pertaining to LEV exposure is available and a lack of evidence regarding risk of this and other new AEDs should not be interpreted as evidence of safety

Accessing Patient Records in Virtual Healthcare Organisations

The ARTEMIS project is developing a semantic web service based P2P interoperability infrastructure for healthcare information systems that will allow healthcare providers to securely share patient records within virtual healthcare organisations. Authorisation decisions to access patient records across organisation boundaries can be very dynamic and must occur within a strict legislative framework. In ARTEMIS we are developing a dynamic authorisation mechanism called PBAC that provides a means of contextual and process oriented access control to enforce healthcare business processes. PBAC demonstrates how healthcare providers can dynamically share patient records for care pathways across organisation boundaries

Decentralization in Bitcoin and Ethereum Networks

Blockchain-based cryptocurrencies have demonstrated how to securely implement traditionally centralized systems, such as currencies, in a decentralized fashion. However, there have been few measurement studies on the level of decentralization they achieve in practice. We present a measurement study on various decentralization metrics of two of the leading cryptocurrencies with the largest market capitalization and user base, Bitcoin and Ethereum. We investigate the extent of decentralization by measuring the network resources of nodes and the interconnection among them, the protocol requirements affecting the operation of nodes, and the robustness of the two systems against attacks. In particular, we adapted existing internet measurement techniques and used the Falcon Relay Network as a novel measurement tool to obtain our data. We discovered that neither Bitcoin nor Ethereum has strictly better properties than the other. We also provide concrete suggestions for improving both systems.Comment: Financial Cryptography and Data Security 201

Development and Validation of a 28-gene Hypoxia-related Prognostic Signature for Localized Prostate Cancer.

BACKGROUND: Hypoxia is associated with a poor prognosis in prostate cancer. This work aimed to derive and validate a hypoxia-related mRNA signature for localized prostate cancer. METHOD: Hypoxia genes were identified in vitro via RNA-sequencing and combined with in vivo gene co-expression analysis to generate a signature. The signature was independently validated in eleven prostate cancer cohorts and a bladder cancer phase III randomized trial of radiotherapy alone or with carbogen and nicotinamide (CON). RESULTS: A 28-gene signature was derived. Patients with high signature scores had poorer biochemical recurrence free survivals in six of eight independent cohorts of prostatectomy-treated patients (Log rank test P \u3c .05), with borderline significances achieved in the other two (P \u3c .1). The signature also predicted biochemical recurrence in patients receiving post-prostatectomy radiotherapy (n = 130, P = .007) or definitive radiotherapy alone (n = 248, P = .035). Lastly, the signature predicted metastasis events in a pooled cohort (n = 631, P = .002). Prognostic significance remained after adjusting for clinic-pathological factors and commercially available prognostic signatures. The signature predicted benefit from hypoxia-modifying therapy in bladder cancer patients (intervention-by-signature interaction test P = .0026), where carbogen and nicotinamide was associated with improved survival only in hypoxic tumours. CONCLUSION: A 28-gene hypoxia signature has strong and independent prognostic value for prostate cancer patients

Scalable Open-Vote Network on Ethereum

McCorry et al. (Financial Cryptography 2017) presented the first implementation of a decentralized self-tallying voting protocol on Ethereum. However, their implementation did not scale beyond 40 voters since all the computations were performed on the smart contract. In this paper, we tackle this problem by delegating the bulk computations to an off-chain untrusted administrator in a verifiable manner. Specifically, the administrator tallies the votes off-chain and publishes a Merkle tree that encodes the tallying computation trace. Then, the administrator submits the Merkle tree root and the tally result to the smart contract. Subsequently, the smart contract transits to an intermediate phase where at least a single honest voter can contend the administrator\u27s claimed result if it was not computed correctly. Then, in the worst case, the smart contract verifies the dispute at the cost of an elliptic curve point addition and scalar multiplication, and two Merkle proofs of membership which are logarithmic in the number of voters. This allows our protocol to achieve higher scalability without sacrificing the public verifiability or voters\u27 privacy. To assess our protocol, we implemented an open-source prototype on Ethereum and carried out multiple experiments for different numbers of voters. The results of our implementation confirm the scalability and efficiency of our proposed solution which does not exceed the current block gas limit for any practical number of voters

Quality indicators for Palliative Day Services: A modified Delphi study

BACKGROUND: The goal of Palliative Day Services is to provide holistic care that contributes to the quality of life of people with life threatening-illness and their families. Quality indicators provide a means by which to describe, monitor and evaluate the quality of Palliative Day Services provision, and act as a starting point for quality improvement. However, currently, there are no published quality indicators for Palliative Day Services. AIM: To develop and provide the first set of quality indicators that describe and evaluate the quality of Palliative Day Services. DESIGN AND SETTING: A modified Delphi technique was used to combine best available research evidence derived from a systematic scoping review with multi-disciplinary expert appraisal of the appropriateness and feasibility of candidate indicators. The resulting indicators were compiled into ‘toolkit’, and tested in five UK Palliative Day Service settings. RESULTS: A panel of experts independently reviewed evidence summaries for 182 candidate indicators and provided ratings on appropriateness, followed by a panel discussion and further independent ratings of appropriateness, feasibility, and necessity. This exercise resulted in the identification of 30 indicators which were used in practice testing. The final indicator set comprised 7 structural indicators, 21 process indicators, and 2 outcome indicators. CONCLUSIONS: The indicators fulfil a previously unmet need among Palliative Day Service providers by delivering an appropriate and feasible means to assess, review, and communicate the quality of care, and to identify areas for quality improvement