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The Coronavirus (Covid-19) pandemic is exerting unprecedented pressure on NHS Health and Social Care provisions, with frontline staff, such as those of critical care units, encountering vast practical and emotional challenges on a daily basis. Although staff are being supported through organisational provisions, facilitated by those in leadership roles, the emergence of mental health difficulties or the exacerbation of existing ones amongst these members of staff is a cause for concern. Acknowledging this, academics and healthcare professionals alike are calling for psychological support for frontline staff, which not only addresses distress during the initial phases of the outbreak but also over the months, if not years, that follow. Fortunately, mental health services and psychology professional bodies across the United Kingdom have issued guidance to meet these needs. An attempt has been made to translate these sets of guidance into clinical provisions via the recently established Homerton Covid Psychological Support (HCPS) pathway delivered by Talk Changes (Hackney & City IAPT). This article describes the phased, stepped-care and evidence-based approach that has been adopted by the service to support local frontline NHS staff. We wish to share our service design and pathway of care with other Improving Access to Psychological Therapies (IAPT) services who may also seek to support hospital frontline staff within their associated NHS Trusts and in doing so, lay the foundations of a coordinated response.
Key learning aims
(1) To understand the ways staff can be psychologically and emotionally impacted by working on the frontline of disease outbreaks.
(2) To understand the ways in which IAPT services have previously supported populations exposed to crises.
(3) To learn ways of delivering psychological support and interventions during a pandemic context based on existing guidance and research.
Background: There are few published reports on the safety and efficacy of stereoelectroencephalography (SEEG) in the presurgical evaluation of pediatric drug-resistant epilepsy. Our objective was to describe institutional experience with pediatric SEEG in terms of (1) insertional complications, (2) identification of the epileptogenic zone and (3) seizure outcome following SEEG-tailored resections. Methods: Retrospective review of 29 patients pediatric drug resistant epilepsy patients who underwent presurgical SEEG between 2005 – 2018. Results: 29 pediatric SEEG patients (15 male; 12.4 ± 4.6 years old) were included in this study with mean follow-up of 6.0 ± 4.1 years. SEEG-related complications occurred in 1/29 (3%)—neurogenic pulmonary edema. A total of 190 multi-contact electrodes (mean of 7.0 ± 2.5per patient) were implanted across 30 insertions which captured 437 electrographic seizures (mean 17.5 ± 27.6 per patient). The most common rationale for SEEG was normal MRI with surface EEG that failed to identify the EZ (16/29; 55%). SEEG-tailored resections were performed in 24/29 (83%). Engel I outcome was achieved following resections in 19/24 cases (79%) with 5.9 ± 4.0 years of post-operative follow-up. Conclusions: Stereoelectroencephalography in presurgical evaluation of pediatric drug-resistant epilepsy is a safe and effective way to identify the epileptogenic zone permitting SEEG-tailored resection.
Background: Temporal lobe epilepsy (TLE) accounts for approximately 20% of pediatric epilepsy cases. Of those, many are considered medically intractable and require surgical interventions. In this study, we hypothesized that mesial temporal sclerosis (MTS) was less common in patients who had undergone surgery for intractable pediatric TLE than in adult series. We further hypothesized that there was a radiological and pathological discordance in identifying the cause of pediatric TLE. Methods: We retrospectively reviewed the charts of pediatric patients with TLE who had undergone surgical treatments as part of the University of Alberta’s Comprehensive Epilepsy Program between 1988 and 2018. Along with preoperative magnetic resonance imaging (MRI) reports, post-surgical pathology results and seizure outcomes were studied Results: Of the 83 pediatric patients who had undergone temporal lobe epilepsy surgery, 28% had tumors, 22% had dual pathologies, 18% had MTS, 11% had focal cortical dysplasia, and 22% had other pathologies. In addition, for 36% of these patients, discordance between their pre-surgical MRI reports and post-surgical pathology reports were found. Conclusions: This was one of the largest retrospective cohort studies of pediatric patients who had undergone surgery for intractable TLE. This study showed that tumors, and not MTS, were the most common pathology in surgical pediatric TLE.
The Berkeley Visible Image Tube (BVIT) has been a user instrument on the SALT 10-m telescope for the past six years. It can observe transient astrophysical phenomena occurring on time-scales of micro-seconds. This overview presented some recent observations of a dMe flare star, and discussed the recent results of our optical Search for Extraterrestrial Intelligence (OSETI) around nearby exoplanet-hosting stars.
Background: Selective amygdalohippocampectomy (SAH) is a surgical option in well-selected cases of pediatric medically refractory temporal lobe epilepsy (TLE). The objective of this study was to compare the surgical outcome and the rate of reoperation for ongoing or recurrent seizures between SAH and anterior temporal lobectomy (ATL) in pediatric TLE. Methods: Retrospective review of 78 pediatric intractable TLE patients referred to the Comprehensive Epilepsy Program at our institution between 1988 and 2015 treated initially with either a trans-middle temporal gyrus SAH (19) or ATL (59). Patients underwent baseline long-term video electroencephalography and 1.5-Tesla MRI. Neuropsychological testing was performed preoperatively and 12-months postoperatively (including reoperations). Results: The mean follow-up was 64 months (range, 12-186 months). The average age at initial surgery was 10.6±5 years with an average delay of 5.7±4 years between seizure onset and surgery. Ultimately 78% were seizure-free (61/78) at most recent follow-up. Seizure freedom after initial surgical treatment was achieved in 81% of patients who underwent ATL (48 patients) versus 42% in SAH (8 patients; p<0.001). Of patients with ongoing disabling seizures following SAH, reoperation (ATL) was offered in 8 resulting in seizure freedom in 63%, without interval neuropsychological decline. Conclusions: SAH amongst well-selected pediatric TLE results in significantly worse seizure control compared with ATL.
The yields of spring barley during a medium-term (7 years) compost and slurry addition experiment and the soil carbon (C) and nitrogen (N) contents, bacterial community structure, soil microbial biomass and soil respiration rates have been determined to assess the effects of repeated, and in some cases very large, organic amendments on soil and crop parameters. For compost, total additions were equivalent to up to 119 t C/ha and 1·7 t N/ha and for slurry they were 25 t C/ha and 0·35 t N/ha over 7 years, which represented very large additions compared to control soil C and N contents (69 t C/ha and 0·3 t N/ha in the 0–30 cm soil depth). There was an initial positive response to compost and slurry addition on barley yield, but over the experiment the yield differential between the amounts of compost addition declined, indicating that repeated addition of compost at a lower rate over several years had the same cumulative effect as a large single compost application. By the end of the experiment it was clear that the addition of compost and slurry increased soil C and N contents, especially towards the top of the soil profile, as well as soil respiration rates. However, the increases in soil C and N contents were not proportional to the amount of C and N added, suggesting either that: (i) a portion of the added C and N was more vulnerable to loss; (ii) that its addition rendered another C or N pool in the soil more susceptible to loss; or (iii) that the C inputs from additional crop productivity did not increase in line with the organic amendments. Soil microbial biomass was depressed at the highest rate of organic amendment, and whilst this may have been due to genuine toxic or inhibitory effects of large amounts of compost, it could also be due to the inaccuracy of the substrate-induced respiration approach used for determining soil biomass when there is a large supply of organic matter. At the highest compost addition, the bacterial community structure was significantly altered, suggesting that the amendments significantly altered soil community dynamics.
Background: Dysembryoblastic neuroepithelial tumors (DNETs) are benign tumors of the cerebral cortex that most commonly occur in children or young adults. Seizures are a frequent presenting feature, with an incidence of 80-100%, and are often an indication for surgical resection. Methods: We performed a retrospective chart review of children with DNETs who underwent epilepsy surgery between 1998 and 2014. Results: A total of 12 subjects were identified (6 males, 6 females), all of whom had seizures prior to surgical resection. Of these patients, 1 had infantile spasms, 2 had simple partial seizures and 10 had complex partial seizures. Tumors were located in the temporal (n=7), frontal (n=3) or parietal (n=2) cortex. These patients went on to have surgery on average 15 months after seizure onset, 3 had incomplete resections. At an average follow up of 6 years 4 months, all patients were class 1 on Engel’s Classification. All but one subject with rare non-disabling seizures were seizure free, with only 6 on medication. Follow up MR imaging revealed tumor recurrence in 1 subject. Conclusions: Despite differing seizure seminology and tumor location, surgical resection of these low-grade tumors resulted in excellent seizure outcome even in the setting of incomplete tumor resection.
This paper brings together the work of the GI Solvency II Technical Provisions working party. The working party was formed in 2009 for the primary purpose of raising awareness of Solvency II and the impact it would have on the work that reserving actuaries do. Over the years, the working party’s focus has shifted to exploring and promoting discussion of the many practical issues raised by the requirements and to promoting best practice. To this end, we have developed, presented and discussed many of the ideas contained in this paper at events and forums. However, the size of the subject means that at no one event have we managed to cover all of the areas that the reserving actuary needs to be aware of. This paper brings together our thinking in one place for the first time. We hope experienced practitioners will find it thought provoking, and a useful reference tool. For new practitioners, we hope it helps to get you up-to-speed quickly. Good luck!
Anorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.
We performed a randomized controlled trial (RCT) with 82 adolescents, aged 12–18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).
The primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group.
Outcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT.
The Next Generation Transit Survey (NGTS) is a new ground-based survey for transiting exoplanets. Our primary goal is to find the first statistically-significant sample of Neptunes and super-Earths that are bright enough for radial velocity confirmation. By measuring precise masses and radii we will constrain the bulk composition and internal structure of planets that span the transition between the gas giants and terrestrial planets. Our brightest exoplanets will also be suitable for atmospheric characterisation with large facilities such as the VLT, JWST and the E-ELT. NGTS construction began in June 2013, and the survey is due to commence in 2014.
We report secondary eclipse detections of the transiting hot Jupiter WASP-3b at 3.6, 4.5 and 8.0μm using the Spitzer Space Telescope's Infrared Array Camera. We find planet-to-star flux ratios of 0.210+0.043−0.029, 0.281+0.012−0.011 and 0.332+0.050−0.034% in the three bands respectively. Comparisons with 1D atmospheric models show these values strongly favour inefficient redistribution of heat around the planet and also favour the presence of a temperature inversion. In addition, WASP-3 probes the cut-off region of a proposed activity-inversion correlation and we find evidence of atmospheric differences between this system and a similarly active system, WASP-4.
Gravitational microlensing observations will lead to a census of planets that orbit stars of different populations. From 2008, ARTEMiS will provide an expert system that allows to adopt a three-step strategy of survey, follow-up and anomaly monitoring of gravitational microlensing events that is capable of detecting planets of Earth mass and below. The SIGNALMEN anomaly detector, an integral part, has already demonstrated its performance during a pilot season. Embedded into eSTAR, ARTEMiS serves as an open platform that links with existing microlensing campaigns. Real-time visualization of ongoing events along with an interpretation moreover allows to communicate “Science live to your home” to the general public.
The WASP consortium is conducting an ultra-wide field survey of stars between 8–15 mag from both hemispheres. Our primary science goal is to detect extra-solar ‘hot-Jupiter’-type planets that eclipse (or transit) bright host stars and for which further detailed investigation will be possible. We summarize the design of the SuperWASP instruments and describe the first results from our northern station SW-N, sited in La Palma, Canary Islands. Our second station, which began operations this year, is located at the South African Astronomical Observatory. Between April and September, 2004, SW-N continuously observed ~6.7 million stars. The consortium's custom-written, fully automated data reduction pipeline has been used to process these data, and the information is now stored in the project archive, held by the Leicester database and archive service (LEDAS). We have applied a sophisticated, automated algorithm to identify the low-amplitude (~0.01 mag), brief (~few hours) signatures of transiting exoplanets. In addition, we have assessed each candidate in the light of all available catalogue information in order to reject data artefacts and astrophysical false positive detections. The highest priority candidates are currently being subjected to further observations in order to select the true planets. Once the exoplanets are confirmed, a host of exciting opportunities are open to us. In this paper, we describe two techniques that exploit the transits in order to detect other objects within the same system. The first involves determining precise epochs for a sequence of transit events in order to detect the small timing variations caused by the gravitational pull of other planets in the same system. The second method employs ultra-high precision photometry of the transits to detect the deviations caused by the presence of exoplanetary moons. Both of these techniques are capable of detecting objects the size of terrestrial planets.