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Background: New-onset refractory status epilepticus (NORSE) is a rare clinical presentation affecting previously healthy individuals. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE and applies when a preceding fever occurs. The NORSE/FIRES Family Registry has been developed to gain insight into risk factors and to assess the spectrum of clinical outcomes amongst survivors. Methods: Survivors, surrogates, and physicians can enter patient data into the REDCap-based registry: https://www.norseinstitute.org/norse-registry-2. Information collected includes medical history, clinical presentation, and quality of life, among others. Participants are invited to complete follow-up surveys for up to two years following presentation of seizures. Enrollment is ongoing in multiple languages. Results: 56 participants are enrolled from 12 countries (2-78 years, median: 12.5, IQR: 20.5, 31 survivors). At ≥6 months after onset, survivors experience a mean of ≥12 seizures per month and remain on a median of 4 (IQR: 3) anti-seizure medications. The median quality of life amongst all survivors was rated 4/10 (IQR: 3.5). Conclusions: Preliminary data suggests that survivors of NORSE/FIRES have a high seizure burden and poor quality of life. This international multi-lingual family registry will help develop hypotheses for future studies and provides an opportunity for families to contribute to the scientific understanding of this disease.
To systematically review evidence from systematic reviews of interventions to improve dietary behaviours and reduce food wastage in secondary school pupils.
CINAHL, Cochrane Reviews, EMBASE, MEDLINE, PsychINFO and Web of Science were searched for systematic reviews of school-based dietary interventions from 2000 to 2020 published in a peer-reviewed journal in English. Articles were reviewed independently by two authors. AMSTAR-2 was used for quality assessment.
Secondary school dietary interventions.
Adolescents (aged 11–18).
In total, thirteen systematic reviews of dietary interventions in secondary schools met the inclusion criteria. A number of key characteristics of interventions that contributed to improvements in food choices in secondary school pupils were identified. These included the combination of education and environmental restructuring, incorporation of computer-based feedback, media or messaging, peer and/or parent involvement, an increase in the availability of healthy foods and the use of behavioural theory as a basis to the intervention. Intervention components that contributed specifically to a reduction in sugar-sweetened beverage intake or an increase in fruit and vegetable consumption, which are particularly relevant to adolescents, could not be determined. Similarly, evidence for interventions that improve nutritional knowledge and attitudes was limited.
This systematic review of systematic reviews has identified a number of components of dietary interventions that can be explored to improve dietary behaviours in secondary school environments and, if demonstrated to be effective, be considered for inclusion in policies and strategies to improve the school food environment and promote dietary change.
The present study sought to unravel the psychological processes through which mass incarceration, specifically paternal incarceration, is negatively affecting the next generation of children. Data came from 4,327 families from 20 cities who participated in a 10-year longitudinal study. Parents and children reported on children’s rule-breaking behaviors and depressive symptoms when they were on average ages 5 (2003–2006), 9 (2007–2010), and 15 (2014–2017). Parental surveys and disposition information were combined to assess paternal incarceration at each age. Results showed that children who experienced paternal incarceration at age 5 also demonstrated more rule-breaking behaviors at age 15. Children’s age-9 depressive symptoms partially mediated our finding, such that children who experienced paternal incarceration at age 5 also showed greater depressive symptoms at age 9, which in turn predicted greater rule-breaking behaviors at age 15. Paternal incarceration predicted future rule-breaking behaviors more strongly than did other forms of father loss. Because we found paternal incarceration during childhood is associated with worsened adjustment into adolescence, we discussed the need for developmentally appropriate practices in the criminal justice system.
As Ngāi Tahu (southern Maori), we take issue with widespread reference in scholarly publication to Polynesian voyagers reaching the Antarctic, an idea that originated in the translation of Rarotongan traditions in the nineteenth century. Analysis of those indicates that they contain no plausible reference to Antarctic seafaring. Southern Māori interests have extended into the Subantarctic Islands for 800 years but there is no reference to Antarctica in our historical traditions. Our archaeology and history document a southern boundary to Māori occupation at Port Ross (Auckland Islands), despite habitable islands existing further south. We think it is very unlikely that Māori or other Polynesian voyaging reached the Antarctic.
Background: A significant proportion of glioblastoma multiforme (GBM) patients are considered for repeat resection, but evidence regarding best management remains elusive. Methods: An electronic portfolio of MR images of 37 cases of pathologically confirmed recurrent GBM with an accompanying clinical vignette was constructed. Surgical responders from various countries, training backgrounds, and years’ experience were asked for each case to select: their chosen management (repeat surgery, chemotherapy, radiation, or conservative), confidence in recommended management, and whether they would include the patient in a randomized trial that gave a 50% chance of re-operation. Responses were evaluated with kappa statistics and values interpreted according to Landis and Koch (0–0.2, slight; 0.21–0.4, fair; 0.41–0.6, moderate; 0.61–0.8, substantial; 0.81-1.0 perfect agreement). Results: 26 surgeons responded to the survey. Agreement regarding best management of recurrent GBM was slight, even when management options were dichotomized (repeat surgery vs. all others) (k=0.198 (95%CI 0.133-0.276). Country of practice, years’ experience, and training background did not improve agreement. Responders were willing to include more than 70% of patients in a randomized trial. Conclusions: Only slight agreement exists regarding the question of re-operation for patients with recurrent GBM. This supports the need for a randomized controlled trial.
We report a case of a monochorionic diamniotic twin with an uncomplicated pregnancy, but with an unexpected large intertwin hemoglobin (Hb) difference at birth. Twin 1 was delivered vaginally and had an uneventful neonatal course. The umbilical cord of Twin 1 was clamped approximately 5 min after birth. After the birth of Twin 1, Twin 2 developed severe bradycardia and showed limited cardiac output on ultrasound, for which an emergency cesarean section was performed. A full blood count revealed an Hb of 20.1 g/dL for Twin 1 and 10.2 g/dL for Twin 2 (intertwin difference 9.9 g/dL). Reticulocyte counts were similar, 40‰ and 38‰, respectively. Placental examination revealed 10 vascular anastomoses, including one arterio-arterial anastomosis with a diameter of 1.4 mm. Additionally, a large chorangioma was present on the placental surface of Twin 2. There was no color difference on the maternal side of the placenta. Based on the reticulocyte count ratio and the placental characteristics, twin anemia polycythemia sequence was ruled out as the cause of the large intertwin Hb difference. In this report, we discuss the various potential causes that could explain the large intertwin Hb difference including the role of delayed cord clamping in Twin 1, and the role of a large chorangioma, which may have attracted blood from the fetal circulation of Twin 2.
Viburnum is a temperate-zone genus that also occurs in mountains of South America and Malesia, and seeds of many species have morphophysiological dormancy (MPD). Information on the level of MPD in seeds of species in various clades of Viburnum potentially would increase our understanding of the evolutionary relationships between the nine levels of MPD. Our aim was to determine the level of MPD in seeds of Viburnum plicatum var. formosanum that is endemic to mountains (1800–3000 m a.s.l.) in Taiwan and a member of the Lutescentia clade. The temperature requirements for embryo growth and root and shoot emergence and response of seeds to gibberellic acid (GA) were determined. No fresh seeds germinated during 16 weeks of incubation at 15/5, 20/10, 25/15, 30/20 or 25°C. Embryo growth and root emergence occurred during moist cold stratification at 5°C or at a temperature sequence of 15/5 to 5°C. During cold stratification, embryos length increased from 0.76 ± 0.06 to 3.40 ± 0.26 mm and the embryo length:seed length ratio from 0.20 ± 0.02 to 0.68 ± 0.07. In a temperature sequence simulating field conditions, embryos grew inside seeds at 5°C, roots emerged at 15/5°C and shoots emerged at 20/10°C. The optimum temperature for embryo growth was 5°C. Neither GA3 nor GA4 was effective in promoting root emergence. We conclude that seeds of V. plicatum var. formosanum have deep complex MPD, which is a first report for Viburnum. Dormancy release during the cool season at high elevations helps to ensure that seeds germinate at the beginning of the warm season.
Disasters can have impact on the demand and supply of blood, with such a difficult perspective, planning of an appropriate response to counterbalance the need for blood is of paramount importance. The primary objective of this study was to evaluate how the impact of blood imbalances may be absorbed by inert recruitment of donors during 2 life-threatening earthquakes that shook Taiwan on the same date in 2016 and 2018.
A retrospective database search from blood bank registries was developed.
Despite the public efforts to restrain the flow, a 3- to 4-fold increase in volunteers responded to the earthquakes. This surge alleviated after a day and did not contribute to sub-par collections. Those who donated more than usual immediately after the event were identified as first-time, younger, and female populations. The hospitals providing inpatient care to the injured transfused a slightly decreased amount of packed red cells, whereas the use of whole blood, platelets, and plasma remained stable. The inert recruiting was effective in reducing the duration of donor overabundance.
Compared with other examples, the inert recruiting approach was effective in reducing the duration of donor overabundance to 1 day and may be useful for disaster preparedness of transfusion supplies.
During the last few decades, the lake-terminating glaciers in the Himalaya have receded faster than the land-terminating glaciers as proglacial lakes have exacerbated the mass loss of their host glaciers. Monitoring the impacts of glacier recession and dynamics on lake extent and water volume provides an approach to assess the mass interplay between glaciers and proglacial lakes. We describe the recession of Longbasaba Glacier and estimate the mass wastage and its contribution to the water volume of its proglacial lake. The results show that the glacier area has decreased by 3% during 1988–2018, with a more variable recession prior to 2008 than in the last decade. Longbasaba Lake has expanded by 164% in area and 237% in water volume, primarily as a result of meltwater inflow produced from surface lowering of the glacier. Over the periods 1988–2000 and 2000–18, the mass loss contributed by glacier thinning has decreased from 81 to 61% of the total mass loss, accompanied by a nearly doubled contribution from terminus retreat. With the current rate of retreat, Longbasaba glacier is expected to terminate in its proglacial lake for another four decades. The hazard risk of this lake is expected to continue to increase in the near future because of the projected continued glacier mass loss and related lake expansion.
Deep neural networks (DNN) have solved many tasks, including image classification, object detection, and semantic segmentation. However, when there are huge parameters and high level of computation associated with a DNN model, it becomes difficult to deploy on mobile devices. To address this difficulty, we propose an efficient compression method that can be split into three parts. First, we propose a cross-layer matrix to extract more features from the teacher's model. Second, we adopt Kullback Leibler (KL) Divergence in an offline environment to make the student model find a wider robust minimum. Finally, we propose the offline ensemble pre-trained teachers to teach a student model. To address dimension mismatch between teacher and student models, we adopt a $1\times 1$ convolution and two-stage knowledge distillation to release this constraint. We conducted experiments with VGG and ResNet models, using the CIFAR-100 dataset. With VGG-11 as the teacher's model and VGG-6 as the student's model, experimental results showed that the Top-1 accuracy increased by 3.57% with a $2.08\times$ compression rate and 3.5x computation rate. With ResNet-32 as the teacher's model and ResNet-8 as the student's model, experimental results showed that Top-1 accuracy increased by 4.38% with a $6.11\times$ compression rate and $5.27\times$ computation rate. In addition, we conducted experiments using the ImageNet$64\times 64$ dataset. With MobileNet-16 as the teacher's model and MobileNet-9 as the student's model, experimental results showed that the Top-1 accuracy increased by 3.98% with a $1.59\times$ compression rate and $2.05\times$ computation rate.
This essay treats of the (Neo)platonic influences in the thought of Thomas Aquinas, in particular the notion of participation. It describes Aquinas’ doctrine of participation in being as developed from his principal Neoplatonic sources, to wit, Boethius’ De hebdomadibus, Dionysius’ De divinis nominibus, and the Liber de causis. It argues that the doctrine of creation in terms of participation the Christian conditions of creation.
Fibromyalgia (FM) is a chronic widespread pain syndrome. Although its mechanism remains relatively unknown, accelerated neurodegeneration in the brain has been reported in patients with FM. Sleep disturbance can increase the risk of neurocognitive disorders, which are associated with tau and beta-amyloid (Aβ) protein accumulation. We hypothesize neurodegeneration in patients with FM may be associated with sleep disturbance.
In this case-control study, we analyzed serum tau and Aβ levels and their association with symptom profiles for patients with FM, by recruiting 22 patients with FM and 22 age-matched healthy participants. The visual analog scale, Fibromyalgia Impact Questionnaire, pressure pain threshold test, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory-II, Beck Anxiety Inventory, and serum tau and beta-amyloid-42 (Aβ-42) levels were recorded. The Mann–Whitney test was conducted to compare questionnaire and protein level results between the groups. Pearson correlation test was conducted to investigate the correlation of questionnaire scores with tau and Aβ-42 levels in patients with FM. The significance level was set at P < .05.
Serum tau and Aβ-42 levels were significantly higher in patients with FM than in controls. A positive correlation between serum tau levels and PSQI scores was observed in patients with FM (r = 0.476, P = .025). We found that only sleep disturbance in patients with FM was significantly associated with higher serum tau levels among all symptom scores.
We suggest sleep disturbance may play a vital role in the pathomechanism of accelerated neurodegeneration in FM.
Despite evidence of gender differences in bipolar disorder characteristics and comorbidity, there is little research on the differences in treatment and service use between men and women with bipolar disorder.
To use routine data to describe specialist mental health service contact for bipolar disorder, including in-patient, community and support service contacts; to compare clinical characteristics and mental health service use between men and women in contact with secondary services for bipolar disorder.
Cross-sectional analysis of mental health patients with bipolar disorder in New Zealand, based on complete national routine health data.
A total of 3639 individuals were in contact with specialist mental health services with a current diagnosis of bipolar disorder in 2015. Of these 58% were women and 46% were aged 45 and over. The 1-year prevalence rate of bipolar disorder leading to contact with specialist mental health services was 1.56 (95% CI 1.50–1.63) per 100 000 women and 1.20 (95% CI 1.14–1.26) per 100 000 men. Rates of bipolar disorder leading to service contact were 30% higher in women than men (rate ratio 1.30, 95% CI 1.22–1.39). The majority (68%) had a diagnosis of bipolar I disorder. Women were more likely to receive only out-patient treatment and have comorbid anxiety whereas more men had substance use disorder, were convicted for crimes when unwell, received compulsory treatment orders and received in-patient treatment.
Although the prevalence of bipolar disorder is equal between men and women in the population, women were more likely to have contact with specialist services for bipolar disorder but had a lower intensity of service interaction.
To assess the prevalence of influenza and respiratory syncytial virus (RSV) in adults hospitalized for a respiratory infection in the winter months and to evaluate the impact of a viral diagnosis on empirical antimicrobial management (antibiotics and antivirals).
Observational cohort study.
Acute-care university hospital.
The study included 963 adult patients hospitalized over a 4-year surveillance period.
Annual surveillance timelines were defined according to epidemiological criteria related to the circulation of RSV and influenza viruses in the general population. Patients were screened following a severe acute respiratory infection (SARI) case definition at the emergency department and were enrolled for molecular assay targeting influenza/RSV viruses after oral informed consent. Epidemiological and clinical data were recorded prospectively, microbiological investigations, antimicrobial management, and outcome data were reviewed retrospectively.
An influenza or RSV virus was documented in 316 of 963 patients (33%). Optimization of antimicrobial management (AM) was achieved in 162 of 265 patients (61%) with a positive viral diagnosis and no bacterial infection at admission (AM treatment not initiated, n = 111; discontinued, n = 51). In contrast, only 128 of 462 patients (28%) with negative microbiological investigations did not have AM treatment initiated (n = 116) or had such treatment discontinued (n = 12). Early, targeted antiviral treatment was prescribed in 235 of 253 patients (93%) confirmed with influenza. Epidemiological, clinical, and outcome data were similar in both groups.
Epidemiological surveillance associated with influenza/RSV molecular diagnosis in adults hospitalized for severe winter respiratory infections dramatically enhanced antimicrobial management.