Development of a core outcome set for epilepsy in pregnancy (E-CORE): a national multi-stakeholder modified Delphi consensus study.

OBJECTIVE: To develop a set of core outcomes for studies on pregnant women with epilepsy. DESIGN: Delphi consensus study. POPULATION: Healthcare professionals, and patient representatives with lived experience of epilepsy in the UK. METHODS: We used a modified Delphi method and a consultation meeting to achieve consensus. Potential outcomes were identified by systematic review, and were scored using a Likert scale anchored between 1 (least important) and 5 (most important). We included outcomes that scored ≥4 by >70% of participants, and outcomes that scored ≤2 by <15% of participants. MAIN OUTCOME MEASURES: Outcomes in studies on epilepsy in pregnancy. RESULTS: Seventy-five healthcare professionals completed the first round, 48 (64%) completed the second round, and 37 (49%) completed the third round of the survey. Twenty-four patient representatives participated. The final core outcome set included 31 outcomes in three domains: neurological, offspring, and obstetric. Outcomes in the neurological domain were seizure control in pregnancy and postpartum, status epilepticus, maternal mortality, drowning, sudden unexpected death in epilepsy, postnatal depression, and quality of life. Offspring domain included congenital abnormalities (major and minor), fetal anticonvulsant syndrome, neurodevelopment, autism disorder, neonatal clinical complications, admission to a neonatal intensive care unit, and anthropometric measurements. The obstetric domain included live birth, stillbirth, miscarriage, ectopic, termination of pregnancy, admission to a high dependency or intensive care unit, breastfeeding, mode of delivery, preterm birth, pre-eclampsia, and eclampsia. Outcomes specific for studies on anti-epileptic drugs (AEDs) included maternal AED toxicity, AED compliance, neonatal withdrawal symptoms, and neonatal haemorrhagic disease. CONCLUSION: Embedding this core set in future clinical trials will promote the standardisation of reporting to inform clinical practice. TWEETABLE ABSTRACT: A Delphi method identifying core outcomes for epilepsy in pregnancy. Final core set includes 31 outcomes.

Environmental risk assessment of compost prepared from salvinia, egeria densa, and alligator weed.

Approximately 70,000 m(3) of salvinia (Salvinia molesta) was removed from the Hawkesbury-Nepean River, New South Wales (NSW), Australia, during 2004. This study assessed the risks associated with applying compost prepared from aquatic weeds (AWC) to land, namely, survival and spread of aquatic and terrestrial weeds, eutrophication of waterways, accumulation of heavy metals and phytotoxicity. The results demonstrate composting is an effective method of reducing the viability of aquatic and terrestrial weeds. However, mortality of alligator weed (Alternanthera philoxeroides), which was used as an indicator plant, was significantly (P < 0.001) correlated with the temperature within the windrows and the length of time the material was subjected to composting. Conditions within the central core of the windrow were sufficient to kill the alligator weed, although not all of the aquatic weed material was exposed to the windrows' central core. This resulted in alligator weed continuing to grow at the base of the windrow. To reduce the risk of weeds surviving and spreading in aquatic and terrestrial environments it is suggested compost windrows should be located on an appropriate hard pad to enable complete mixing of the material and ensure all material is exposed to temperatures >55 degrees C for greater than three consecutive days. The likelihood of other risks associated with the AWC was low. If composting is selected as the preferred method for managing organic material harvested from waterways, then ongoing monitoring and evaluation is required to validate the composting process and ensure consumer confidence in the final product.

The probability of achieving full allelic representation for LCN-STR profiling of haploid cells.

Modem forensic techniques allow DNA to be extracted from ever decreasing amounts of cellular material. Low copy number (LCN) profiling enables the production of STR profiles from small numbers of cells. Moreover, methods such as laser micro-dissection enables forensic scientists to potentially isolate individual cells for PCR. The DNA derived from haploid cells (semen) is a common source of forensic evidence in sexual assault cases. Haploid cells contain only half the DNA complement of diploid cells (3 pg compared to 6 pg). The smaller the number of cells sampled, the smaller the probability that there is a full representation of the alleles comprising the donor profile. This paper investigates the relationship between the number of cells sampled and the probability of full representation of all alleles in the donor sample. It also considers the effect of typing several loci as opposed to just a single locus.

The use of phosphate buffered saline for the recovery of cells and spermatozoa from swabs.

In the forensic science laboratory, the recovery of spermatozoa from vaginal swabs, or vaginal cells from penile swabs, can help determine if sexual intercourse may have taken place. There are several methods used to recover spermatozoa and cells from the swabs before visualisation on a microscope slide and most of these methods use water. Phosphate buffered saline (PBS) is a non-toxic solution used in many biological laboratories. Unlike water, PBS prevents cells rupturing or shrivelling up due to osmosis. This study demonstrates that PBS can be used for the extraction of spermatozoa and cells from swabs and that PBS does not affect subsequent DNA profiling.

Experimental paratuberculosis in calves following inoculation with a rabbit isolate of Mycobacterium avium subsp. paratuberculosis.

The role of wildlife species in the epidemiology of paratuberculosis has been the subject of increased research efforts following the discovery of natural paratuberculosis in free-living rabbits from farms in east Scotland. This paper describes the experimental inoculation of young calves with an isolate of Mycobacterium avium subsp. paratuberculosis recovered from a free-living rabbit. After a 6-month incubation period, all eight calves inoculated with the rabbit isolate had developed histopathological and/or microbiological evidence of M. avium subsp. paratuberculosis infection. Similar results were obtained from a group of calves infected with a bovine isolate of M. avium subsp. paratuberculosis. The virulence of the rabbit isolate for calves demonstrated in this study suggests that rabbits are capable of passing paratuberculosis to domestic ruminants and that wildlife reservoirs of M. avium subsp. paratuberculosis should therefore be considered when formulating control plans for the disease.

Natural paratuberculosis infection in rabbits in Scotland.

Natural paratuberculosis infection of rabbits (Oryctolagus cuniculus) was recently diagnosed in Scotland, and an investigation into the pathology of the disease in wild rabbits is reported in this paper. Evidence of Mycobacterium avium subsp. paratuberculosis (M.a. paratuberculosis) infection was detected in 22% of 110 rabbits; the organism was cultured from 17 of 110 rabbits, and histopathological lesions consistent with M.a. paratuberculosis infection were noted in 18 of 98 rabbits examined. No macroscopical lesions suggestive of M.a. paratuberculosis infection were observed. The histopathological lesions were either severe or mild. Severe lesions consisted of extensive macrophage granulomata and numerous giant cells, with many intracellular acid-fast bacteria in the small intestine. For the examination of formalin-fixed, paraffin wax-embedded tissues, neither immunohistochemistry nor the polymerase chain reaction was as sensitive a method of diagnosis as histopathology.

Paratuberculosis infection of nonruminant wildlife in Scotland.

Recent reports of natural paratuberculosis (or Johne's disease) in rabbits, foxes, and stoats has focused debate on the presence and importance of wildlife reservoirs in the epidemiology of this disease. This paper describes an extensive study investigating 18 nonruminant wildlife species for evidence of paratuberculosis. Using both culture and histopathological analysis, fox, stoat, weasel, crow, rook, jackdaw, rat, wood mouse, hare, and badger were found to harbor Mycobacterium avium subsp. paratuberculosis, the causative organism of paratuberculosis, suggesting that the epidemiology of this disease is more complex than previously realized.

Paratuberculosis in wild rabbits (Oryctolagus cuniculus)

A survey of wild rabbits in Tayside, Scotland revealed that 67 per cent were infected with Mycobacterium avium subspecies paratuberculosis. In general, the infected rabbits had histopathological changes within the lymph nodes and intestines which were consistent with the changes due to paratuberculosis in ruminants. The survey raises the possibility that rabbits and other wildlife may be involved in the epidemiology of paratuberculosis, a possibility which has important implications for the control of the disease.

Changing relation between home and clinic blood-pressure measurements: do home measurements predict clinic hypertension?

Blood-pressure screening in a family health centre identified 114 patients (53 male, 61 female) with diastolic pressures of 95 mm Hg and greater after three readings in the seated position (mean 163 [SEM 2]/104 mm Hg). All were instructed in the use of the 'Copal UA 231/251' electronic sphygmomanometer and produced a series of readings taken at home over 3 days. They were recalled after 2 weeks and 4 weeks for repeat clinic measurements of blood pressure. Blood pressure fell on successive clinic visits; at the final visit only 59 patients (31 male, 28 female) had diastolic pressures of 95 mm Hg or greater. Average day-time home blood-pressure measurements (155/94 mm Hg) were significantly lower than the screening blood-pressure measurements but were not significantly different from those at the third clinic visit (154/97 mm Hg). Home blood-pressure measurements were successful in predicting outcome at the third clinic visit in 90 (79%) patients; home-monitored pressures suggested normotension when the final clinic visit diastolic blood pressure was still above 95 mm Hg in only 16 (14%) patients. Only 2 of these had a final clinic diastolic pressure above 105 mm Hg. Home monitoring represents a practicable and acceptable alternative to repeated clinic measurements in the initial assessment of hypertensive patients.

Possible cataractogenic effect of radionuclides deposited within the eye from the blood stream.

The clinical and histological examination of a cataract in a man of 47 is described together with a review of the deposition of radionuclides in the eye. It is suggested that the cataract was possibly due, at least in part, to irradiation of the sensitive cells in the germinative zone of the lens epithelium by alpha particles deposited in the pigmented tissues of the eye from the 239Pu circulating in the blood.