Care delivery and self-management strategies for children with epilepsy.

BACKGROUND: Epilepsy is a neurological disorder affecting both children and adults. Epileptic seizures are the result of excessive and abnormal cortical cell electrical activity in the brain. In response to criticism that epilepsy care for children has little impact on long-term outcomes, healthcare professionals and administrators have developed various service models and strategies to address perceived inadequacies. This is an updated version of a Cochrane Review previously published in 2018. OBJECTIVES: To assess the effects of any specialised or dedicated intervention for epilepsy versus usual care in children and adolescents with epilepsy and their families. SEARCH METHODS: We searched the following databases on 14 January 2020: the Cochrane Register of Studies (CRS Web), MEDLINE (Ovid, 1946 to 13 January 2020), PsycINFO (1887 to 14 January 2020), CINAHL Plus (1937 to 14 January 2020), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The Cochrane Register of Studies (CRS Web) includes the Cochrane Epilepsy Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL). We also contacted experts in the field seeking information on unpublished and ongoing studies and checked the websites of epilepsy organisations and the reference lists of included studies. SELECTION CRITERIA: We included randomised controlled trials recruiting children and adolescents with epilepsy. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion and extracted the relevant data. We assessed the following outcomes: 1. Seizure frequency and severity; 2. Appropriateness and volume of medication prescribed (including evidence of drug toxicity); 3. Participants' reported knowledge of information and advice received from professionals; 4. Participants' reports of health and quality of life; 5. Objective measures of general health status; 6. Objective measures of social or psychological functioning (including the number of days spent on sick leave/absence from school or work, and employment status); and 7. Costs of care or treatment. The results of the data extraction and quality assessment for each study were presented in structured tables and as a narrative summary. All summary statistics were extracted for each outcome. MAIN RESULTS: We included nine studies of eight interventions in the review, reporting on seven distinct self-management programmes for educating or counselling children with epilepsy and their parents, and one new model of care. Based largely on self-reported outcomes, each programme showed some benefits for the well-being of children with epilepsy; however, all of the included studies had methodological flaws. No single programme was evaluated with different study samples, and in no instance was the same outcome measured and reported in the same way across studies, precluding any possible meta-analysis, even if the interventions were considered sufficiently similar to include in meta-analysis.  We chose the outcomes for which data might be important for decisions about the interventions as per guidance in the Cochrane Handbook for Systematic Reviews of Interventions. We found moderate certainty evidence that one of the educational interventions reduced seizure frequency. There was low certainty evidence that two other educational interventions reduced seizure severity, seizure control, and seizure cure rates. The evidence for all other outcomes (drug adherence, knowledge, self-efficacy and self-perception of epilepsy on quality of life) was mixed. AUTHORS' CONCLUSIONS: Whilst each of the programmes evaluated in this review showed some benefit to children with epilepsy, their impact was extremely variable. No programme showed benefits across the full range of outcomes, and all studies had methodological problems. There is currently insufficient evidence in favour of any single programme. Further evidence from randomised controlled trials using validated measures and considering clinical meaningfulness as well as statistical significance of results is required.

Volatile compounds reveal age: a study of volatile organic compounds released by Chrysomya rufifacies immatures.

Age determination of insects collected from vertebrate remains is an essential step in estimating time since colonization as related to the post-mortem interval. Long-established methods for making such estimates rely on determining age related to stage of development at the time of collection in relation to conditions experienced. However, such estimates are based on the completion of a stage of development. Methods allowing for more precise estimates of age (i.e., within a stage of development) are sorely needed. This study examined the potential of volatile organic compounds emitted by blow fly, Ch. rufifacies (Macquart), immatures to determine stage of development, which could potentially be used to estimate the age. Volatile organic compounds (VOCs) from the larval and pupal stages of Ch. rufifacies were collected by headspace solid-phase micro-extraction followed by gas chromatography-mass spectrometry (GC-MS). Analyses indicated 37 compounds shift quantitatively, as well as qualitatively, as the larvae and pupae age. Furthermore, compounds, such as 2-ethyl-1-hexanol, phenol, butanoic acid, hexadecanoic acid, octadecanoic acid, 2-methyl propanamide, and 2-methyl butanoic acid, serve as indicator compounds of specific stages within Ch. rufifacies development. This information could be important to determine if these compounds can be used in the field to predict the presence of certain developmental stages, in order to determine the potential of using volatile markers to estimate time of colonization.

The Role of Racial Residential Segregation in Black-White Disparities in Firearm Homicide at the State Level in the United States, 1991-2015.

OBJECTIVE: To investigate the relationship between racial residential segregation and differences in Black-White disparities in overall firearm homicides across U.S states. METHODS: Using a linear regression, we evaluated the relationship between racial residential segregation, as measured by the index of dissimilarity, and the Black-White firearm homicide disparity ratio in 32 states over the period 1991-2015. To account for clustering of observations within states, we used a generalized estimating equations approach. RESULTS: After controlling for measures of White and Black deprivation, multivariate analysis showed that racial segregation was positively associated with the Black-White firearm homicide disparity. For each 10-point increase in the index of dissimilarity, the ratio of Black to White firearm homicide rates in a state increased by 39%. After controlling for levels of White and Black deprivation, racial segregation remained negatively associated with White firearm homicide rates and positively associated with Black firearm homicide rates. CONCLUSIONS: These findings suggest that racial segregation may increase the disparity in firearm homicide between the Black and White population.

The Relationship Between Structural Racism and Black-White Disparities in Fatal Police Shootings at the State Level.

OBJECTIVE: The objective of this study was to discern the relationship between state-level structural racism and Black-White disparities in police shootings of victims not known to be armed. METHODS: Using a Poisson regression, we evaluated the effect of structural racism on differences between states in Black-White disparities in fatal police shootings involving victims not known to be armed during the period from January 1, 2013 through June 30, 2017. We created a state racism index, which was comprised of five dimensions: (1) residential segregation; and gaps in (2) incarceration rates; (3) educational attainment; (4) economic indicators; and (5) employment status. RESULTS: After controlling for numerous state-level factors and for the underlying rate of fatal shootings of black victims in each state, the state racism index was a significant predictor of the Black-White disparity in police shooting rates of victims not known to be armed (incidence rate ratio: 1.24; 95% confidence interval, 1.02-1.50). For every 10-point increase in the state racism index, the Black-White disparity ratio of police shooting rates of people not known to be armed increased by 24%. CONCLUSION: These findings suggest that structural racism is an important predictor of the Black-White disparity in rates of police shootings of unarmed victims across states.

Profiling Clinical Researchers Effectively using Embeddings and Clustering.

Effective researcher profiling is key to support rapid research team formation. We developed a profiling method using (1) widely accessible publication titles, (2) document embedding vector representations to consider background, and (3) both general and specific types of datasets. Our results showed that the most similar researchers have cosine similarities of 0.287/0.258. Our preliminary results can support biomedical informaticians to expedite collaborative clinical studies, enhance research quality, and eventually improve patient healthcare outcomes.

Synthesis and characterizations of super adsorbent hydrogel based on biopolymer, Guar Gum-grafted-Poly (hydroxyethyl methacrylate) (Gg-g-Poly (HEMA)) for the removal of Bismarck brown Y dye from aqueous solution.

Chemical modification of guar gum was done by graft copolymerization of monomer hydroxyethyl methacrylate (HEMA) using azobisisobutyronitrile (AIBN) as initiator. Optimal reaction parameters were settled by varying one reaction condition and keeping the other constant. The optimum reaction conditions worked out were solvent system: binary, [H2O] = 15.00 mL, [acetone] = 5.00 mL, [HEMA] = 82.217× 10-2 mol/L, [AIBN] = 3.333 × 10-2 mol/L, reaction time = 3 h, reaction temperature = 60 °C on to 1.00 g guar gum with Pg = 1694.6 and %GE = 68,704.152. Pure guar gum polymer and grafts were analyzed by several physicochemical investigation techniques like FTIR, SEM, XRD, EDX, and swelling studies. Percent swelling of the guar gum polymer and grafts was investigated at pH 2.2, 7.0, 7.4 and 9.4 concerning time. The finest yield of Ps was recorded at pH 9.4 with time 24 h for graft copolymer. Guar gum and grafted samples were explored for the sorption of toxic dye Bismarck brown Y from the aqueous solution with respect to variable contact time, pH, temperature and dye concentration so as to investigate the stimuli responsive sorption behaviour. Graft copolymers showed better results than guar gum with percent dye uptake (Du) of 97.588 % in 24 h contact time, 35 °C temperature, 9.4 pH at 150.00 ppm dye feed concentration as compared to Guar gum which only showed 85.260 % dye uptake at alike dye fed concentration. The kinetic behaviour of the polymeric samples was evaluated by applying many adsorption isotherms and kinetic models. The value of 1/n was between 0 â†’ 1 showing that there was physisorption of the BB dye that took place on the surface of the polymers. Thermodynamics of BB Y adsorption onto hydrogels was investigated concerning the Van't Hoff equation. -∆G° values obtained from the curve proved the spontanity of the process. Within the context of adsorption efficiency, an investigation was conducted to examine the process of sorption of Bismarck brown Y dye from aqueous solutions. The graft copolymers demonstrated remarkable adsorption abilities, achieving a dye uptake (Du) of 97.588 % over a 24-h period at a temperature of 35 °C, pH level of 9.4, and a dye concentration of 150.00 ppm. The raised adsorption capacity was additionally corroborated by the application of several adsorption isotherms and kinetic models, which indicated that physisorption is the prevailing process/mechanism. Additionally, the thermodynamic research, utilising the Van't Hoff equation, validated the spontaneity of the adsorption phenomenon, as evidenced by the presence of a negative ∆G° values. The thermodynamic analysis revealed herein establishes a strong scientific foundation for the effectiveness of adsorbent composed of graft copolymers based on guar gum. The research conclude the efficiency of the guar gum based grafted copolymers for the water remediation as efficient adsorbents. The captured dye can be re-utilised and the hydrogels can be used for the same purpose in number of cycles.

Prognostic Value of Late Gadolinium Enhancement Detected on Cardiac Magnetic Resonance in Cardiac Sarcoidosis.

BACKGROUND: Sarcoidosis is a complex multisystem inflammatory disorder, with approximately 5% of patients having overt cardiac involvement. Patients with cardiac sarcoidosis are at an increased risk of both ventricular arrhythmias and sudden cardiac death. Previous studies have shown that the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with an increased risk of mortality and ventricular arrhythmias and may be useful in predicting prognosis. OBJECTIVES: This systematic review and meta-analysis assessed the value of LGE on CMR imaging in predicting prognosis for patients with known or suspected cardiac sarcoidosis. METHODS: The authors searched the Embase and MEDLINE databases from inception to March 2022 for studies reporting individuals with known or suspected cardiac sarcoidosis referred for CMR with LGE. Outcomes were defined as all-cause mortality, ventricular arrhythmia, or a composite outcome of either death or ventricular arrhythmias. The primary analysis evaluated these outcomes according to the presence of LGE. A secondary analysis evaluated outcomes specifically according to the presence of biventricular LGE. RESULTS: Thirteen studies were included (1,318 participants) in the analysis, with an average participant age of 52.0 years and LGE prevalence of 13% to 70% over a follow-up of 3.1 years. Patients with LGE on CMR vs those without had higher odds of ventricular arrhythmias (odds ratio [OR]: 20.3; 95% CI: 8.1-51.0), all-cause mortality (OR: 3.45; 95% CI: 1.6-7.3), and the composite of both (OR: 9.2; 95% CI: 5.1-16.7). Right ventricular LGE is invariably accompanied by left ventricular LGE. Biventricular LGE is also associated with markedly increased odds of ventricular arrhythmias (OR: 43.6; 95% CI: 16.2-117.2). CONCLUSIONS: Patients with known or suspected cardiac sarcoidosis with LGE on CMR have significantly increased odds of both ventricular arrhythmias and all-cause mortality. The presence of biventricular LGE may confer additional prognostic information regarding arrhythmogenic risk.

Dietary Intake and Pneumococcal Vaccine Response Among Children (5-7 Years) in Msambweni Division, Kwale County, Kenya.

Background: Vaccine and sufficient food availability are key factors for reducing pneumonia outbreaks in sub-Saharan Africa. Methods: In this study, the 10-valent pneumococcal conjugate vaccine (Synflorix® or PCV10) was administered to a child cohort (5-7 years old, n = 237) in Msambweni, Kenya, to determine relationships between dietary intake, nutritional/socioeconomic status of mothers/caregivers, and vaccine response. 7-day food frequency questionnaire (FFQ), dietary diversity score (DDS) and single 24-h dietary recall were used to address participants' dietary assessment and nutritional status. Individual food varieties were recorded and divided into 9 food groups as recommended by Food and Agriculture Organization. Anthropometric measurements, nasopharyngeal swabs and vaccine administration were performed at the initial visit. Participants were followed 4-8 weeks with a blood draw for pneumococcal IgG titers assessed by Luminex assay. Findings: Chronic malnutrition was prevalent in the cohort (15% stunting, 16% underweight). Unbalanced dietary intake was observed, with mean energy intake 14% below Recommended Dietary Allowances (1,822 Kcal) for 5-7 years age range. 72% of the daily energy was derived from carbohydrates, 18% from fats and only 10% from proteins. Poor anthropometric status (stunting/underweight) was associated with low socioeconomic/educational status and younger mother/caregiver age (p < 0.002). Limited intake of essential micronutrients (vitamins A, E, K) and minerals (calcium, potassium) associated with low consumption of fresh fruits, vegetables, and animal source foods (dairy, meat) was observed and correlated with poor vaccine response (p < 0.001). In contrast, children who consumed higher amounts of dietary fiber, vitamin B1, zinc, iron, and magnesium had adequate vaccine response (p < 0.05). Correlation between higher dietary diversity score (DDS), higher Vitamin E, K, Zinc intake and adequate vaccine response was also observed (p < 0.03). Interpretation: Overall, this study highlights ongoing food scarcity and malnutrition in Kenya and demonstrates the links between adequate socioeconomic conditions, adequate nutrient intake, and vaccine efficacy.

Study on ascending and descending vertical dispersal behavior of third instar larvae of Chrysomya megacephala (Fabricius) (Diptera:Calliphoridae): An evidence that blowflies survive burial.

Although the pupation behavior of blowflies has been widely studied, this preliminary study was done on the vertical dispersal behavior (both ascending and descending) and fly emergence rate of third instar larvae of Chrysomya megacephala (Fabricius) to evaluate weather immature stages of blowflies survive burial and emerge out as adult. Third instar larvae of Chrysomya megacephala were placed at three different depths (5 cm, 25 cm and 45 cm) of soil under laboratory conditions to determine the impact of soil depth on the ascending and descending vertical dispersal behavior and the subsequent emergence of adults. The results of this study, although preliminary, but valuable to the field of forensic entomology because they provide new information about both ascending and descending vertical dispersal behavior of Chrysomya megacephala forensically important species of blowfly. In all the cases, maximum number of pupae recovered at the depth of 0 to 5 cm are 35.5 ± 4.5, 34 ± 1, 25 ± 5, when food was located at 5 cm, 25 cm and 45 cm depth respectively. This means that maximum no of larvae reached to the depth of 0 to 5 cm by ascending dispersal irrespective of at which depth they are placed. Paramount pupae were recovered from shallow burial depth of 0-5 cm in ascending dispersal and showed highest eclosion success i.e. 90.1% followed by 25 cm and 45 cm i.e. 71.7% and 55% respectively. While the number of pupae recovered as well as eclosion success was less in descending dispersal with an average of 62.8%, 39.25% and 33.9% at depths of 5, 25 and 45 cm respectively. This manifest if larvae disperse ascendingly, it increases their chance of survival.

Cuticular hydrocarbons as a tool for determining the age of Chrysomya rufifacies (Diptera: Calliphoridae) larvae.

Calliphoridae are one of the most important insect groups encountered as evidence collected from a crime scene. Age determination of the immature stages of these necrophagous flies is an important step toward estimating the time of colonization and inferring a minimum postmortem interval (PMImin ) in most instances. To determine if the cuticular hydrocarbons could be used to establish whether the development stages yield characteristics profiles, allowing for age estimation, hydrocarbons were extracted from 1st and 2nd, as well as feeding and post-feeding 3rd instar Chrysomya rufifacies, the hairy maggot blow fly. Extracted hydrocarbons were analyzed using gas chromatography coupled to mass spectrometry with the aim to investigate the changes in chemical profiles of each larval stage. A total of 23 compounds were identified with most of them being alkanes (65%) with carbon chain lengths of 9-33 carbons, alkenes (18%), and methyl-branched alkanes (17%). All the hydrocarbons except pentadecane (C15), hexadecane (C16), and nonacosane (C29) showed significant differences in their expression throughout larval development. For 1st instars, nonane was the most abundant (17% of the total hydrocarbons content) compound. Accounting for 11% and 10% of the cuticular hydrocarbons, tricosane and pentacosane, respectively, were the notable hydrocarbons in 2nd instars. For post-feeding 3rd instars, hentriacontane and tritriacontane were present with relative abundances 18% and 15%, respectively. On average, there was a shift from low to high molecular weight hydrocarbons as the larvae aged. These results indicate the change in hydrocarbons makeup as larvae age and could potentially be used to determine the age of immature C. rufifacies and hence aid in PMImin estimations. However, future research is needed to validate these results under natural conditions in the field.

Fruit and vegetable consumption and emotional distress tolerance as potential links between food insecurity and poor physical and mental health among homeless adults.

Food insecurity is associated with mental health outcomes among adults experiencing homelessness. Different theoretical explanations have emerged to account for the negative health outcomes among vulnerable populations. The neomaterial theoretical perspective suggests that nutritional deficiencies from experiencing food insecurity are related to negative health outcomes. Whereas, the psychosocial theoretical perspective indicates that perceived disadvantages or inability to cope emotionally (i.e. lower distress tolerance) from food insecurity leads to adverse health outcomes. Building on these theoretical perspectives, the purpose of the study was to determine whether fruit and vegetable consumption (as a measure of diet quality) or emotional distress tolerance act as potential links between food insecurity and poor physical and mental health among adults experiencing homelessness. Adults were recruited from six area shelters in Oklahoma City (N = 566) during July-August 2016. Data was collected via a self-administered questionnaire on a tablet computer. Self-rated poor health, depression, and post-traumatic stress disorder (PTSD) were regressed on food insecurity using logistic regressions. Indirect effects were assessed using bootstrapping methods outlined by Preacher and Hayes. In covariate-adjusted models, lower levels of distress tolerance, but not fruit and vegetable consumption, partially mediated the association between food insecurity and poor health (ß = 0.28, [0.14, 0.44]), depression (ß = 0.56, [0.33, 0.88]), and PTSD (ß = 0.39, [0.22, 0.60]). Results suggest that experiencing food insecurity may lower the ability to withstand emotional distress and consequently contributes to negative health outcomes.