Adjustment in children with intractable epilepsy:importance of seizure duration and family factors

Seventy-five families of children with intractable epilepsy but without a severe learning disability (mean age 7 years 1 month, SD 2 years 6 months; range 2 to 12 years) who attended a regional paediatric neurology service, were surveyed. A postal questionnaire was used which included standardized measures of child and family adjustment; forty-eight families responded (64%; 31 males, 17 females). There was no significant difference between responders and non-responders in terms of age, sex, number of other chronic illnesses and disabilities, age at epilepsy diagnosis, seizure type, nor number of antiepileptic drugs currently prescribed (p > 0.05). The importance of including multidimensional measures of outcome was highlighted by the finding that epilepsy, pharmacological, and psychosocial factors were differentially associated with specific adjustment difficulties. Two factors appeared to be most pervasively implicated across a range of adjustment problems: frequency of rectal diazepam administration and family patterns of relating to each other (p <0.05). It appeared that duration of seizures (as indicated by frequency of rectal diazepam administration), rather than the frequency of seizures per se, was more pernicious in terms of poor adjustment. Intrafamilial relations (degree of conflict/cohesion and soon) were not only associated with adjustment difficulties in the child, but also with the frequency of seizures themselves. Implications for psychological interventions in intractable epilepsy in childhood are highlighted.

Simultaneous use of mitomycin-C with Baerveldt implantation

BACKGROUND AND OBJECTIVE: To evaluate the outcome of Baerveldt implantation with adjunctive mitomycin-C in cases of complicated glaucoma. PATIENTS AND METHODS: The authors reviewed the charts of all patients who had undergone Baerveldt implantation with mitomycin-C between January 1993 and March 1995. Success was defined before data collection as an intraocular pressure (IOP) between 5 and 21 mm Hg, with or without medications. The success rate was calculated using the Kaplan-Meier actuarial method. RESULTS: Twenty-nine patients were identified. The mean preoperative IOP was 33.6 mm Hg, with an average of 2.0 antiglaucoma medications. The probability of success at 6 and 12 months for patients who received mitomycin-C during Baerveldt implantation was 82.4% and 73.3%, respectively. Choroidal effusion with a flat anterior chamber (10.3%), corneal edema (6.8%), and conjunctival erosion (6.8%) were the most frequent complications. CONCLUSION: In this retrospective series of complicated glaucoma, the implantation of a Baerveldt drainage device with adjunctive mitomycin-C had a satisfactory outcome. The complications encountered and the clinical efficacy were comparable to those of previously reported series in which mitomycin-C was not used.

Ultrasound biomicroscopy in deep sclerectomy

Purpose: To evaluate by ultrasound biomicroscopy (UBM) the anatomical characteristics and the intraocular pressure (IOP) lowering mechanisms of deep sclerectomy after long-term follow-up. Methods: In all, 22 eyes of 21 consecutive patients who had deep sclerectomy were examined by UBM. Several UBM variables were prospectively evaluated, including the presence and maximum length and height of the intrascleral space, the minimum thickness of residual trabeculo-Descemet membrane (TDM), the presence and type of subconjunctival filtering bleb, and the presence of other possible drainage sites, for example suprachoroidal. Surgical success was considered to be achieved when the IOP was

The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle-closure glaucoma (EAGLE): Study protocol for a randomized controlled trial

BACKGROUND: Glaucoma is the leading cause of irreversible blindness. Although primary open-angle glaucoma is more common, primary angle-closure glaucoma (PACG) is more likely to result in irreversible blindness. By 2020, 5·3 million people worldwide will be blind because of PACG. The current standard care for PACG is a stepped approach of a combination of laser iridotomy surgery (to open the drainage angle) and medical treatment (to reduce intraocular pressure). If these treatments fail, glaucoma surgery (eg, trabeculectomy) is indicated. It has been proposed that, because the lens of the eye plays a major role in the mechanisms leading to PACG, early clear lens extraction will improve glaucoma control by opening the drainage angle. This procedure might reduce the need for drugs and glaucoma surgery, maintain good visual acuity, and improve quality of life compared with standard care.EAGLE aims to evaluate whether early lens extraction improves patient-reported, clinical outcomes, and cost-effectiveness, compared with standard care.

METHODS/DESIGN: EAGLE is a multicentre pragmatic randomized trial. All people presenting to the recruitment centres in the UK and east Asia with newly diagnosed PACG and who are at least 50 years old are eligible.The primary outcomes are EQ-5D, intraocular pressure, and incremental cost per quality adjusted life year (QALY) gained. Other outcomes are: vision and glaucoma-specific patient-reported outcomes, visual acuity, visual field, angle closure, number of medications, additional surgery (e.g., trabeculectomy), costs to the health services and patients, and adverse events.A single main analysis will be done at the end of the trial, after three years of follow-up. The analysis will be based on all participants as randomized (intention to treat). 400 participants (200 in each group) will be recruited, to have 90% power at 5% significance level to detect a difference in EQ-5D score between the two groups of 0·05, and a mean difference in intraocular pressure of 1·75 mm Hg. The study will have 80% power to detect a difference of 15% in the glaucoma surgery rate.

TRIAL REGISTRATION: ISRCTN44464607.

Soil Moisture Deficit as a predictor of the trend in soil water status of grass fields

Nutrient loss from agricultural land following organic fertilizer spreading can lead to eutrophication and poor water quality. The risk of pollution is partly related to the soil water status during and after spreading. In response to these issues, a decision support system (DSS) for nutrient management has been developed to predict when soil and weather conditions are suitable for slurry spreading. At the core of the DSS, the Hybrid Soil Moisture Deficit (HSMD) model estimates soil water status relative to field capacity (FC) for three soil classes (well, moderately and poorly drained) and has potential to predict the occurrence of a transport vector when the soil is wetter than FC. Three years of field observation of volumetric water content was used to validate HSMD model predictions of water status and to ensure correct use and interpretation of the drainage classes. Point HSMD model predictions were validated with respect to the temporal and spatial variations in volumetric water content and soil strength properties. It was found that the HSMD model predictions were well related to topsoil water content through time, but a new class intermediate between poor and moderate, perhaps ‘imperfectly drained’, was needed. With correct allocations of a field into a drainage class, the HSMD model predictions reflect field scale trends in water status and therefore the model is suitable for use at the core of a DSS.

Population enumeration and assessing conservation status in a widespread amphibian: A case study of Rana temporaria in Ireland

Global amphibian declines are a major element of the current biodiversity crisis. Monitoring changes in the distribution and abundance of target species is a basic component in conservation decision making and requires robust and repeatable sampling. For EU member states, surveillance of designated species, including the common frog Rana temporaria, is a formal requirement of the 'EC Habitats & Species Directive'. We deployed established methods for estimating frog population density at local water bodies and extrapolated these to the national and ecoregion scale. Spawn occurred at 49.4% of water bodies and 70.1% of independent 500-m survey squares. Using spawn mat area, we estimated the number of adult breeding females and subsequently the total population assuming a sex ratio of 1:1. A negative binomial model suggested that mean frog density was 23.5 frogsha [95% confidence interval (CI) 14.9-44.0] equating to 196M frogs (95%CI 124M-367M) throughout Ireland. A total of 86% of frogs bred in drainage ditches, which were a notably common feature of the landscape. The recorded distribution of the species did not change significantly between the last Article 17 reporting period (1993-2006) and the current period (2007-2011) throughout the Republic of Ireland. Recording effort was markedly lower in Northern Ireland, which led to an apparent decline in the recorded distribution. We highlight the need to coordinate biological surveys between adjacent political jurisdictions that share a common ecoregion to avoid apparent disparities in the quality of distributional information. Power analysis suggested that a reduced sample of 40-50 survey squares is sufficient to detect a 30% decline (consistent with the International Union for Conservation of Nature Category of 'Vulnerable') at 80% power providing guidance for minimizing future survey effort. Our results provin assessments for R. temporaria and other clump-spawning amphibians. 2013 The Zoological Society of London.

Farmer perception of suitable conditions for slurry application compared with decision support system recommendations

The application of slurry nutrients to land can be associated with unintended losses to the environment depending on soil and weather conditions. Correct timing of slurry application, however, can increase plant nutrient uptake and reduce losses. A decision support system (DSS), which predicts optimum conditions for slurry spreading based on the Hybrid Soil Moisture Deficit (HSMD) model, was investigated for use as a policy tool. The DSS recommendations were compared to farmer perception of suitable conditions for slurry spreading for three soil drainage classes (well, moderate and poorly drained) to better understand on farm slurry management practices and to identify potential conflict with farmer opinion. Six farmers participated in a survey over two and a half years, during which they completed a daily diary, and their responses were compared to Soil Moisture Deficit (SMD) calculations and weather data recorded by on farm meteorological stations. The perception of land drainage quality differed between farmers and was related to their local knowledge and experience. It was found that the allocation of grass fields to HSMD drainage classes using a visual assessment method aligned farmer perception of drainage at the national scale. Farmer opinion corresponded to the theoretical understanding that slurry should not be applied when the soil is wetter than field capacity, i.e. when drainage can occur. While weather and soil conditions (especially trafficability) were the principal reasons given by farmers not to spread slurry, farm management practices (grazing and silage) and current Nitrates Directive policies (closed winter period for spreading) combined with limited storage capacities were obstacles to utilisation of slurry nutrients. Despite the slightly more restrictive advice of the DSS regarding the number of suitable spreading opportunities, the system has potential to address an information deficit that would help farmers to reduce nutrient losses and optimise plant nutrient uptake by improved slurry management. The DSS advice was in general agreement with the farmers and, therefore, they should not be resistant to adopting the tool for day to day management.

Assessing Historical and Current Threats to Common Frog (Rana Temporaria) Populations in Ireland

Ponds are an ephemeral feature of the landscape but their large-scale loss can have profound implications for biodiversity and the persistence of amphibian populations. We quantified rates of pond loss throughout Ireland over a period of approximately 125 yr. Environmental parameters and perceived risk factors associated with the current occurrence and density of the Common Frog, Rana temporaria, were also analyzed. The numbers of farmland ponds declined by 54% between 1887–1913 and 2005–11, with most ponds and the greatest losses
in the East, coincident with agricultural intensification and human habitation. The decline of pond numbers was significant but, at approximately 0.5% per annum, was substantially less than losses recorded in other European countries. Losses were coincident with major changes to the agricultural landscape including extensive land drainage. However, losses of pond and natural wetland habitats throughout Ireland may have been partially or wholly mitigated by a synchronous expansion of artificial field margin ditches associated with drainage projects during the mid-20th Century. The ecology of the Common Frog in Ireland was similar to its ecology elsewhere and it appears largely unaffected by pollution and disturbance. Consequently, the conservation status of the frog in Ireland was judged ‘‘favorable’’ and should remain so for the foreseeable future.

Later Pleistocene evolution of the Exe valley: A chronstratigraphic model of terrace formation and its implications for Palaeolithic archaeology

This paper presents the ?rst systematic chronostratigraphic study of the river terraces of the Exe catchment in South West England and a new conceptual model for terrace formation in unglaciated basins with applicability to terrace staircase sequences elsewhere. The Exe catchment lay beyond the maximum extent of Pleistocene ice sheets and the drainage pattern evolved from the Tertiary to the Middle Pleistocene, by which time the major valley systems were in place and downcutting began to create a staircase of strath terraces. The higher terraces (8-6) typically exhibit altitudinal overlap or appear to be draped over the landscape, whilst the middle terraces show greater altitudinal separation and the lowest terraces are of a cut and ?ll form. The terrace deposits investigated in this study were deposited in cold phases of the glacial-interglacial Milankovitch climatic cycles with the lowest four being deposited in the Devensian Marine Isotope Stages (MIS) 4-2. A new cascade process-response model is proposed of basin terrace evolution in the Exe valley, which emphasises the role of lateral erosion in the creation of strath terraces and the reworking of inherited resistant lithological components down through the staircase. The resultant emergent valley topography and the reworking of artefacts along with gravel clasts, have important implications for the dating of hominin presence and the local landscapes they inhabited. Whilst the terrace chronology suggested here is still not as detailed as that for the Thames or the Solent System it does indicate a Middle Palaeolithic hominin presence in the region, probably prior to the late Wolstonian Complex or MIS 6. This supports existing data from cave sites in South West England.

Stage at diagnosis and colorectal cancer survival in six high-income countries:A population-based study of patients diagnosed during 2000-2007

Background. Large international differences in colorectal cancer survival exist, even between countries with similar healthcare. We investigate the extent to which stage at diagnosis explains these differences. Methods. Data from population-based cancer registries in Australia, Canada, Denmark, Norway, Sweden and the UK were analysed for 313 852 patients diagnosed with colon or rectal cancer during 2000-2007. We compared the distributions of stage at diagnosis. We estimated both stage-specific net survival and the excess hazard of death up to three years after diagnosis, using flexible parametric models on the log-cumulative excess hazard scale. Results. International differences in colon and rectal cancer stage distributions were wide: Denmark showed a distribution skewed towards later-stage disease, while Australia, Norway and the UK showed high proportions of 'regional' disease. One-year colon cancer survival was 67% in the UK and ranged between 71% (Denmark) and 80% (Australia and Sweden) elsewhere. For rectal cancer, one-year survival was also low in the UK (75%), compared to 79% in Denmark and 82-84% elsewhere. International survival differences were also evident for each stage of disease, with the UK showing consistently lowest survival at one and three years. Conclusion. Differences in stage at diagnosis partly explain international differences in colorectal cancer survival, with a more adverse stage distribution contributing to comparatively low survival in Denmark. Differences in stage distribution could arise because of differences in diagnostic delay and awareness of symptoms, or in the thoroughness of staging procedures. Nevertheless, survival differences also exist for each stage of disease, suggesting unequal access to optimal treatment, particularly in the UK. © 2013 Informa Healthcare.

Condition Assessment and Preservation of Open-Air Rock Art Panels During Climate Change

Thousands of Neolithic and Bronze Age open-air rock art panels exist across the countryside in northern England. However, desecration, pollution, and other factors are threatening the survival of these iconic stone monuments. Evidence suggest that rates of panel deterioration may be increasing, although it is not clear whether this is due to local factors or wider environmental influences accelerated by environmental change. To examine this question, 18 rock art panels with varied art motifs were studied at two major panel locations at Lordenshaw and Weetwood Moor in Northumberland. A condition assessment
tool was used to first quantify the level of deterioration of each panel (called “staging”). Stage estimates then were compared statistically with 27 geochemical and physical descriptors of local environments, such as soil moisture, salinity, pH, lichen coverage, soil anions and cation levels, and panel orientation, slope, and standing height. In parallel, climate modelling was performed using UKCP09 to assess how projected climatic conditions (to 2099) might affect the environmental descriptors most correlated with elevated stone deterioration. Only two descriptors significantly correlated (P < 0.05) with increased stage: the standing height of the panel and the exchangeable cation content of the local soils, although moisture conditions also were potentially influential at some panels. Climate modelling predicts warming temperatures, more seasonally variable precipitation, and increased wind speeds, which hint stone deterioration could accelerate in the future due to increased physiochemical weathering. We recommend key panels be targeted for immediate management intervention, focusing on reducing wind exposures, improving site drainage, and potentially immobilizing soil salts.

Environmental Aspects of Underground Construction and Exploration of Underground Structure – State of the Art

An underground work (such as a tunnel or a cavern) has many, well known, environmental qualities such as: no physical barriers crossing the land, less maintenance costs than an analogous surface structure, less expenses for heating and conditioning; a localized emission of noise, gas, dust during operation and, finally, a better protection against seismic actions.
It cannot be forgotten, anyway, that some negative environmental features are present such as, for example, : perturbation, pollution and drainage of the groundwater; settlements; disposal of waste rock.
In the paper the above mentioned concepts are discussed and analysed to give a global overview of all this aspects.

Inverse planned constant dose rate volumetric modulated arc therapy (VMAT) as an efficient alternative to five-field intensity modulated radiation therapy (IMRT) for prostate

Purpose: The aim of this work was to determine if volumetric modulated arc therapy (VMAT) plans, created for constant dose-rate (cdrVMAT) delivery are a viable alternative to step and shoot five-field intensity modulated radiation therapy (IMRT). Materials and methods: The cdrVMAT plans, inverse planned on a treatment planning system with no solution to account for couch top or rails, were created for delivery on a linear accelerator with no variable dose rate control system. A series of five-field IMRT and cdrVMAT plans were created using dual partial arcs (gantry rotating between 260° and 100°) with 4° control points for ten prostate patients with the average rectal constraint incrementally increased. Pareto fronts were compared for the planning target volume homogeneity and average rectal dose between the two techniques for each patient. Also investigated were tumour control probability and normal tissue complication probability values for each technique. The delivery parameters [monitor units (MU) and time] and delivery accuracy of the IMRT and VMAT plans were also compared. Results: Pareto fronts showed that the dual partial arc plans were superior to the five-field IMRT plans, particularly for the clinically acceptable plans where average rectal doses were less for rotational plans (p = 0·009) with no statistical difference in target homogeneity. The cdrVMAT plans had significantly more MU (p = 0·005) but the average delivery time was significantly less than the IMRT plans by 42%. All clinically acceptable cdrVMAT plans were accurate in their delivery (gamma 99·2 ± 1·1%, 3%3 mm criteria). Conclusions Accurate delivery of dual partial arc cdrVMAT avoiding the couch top and rails has been demonstrated.

Advantages and limitations of navigation-based multicriteria optimization (MCO) for localized prostate cancer IMRT planning

Efficacy of inverse planning is becoming increasingly important for advanced radiotherapy techniques. This study's aims were to validate multicriteria optimization (MCO) in RayStation (v2.4, RaySearch Laboratories, Sweden) against standard intensity-modulated radiation therapy (IMRT) optimization in Oncentra (v4.1, Nucletron BV, the Netherlands) and characterize dose differences due to conversion of navigated MCO plans into deliverable multileaf collimator apertures. Step-and-shoot IMRT plans were created for 10 patients with localized prostate cancer using both standard optimization and MCO. Acceptable standard IMRT plans with minimal average rectal dose were chosen for comparison with deliverable MCO plans. The trade-off was, for the MCO plans, managed through a user interface that permits continuous navigation between fluence-based plans. Navigated MCO plans were made deliverable at incremental steps along a trajectory between maximal target homogeneity and maximal rectal sparing. Dosimetric differences between navigated and deliverable MCO plans were also quantified. MCO plans, chosen as acceptable under navigated and deliverable conditions resulted in similar rectal sparing compared with standard optimization (33.7 ± 1.8Gy vs 35.5 ± 4.2Gy, p = 0.117). The dose differences between navigated and deliverable MCO plans increased as higher priority was placed on rectal avoidance. If the best possible deliverable MCO was chosen, a significant reduction in rectal dose was observed in comparison with standard optimization (30.6 ± 1.4Gy vs 35.5 ± 4.2Gy, p = 0.047). Improvements were, however, to some extent, at the expense of less conformal dose distributions, which resulted in significantly higher doses to the bladder for 2 of the 3 tolerance levels. In conclusion, similar IMRT plans can be created for patients with prostate cancer using MCO compared with standard optimization. Limitations exist within MCO regarding conversion of navigated plans to deliverable apertures, particularly for plans that emphasize avoidance of critical structures. Minimizing these differences would result in better quality treatments for patients with prostate cancer who were treated with radiotherapy using MCO plans.

The taphonomy of Last Glacial–Interglacial Transition (LGIT) distal volcanic ash in small Scottish lakes

An extensive micro-tephrostratigraphic survey of three small lakes in the Scottish Inner Hebrides was conducted encompassing the Last Glacial–Interglacial Transition (LGIT). The lakes are highly contrasting in terms of lake area to catchment ratio, the presence or absence of stream inlets draining the catchment, and in the complexity of the catchment drainage network. A suite of distal Icelandic volcanic ashes was consistently detected in all three lakes, with three, namely Penifiler Tephra, Vedde Ash and Ashik Tephra, being common to all the lakes. These ashes were chosen to examine the taphonomic intercomparability of ash location and concentration among the lakes. Findings reveal that the part played by catchment inlets in determining ash concentration and within-basin location applies to microtephra layers as much as it does in studies of macrotephra layer thickness. The position of ash concentration maxima is also shown to vary significantly for different LGIT periods and may be a consequence of lake-level changes, especially during the early Holocene. High-resolution stratigraphic analysis through the Vedde Ash visible macrotephra at Loch Ashik reveals a high degree of complexity in taphonomic behaviour between the different geochemical components, with possible implications for the correct interpretation of the isochron position. The detection of multiple intact ash isochrons and the taphonomic processes responsible for their deposition should prove useful in future tephrostratigraphic surveys, as well as having applications within other palaeolimnological disciplines.