Malformation risks of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register

Objective: To assess the relative risk of major congenital malformation (MCM) from in utero exposure to antiepileptic drug (AEDs).

Randomized controlled trial of interferential therapy and manipulative therapy for acute low back pain.

Study Design. A multi-center assessor-blinded randomized clinical trial was conducted. Objectives. To investigate the relative effectiveness of interferential therapy and manipulative therapy for patients with acute low back pain when used as sole treatments and in combination. Summary of Background Data. Both manipulative therapy and interferential therapy are commonly used treatments for low back pain. Evidence for the effectiveness of manipulative therapy is available only for the short term. There is no evidence for interferential therapy and no study has investigated the effectiveness of interferential therapy combined with manipulative therapy. Methods. Consenting subjects (n=240) were randomly assigned to receive a copy of the Back Book and either manipulative therapy (MT; n=80), interferential therapy (IFT; n=80) or combined manipulative therapy and interferential therapy (CT; n=80). Follow-up outcome questionnaires were posted at discharge, 6 and 12 months. Results. The groups were balanced at baseline for low back pain and demographic characteristics. All interventions were found to significantly reduce functional disability and pain and increase quality of life at discharge and to maintain these improvements at 6 and 12 months. No significant differences were found between groups for reported LBP recurrence, work absenteeism, medication consumption, exercise participation and healthcare use at 12 months. Conclusions. For acute low back pain, interferential therapy whether used in isolation or in combination with manipulative therapy was as effective as manipulative therapy alone (in addition to the Back Book).

A descriptive study of the usage of spinal manipulative therapy techniques within a randomised clinical trial in acute low back pain

The majority of randomized clinical trials (RCTs) of spinal manipulative therapy have not adequately de?ned the terms ‘mobilization’ and ‘manipulation’, nor distinguished between these terms in reporting the trial interventions. The purpose of this study was to describe the spinal manipulative therapy techniques utilized within a RCT of manipulative therapy (MT; n=80), interferential therapy (IFT; n=80), and a combination of both (CT; n=80) for people with acute low back pain (LBP). Spinal manipulative therapy was de?ned as any ‘mobilization’ (low velocity manual force without a thrust) or ‘manipulation’ (high velocity
thrust) techniques of the spine described by Maitland and Cyriax.
The 16 physiotherapists, all members of the Society of Orthopaedic Medicine, utilized three spinal manipulative therapy patterns in the RCT: Maitland Mobilization (40.4%, n=59), Maitland Mobilization/Cyriax Manipulation (40.4%, n=59) and Cyriax Manipulation (19.1%, n=28). There was a signi?cant difference between the MT and CT groups in their usage of spinal manipulative therapy techniques (w2=9.178; df=2;P=0.01); subjects randomized to the CT group received three times more Cyriax Manipulation (29.2%, n=21/72) than those randomized to the MT group (9.5%, n=7/74; df=1; P=0.003).
The use of mobilization techniques within the trial was comparable with their usage by the general population of physiotherapists in Britain and Ireland for LBP management. However, the usage of manipulation techniques was considerably higher than reported in physiotherapy surveys and may re?ect the postgraduate training of trial therapists.

Nursing babies at risk of cerebral palsy in the neonatal period

Cerebral palsy (CP) is a leading cause of physical disability in childhood with evidence that 90% of children with the condition sustain damage or malformation to their developing brain during the antenatal period. With half of all cases of children with CP being born prematurely many need extra help and support in the neonatal period. The aims of neonatal nursing for this high risk group include prevention of further neurological complications as well as working maintain stable infant physiology and provide information and support to parents. While a diagnosis of CP is seldom welcome there is now evidence that most children with CP are mildly affected, most have a normal life expectancy, most are well adjusted and most are happy, reporting a quality of life similar to children without CP. Neonatal nurses are ideally placed to communicate and prepare parents of children at high risk of developing CP about more positive future likely outcomes than previously thought.

Dietary patterns and bone mineral status in young adults: the Northern Ireland Young Hearts Project

Studies of individual nutrients or foods have revealed much about dietary influences on bone. Multiple food or nutrient approaches, such as dietary pattern analysis, could offer further insight but research is limited and largely confined to older adults. We examined the relationship between dietary patterns, obtained by a posteriori and a priori methods, and bone mineral status (BMS; collective term for bone mineral content (BMC) and bone mineral density (BMD)) in young adults (20-25 years; n 489). Diet was assessed by 7 d diet history and BMD and BMC were determined at the lumbar spine and femoral neck (FN). A posteriori dietary patterns were derived using principal component analysis (PCA) and three a priori dietary quality scores were applied (dietary diversity score (DDS), nutritional risk score and Mediterranean diet score). For the PCA-derived dietary patterns, women in the top compared to the bottom fifth of the 'Nuts and Meat' pattern had greater FN BMD by 0.074 g/cm(2) (P=0.049) and FN BMC by 0.40 g (P=0.034) after adjustment for confounders. Similarly, men in the top compared to the bottom fifth of the 'Refined' pattern had lower FN BMC by 0.41 g (P-0.049). For the a priori DDS, women in the top compared to the bottom third had lower FN BMD by 0.05 g/cm(2) after adjustments (P=0.052), but no other relationships with BMS were identified. In conclusion, adherence to a 'Nuts and Meat' dietary pattern may be associated with greater BMS in young women and a 'Refined' dietary pattern may be detrimental for bone health in young men.

FASCIOLA-HEPATICA - TEGUMENTAL SURFACE CHANGES IN ADULT AND JUVENILE FLUKES FOLLOWING TREATMENT IN-VITRO WITH THE SULFOXIDE METABOLITE OF TRICLABENDAZOLE (FASINEX)

The effects of the novel benzimidazole, triclabendazole (Fasinex, Ciba-Geigy), in its active sulphoxide metabolite form (TCBZ-SX), on the tegumental surface of Fasciola hepatica has been examined in vitro. The tegument of adult flukes incubated in TCBZ-SX (50 mug/ml) appeared swollen and blebbed after only 6 h. In addition, progressive spine loss at the oral cone was evident following 12 h treatment. After 24 h, the tegumental syncytium and spines had completely sloughed away, leaving an exposed basal lamina and empty spine sockets. Juvenile flukes (3 weeks old) also demonstrated tegumental alterations after treatment with TCBZ-SX (20 mug/ml). The syncytium became extremely roughened and corrugated on both dorsal and ventral surfaces after only 3 h. Following 6- and 9-h incubations, there were many deep furrows, which were especially pronounced on the ventral surface, and by 18 h, the juvenile tegument was severely disrupted, especially on the ventral surface. In all cases, the effects were more marked than in the previous incubation periods. The results confirm the potent activity of triclabendazole against F. hepatica and suggest that the tegument of adult and juvenile flukes may be a target organ for this important fasciolicide.

Aneurysms increase the risk of rebleeding after stereotactic radiosurgery for hemorrhagic arteriovenous malformations

BACKGROUND AND PURPOSE:
The purpose of this study was to define the risk of rebleeding after stereotactic radiosurgery (SRS) for hemorrhagic arteriovenous malformations with or without associated intracranial aneurysms.

METHODS:
Between 1987 and 2006, we performed Gamma Knife SRS on 996 patients with brain arteriovenous malformations; 407 patients had sustained an arteriovenous malformation hemorrhage. Sixty-four patients (16%) underwent prior embolization and 84 (21%) underwent prior surgical resection. The median target volume was 2.3 mL (range, 0.1-20.7 mL). The median margin dose was 20 Gy (range, 13.5-27 Gy).

RESULTS:
The overall rate of total obliteration defined by angiography or MRI was 56%, 77%, 80%, and 82% at 3, 4, 5, and 10 years, respectively. Before obliteration, 33 patients (8%) sustained an additional hemorrhage after SRS. The overall annual hemorrhage rate until obliteration after SRS was 1.3%. The presence of a patent aneurysm was significantly associated with an increased rehemorrhage risk after SRS (annual hemorrhage rate, 6.4%) compared with patients with a clipped or embolized aneurysm (annual hemorrhage rate, 0.8%; P=0.033).

CONCLUSIONS:
When an aneurysm is identified in patients with arteriovenous malformations selected for SRS, additional endovascular or surgical strategies should be considered to reduce the risk of bleeding during the latency interval.

Creating a Circus of Words, Music, and Sound: From Roaratorio to Owenvarragh

This article documents the creation of a work by the authors based on a score written by the composer John Cage entitled 'Owenvarragh: A Belfast Circus on The Star Factory.' The article is part of a documentary portfolio in the journal which also includes a volume of the poetry created by Dowling in accordance with the instructions of the Cage score, and a series of documentary videos on the creation of the work and its first performance. Cage's score is based on his work 'Roaratorio: An Irish Circus on Finnegan's Wake' (1979) and it provides a set of detailed instructions for the musical realisation of a literary work. The article documents this first fully realised version of the score since Cage first produced 'Roaratorio' in 1979. The work, which was motivated by the Cage centenary year in 2012, musically realises Carson's book 'The Star Factory' (1998), a novelestic autobiography of Carson's Belfast childhood. The score required the creation of a fixed media piece based on over 300 field recordings of the sounds and places mentioned in the book, a volume of poetry created from the book which is recited to form the rhythmic spine of the work, and the arrangement of a performance including these two components along with live musical performance by the authors in collaboration with three other musicians under their direction, and a video installation created for the work. The piece has been performed three times: in association with the Sonorities 2012 Festival at Queen's University of Belfast (March 2012), at The Belfast Festival at Queen's (October 2012), and in the Rymer Auditoium of the University of York (June 2013).

Additional information:

The work which the article documents was conceived by Monaghan and Dowling, and the project was initiated by Monaghan after a she received a student prize to support its development and first performance. Elements of the project will be included in her PhD dissertation for which Dowling is a supervisor. Monaghan created the fixed media piece based on over 300 field recordings, the largest single aspect of realising Cage's score. Dowling was responsible for initiating the collaboration with Ciaran Carson, and for two other components: the creation of a volume of poetry derived from the literary work which is recited in the performance, and the creation of and supervision of the technical work on a video which accompanies the piece. The co-authors consulted closely during the work on these large components from May 2011 until March 2012 when the first performance took place. The co-authors also shared in numerous other artistic and organisational aspects of the production, including the arrangement and performnance of the music, musical direction to other performers, and marketing.

Multicentre trial of weekly risedronate on bone density in adults with cystic fibrosis

Background: The aim of this study was to assess the efficacy, tolerability and safety of risedronate in adults with CF. Methods: Patients with a lumbar spine (LS), total hip (TH) or femoral neck (FN) bone mineral density (BMD) Z-score of -1 or less were randomised to receive risedronate 35mg weekly or placebo, and calcium (1g)+vitamin D (800IU). Results: At baseline, BMD Z-scores in the risedronate (n = 17) and placebo (n = 19) groups were similar. By 24. months, 7/17 risedronate patients vs 0/19 placebo patients stopped the study medication due to bone pain. After 24. months treatment, the mean difference (95% CI) in change in LS, TH and FN BMD between the risedronate vs placebo groups was 4.3% (0.4, 8.2) p = 0.03; 4.0% (-0.5, 8.6) p = 0.08; and 2.4% (-3.5, 8.2) p =0.41. Conclusions: After two years treatment there was a significant increase in LS BMD with weekly risedronate compared to placebo. © 2011 European Cystic Fibrosis Society.

Laughter Type Recognition from Whole Body Motion

Despite the importance of laughter in social interactions it remains little studied in affective computing. Respiratory, auditory, and facial laughter signals have been investigated but laughter-related body movements have received almost no attention. The aim of this study is twofold: first an investigation into observers' perception of laughter states (hilarious, social, awkward, fake, and non-laughter) based on body movements alone, through their categorization of avatars animated with natural and acted motion capture data. Significant differences in torso and limb movements were found between animations perceived as containing laughter and those perceived as nonlaughter. Hilarious laughter also differed from social laughter in the amount of bending of the spine, the amount of shoulder rotation and the amount of hand movement. The body movement features indicative of laughter differed between sitting and standing avatar postures. Based on the positive findings in this perceptual study, the second aim is to investigate the possibility of automatically predicting the distributions of observer's ratings for the laughter states. The findings show that the automated laughter recognition rates approach human rating levels, with the Random Forest method yielding the best performance.