Low Return Rate Research Articles

First-time whole blood donation: A critical step for donor safety and retention on first three donations

Aim of the studyWhole blood donation is generally safe although vasovagal reactions can occur (approximately 1%). Risk factors are well known and prevention measures are shown as efficient. This study evaluates the impact of the donor's retention in relation to the occurrence of vasovagal reaction for the first three blood donations. Material and methodsOur study of data collected over three years evaluated the impact of classical risk factors and provided a model including the best combination of covariates predicting VVR. The impact of a reaction at first donation on return rate and complication until the third donation was evaluated. ResultsOur data (523,471 donations) confirmed the classical risk factors (gender, age, donor status and relative blood volume). After stepwise variable selection, donor status, relative blood volume and their interaction were the only remaining covariates in the model. Of 33,279 first-time donors monitored over a period of at least 15 months, the first three donations were followed. Data emphasised the impact of complication at first donation. The return rate for a second donation was reduced and the risk of vasovagal reaction was increased at least until the third donation. ConclusionFirst-time donation is a crucial step in the donors’ career. Donors who experienced a reaction at their first donation have a lower return rate for a second donation and a higher risk of vasovagal reaction at least until the third donation. Prevention measures have to be processed to improve donor retention and provide blood banks with adequate blood supply.

Evidence for episodic acidification effects on migrating Atlantic salmon Salmo salar smolts.

Field studies were conducted to determine levels of gill aluminium as an index of acidification effects on migrating Atlantic salmon Salmo salar smolts in the north-eastern U.S.A. along mainstem river migration corridors in several major river basins. Smolts emigrating from the Connecticut River, where most (but not all) tributaries were well buffered, had low or undetectable levels of gill aluminium and high gill Na(+) /K(+) -ATPase (NKA) activity. In contrast, smolts emigrating from the upper Merrimack River basin where most tributaries are characterized by low pH and high inorganic aluminium had consistently elevated gill aluminium and lower gill NKA activity, which may explain the low adult return rates of S. salar stocked into the upper Merrimack catchment. In the Sheepscot, Narraguagus and Penobscot Rivers in Maine, river and year-specific effects on gill aluminium were detected that appeared to be driven by underlying geology and high spring discharge. The results indicate that episodic acidification is affecting S. salar smolts in poorly buffered streams in New England and may help explain variation in S. salar survival and abundance among rivers and among years, with implications for the conservation and recovery of S. salar in the north-eastern U.S.A. These results suggest that the physiological condition of outmigrating smolts may serve as a large-scale sentinel of landscape-level recovery of atmospheric pollution in this and other parts of the North Atlantic region.

Logos and Inserts can Reduce Survey Return Rates: An Experiment in California

Survey methodologists seek techniques that make the mail they send more likely to be opened, completed, and returned than missed, ignored, or thrown away. Traditional design wisdom recommends against using color and logos, which can make the delivery envelope look like marketing, fundraising, and other “junk mail.” Yet there have been few experimental tests of this assertion. Theoretically, a distinctive graphic representing a recognizable and beloved sponsor, combined with a prominent motivational message should serve dual roles of a) distinguishing surveys from marketing, advertising, fundraising, and b) encourage the respondent to participate. In this experiment, a random half of envelopes had a sponsor logo on the outside and a motivational insert affixed to the cover letter. The response task was a one-page screener form asking for basic household information and a telephone number for a subsequent telephone survey. The experiment used a random sample of addresses from the USPS Delivery Sequence File (DSF) in two California communities with hard-to-survey characteristics. The logo envelope received about a 1.3 percentage point lower return rate in the first mailing in which it was used, but not in the second mailing. Further, that difference was only significant in one of the two communities (a 2.8 point difference in that community v. 0.7 points in the other). Traditional advice about avoiding logos in mail surveys seems sound, but effects are not universal. Comparing experimental and control conditions at their first use, forms returned from logo/insert packets were less likely to report adults age 41 years old and over (70.8% v. 78.2% in non-logo/non-insert mailings). In their second use, logo/insert packets were more likely to reporting at least one adult 18-40 in the household (76.8% v. 66.9% for non-logo/non-insert mailings). Suggestions for future research are discussed.

V24. Seizure diaries from the patients’ perspective

Patient-reported seizure frequency is a key measure of modern epileptology regarding both research and individual treatment. Several studies from the last two decades, however, provided unambiguous evidence that patients underreport seizures. Here, we wanted to assess how patients experience the self-monitoring of their seizures and how they evaluate the data quality of their diaries. A novel 10-sided questionnaire addressed the following domains: sociodemographic characteristics, personality, epilepsy, treatment, seizure experience (separately for day and night), and documenting seizures/not documenting seizures, respectively. The survey was distributed to 1100 adult patients from our unit. We finally received N = 170 usable questionnaires (15.3%) indicating the patients’ little interest in this issue. On average, patients estimated to be aware of 5.3 out of 10 daytime seizures (95% CI 4.1–6.5) while relatives/colleagues appear to notice 7.1 (95% CI 6.1–8.1). For nocturnal seizures, patients stated to notice 2.6 out of 10 (95% CI 1.5–3.7) while relatives notice 4.6 (95% CI 3.4–5.8). One-hundred-four patients (61%, 95% CI 54–68%) reported to keep a seizure diary. These patients estimated to document 87% (95% CI 79–95%) of all daytime seizures they were aware of; for perceived nocturnal seizures the documentation rate was 77% (95% CI 67–87%). From this patient-reported data, the rate of documented daytime seizures can be estimated as 62% (95% CI 48–77%) in documenters and 38% (95% CI 26–53%) in the total sample. The respective percentages for documented nocturnal seizures are 35% (95% CI 23–50%) in documenters and 21% (95% CI 12–34%) in the total sample ( Fig. 1 ). In view of the low return rate, our data are even likely to overestimate the average documentation quality. Patients are well aware of the inherent difficulties to provide valid seizure counts and, consistent with many studies, lacking seizure awareness is the main cause of seizure underreporting. Note: First authorship is shared by CH and BB.

Patient Activity Levels After Reverse Total Shoulder Arthroplasty

Objectives:Indications for reverse total shoulder arthroplasty (RTSA) are expanding, resulting in younger patients who wish to remain active following the procedure. Little information, however, is available to help manage expectations of both physicians and patients for return to sporting activities. The purpose of this study was to determine the rate of return of sports activities, assess average time to return to sports for patients having undergone RTSA.Methods:A prospectively collected registry was queried for consecutive patients who underwent RTSA at our institution between 2007 and 2013. Patients with a minimum of 1-year follow-up were included. Patients without preoperative sporting activity were excluded. All patients were asked to complete a questionnaire regarding their physical fitness, sporting activities. The questionnaire was designed in accordance with previously published activity assessments for total joint arthroplasty. Each patient also completed an ASES and VAS assessment.Results:76 patients played a sport preoperatively and met inclusion/exclusion criteria. The average follow-up was 31.6 months (12-65 mons) and average age was 74.84 years (49.9 - 92.6 yrs). Preoperative diagnoses were cuff tear arthropathy (55.2%), osteoarthritis (30.9%), proximal humerus fracture (17.1%), and rheumatoid arthritis (5.2%). 73% of the cohort had undergone prior ipsilateral shoulder surgery. Average VAS pain scores improved from 6.57 to 0.63 (p<0.001). Average ASES scores improved from 34.30 to 81.45 (p<0.001). 85.5% of patients who participated in sports preoperatively returned to at least one sport following RTSA. Average time to full return to sport was 5.3 months. Walking had the highest direct rate of return (85.7%), followed by fitness sports (81.5%), swimming (66.7%), running (57.1%), cycling (50.0%) and golf (50%). Age less than 70 years had significant improvement in rate of return to sports (p<0.002). 41.1% reported improved physical fitness following RTSA. 88.2% felt their sports outcome was good to excellent and 93.4% felt their surgical outcome was good to excellent. The two most commonly reported reasons for not returning to a sport were pain (13.1%) and lack of interest (9.2%). For all types of sports and rates of return see fig 1.Conclusion:Patients undergoing RTSA had an 85% rate of return to one or more sporting activities at an average of 5.3 months following surgery. Non-contact high demand activities (swimming, skiing, golf, and tennis) had lower return rates than lower demand activities. Age greater than 70 years old was a significant predictor of decreased return to activities. This is the only study to document both preoperative and postoperative sports and activities of daily living following RTSA. The present study offers valuable information to help manage patient and surgeon expectations.

Consequences of Actively Managing a Small Bull Trout Population in a Fragmented Landscape

AbstractHabitat fragmentation, which affects many native salmonid species, is one of the major factors contributing to the declines in distribution and abundance of Bull Trout Salvelinus confluentus. Increasingly, managers are considering options to maintain and enhance the persistence of isolated local populations through active management strategies. Understanding the ecological consequences of such actions is a necessary step in conservation planning. We used an individual‐based model to evaluate the consequences of an ongoing management program aimed at mitigating the anthropogenic fragmentation of the lower Clark Fork River in Montana. Under this program juvenile Bull Trout are trapped and transported from small, headwater source populations to Lake Pend Oreille, Idaho, for rearing, and adults are subsequently recaptured in their upstream migration and returned to the natal population for spawning. We examined one of these populations and integrated empirical estimates of demographic parameters to simulate different management scenarios where moderate (n = 4) and high (n = 8) numbers of age‐2, age‐3, or age‐4 Bull Trout were removed for transport with variable return rates under both demographic stochasticity and environmental perturbations. Our results indicated the risks from removal with no returns increased substantially when removal totals and age of Bull Trout removed from the simulated population increased. Specifically, removing eight age‐3 or age‐4 individuals resulted in 26% and 62% reductions in average adult population size, respectively, across simulations. We found the risks of transport were not likely alleviated with low (3%) or moderate (6%) return rates, and there were considerable risks of declines for the source population even when return rates were extremely high (&gt;12%). Our simulations indicated little risk of declines for the source population with removals of age‐2 Bull Trout, and any risks were alleviated with low return rates. However, we found higher return rates were particularly beneficial in the presence of large, density‐independent perturbations.

ESG Rating in Investment Risk Analysis of Companies Listed on the Public Market in Poland

This study verifies the hypothesis that greater transparency of public companies in disclosing non‐financial (ESG) data results in lower volatility of return rates on securities issued by them, thereby reducing investment portfolio risk understood as return rate volatility. Non‐financial data reporting contributes to increased transparency, predictability of companies' operations and hence to significant reduction in information asymmetry on the capital market, and ultimately considerably reduces forecasting errors in risk–return profile of investment portfolios. The research conducted has shown that there is a large information gap on the Polish market, especially as regards ESG reporting. The overall level of reporting on non‐financial data is low. In the analysed period, the shares issued by companies with higher ESG rating were distinguished by an over‐average return rate and lower return rate volatility as well as lower forecasting error in return rates, which is indicated by the standard error parameter (alpha and beta coefficients).

Counting seizures: The primary outcome measure in epileptology from the patients’ perspective

PurposePatient-reported seizure counts represent a key outcome measure for individual treatments and clinical studies in epileptology. Video-EEG based research, however, demonstrated lack of validity due to underreporting. Here we examined the practice of keeping seizure diaries and the patients’ attitudes toward seizure counting. MethodsAnticipating a low return rate, a comprehensive survey was mailed to 1100 adult outpatients. Besides methods and reasons to document or not to document seizures, the questionnaire addressed clinical, personality and sociodemographic characteristics as well as the subjective experience of seizures. ResultsQuestionnaires from 170 patients (15%) could be included in our analysis. Patients estimated to be aware of 5.3 out of 10 daytime seizures (nocturnal seizures: 2.6) while they supposed that relatives/colleagues noticed 7.1 (nocturnal: 4.6). Almost two-thirds of the patients reported to keep a seizure diary with a self-estimated documentation rate of 8.7 out of 10 noticed daytime seizures (nocturnal: 7.7). Documenters and non-documenters showed only marginal group differences with regard to clinical, personality and sociodemographic characteristics. Importantly, patients were more committed to keep a seizure diary when they judged it to be relevant for clinical treatment decisions. ConclusionPatients appear to know that they underreport seizures. According to their view, seizure unawareness as induced by seizures themselves seems to be a more important factor than omitting documentation of noticed seizures. Thus, the potential to improve the validity of seizure diaries of electronic devices which facilitate documenting noticed seizures appears limited.

Evidence that Risk Adjustment is Unnecessary in Estimates of the User Cost of Money

Investors value the special attributes of monetary assets (e.g., exchangeability, liquidity, and safety) and pay a premium for holding them in the form of a lower return rate. The user cost of holding monetary assets can be measured approximately by the difference between the returns on illiquid risky assets and those of safer liquid assets. A more appropriate measure should adjust this difference by the differential risk of the assets in question. We investigate the impact that time non-separable preferences has on the estimation of the risk-adjusted user cost of money. Using U.K. data from 1965Q1 to 2011Q1, we estimate a habit-based asset pricing model with money in the utility function and find that the risk adjustment for risky monetary assets is negligible. Thus, researchers can dispense with risk adjusting the user cost of money in constructing monetary aggregate indexes.

Adverse Selection and Moral Hazard in Equity Partnerships: Evidence from Hollywood's Slate Financing Agreements

We use a movie industry project-by-project data set to analyze the principal�agent problem in slate financing arrangements. Under this specific film financing regime, which has become a significant mode of raising capital in Hollywood over the past decade, an external investor concludes a long-term contract with a film producer and commits to cofinance a larger number of future film projects of that particular partner. In line with our theoretical conjectures, slate cofinanced movies receive poorer quality ratings and yield considerably lower return rates. Our data suggests that a substantial part of these performance differences may be attributed to adverse project selection and producer moral hazard.

Scale-Up, Retention and HIV/STI Prevalence Trends among Female Sex Workers Attending VICITS Clinics in Guatemala

BackgroundSince 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala.MethodsDemographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention.ResultsDuring 2007–2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention.ConclusionsOur data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed.

Integrative tracking methods elucidate the evolutionary dynamics of a migratory divide.

Migratory divides, the boundary between adjacent bird populations that migrate in different directions, are of considerable interest to evolutionary biologists because of their alleged role in speciation of migratory birds. However, the small size of many passerines has traditionally limited the tools available to track populations and as a result, restricted our ability to study how reproductive isolation might occur across a divide. Here, we integrate multiple approaches by using genetic, geolocator, and morphological data to investigate a migratory divide in hermit thrushes (Catharus guttatus). First, high genetic divergence between migratory groups indicates the divide is a region of secondary contact between historically isolated populations. Second, despite low sample sizes, geolocators reveal dramatic differences in overwintering locations and migratory distance of individuals from either side of the divide. Third, a diagnostic genetic marker that proved useful for tracking a key population suggests a likely intermediate nonbreeding location of birds from the hybrid zone. This finding, combined with lower return rates from this region, is consistent with comparatively lower fitness of hybrids, which is possibly due to this intermediate migration pattern. We discuss our results in the context of reproductive isolating mechanisms associated with migration patterns that have long been hypothesized to promote divergence across migratory divides.

PREDIKSI HARGA SAHAM MENGGUNAKAN SUPPORT VECTOR REGRESSION DENGAN ALGORITMA GRID SEARCH

The stock market has become a popular investment channel in recent years because of the low return rates of other investment. The stock price prediction is in the interest of both private and institution investors. Accurate forecasting of stock prices is an appealing yet difficult activity in the business world. Therefore, stock prices forecasting is regarded as one of the most challenging topics in business. The forecasting techniques used in the literature can be classified into two categories: linear models and non linear models. One of forecasting techniques in nonlinear models is support vector regression (SVR). Basically, SVR adopts the structural risk minimization principle to estimate a function by minimizing an upper bound of the generalization. The optimal parameters of SVR can be use Grid Search Algorithm method. Concept of this method is using cross validation (CV). In this paper, the SVR model use linear kernel function. The accurate prediction of stock price, in telecommunication, is 92.47% for training data and 83.39% for testing data. Keywords: Stock price, SVR, Grid Search, Linear kernel function.

Offering mental health services in a conflict affected region of Pakistan: who comes, and why?

BackgroundNorth West Pakistan is an area ravaged by conflict and population displacement for over three decades. Recently, drone attacks and military operations have aggravated underlying mental disorders, while access to care is limited. Among patients attending a mental health clinic integrated in district hospital conducted by psychologists; we describe service utilization, patient characteristics, presenting complaints, morbidity patterns, and follow-up details.Methodology/Principal FindingsA retrospective study using routinely collected programme data was conducted from February to December 2012. A total of 1545 consultations were conducted for 928 patients (86% females). There were 71(8%) children and adolescents. An increase was observed from February to July, followed by a decline. 163 new patients (18%) were on psychotropic medication at presentation. The most common morbidity in females (36%) were symptoms of adjustment disorders and acute reactions. Depression and anxiety were common in both genders while post traumatic disorder was frequent in males (21%). Out of the 928 new patients, 639(69%) had a follow up visit planned with their psychologist, but only 220(34%) new patients returned for a follow up visit.ConclusionIn a district hospital, mental health services managed by psychologists were well attended. There is a need to consider widening the current package of care to cater to the diversity of mental health disorders, gender difference, children and adolescents. Standardized diagnostic and monitoring tools would also need to be adapted accordingly and to assess patient progress. Innovative approaches to tackle the problem of the low return rate are needed.

Covariates of release mortality and tag loss in large-scale tuna tagging experiments

The data from tag-recapture experiments, which are used to help understand animal behaviour and dynamics, and to provide input data for population models such as stock assessments, are affected by mortality associated with tagging and by tag shedding. These processes introduce bias and uncertainty into parameters estimated in population models such as tuna stock assessments. The causes and magnitudes of tag shedding and post-release mortality in tuna tagging experiments are not well understood. We analysed data from tuna tagging experiments in the Western Pacific (330,000 releases) and Indian Oceans (168,000 releases) to investigate factors affecting post-release mortality and tag shedding. Tag return rates were modelled as functions of the tagger identity, tagger experience, tagging assistant, tagging station, treatment of the fish, use of oxytetracycline, tuna species, and size at release. The release event was included in models as a fixed effect, so that differences in recapture rate among release events did not affect other parameter estimates. We found differences in tag return rates among taggers and tagging assistants, with tagger experience, and between tagging stations. Substantially lower return rates were associated with some types of damage to fish and with internally implanted tags, and when oxytetracycline was injected. Return rates varied with tuna size and species. In the Western Pacific yellowfin and bigeye return rates were more affected by some covariates than were skipjack, while differences were not observed in the Indian Ocean, where sample sizes were smaller. Results suggest that tagging mortality may be quite high, and that more care and better recording of fish treatment would increase the reliability of assessment inputs. We provide new effective release numbers that have been adjusted to allow for estimated tagging mortality and tag shedding.

Letter to the Editor

To the Editor: Boykin et al. [2] presented a review of 18 rowers (21 hips) with MRI-confirmed labral tears in the anterior half of the acetabulum treated from 2003 to 2010. The most common presentations were groin pain (15 of 21 hips) and positive anterior femoroacetabular impingement (FAI) sign (17 of 21 hips). Fifteen of 21 hips had radiographic FAI (10 pure cam lesions and five mixed cam/pincer). Mechanism of labral injury was proposed to be repeated hip hyperflexion. It was stated that rowers’ hips go from extreme flexion to extension during the stroke. Among the hips that were treated with arthroscopic surgery (18 of 21), femoral head/neck osteochondroplasty was performed in six cases. Among these 18 patients, 10 returned to rowing, six did not, and two had missing data at a mean of 8 months (range, 3 to 25 months) after surgery. The unfavorable return to sport in this series was contrasted with an epidemiologic study showing a low percentage of rowing injuries resulted in an inability to train for more than 1 month [9]. Regarding mechanism of injury, rowers’ hips do not enter anatomical extension during rowing (approximately 20° of hip flexion remains in the finish position) [3, 8]. Hyperflexion implies joint flexion beyond normal limits [5]. Normal passive ROM at the hip joint is 135° flexion and 30° extension [4]. Kinematic analysis reveals that the ROM of the hip falls within normal ROM during rowing, and is not hyperflexed [3]. Therefore, it is likely that the high incidence of FAI in this series precipitated the tears and symptoms among majority of the rowers. Importantly, femoral alpha angle measurement of Magnetic Resonance Arthrography shows considerable variability, and clinical impingement tests remain the most reliable predictor of the presence of FAI [6]. With regards to the main goal of the paper — determining “the likelihood that a rower with labral injury, treated arthroscopically, will return to sport,” — is it possible that the low postoperative return rate was a consequence of performing femoral head/neck osteochondroplasty in only six of 15 hips with cam lesions, therefore, not directly addressing the joint impairment? Additionally, the three patients with bilateral hip pathology were only surgically treated unilaterally. How did the three untreated hips impact return to rowing? Furthermore, it is known that symptom duration longer than 3 years is associated with poor outcome after hip arthroscopy [1], however, no preoperative symptom duration was presented [2]. Finally, as return to rowing was assessed as early as 3 months postoperatively, what was the rehabilitation protocol? Return to sport after hip arthroscopy should be advanced slowly to prevent continued irritation or reinjury [7]. In the cited retrospective study regarding musculoskeletal injury present in elite-level rowers competing at the Junior World Rowing Championships, [9] the authors emphasized that study design may have resulted in under-reporting of severe rowing injury, as severely injured rowers may not have recovered to compete at the World Rowing Championships. Additionally, without presenting return to sport data in context of number of rowers who wanted to return to rowing but could not due to reoccurring symptoms, this aspect of analysis by Boykin et al. is limited in its utility [2].

The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates

Study DesignRetrospective consecutive case review pre- and postintervention. ObjectivesCharacterize the effects of the intervention.Summary of Background Data: Complication rates in adult spinal deformity surgery are unacceptable. System approaches are necessary to increase patient safety. This group reported on the dual–attending surgeon approach, a live multidisciplinary preoperative screening conference, and the intraoperative protocol for the management of coagulopathy. The outcomes were demonstrated by complication rates before and after the institution of this protocol. MethodsForty consecutive patients in Group A were managed without the 3-pronged approach. A total of 124 consecutive patients in Group B had a dual–attending surgeon approach, were presented and cleared by a live multidisciplinary preoperative conference, and were managed according to the intraoperative protocol. ResultsGroup A had an average age of 62 years (range, 39–84 years). Group B had an average age of 64 years (range, 18–84 years). Most patients in both groups had fusions from 9 to 15 levels. Complication rates in Group B were significantly lower (16% vs. 52%) (p < .001). Group B showed significantly lower return rates to the operating room during the perioperative 90-day period (0.8% vs. 12.5%) (p < .001). Group B also had lower rates of wound infection requiring debridement (1.6% vs. 7.5%), lower rates of deep vein thrombosis/pulmonary embolism (3.2% vs. 10%), and lower rates of postoperative neurological complications (0.5% vs. 2.5%) (not significant). Group B had significantly lower rates of urinary tract infection requiring antibiotics (9.7% vs. 32.5%) (p < .001). ConclusionsThese data suggests that a team approach consisting of a dual–attending surgeon approach in the operating room, a live preoperative screening conference, and an intraoperative protocol for managing coagulopathy will significantly reduce perioperative complication rates and enhance patient safety in patients undergoing complex spinal reconstructions for adult spinal deformity.

A survey of seizures and current treatments in 15q duplication syndrome

Seizures are common in individuals with duplications of chromosome 15q11.2-q13 (Dup15q). The goal of this study was to examine the phenotypes and treatments of seizures in Dup15q in a large population. A detailed electronic survey was conducted through the Dup15q Alliance containing comprehensive questions regarding seizures and their treatments in Dup15q. There were 95 responses from Dup15q families. For the 83 with idic(15), 63% were reported to have seizures, of which 81% had multiple seizure types and 42% had infantile spasms. Other common seizure types were tonic-clonic, atonic, myoclonic, and focal. Only 3 of 12 individuals with int dup(15) had seizures. Broad spectrum antiepileptic drugs (AEDs) were the most effective medications, but carbamazepine and oxcarbazepine were also effective, although typical benzodiazepines were relatively ineffective. There was a 24% response rate (>90% seizure reduction) to the first AED tried. For those with infantile spasms, adrenocorticotropic hormone (ACTH) was more effective than vigabatrin. This is the largest study assessing seizures in Duplication 15q syndrome, but because this was a questionnaire-based study with a low return rate, it is susceptible to bias. Seizures are common in idic(15) and typically difficult to control, often presenting with infantile spasms and progressing to a Lennox-Gastaut-type syndrome. Seizures in those with int dup(15) are less common, with a frequency similar to the general autism population. In addition to broad spectrum AED, medications such as carbamazepine and oxcarbazepine are also relatively effective in controlling seizures in this population, suggesting a possible multifocal etiology, which may also explain the high rate of infantile spasms. Our small sample suggests a relative lack of efficacy of vigabatrin and other γ-aminobutyric acid (GABA)ergic medications, such as typical benzodiazepines, which may be attributable to abnormal GABAergic transmission resulting from the duplication of a cluster of GABAβ3 receptor genes in the 15q11.2-13 region.

Management of Febrile Neonates in US Pediatric Emergency Departments

Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI. Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P < .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management. There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations.

English

Toxoplasmosis&nbsp; is&nbsp; an&nbsp; anthropozoonosis&nbsp; of&nbsp; medical&nbsp; and&nbsp; veterinary&nbsp; importance,&nbsp; due&nbsp; to&nbsp; the protozoan Toxoplasma gondii. Oocysts shed by felids play a key role in parasite transmission as they contaminate meat-producing animals, vegetables and water consumed later by humans. This study tried to study the effectiveness of spiramycin in the treatment of toxoplasmosis in the laboratory of the Abass NDAO Hospital&rsquo;s (CHAN) in human immunodeficiency virus (HIV)-positive women (82 cases) using the enzyme immunoassay method solid phase (EIA). It reveals a negativity of IgM antibodies and progressive regression of IgG antibodies more visible in three women as high (between 50 and 100 International Units (IU)/ml) and in three other unreliable in the first immunoglobin M (IgM) serology by a seroconversion at the second serology with a stabilization of immunoglobin (IgG) 10 IU/ml. The effectiveness of current treatment has been demonstrated by low return rate IgG antibodies to 10 IU/ml in those who received 3 million IU of Rovamycin at a dose of 2 tablets for day to one month. These first results need to be followed by more extensive investigations. Key words: Prevalence, treatment, toxoplasmosis, Toxoplasma gondii.