Small Risk Research Articles

Acute disseminated encephalomyelitis and transverse myelitis following COVID-19 vaccination – A self-controlled case series analysis

Acute Disseminated Encephalomyelitis (ADEM) and Transverse Myelitis (TM) are within the group of immune mediated disorders of acquired demyelinating syndromes. Both have been described in temporal association following various vaccinations in case reports and case series and have been evaluated in observational studies. A recent analysis conducted by The Global Vaccine Data Network (GVDN) observed an excess of ADEM and TM cases following the adenoviral vectored ChAdOx1 nCoV-19 (AZD1222) and mRNA-1273 vaccines, compared with historically expected background rates from prior to the pandemic. Further epidemiologic studies were recommended to explore these potential associations.We utilized an Australian vaccine datalink, Vaccine Safety Health-Link (VSHL), to perform a self-controlled case series analysis for this purpose. VSHL was selected for this analysis as while VSHL data are utilised for GVDN association studies, they were not included in the GVDN observed expected analyses. The VSHL dataset contains vaccination records sourced from the Australian Immunisation Register, and hospital admission records from the Victorian Admitted Episodes Dataset for 6.7 million people. These datasets were used to determine the relative incidence (RI) of G040 (ADEM) and G373 (TM) ICD-10-AM coded admissions in the 42-day risk window following COVID-19 vaccinations as compared to control periods either side of the risk window.We observed associations between ChAdOx1 adenovirus vector COVID-19 vaccination and ADEM (all dose RI: 3.74 [95 %CI 1.02,13.70]) and TM (dose 1 RI: 2.49 [95 %CI: 1.07,5.79]) incident admissions. No associations were observed between mRNA COVID-19 vaccines and ADEM or TM. These findings translate to an extremely small absolute risk of ADEM (0.78 per million doses) and TM (1.82 per million doses) following vaccination; any potential risk of ADEM or TM should be weighed against the well-established protective benefits of vaccination against COVID-19 disease and its complications.This study demonstrates the value of the GVDN collaboration leveraging large population sizes to examine important vaccine safety questions regarding rare outcomes, as well as the value of linked population level datasets, such as VSHL, to rapidly explore associations that are identified.

Long-term efficacy and safety of a treatment strategy for HIV infection using protease inhibitor monotherapy: 8-year routine clinical care follow-up from a randomised, controlled, open-label pragmatic trial (PIVOT)

Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference-0.6%, 95% CI-3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P=0.08) over the entire follow-up period. A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. The National Institute for Health Research Health Technology Assessment programme.

A Possible Case of Hypertensive Crisis With Aortic Dissection After an Anti-COVID-19 Vaccine.

Aortic dissection, a potentially fatal event, usually presents with acute intense chest or back pain. Painless aortic dissections constitute about 10% of all cases. High blood pressure is a common finding in both painless and painful aortic dissections. During the coronavirus disease (COVID-19) pandemic, various anti-COVID vaccines have been massively used. Although these vaccines are generally safe, there is a small risk of adverse effects which are mostly mild and transient, but sometimes they could be life-threatening. We report a case of painless aortic dissection that occurred within minutes of receiving the COVID-19 inactivated vaccine. A 65-year-old woman with chronic controlled systemic hypertension developed slurred speech, decreased level of consciousness, generalized weakness, and dyspnea without chest, back, or abdominal pain a few minutes after receiving the second dose of inactivated COVID-19 vaccine; she had a systolic blood pressure of 220mmHg and left-sided pleural effusion. Drainage of the pleural effusion revealed gross blood and a spiral chest and mediastinum CT with intravenous contrast showed a penetrating atherosclerotic ulcer in the descending aorta. Therefore, thoracic endovascular aortic repair (TEVAR) was carried out, and the patient was discharged in satisfactory condition after 3days.

COVID-19 Vaccines and the Menstrual Cycle: A Cross-Sectional Study

Objective: This study aimed to explore the impact of various COVID-19 vaccines on the menstrual cycle of Jordanian women. Materials and Methods: We conducted a retrospective analysis of tracked menstrual changes using an anonymous questionnaire written in the local language. We received 732 responses, and after exclusions, 617 responses were analyzed. The questionnaire covered six sectors: demographics, medical history, COVID-19 infection and vaccination status, obstetric and gynecological history, menstrual cycle history, and specific questions about cycle length, flow, and any symptoms before and after each vaccine shot. Participants included Jordanian females who had received any type of COVID-19 vaccine. Results: Among the participants analyzed, two-thirds were between the ages of 20-35, and the majority had a normal BMI (59.6%). Most participants were single, nulliparous, and had never used contraception methods (79.3%, 82.0%, and 93.8%, respectively). Only a small percentage had other risk factors influencing menstrual cycle changes, such as surgical procedures (10.5%) and specific medications (8.10%). Baseline menstrual information was recorded. Forty percent of participants experienced changes in menstrual duration, and approximately one-fifth reported heavier and more severe premenstrual syndrome (PMS) symptoms. Body mass index (BMI) was directly correlated with bleeding intensity after vaccination. Parity was weakly directly proportional to bleeding intensity after vaccination. However, BMI and parity did not significantly correlate with menstrual duration, menstrual cycle length, PMS symptoms, or cramps after vaccination. Conclusion: In a population of young, non-sexually active women with a normal BMI, most participants did not experience significant changes in their menstrual cycles after receiving the COVID-19 vaccine. Only one-fifth of participants reported shorter duration, heavier bleeding, more frequent, more painful, and more severe PMS symptoms post-vaccination.

A meta‐analysis of clinical studies of moxibustion for pressure ulcer healing

AbstractIn this study, we aimed to evaluate the effect of moxibustion on pressure ulcers. A thorough search was performed for articles published from database inception up to 14 December 2023. Randomized controlled trials, which evaluated the effects of moxibustion were included. Finally, 11 relevant trails that enrolled a total of 795 participants met inclusion criteria. The results of meta‐analysis suggested beneficial effects of moxibustion for pressure ulcer compared with control on the response rate (RR: 1.21; 95% CI: 1.13–1.29; p = 0.82; I2 = 0%), healing time (MD: −5.69; 95% CI: −9.58 to −1.80; p<0.05; I2 = 97%) and pressure ulcer scale for healing scores (MD: −1.13; 95% CI: −1.36 to −0.89; p = 0.79; I2 = 0%). The evidence suggests that moxibustion possesses satisfactory efficacy in promoting healing of pressure ulcers. However, due to the small number of trials included in this study, as well as the small sample size and high risk of bias, we were unable to draw firm conclusions about the effectiveness of moxibustion for pressure ulcers.

P1105 Short-term exposure to environmental air pollution and inflammatory bowel disease flares: a time-stratified case cross-over study

Abstract Background Some epidemiological studies suggest that long-term exposure to environmental air pollutants, such as particulate matter (PM), could have a role in inflammatory bowel disease (IBD) incidence and pathogenesis. However, less is known about the potential effect of short-term air pollution exposure. The aim of this study is to investigate whether short-term exposure to environmental air pollution is associated with the occurrence of IBD flares. Methods Anonymized hospital discharge records (HDR) with ICD-9-CM codes 555 (Crohn’s disease) and 556 (ulcerative colitis) for years 2002-2009 from all hospitals of the Lombardy region were collected. All HDR of adult patients (18-75 years) resident in Milan were included, except for recurrent hospitalizations within 6 months. Each record was assigned daily PM ≤10 µm (PM10) concentrations at municipality level by averaging PM10 levels of the day of admission with the levels of the day before (lag01) and of each preceding day up to six days before (lag06). To evaluate the association between PM10 and IBD-related hospitalizations, a time-stratified case-crossover study design was applied. Conditional logistic regression models, calculating Odds Ratios (OR) and 95% Confidence Intervals (95%CI) per increments of 10 µg/m3 of PM10, were performed. Results Overall, 2,176 hospital admissions (males=1,137, Crohn’s disease=1,264, ulcerative colitis=912) were included. In the entire population no clear association between PM10 and IBD-related hospitalization was identified, notwithstanding a small risk increase for males (OR: 1.03; 95%CI: 0.99-1.08 at lag04). When further stratifying for ICD code, an increased risk of hospitalization for "left-sided ulcerative colitis" (ICD code: 556.5) was found in males only, for exposures in all days preceding hospitalization up to lag04 (1.28; 1.05-1.28; 59 cases, 207 controls) (Figure 1). In females, the association was weaker, although positive (1.14; 0.91-1.42; 49 cases, 164 controls). No relevant findings emerged when looking at other ICD codes. Conclusion We observed an increased risk of IBD-related hospitalization in male patients with left-sided ulcerative colitis per increasing levels of air pollution in the days preceding hospital admission. Although preliminary, our findings suggest the possible role of sex as an effect modifier of the influence that air pollution might exert on IBD flares. Further studies are needed to better comprehend the complex framework characterizing the interplay between environmental and individual factors contributing to IBD.

Partial substitution of red meat or processed meat with plant-based foods and the risk of colorectal cancer

ObjectivesShifting from animal-based to plant-based diets could reduce colorectal cancer (CRC) incidence. Currently, the impacts of these dietary shifts on CRC risk are ill-defined. Therefore, we examined partial substitutions of red or processed meat with whole grains, vegetables, fruits or a combination of these in relation to CRC risk in Finnish adults.MethodsWe pooled five Finnish cohorts, resulting in 43 788 participants aged ≥ 25 years (79% men). Diet was assessed by validated food frequency questionnaires at study enrolment. We modelled partial substitutions of red (100 g/week) or processed meat (50 g/week) with corresponding amounts of plant-based foods. Cohort-specific hazard ratios (HR) for CRC were calculated using Cox proportional hazards models and pooled together using random-effects models. Adjustments included age, sex, energy intake and other relevant confounders.ResultsDuring the median follow-up of 28.8 years, 1124 CRCs were diagnosed. We observed small risk reductions when red meat was substituted with vegetables (HR 0.97, 95% CI 0.95 − 0.99), fruits (0.97, 0.94 − 0.99), or whole grains, vegetables and fruits combined (0.97, 0.95 − 0.99). For processed meat, these substitutions yielded 1% risk reductions. Substituting red or processed meat with whole grains was associated with a decreased CRC risk only in participants with < median whole grain intake (0.92, 0.86 − 0.98; 0.96, 0.93 − 0.99, respectively; pinteraction=0.001).ConclusionsEven small, easily implemented substitutions of red or processed meat with whole grains, vegetables or fruits could lower CRC risk in a population with high meat consumption. These findings broaden our insight into dietary modifications that could foster CRC primary prevention.

PEMBENTUKAN PORTOFOLIO OPTIMAL INVESTASI MENGGUNAKAN MODEL MARKOWITZ DAN MODEL INDEKS TUNGGAL PADA ASET BEBAS RISIKO DAN ASET BERISIKO

Optimal Portfolio is one way that can be used to determine stock portfolios that generate large returns with the smallest risk. The purpose of this study is to determine the optimal portfolio of risk-free assets and risk assets using the Markowitz Model, Single Index Model and portfolio performance by comparing the resulting rate of return and risk. The research sample used was LQ 45 shares listed on the Indonesia Stock Exchange from August 2014 to July 2019. The sampling technique used was purposive sampling technique, namely the selection of data based on certain criteria in order to obtain a sample of 29 listed companies. The method used is to use the Markowitz Model, the Single Index Model and portfolio performance. From the optimal portfolio formation based on the Method, there are 9 shares included in risk free assets and 20 shares included in risk assets. The results of the analysis show that by using the Single Index Model the return from the optimal portfolio produced is higher than using the Markowitz Model, as well as the risk generated on the Single Index Model is smaller than using the Markowitz Model both on risk-free assets and risk assets, this is assured with the results obtained from portfolio performance.

Surgical versus non-surgical treatment for carpal tunnel syndrome.

Surgical versus non-surgical treatment for carpal tunnel syndrome.

Critical research gaps in treating growth faltering in infants under 6 months: A systematic review and meta-analysis.

In 2020, 149.2 million children worldwide under 5 years suffered from stunting, and 45.4 million experienced wasting. Many infants are born already stunted, while others are at high risk for growth faltering early after birth. Growth faltering is linked to transgenerational impacts of poverty and marginalization. Few interventions address growth faltering in infants under 6 months, despite a likely increasing prevalence due to the negative global economic impacts of the COVID-19 pandemic. Breastfeeding is a critical intervention to alleviate malnutrition and improve child health outcomes, but rarely receives adequate attention in growth faltering interventions. A systematic review and meta-analysis were undertaken to identify and evaluate interventions addressing growth faltering among infants under 6 months that employed supplemental milks. The review was carried out following guidelines from the USA National Academy of Medicine. A total of 10,405 references were identified, and after deduplication 7390 studies were screened for eligibility. Of these, 227 were assessed for full text eligibility and relevance. Two randomized controlled trials were ultimately included, which differed in inclusion criteria and methodology and had few shared outcomes. Both studies had small sample sizes, high attrition and high risk of bias. A Bangladeshi study (n = 153) found significantly higher rates of weight gain for F-100 and diluted F-100 (DF-100) compared with infant formula (IF), while a DRC trial (n = 146) did not find statistically significant differences in rate of weight gain for DF-100 compared with IF offered in the context of broader lactation and relactation support. The meta-analysis of rate of weight gain showed no statistical difference and some evidence of moderate heterogeneity. Few interventions address growth faltering among infants under 6 months. These studies have limited generalizability and have not comprehensively supported lactation. Greater investment is necessary to accelerate research that addresses growth faltering following a new research framework that calls for comprehensive lactation support.

Epidemiology studies on effects of lithium salts in pregnancy are confounded by the inability to control for other potentially teratogenic factors.

In bipolar women who took lithium during pregnancy, several epidemiology studies have reported small increases in a rare fetal cardiac defect termed Ebstein's anomaly. Behavioral, environmental, and lifestyle-associated risk factors associated with bipolar disorder and health insurance status were determined from an Internet search. The search was conducted from October 1, 2023, through October 14, 2023. The search terms employed included the following: bipolar, bipolar disorder, mood disorders, pregnancy, congenital heart defects, Ebstein's anomaly, diabetes, hypertension, Medicaid, Medicaid patients, alcohol use, cigarette smoking, marijuana, cocaine, methamphetamine, narcotics, nutrition, diet, obesity, body mass index, environment, environmental exposures, poverty, socioeconomic status, divorce, unemployment, and income. No quotes, special fields, truncations, etc., were used in the searches. No filters of any kind were used in the searches. Women who remain on lithium in the United States throughout their pregnancy are likely to be experiencing mania symptoms and/or suicidal ideation refractory to other drugs. Pregnant women administered the highest doses of lithium salts would be expected to have been insufficiently responsive to lower doses. Any small increases in the retrospectively determined risk of fetal cardiac anomalies in bipolar women taking lithium salts cannot be disentangled from potential developmental effects resulting from very high rates of cigarette smoking, poor diet, alcohol abuse, ingestion of illegal drugs like cocaine or opioids, marijuana smoking, obesity, and poverty. The small risks in fetal cardiac abnormalities reported in the epidemiology literature do not establish a causal association for lithium salts and Ebstein's anomaly.

Opioids: Analgesia, Euphoria, Dysphoria, and Oblivion: Observations and a Hypothesis

Introduction: In a previous paper, we inquired into the root causes of the two opioid crises our nation is facing, one evolved from the effects of political and psychosocial forces, one manufactured by the Centers for Disease Control and Prevention. This inquiry led us to suspect that the very different opioid consumption patterns of various groups of people were driven by very different motivations related to the opioid experience. Here we explore four potential motivations or disincentives: analgesia, euphoria, dysphoria, and the search for oblivion. We particularly focus on two populations more likely to be motivated by the search for oblivion: people addicted to opioids and terminal cancer patients, and the problem of tolerance. Methods: Analytic review of the scientific literature. Results and Discussion: Essentially all patients managed in American clinics, including many patients with cancer, are motivated by a simple desire for analgesia. A search for euphoria almost certainly motivates the population of people who use mind-altering drugs, including opioids, for recreation. Dysphoria is a feeling of unpleasantness associated with a particular opioid sufficient to motivate a patient to refuse the drug. It represents a common challenge in managing patients in chronic pain. The search for oblivion appears to be the primary motivation for people with opioid addiction. It may also be a motivating factor in certain patients with terminal cancer who suffer not just pain but also agonizing existential crisis. Conclusion: A greater appreciation on the part of clinicians, scientists and policy makers of the different factors that motivate use of opioids could have major implications for how we handle different people consuming opioids. It could disabuse us of the suspicion that every patient in pain is seeking euphoria rather than analgesia and help us to understand their vanishingly small risk of drug abuse or addiction. It could lead to serious study of the mechanisms of dysphoria and the development of means to circumvent it. It could lead to improved approaches to patients with pain from terminal cancer and optimal strategies for dealing with the addiction crisis in the streets. Methods: Analytic review of the scientific literature. Results and Discussion: Essentially all patients managed in American clinics, including many patients with cancer, are motivated by a simple desire for analgesia. A search for euphoria almost certainly motivates the population of people who use mind-altering drugs, including opioids, for recreation. Dysphoria is a feeling of unpleasantness associated with a particular opioid sufficient to motivate a patient to refuse the drug. It represents a common challenge in managing patients in chronic pain. The search for oblivion appears to be the primary motivation for people with opioid addiction. It may also be a motivating factor in certain patients with terminal cancer who suffer not just pain but also agonizing existential crisis.

The profile of adolescents assisted by the emergency department of a Brazilian private tertiary hospital

IntroductionAdolescents represent an important demographic percentage in the studied population and in Emergency Departments (ED). It is imperative that health professionals and services are prepared to address this population. This work aims to characterize adolescents at the ED of a Brazilian private tertiary hospital. MethodsThe study was an observational, retrospective longitudinal cohort that included 37,450 visits of patients aged 10 to 21 years of age, between January 2018 and June 2022 in the ED of a private tertiary hospital. The study evaluated the reason for the consultation, diagnosis, need for hospitalization, the medical professional responsible for the care, severity, and paying source of care. Results53.7% were female. Mean age was 16.2y for girls and 15.6y for boys (p < 0.005). The most common complaints were flu-like symptoms (17.4%), sore throat (8.2%), fever (6.7%) and limb trauma (6.3%). Flu-like symptoms were the main consultations caused in all age groups and genders. 36.8% were attended by a general practitioner, 35.8% by a pediatrician, 15.1% by orthopedics and 5.6% by surgeons. The hospitalization rate was 5.5%. There was a strong correlation between age and hospitalization rate (correlation coefficient [r = 0.93]; p < 0.001). The most prevalent diagnoses in hospitalizations were acute abdomen (12.7%) and trauma (9.4%). 78.2% of the consultations were classified as “not urgent”. There was a strong correlation between age and severity (r = 0.86; p < 0.001). 92.7% of the consultations were paid by medical insurance. ConclusionIn this study, flu-like symptoms were the single main reason for adolescents to search for immediate health care, in every age subgroup and gender, but represented a small risk for hospital admission. Limb trauma was more common in younger male teenagers. Acute abdominal pain and trauma were the most frequent causes of hospital admissions. There was a significant and strong correlation between age and both admission rate and severity.

An Economic Analysis of the Impact of Digital Currencies on Land Asset Securities Transactions

Abstract Dilemmas in financing, risk control, and liquidity have arisen in the face of the current land system, and land securitization can provide a way of thinking to solve these problems. This paper proposes four financial instruments for land asset securitization. It calculates the transaction pricing of that land asset security by splitting it into a composite of independent financial derivative values based on the risk-free arbitrage theory in financial engineering. Finally, based on the multiple fractals and volatility spillover index method, the impact of digital currency on the trading dependence and risk spillover of land asset securities when land is securitized as an asset is studied in depth. The results show that the fractal characteristics of land stocks are 0.756, and land bonds are 0.737. The multiple fractal characteristics of the cross-correlation of different land security assets are differentiated, which indicates that the impact of digital currency on the land security assets among them is stronger in the long memory of small fluctuations. The inverse persistence of large fluctuations is stronger. The risk spillover results show that there is a small risk correlation between digital currencies and land securities transactions.

Outcomes of ureteroscopy and laser fragmentation using a 60 W MOSES laser: a 3-year prospective study from a University Teaching Hospital.

Modulated optics enhancement system (MOSES) holmium lasers use "pulse modulation" to increase the efficacy of laser lithotripsy. As the clinical evidence on the efficacy of 60 W holmium laser with MOSES technology is scarce, we analyzed the outcomes of patients treated with this laser at our institution. A total of 96 consecutive patients with urinary stones (72 renal stones and 24 ureteral stones) were treated with the 60 W MOSES laser from 2019 until 2022 and were included in our analysis. Patient data and outcomes were prospectively collected, and analysis was performed regarding patient demographics, stone parameters, as well as stone-free rate, operating time, length of stay, and perioperative and postoperative complications. With a median age of 55 (IQR: 35-69.25) years, the male:female ratio was 53:43. The median stone size was 12 mm (IQR: 7-19), with a mean number of urinary stones of 1.82 (SD ± 1.4). While 36 (35%) patients were pre-stented, a ureteral access sheath was inserted in 36 (37.5%) patients. The median operative time was 44 min (IQR: 22.5-59.5), and 63 (65.5%) patients received postoperative stenting. Perioperative complications (all Clavien ⩽ II complications) were observed in 5 (5.2%) patients (four urinary tract infections and one acute urinary retention), and after the first procedure, 90 (93.8%) patients were stone-free. The median length of hospital stay was 1 day (IQR: 1-1). This study demonstrated that the 60 W MOSES laser was safe and efficient for the treatment of urinary stones with high stone-free rates and a small risk of minor complications. More studies with larger cohorts are necessary in the future to confirm our results.

Identifikasi Risiko Keselamatan Kerja Dengan Menggunakan Metoda Job Safety Analysis (JSA) Pada Rencana Proyek Perkantoran Terpadu Kota Payakumbuh

Office facilities and infrastructure are one of the main components supporting the running of government activities in an area, which aims to provide services to the community. Therefore, the Payakumbuh City Government will carry out work to build an office complex consisting of the Health Service Office, Inspectorate Office, Social Service Office and Environmental Service Office. Based on PUPR Ministerial Regulation No. 10 of 2021, it is required that before construction work is carried out, an Occupational Health and Safety study or known as Job Safety Analysis (JSA) must first be carried out. This research was conducted using a semi-qualitative method with analysis of the judgments of experts (justice professionals) which aims to transform raw data into easy-to-understand information in the form of more concise and clear information. In this research, an analysis was carried out to determine the possible risk of occupational hazards based on the frequency and severity values resulting from work, guided by PUPR Ministerial Decree No. 10 of 2021. Based on the research results, it was found that the level of potential risk of occupational accident hazards was divided into 3: major risk level, medium risk level and high level. small risk. There are 4 variables at the high risk level, 20 variables at the medium risk level and 26 variables at the small risk level. Of the three risk level categories, mitigation can be done using control methods such as substitution, elimination, engineering and administrative control methods.

Neurodevelopmental outcomes in a cohort of Australian families with self-limited familial epilepsy of neonatal/infantile onset

ObjectivesTo determine: i) seizure recurrence; ii) developmental disability; iii) co-morbidities and risk factors in self-limited familial neonatal and/or infantile epilepsy (SeLFE) in a multigenerational study. MethodsFamilies were retrospectively recruited from epilepsy databases (2021–2022) in 2 paediatric hospitals, Sydney, Australia. Eligible families had 2 first degree relatives with seizures and underwent genetic testing. Demographics/clinical data were collected from interviews and medical records. Vineland Adaptive Behaviour Scales-Third Edition measured adaptive function. ResultsFifteen families participated. Fourteen had a genetic diagnosis (93%): 11 pathogenic; PRRT2 (n=4), KCNQ2 (n=3), SCN2A (n=4), 3 likely pathogenic; KCNQ2 (n=1), SCN8A (n=2). Seizures affected 73 individuals (ages 1–76 years); 30 children and 20 adults had in-depth phenotyping. Ten of 50 individuals (20%) had seizure recurrence, aged 8–65 years. Median time from last neonatal/infantile seizure was 11.8/12.8 years. Predictors of recurrence were high seizure number (p=0.05) and longer treatment duration (p=0.03). Seven children had global developmental delay (GDD): mild (n=4), moderate (n=1) and severe (n=2). Vineland-3 identified 3 had low-average and 3 had mild-moderately impaired functioning. The majority (82%) were average. GDD was associated with older age at last seizure (p=0.03), longer epilepsy duration (p=0.02), and higher number of anti-seizure medications (p=0.05). Four children had speech delay, 5 (10%) had Autism Spectrum Disorder. Paroxysmal kinesiogenic dyskinesia (n=5) occurred in 4 families and hemiplegic migraine (n=8) in 3 families. ConclusionsIndividuals with SeLFE have a small risk of recurrent seizures (20%) and neurodevelopmental disability. Significant predictors are higher seizure number and longer epilepsy duration. Developmental surveillance is imperative.

Movement response of small mammals to burn severity reveals importance of microhabitat features

Abstract Disturbance events are increasing at a global scale, with cascading impacts to ecosystems and residents therein that include fragmentation and altered vegetation structure and composition. Such changes may disproportionately impact small mammal movements, risk perception, and community dynamics as smaller species perceive such changes at finer spatial scales. We examined movement response to burn severity, vegetation structure, and composition in Mexican woodrats (Neotoma mexicana), a common but understudied small mammal species. The study was conducted on Mt. Graham in southeastern Arizona, United States, following a fire that burned over 19,400 ha. We measured path tortuosity of woodrats translocated over patches of different burn severity. Tortuosity can indicate microhabitat selection, foraging behavior, and perceived predation risk—features affecting population-level processes that changes in community composition alone cannot fully demonstrate. We captured woodrats, released them 50 m away from their midden, and used fluorescent powder to track woodrat movement paths through areas of low–severe burn severity. We analyzed features of the resulting powder trails including straightness, average step length, fractal dimension, and squared displacement. We also compared used versus expected vegetation structure and composition along movement paths across burn severities. Analyses indicated shorter step length with increased bare ground, as well as higher squared displacement in areas with more logs. Vegetation analyses likewise showed that logs were heavily used in low-burned areas, whereas dense vegetation was avoided in highly burned areas. Burn severity alone did not have a direct effect on movement parameters, rather its influence on vegetative composition and structure appears to be most important. Selection for logs and avoidance of dense vegetation may be attributed to auditory concealment and ease of travel. With projected increases in wildfire extent and severity, this work represents an understudied approach to understanding these disturbances and their effects on ecological communities.

Transformation of the historical heritage and spatial perception of Ilūkste

The development plan of the Upper Daugava Region (2022-2027) identifies Ilūkste as a potentially strong development centre of regional importance. The plan is designed to improve the quality of roads of regional importance infrastructure development and tourism in the Ilūkste area. This document encourages the initiation of serious cultural landscape research for Ilūkste. The scale of the existing Daugavpils development, the visibility and proximity of the city do not weaken and create strong competition for Ilūkste, but on the contrary - strengthen the revival of Ilūkste as a historic centre alongside a large-scale settlement. That means that on opposite banks of the Daugava there are two different urban spaces with different cultural and historical layers and scales. The preservation of cultural heritage is increasingly being discussed in the forums of the European Union, highlighting the values that are being lost in warfare and in the wastefulness of national economic policies. The problem of heritage conservation is also present in areas where there is no war, but where mistakes have been made due to the ineptitude of the political authorities. This is also true of the Latvian Awakening in the 1990s, when, after the occupation, "business as usual" still continued. With the collapse of collectivisation and the development of private enterprise, no attention was paid to the concepts of landscape, viewpoints, silhouettes, landmarks, climaxes, etc. The smaller the scale of the cultural landscape, the deeper the cracks of neglect that are left in the cultural landscape. The small town of Ilūkste is one example in Latvia. The loss of the intrinsic spatiality of a historic small town risks transforming not only the perception of place and people at a local level, but also at a regional and national level, thereby changing the character and uniqueness of a nation's living space. Natural and man-made elements are constantly changing, seeking to adapt. Biological processes, economic and political power, generational change, rapid technological development can all influence the development of an area. As one changes, another is subjected to change, resulting in a complete or partial transformation. This is most evident in small towns, which have long been subject to political change and the outflow of the younger generation to the metropolises. Historical space is thus also surrounded by indifference and neglect. The current municipality of Ilūkste has energetically set to work to recover the historic identity of the settlement, conscious of both the revival of the former Jesuit church and convent and the dismantling or renovation of aesthetically poor-quality buildings.

Routine use of cell salvage during cesarean section: A practice evaluation.

Intraoperative cell salvage is a well-documented alternative to donor blood transfusion given the scarcity of donor blood pools and the incumbent risk of allogenic blood transfusion. Its use in obstetrics has been limited by concern over fetal alloimmunization due to the risk of fetomaternal hemorrhage. However, there are a paucity of studies reporting on outcome. The aim of this study was to report on a four-year experience of routine use of intraoperative cell salvage and the impact on subsequent pregnancy outcomes. This was a tertiary center retrospective service evaluation cohort study and included all women undergoing cesarean section between December 2014 and November 2018 in a tertiary obstetric unit, identifying women who had reinfusion of intraoperative cell salvage. Data regarding index pregnancy as well as subsequent pregnancies at the hospital were extracted from hospital electronic records. Subsequent pregnancy outcome and maternal antibody status in that pregnancy were collected up until November 2022. During the study period, 6656 cesarean sections were performed, with 436 (6.6%) receiving reinfusion of salvaged blood. The mean volume of reinfused blood was 396 mL. A total of 49 (0.7%) women received donor blood transfusion. Of those who received reinfusion of salvaged blood, 79 (18.1%) women had subsequent pregnancies over the eight-year follow-up period. There was one case (0.23%) of fetal cell alloimmunization demonstrated by the presence of anti-D antibodies on the subsequent pregnancy booking bloods. Routine intraoperative cell salvage may be used to reduce the need for blood transfusion during cesarean section. The risk of fetal cell alloimmunization in a future pregnancy following reinfusion of intraoperative cell salvage is one in 436. Given an apparent small risk of fetal cell alloimmunization, further work is required to establish the safety profile of intraoperative cell salvage in pregnancy.