Developing an Evidence-Based Epilepsy Risk Assessment eHealth Solution: From Concept to Market

INTRODUCTION: Sudden unexpected death in epilepsy (SUDEP) is possibly the most common cause of death as a result of complications from epilepsy. The need to educate and regularly review risk for all patients with epilepsy is paramount, but rarely delivered in actual clinical practice. Evidence suggests that education around SUDEP and modifiable risk variables translate into better self-management of epilepsy. OBJECTIVE: We aimed to develop and implement an eHealth solution to support education and self-management of risks, in epilepsy. METHODS: We undertook an innovation pathways approach, including problem identification, feasibility assessment, design, implementation, and marketing. People with epilepsy were provided a smartphone-based app (Epilepsy Self-Monitor, EpSMon), which translates the clinical risk assessment tool into an educational and self-monitoring platform, for the self-management of epilepsy. RESULTS: Results include the success of the marketing campaign, and in what areas, with an estimated reach of approximately 38 million people. EpSMon has proved a success in academic and clinical circles, attracting awards and nominations for awards. The number of users of EpSMon, after 3 months, turned out to be lower than expected (N=221). A 4-month trial of the app in use in the United Kingdom, and the success of the marketing strategy, point to necessary changes to the model of delivery and marketing, summarized in this paper. These include the marketing message, user cost model, and need for the availability of an Android version. CONCLUSIONS: EpSMon has proven a success in respect to its reception by academics, clinicians, stakeholder groups, and the patients who use it. There is work needed to promote the model and increase its acceptability/attractiveness, including broadening the marketing message, increasing its availability, and reducing its cost. Future development and promotion of the tool will hopefully inform iterative design of its core features for a receptive audience and lead to increased uptake as it is launched worldwide in 2016

Relationship between photonic band structure and emission characteristics of a polymer distributed feedback laser

G. A. Turnbull, P. Andrew, M. J. Jory, William L. Barnes, and I. D. W. Samuel, Physical Review B, Vol. 64, article 125122 (2001). "Copyright © 2001 by the American Physical Society."We present an experimental study of the emission characteristics and photonic band structure of a distributed feedback polymer laser, based on the material poly[2-methoxy-5-(2′-ethylhexyloxy)-1,4-phenylene vinylene]. We use measurements of the photonic band dispersion to explain how the substrate microstructure modifies both spontaneous and stimulated emission. The lasing structure exhibits a one-dimensional photonic band gap around 610 nm, with lasing occurring at one of the two associated band edges. The band edge (frequency) selection mechanism is found to be a difference in the level of output coupling of the modes associated with the two band edges. This is a feature of the second-order distributed feedback mechanism we have employed and is clearly evident in the measured photonic band structur

Early Life History Characteristics and Contribution of Stocked Juvenile Alligator Gar in Lake Texoma, Oklahoma

Due to concerns of overexploitation and population decline caused by anthropogenic influences, fisheries managers have turned to hatchery produced Alligator Gar (Atractosteus spatula) stocking to supplement inconsistent wild year classes. Aquaculture can be a useful option to reestablish or supplement natural populations, as many states currently have stocking programs to reintroduce this species. Recent interest in Alligator Gar ecology and conservation has led the Oklahoma Department of Wildlife Conservation to attempt to better understand early life historycharacteristics of age-0 Alligator Gar in Lake Texoma by tracking growth, diet, habitat use, mortality and stocking contribution. A total of 33,900 Alligator Gar fingerlings were stocked into Lake Texoma in 2017. During June-September 2017, a total of 46 age-0 Alligator Gar were captured in 279 net nights of effort using mini-fyke nets. Mean CPUE (catch-per-unit-effort; number per net night) was highly variable with CPUE varying based on vegetation stem density in the location of the net set. Of the 46 Alligator Gar captured in 2017, 84.5% (39 of 46) were stocked (OTC mark present). During the 4-month sampling period, the daily mortality estimate for stocked age-0 Alligator Gar was 0.049%/day. After the first four months (4.7% mortality rate), 32,306 of the initial 33,900 Alligator Gar remained in the system. The annual estimated mortality rate is 16.7%. The mortality estimate of fish stocked into Lake Texoma is substantially lower than the 94.8% mortality rate observed in the hatchery over three months (1,043 of 20,001 age-0 Alligator Gar remained). Stocking Alligator Gar as fingerlings when water level and habitat availability is sufficient may be more beneficial than holding them in a hatchery setting. Conversely, stocking Alligator Gar early may not be beneficial in a marginal year when nursery habitat is limited and inflow is not consistent enough to maintain a constant pool elevation. During these years it may be better to grow-out fingerlings to larger sizes, such that when stocked they are not easily preyed upon

An Investigation into the Effects of Elevated Water Hardness on Channel Catfish Egg Viability

Channel catfish (Ictalurus punctatus) are a popular sportfish across the United States and are often stocked to enhance fishing opportunities. There has been increased research into their life history, management, and population characteristics over recent decades. In a study conducted on channel catfish recruitment in Thunderbird Reservoir, Oklahoma, researchers found that recruitment was negatively associated with total annual water hardness, hypothesizing that larval fish survival decreased when water hardness was > 170 mg/L. To test this hypothesis, we investigated the effects of water hardness on channel catfish egg hatch rates to determine if total water hardness impacts the survivability of larva. Fertilized eggs were obtained from the Holdenville State Fish Hatchery, Oklahoma and transferred to the Oklahoma Fishery Research Laboratory. Eggs were divided and placed in tanks of seven water hardness levels (78 [control], 100, 200, 300, 500, 1000, 3000 mg/L CaCo3). Overall survival, hatch rate, and larval abnormalities were recorded and analyzed for differences between hardness levels and fish. Water hardness did not influence survival or growth early in life in our study. However, we did observe that the spawning matrix deteriorated in higher hardness concentrations (≥ 500 mg/L). Future studies should investigate the effects of water hardness on channel catfish survival post yolk-sac abortion to determine if mortality increases later in life and determine if water quality optima vary between catfish populations at smaller spatial extents. Future work examining the effects of varying water chemistry levels on egg/larval fish survival can replicate our methods, providing additional insight into the early life history of Channel Catfish or other catfish species

Age Appropriate Wisdom? Ethnobiological Knowledge Ontogeny in Pastoralist Mexican Choyeros

We investigate whether age profiles of ethnobiological knowledge development are consistent with predictions derived from life history theory about the timing of productivity and reproduction. Life history models predict complementary knowledge profiles developing across the lifespan for women and men as they experience changes in embodied capital and the needs of dependent offspring. We evaluate these predictions using an ethnobiological knowledge assessment tool developed for an off-grid pastoralist population, known as Choyeros, from Baja California Sur, Mexico. Our results indicate that while individuals acquire knowledge of most dangerous items and edible resources by early adulthood, knowledge of plants and animals relevant to the age and sex divided labor domains and ecologies (e.g., women’s house gardens, men’s herding activities in the wilderness) continues to develop into middle adulthood but to different degrees and at different rates for men and women. As the demands of offspring accumulate for parents with age, reproductive aged adults continue to develop their knowledge to meet their children’s needs. After controlling for vision, post-reproductive adults’ show the greatest ethnobiological knowledge. These findings extend our understanding of the evolved human life history by illustrating how changes in embodied capital and the needs of dependent offspring predict the development of men’s and women’s ethnobiological knowledge across the lifespan

Keeping patients with epilepsy safe: a surmountable challenge?

This quality improvement project was inspired as an answer to a problem that intellectual disability teams have been struggling to manage whilst caring for people with epilepsy (PWE). The issue was that despite guidance to discuss the possibility of sudden unexpected death in epilepsy (SUDEP) be discussed with a newly diagnosed PWE this is rarely done. Additionally when, how, and what to discuss about SUDEP and reduce its risk is arbitrary, non-person centred, and with no structured evidence. Prior to initiating changes a discussion of SUDEP was recorded in just 10% of PWE. We introduced a check-list to help identify risk factors for SUDEP. We then modified the check-list, and then used it via telehealth, a way of contacting patients and their carers over the phone using the check-list approach. Following interventions, discussions of SUDEP are now recorded in 80% of PWE. Feedback from patients, carers and primary and secondary care professionals has been positive. We are now developing an app so that patients and carers can monitor their own risk factors, thus empowering them and increasing their knowledge and awareness of SUDEP

Sudden unexpected death in epilepsy: measures to reduce risk

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Measurements of the pp → ZZ production cross section and the Z → 4ℓ branching fraction, and constraints on anomalous triple gauge couplings at √s = 13 TeV

Four-lepton production in proton-proton collisions, pp -> (Z/gamma*)(Z/gamma*) -> 4l, where l = e or mu, is studied at a center-of-mass energy of 13 TeV with the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 35.9 fb(-1). The ZZ production cross section, sigma(pp -> ZZ) = 17.2 +/- 0.5 (stat) +/- 0.7 (syst) +/- 0.4 (theo) +/- 0.4 (lumi) pb, measured using events with two opposite-sign, same-flavor lepton pairs produced in the mass region 60 4l) = 4.83(-0.22)(+0.23) (stat)(-0.29)(+0.32) (syst) +/- 0.08 (theo) +/- 0.12(lumi) x 10(-6) for events with a four-lepton invariant mass in the range 80 4GeV for all opposite-sign, same-flavor lepton pairs. The results agree with standard model predictions. The invariant mass distribution of the four-lepton system is used to set limits on anomalous ZZZ and ZZ. couplings at 95% confidence level: -0.0012 < f(4)(Z) < 0.0010, -0.0010 < f(5)(Z) < 0.0013, -0.0012 < f(4)(gamma) < 0.0013, -0.0012 < f(5)(gamma) < 0.0013

Improving nocturnal event monitoring in people with intellectual disability in community using an artificial intelligence camera

There is higher prevalence of epilepsy and SUDEP in people with intellectual disability (PwID) compared to general population. Accurate seizure recording particularly at night can be challenging in PwID. Neuro Event Labs seizure monitoring (Nelli) uses high-quality video based artificial intelligence to detect and record possible nocturnal seizures. This study looks to evaluate the clinical utility and acceptability of Nelli in PwID and epilepsy. Family/carers of PwID and drug resistant epilepsy with suspicions of nocturnal seizures who had not tolerated routine or ambulatory EEGs were invited to evaluate Nelli. Relevant demographics and clinical characteristics were collected. Nelli's impact, it's facilitators, barriers and feedback quality was captured from patient and professional stakeholders. Quantitative and thematic analysis was undertaken. Fifteen PwID and epilepsy and four health professionals were involved. Nelli recorded 707 possible seizure events across the study cohort of which 247 were not heard or recognised by carers. Carers recorded 165 episodes of 'restless' or "seizure behaviour" which the Nelli did not deem to be seizures. There was 93% acceptability. Thematic analysis revealed three broad themes of device acceptability, result implementation and possible seizure recognition ability. Nelli allowed for improved communication and care planning in a hitherto difficult to investigate population