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Treatment of Seizures in People with Intellectual Disability
No full textThere is a synergistic relationship between epilepsy and intellectual disability (ID), and the approach to managing people with these conditions needs to be holistic. Epilepsy is the main co-morbidity associated with ID, and clinical presentation tends to be complex, associated with higher rates of treatment resistance, multi-morbidity and premature mortality. Despite this relationship, there is limited level 1 evidence to inform treatment choice for this vulnerable population. This review updates the current evidence base for anti-seizure medication (ASM) prescribing for people with ID. Recommendations are made on the basis of evidence and expert clinical opinion and summarised into a Traffic Light System for accessibility. This review builds on work developed through UK’s Royal College of Psychiatrists, Faculty of Intellectual Disability Psychiatry and includes newer pragmatic data from the Cornwall UK Ep-ID Research Register, a national research register for England and Wales that has been in existence for the last 10 years. The Register acts as a source for an in-depth exploration of the evidence base for prescribing ‘newer’ (third generation, specifically post-2004) ASMs. Its findings are discussed and compared. A practical approach to prescribing and choosing ASMs is recommended on the based evidence. This approach considers the drug profile, including adverse effects and clinical characteristics. The review also details newer specialist ASMs restricted to certain epilepsy syndromes, and potential future ASMs that may be available soon. For completeness, we also explore non-pharmacological interventions, including surgeries, to support epilepsy management
The effects of wearing textured versus smooth shoe insoles for 4-weeks in people with diabetic peripheral neuropathy: a randomised controlled trial
Get PDFPurpose: To determine whether short-term wear of textured insoles alters balance, gait, foot sensation, physical activity, or patient-reported outcomes, in people with diabetic neuropathy. Materials and Methods: 53 adults with diabetic neuropathy were randomised to wear textured or smooth insoles for 4-weeks. At baseline and post-intervention, balance (foam/firm surface; eyes open/closed) and walking were assessed whilst barefoot, wearing shoes only, and two insoles (textured/smooth). The primary outcome was center of pressure (CoP) total sway velocity. Secondary outcomes included other CoP measures, spatiotemporal gait measures, foot sensation, physical activity, and patient-reported outcomes (foot health, falls efficacy). Results: Wearing textured insoles led to improvements in CoP measures when standing on foam with eyes open, relative to smooth insoles (p ≤ 0.04). The intervention group demonstrated a 5% reduction in total sway velocity, indicative of greater balance. The intervention group also showed a 9-point improvement in self-perceived vigour (p = 0.03). Adjustments for multiple comparisons were not applied. Conclusions: This study provides weak statistical evidence in favour of textured insoles. Wearing textured insoles may alter measures of balance, suggestive of greater stability, in people with diabetic neuropathy. Plantar stimulation, through textured insoles, may have the capacity to modulate the perception of foot pain, leading to improved well-being.IMPLICATIONS FOR REHABILITATION Short-term wear of textured insoles can lead to improvements in centre of pressure sway measures when standing on a compliant supporting surface. Wearing textured insoles may have the capacity to help relieve foot pain leading to enhanced self-perceived vitality in people with diabetic peripheral neuropathy
Epigenetic and genotoxic effects of tritium in marine mussels: Comparing waterborne and metal-associated forms
Get PDFTritium (3H), an isotope of hydrogen, is a by-product of the nuclear industry. Decommissioning and normal operations of nuclear facilities can generate tritiated stainless-steel particles (T-SSPs) that could be unintentionally released into the environment. Considering tritium\u27s physicochemical properties and the proximity of nuclear facilities to water bodies, assessing the behaviour and potential effects of these particles in the aquatic environment is imperative. In the present study, marine mussels, Mytilus galloprovincialis, were exposed to: (a) hydrogenated, non-radioactive stainless-steel particles (H-SSPs) (10 mg L−1) (b) T-SSPs (1 and 10 MBq L−1) and (c) tritiated water (HTO) (0.50 and 5.0 MBq L−1) for 5 h and 7 d. Exposure to T-SSPs resulted in significant DNA damage in mussel haemocytes. Tritium bioaccumulation was significantly higher in the digestive gland (DG), regardless of the exposure duration to T-SSPs. Positive correlation between tritium in DG tissues and DNA indicates that tritium is internalised in the cell. After 7 d, global DNA methylation increased in gills exposed to both 1 MBq L−1 of T-SSPs and 5 MBq L−1 of HTO treatments. In the DG tissue, DNA methylation increased following exposure to tritium (water and particulate forms) compared to H-SSPs, suggesting a tissue-specific and pollutant-dependent response. Our findings highlight the enhanced bioaccumulation of T-SSPs compared to HTO. Multivariate analyses of the results suggested an overall stress response in mussels exposed to T-SSPs compared to HTO exposure and controls. Potential epigenetic effects will require more attention as they can bring knowledge across levels of biological organisation and about the transgenerational impact of radionuclides
More than just a magic trick? Exploring an audience\u27s supernatural attributions for magicians\u27 performances
Get PDFPerforming magicians have long believed that some audience members attribute their magical effects to supernatural methods—to their use of “real magic”. In two samples of adults (n = 412 and 292), we explored personality traits and broader beliefs that might predict supernatural attributions for performance magic. Supernatural attributions were uncommon—many respondents wholly rejected the possibility that magicians\u27 magic was sometimes real—but nevertheless highly variable. In Study 1, a greater belief that magic tricks at least sometimes involve supernatural powers was associated with relatively higher extraversion, higher neuroticism, and lower openness to experience. In Study 2, random forests suggested that supernatural magic attributions were embedded in a family of paranormal and conspiratorial beliefs, particularly beliefs in psychic powers (reading and influencing thoughts) and precognition (perceiving the future). In both samples, gender, age, and education had small and inconsistent effects, but people who enjoyed performance magic were more likely to endorse supernatural attributions. Taken together, the findings suggest some truth to performing magicians\u27 suspicions and shed some light on who is more likely to explain magic tricks using supernatural causes
The awareness, attitudes and knowledge of neurologists in Hungary on sudden unexpected death in epilepsy (SUDEP)
Get PDFBackground: A leading cause of epilepsy mortality is Sudden Unexpected Death in Epilepsy (SUDEP). All international epilepsy guidelines encourage clinicians to discuss SUDEP with people with epilepsy (PWE). However,implementation of this guidance has been ambiguous depending on the country in question. This is inspite ofoverwhelming wishes from PWE for their clinician to discuss it with them. There has been no study to inquireinto the knowledge, awareness and attitudes towards SUDEP communication in epilepsy professionals inHungary (population: 9.6 million).Objective: We investigated neurologists and paediatric neurologists views in Hungary on SUDEP counselling.Methods: A cross-sectional online survey of 20 questions many Likert style using validated themes was disseminated among doctors working with PWE, registered to the Hungarian chapter of the International LeagueAgainst Epilepsy (ILAE). A non-discriminatory exponential snowballing technique leading to non-probabilitysampling was used to disseminate the survey to all ILAE members. Questions revolved around SUDEP communication and counselling. Descriptive statistics were used for analysis.Results: Of 58 respondents from 271 ILAE members, 43.1 % respondents had over 15 years of experience, and44.8 % felt communicating and counseling their PWE of SUDEP is an important aspect of their role. One person(1.7 %) told of discussing SUDEP with all PWE while 22.4 % mentioned they do not talk of SUDEP to any PWE.Conclusion: Despite well established guidelines asserting the need to discuss SUDEP with all PWE, epilepsyprofessionals in Hungary are not doing so. This is consistent with other European countries on the same subject
THE EASTERN MEDITERRANEAN SEA ENERGY DIPLOMACY: THE CASE OF LEBANON 2012-2022
Get PDFThis thesis explores the geopolitical implications of energy discoveries in the Eastern Mediterranean Sea (EMS) region, with a particular focus on Lebanon\u27s role within this complex dynamic. The research examines how energy governance, security challenges, and regional conflict and cooperation shape Lebanon\u27s ability to leverage its energy resources from 2012 to 2022. Through interviews with thirty top professionals in the field, the study offers an in-depth examination of the evolving geopolitical and geoeconomic dynamics resulting from maritime boundary disputes, regional tensions, and Lebanon’s energy potential.While energy discoveries in the EMS region present significant opportunities, Lebanon faces challenges in unlocking its full potential due to internal and external factors. The central argument of the thesis posits that Lebanon’s energy sector remains underdeveloped due to political instability, unresolved maritime disputes, and internal governance issues. The study identifies several factors in energy governance and energy security as primary obstacles to Lebanon’s effective participation in regional energy developments. The thesis underscores the potential for energy cooperation among EMS countries, including Lebanon, Cyprus, and Israel as a key to fostering economic interdependence, reducing regional tensions, and promoting long-term stability which is critically important for regional cooperation. It also emphasizes that energy resources in the EMS are not a \u27silver bullet\u27 for resolving all conflicts; rather, they represent a \u27double-edged sword\u27 —while they have the power to drive cooperation, they also intensify geopolitical tensions, making economic interdependence the only essential tool for resolving conflicts and ensuring energy security. The study provides valuable strategic insights and practical recommendations for policymakers and stakeholders, advocating for seizing the opportunities presented by energy resources to enhance collaboration and promote effective energy diplomacy, thereby unlocking the full potential of the EMS region
Investigating behavioural responses of tiger sharks (Galeocerdo cuvier) to novel stimuli by means of benthic baited remote underwater video systems
Get PDFInspection behaviour in sharks, involving their approach and assessment of potential prey or threats, is vital for their predatory efficiency and defensive strategies, heavily influencing ecological dynamics and predator-prey interactions. This study investigates object inspection behaviour in tiger sharks (Galeocerdo Cuvier) using Baited Remote Underwater Video systems (BRUVs) deployed within the iSimangaliso Wetland Park (IWP) Marine Protected Area, in South Africa. Data collection and analysis focused on quantifying the frequency, duration, and characteristics of tiger shark interactions with BRUVs, and on assessing behavioural trends across demographic groups to facilitate the development of a behavioural ethogram. Key findings revealed adult females had significantly longer latency to first contact with the BRUVs, suggesting a precautionary approach towards novel stimuli. Subadults displayed the longest mean duration of behaviours, potentially indicating a higher investment in foraging activities or exploration of their environment. The top four most displayed traits per shark developmental stage and sex were investigatory, exploratory, circling, and aggressive behaviours. These findings have implications for the management and conservation of tiger shark populations, particularly in areas where human-shark interactions occur. A better understanding of inspection behaviour can help ecotourism better manage human-shark interactions. Further studies could develop strategies which help mitigate shark attacks, design effective shark deterrent systems, and inform guidelines for human activities in shark habitats. Furthermore, the development of an ethogram and corresponding usage of benthically deployed BRUVs provides a methodological framework for expanding future studies in shark behaviour research
Testing the Proteus Effect in Autistic and Neurotypical Participants
Get PDFThis study examined the Proteus effect in autistic and neurotypical participants via the video game, The Sims. Thirty-two participants (16 autistic, 16 neurotypical) participated in a free-play session of The Sims, playing as either an attractive or unattractive avatar. In line with predictions, participants who had played as the attractive avatar negotiated for a significantly larger share of a fictional pot of money during a post-play economic game. Further, participants who had used the attractive avatar engaged in significantly more exercise activities in-game and flirted more often with nonplayable characters. While there was some evidence to suggest that autistic people may be less resistant to peer influence in the economic game, this study shows for the first time how the Proteus effect can be demonstrated in autistic people. These findings have important implications for understanding how autistic people experience video games and may be leveraged to improve outcomes for autistic video gamers
Microplastics and nanoplastics in tea: Sources, characteristics and potential impacts
Get PDFRecent scientific studies have raised concerns about the presence and potential impacts of microplastics and nanoplastics (MNPs) in tea-based drinks. This review critically examines publications relating to MNPs in tea, with focus on the type of sample involved, methods and techniques employed to isolate and identify MNPs, and the main qualitative and quantitative findings. Sources of MNPs in tea include production water, plastic packaging and contaminated tea leaves but the most important source is teabags when steeped in boiling water. Here, more than 109 MNPs have been reported to be released per plastic teabag. However, significant quantities of MNPs are also released when plastic-cellulosic composite and biodegradable bags are steeped. Discrepancies among different studies partly reflect inter-brand and inter-material differences, but a more general cause is the adoption of different analytical protocols, including different size cutoffs used during isolation and constrained by identification. Some studies have also reported leaching of plastic additives and residues on steeping, although it is not clear whether these are released from the intact teabags or MNPs that are subsequently mobilised. As teabags generate concentrations of MNPs greater than other beverages or foodstuffs, potential impacts on human health and the environment are a concern and require further study
Microplastics in urine, sputum and lung lavage fluid from patients with respiratory illnesses
Get PDFBecause of the ubiquity of microplastics (MPs) in the environment there are concerns regarding human exposure. In this study, MPs have been determined in three physiological fluids: urine, sputum and bronchoalveolar fluid (BALF); from 30 adult patients in Iran with respiratory conditions. A total of nine small (20–100 μm) and mainly green and red fibres of polyethylene, polypropylene and polystyrene construction were detected in urine samples of eight participants. By contrast, 358 MPs that were dominated by small, white and transparent fibres, but also included larger (100–500 μm) fibres and fragments and spherules of various sizes, were detected in sputum samples. Here, a broader range of polymers was identified but polyurethane was dominant. In BALF samples, 123 MPs were detected that included a higher proportion of larger fibres, along with fragments and spherules. The colour distribution of these MPs was similar to that of sputum samples but polymer distribution was closer to that of urine samples. These observations suggest that MPs that are inhaled and ingested might be fractionated differently though the body. Further research is required to elucidate how particles larger than theoretical limits (set by filtration mechanisms) are present in physiological fluids, what fractionation processes are present, and whether ingested or inhaled MPs are responsible for acute and chronic health impacts