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Post-ictal sleep changes in human focal epilepsy
Get PDFBidirectional interactions between sleep, seizures, and epilepsy remain incompletely understood. Evidence from animal models and people with focal epilepsy suggest that seizures may engage mechanisms of memory consolidation during post-ictal sleep to reinforce and strengthen synaptic connections within the pathological networks that generates seizures, termed seizure-related consolidation (SRC). Human studies of post-ictal sleep changes supportive of SRC, however, are limited by small sample size and restricted observations of post-ictal sleep. We investigated the interplay between seizures and sleep by analyzing sleep-wake and seizure catalogs derived from continuous local field potential (LFP) recordings in 11 people (6 males and 5 females) with drug-resistant focal epilepsy implanted with novel investigational devices and living in their natural environments. Our findings demonstrate that post-ictal rapid-eye-movement sleep duration is reduced, whereas slow-wave sleep duration, slow-wave LFP spectral power and waveform slope are increased compared to inter-ictal nights without preceding seizures. The most significant changes localize to the epileptogenic networks generating the participants’ habitual seizures. These results reveal parallels between SRC and physiological memory consolidation, providing novel insights into the potential role of post-ictal sleep in strengthening epileptic neural engrams, and may have implications for targeted disruption of post-ictal sleep and SRC in focal epilepsy.
Significance Statement This study uses long-term intracranial local field potential (LFP) recordings to investigate the relationship between seizures and sleep in epilepsy. The post-ictal slow-wave sleep duration, spectral power, and waveform slope are increased compared to inter-ictal. Post-ictal rapid-eye-movement sleep duration is reduced. These changes are most significant within the epileptogenic networks that generate the participants habitual seizures. While this study cannot directly elucidate the mechanism involved in post-ictal sleep modulation, the study results are consistent with post-ictal sleep reinforcing pathological seizure networks through a process similar to physiological memory consolidation, here termed seizure-related consolidation (SRC). These results provide novel insights into the potential role of post-ictal sleep in epilepsy, with implications for potential targeted disruption of post-ictal sleep and SRC
Communication during out-of-hours primary care contacts for people with a terminal illness: a scoping review
Get PDFObjectiveTo summarise what is known about communication during out-of-hours primary care contacts for people with a terminal illness.DesignA scoping review following the Joanna Briggs Institute guidance for scoping reviews and conducted in accordance with Arksey & O'Malley's methodological framework for scoping reviews.Data sourcesSearches of MEDLINE, PsycINFO, CINAHL and EMBASE were conducted from inception to 23 July 2024, alongside grey literature searches and hand searching reference lists of relevant reviews.Eligibility criteriaSources were eligible if they provided evidence about communication between people with a terminal condition, their families and/or healthcare professionals during contacts with out-of-hours primary care services.Data extraction and synthesisData were extracted by two independent researchers following Joanna Briggs Institute guidelines for scoping reviews. Findings were thematically synthesised to create a narrative account of the evidence.ResultsOf the 1745 records identified, 18 studies were included in the review. Most used qualitative interviews and/or focus groups. Barriers to good communication included a lack of continuity of care, problems relating to remote consultations, the delegitimising of help seeking, and the challenges of conducting specialist palliative care consultations within a generalist out-of-hours system. Facilitators to good communication included the availability of information about patients and families out of hours, an empathetic and confident approach from out-of-hours professionals, and support from colleagues.ConclusionsThe scoping review showed that there is limited research focusing specifically on end-of-life communication in out-of-hours primary care settings. Further research is needed, particularly using observations or recordings of real interactions. There are several challenges to communication in this setting, but providing clinicians with access to palliative care summaries, alongside training and support in this specialised communication, can facilitate good end-of-life communication with patients and their families
A cross-sectional survey of use, experiences, and expectations of complementary health approaches: associations with subconscious connectedness: How is subconscious connectedness associated with the use, positive experience, and expectation of benefit from psychological and combined psychological/physical complementary and integrative health approaches?
Get PDFBackground: This project examines the association between subconscious connectedness (SC) and engagement with psychological or combined psychological/physical complementary health approaches (PC-CHA) among U.S. adults. SC represents the strength of communication between subconscious and conscious thoughts as measured by the Thought Impact Scale (TIS). PC-CHA comprises a set of non-traditional health practices that employ primarily psychological or blended psychological–physical approaches such as meditation, hypnosis, tai chi, and yoga.Aims: The primary aims of this study are to assess whether higher TIS scores are associated with increased utilisation of PC-CHA, positive experiences with PC-CHA, and higher expectations of PC-CHA benefits.Methods: Logistic and linear regression models examined participants’ TIS score quartiles as a predictor of three outcome variables measuring engagement with PC-CHA while controlling for demographic, socioeconomic, psychological, and health-related covariates. The outcome variables included the prevalence of PC-CHA usage, ratings of previous experiences with PC- CHA, and reports of the expected benefit of PC-CHA, Results: Higher TIS scores were positively associated with greater odds of using PC-CHA and higher expectations of benefit from PC-CHA but are not associated with a more favourable rating of experience with PC-CHA.Conclusions: SC affects healthcare decisions and interactions. Awareness of this effect could enable healthcare providers to deliver more patient-centred care. It could also lead to further investigations on improving clinical interactions, patient counselling, care coordination, cost, safety, efficacy, and health policy
Barriers, facilitators, and moderators: educator perspectives on the implementation of nature-based programs for mental health and well-being in UK secondary schools
Get PDFBackground: Stress and anxiety have risen among young people in the UK, alongside increased rates of mental health disorders. Adolescent mental health struggles represent an unmet need in the UK, impacting individuals and society at large. Decreased interaction with nature is thought to contribute to declining adolescent mental health, and secondary schools are seen as an opportunity to introduce nature-based programs (NbPs) to promote student mental health and well-being (MHWB). Current research, however, has overlooked the practical considerations of implementing NbPs in secondary schools.Aim: This dissertation seeks to identify the factors that improve or impede NbP implementation and understand the interactions between these barriers and facilitators. Methods. Perspectives from secondary school educators involved in facilitating NbPs were collected through semi-structured interviews. The interviews were recorded and transcribed, then analyzed using a thematic, deductive-inductive approach.Results: Educators described barriers and facilitators to NbP implementation. These factors existed at the individual level of students and educators, as well as the institutional level of Department for Education (DfE) policies. Factors at the institutional level influenced the occurrence of factors at the individual level. The characteristics of NbPs moderated the types of barriers and facilitators impacting NbP implementation.Conclusions: Policies regarding the implementation of NbPs must consider the varied characteristics of NbPs and secondary schools. The DfE can improve NbP policy by focusing on institutional factors: increasing NbP funding, allowing for curriculum flexibility, dedicating time for educator planning, and standardizing NbP evaluation frameworks
The risks and opportunities of adopting digital technologies as part of unpaid care
Get PDFThe integration of digital technologies into unpaid care work is rapidly transforming how families provide and experience care. This paper synthesizes existing research on how digital care technologies are reshaping unpaid care work in the Global North and urban China, with particular attention to their impact on inequality, privacy, and care quality. While these technologies offer benefits in terms of convenience, remote care capabilities, and improved coordination among caregivers, they simultaneously introduce significant risks that warrant critical attention. Our analysis reveals that digital care technologies can exacerbate existing social inequalities, with access and effective utilization often stratified along lines of gender, socioeconomic status, and geography. We identify serious privacy concerns operating at two levels: within families, where technologies can disturb traditional privacy boundaries, and in relation to technology companies, where intimate care data becomes commodified. The emergence of ‘transcendent’ caregiving, enabled by digital technologies, has introduced new possibilities for remote care while simultaneously creating challenges around work–life boundaries and caregiver burnout. Furthermore, the datafication of care practices, while offering a promise of quality and ‘scientific’ standards, risks reducing complex care relationships to quantifiable metrics at the expense of emotional and relational dimensions. Our findings suggest that digital care technologies are most effective when they augment rather than replace human care, and when implemented with careful consideration of privacy, equity, and the preservation of meaningful human connections. We conclude that while digital care technologies offer significant potential benefits, their implementation requires careful oversight and regulation to ensure they enhance rather than compromise care quality. These findings have important implications for policy-makers, particularly regarding the need for regulatory frameworks specifically addressing care technologies, and interventions to address digital inequalities in care contexts
Promoting migrant health as a universal right in the United Kingdom
Get PDFMigrants arriving in the United Kingdom (UK), many of whom experience vulnerability before and during migration, face a double burden of communicable and non-communicable diseases shaped by cumulative exposures in their countries of origin, across the migration journey, and compounded by fragmented access to care upon arrival. Despite improvements in pre-entry health assessments, post-arrival provision in reception centres remains inconsistent, with significant gaps in infectious disease screening, mental health support, medication continuity, and timely registration with a general practitioner (GP). Community-led initiatives like Doctors of the World’s Safe Surgeries and the Oxford Refugee Health Initiative promote inclusive healthcare access, yet remain limited in scale. Using a social determinants of health (SDH) lens, this perspective highlights how structural barriers—including overcrowded accommodation, language challenges, and unclear entitlements—undermine the effectiveness of existing health policies and widen inequalities. We propose an essential care package for UK migrant reception centres that integrates early screening, stable access to medicines, mental health assessment, environmental health measures, and robust continuity of care for non-communicable diseases through clear referral pathways into the National Health Service (NHS). Embedding this approach within current public health infrastructure would reduce preventable morbidity, strengthen health system efficiency, and advance the UK’s commitment to Sustainable Development Goals. Strengthening care at the point of arrival is therefore critical to promoting health equity and ensuring that no one is left behind
Point-of-care HIV viral load testing in a community antiretroviral therapy delivery programme: A randomised controlled trial (PHILA)
Get PDFCommunity antiretroviral therapy (ART) delivery programmes allow people with HIV (PWH) to collect treatment nearer to home instead of from clinics. However, delays in laboratory-based viral load (VL) testing can prevent timely community ART prescription renewals. We aimed to determine if clinic point-of-care VL testing could expedite community ART prescription renewals within the Centralised Chronic Medication Dispensing and Distribution programme (CCMDD) in South Africa. We conducted an open-label, randomised controlled trial of point-of-care versus laboratory-based VL testing among PWH who needed community ART CCMDD prescription renewal in one clinic in Durban, South Africa. The primary outcome was community ART CCMDD prescription renewal by three weeks. We enrolled 200 participants between August, 2022 and August, 2023. Median age was 44 years (interquartile range [IQR] 37–49), and 65.5% were female. 93/100 (93.0%) intervention arm participants had a community ART CCMDD prescription renewal within three weeks, versus 81/100 (81.0%) standard-of-care participants (risk difference [RD] 12.0%, 95% confidence interval [CI] 2.9 to 21.2%, p = 0.021). Participants received VL results after a median 0 days (IQR 0–0) in the intervention and 20 days (IQR 7 to not received) in the standard-of-care arm. There was no difference between arms in the proportion retained-in-care between 8 and 16 weeks (89.0% versus 87.0%, RD 2.0% 95% CI -8.0 to 12.0). For community ART CCMDD prescription renewal the mean number of clinic visits required was lower in the intervention arm (1.06) versus the standard-of-care arm (1.60, RD -0.54, 95% CI -0.40 to -0.68), as was the total participant travel cost to participants (South African Rands [ZAR] 47.7 versus ZAR 72.8, RD ZAR -25.1 [95% CI -9.2 to -41.1]). Point-of-care VL testing improved community ART prescription renewals, by reducing time to results, and reducing the number of clinic visits and associated travel costs. Pan-African Clinical Trials Registry: PACTR202002785960123
The causal effects of global supply chain disruptions on macroeconomic outcomes: theory and evidence
No full textWe study the causal effects of global supply chain disruptions by constructing a new index of real-time port congestion using Automatic Identification System data from container ships and a spatial clustering algorithm. We develop a model with search frictions between producers and retailers that links upstream production slack to downstream supply shortages and captures output and price responses to supply chain shocks. The co-movements of output, prices, spare capacity, and market tightness provide novel identification restrictions. We find that demand and supply shocks drove U.S. disinflation in 2020, while the inflation surge in 2021 was driven mainly by supply chain shocks
AstroECP: towards more practical electron channeling contrast imaging
Get PDFElectron channeling contrast imaging (ECCI) is a scanning electron microscope based technique which enables bulk‐sample characterization of crystallographic defects (e.g. dislocations, stacking faults, low‐angle boundaries). Despite its potential, ECCI remains underused for quantitative defect analysis as compared with transmission electron microscope based methods. Here, we overcome barriers that limit the use of ECCI by optimizing signal‐to‐noise contrast and precise determination of the incident beam vector using calibrated, easy‐to‐use simulations and experimental selected‐area electron channeling patterns (SA‐ECPs). We introduce a systematic ECCI workflow, alongside a new open‐source software tool (AstroECP), which includes calibration of stage tilting, SA‐ECP field of view and the energy that forms the ECP/ECCI contrast using dynamical simulations. The functionality of this workflow is demonstrated with case studies that include threading dislocations in GaAs and the cross‐validation of precession‐based ECCI contrast, which is otherwise known as electron channeling orientation determination. To assist the reader, we also provide best‐practice guidelines for ECCI implementation to promote high‐resolution defect imaging in the scanning electron microscope
Consultation-based interventions to optimize medication adherence in primary care: a systematic review
Get PDFObjective: To synthesize evidence on the effectiveness of consultation-based interventions on adherence to primary or secondary preventative medications and clinical outcomes. We focused on consultation-based interventions suitable for primary care settings, without needing specific technologies, and with reasonable time requirements of clinicians. Methods: A database search was undertaken from 2015 onwards, supplemented by previous systematic reviews and citation-searching. Randomized trials targeting adults prescribed long-term medication for cardiovascular prevention, type 2 diabetes mellitus (T2DM), chronic respiratory disease, or osteoporosis were included. Interventions had to meet a priori eligibility criteria for implementation feasibility in primary care. Two reviewers screened, extracted data, and assessed risk of bias using the Cochrane RoB2 tool. Adherence and clinical outcomes were assessed, with meta-analyses conducted using inverse variance heterogeneity methods and sensitivity analyses to explore heterogeneity. Results: 41 studies (n = 26 114) were included. Meta-analysis showed significant adherence improvements for T2DM [standardized mean difference (SMD) 0.60, 95% confidence interval (CI) 0.10 to 1.11] and chronic respiratory disease (SMD 0.22, 95% CI 0.07 to 0.38), but effects were not robust to sensitivity analyses. No significant adherence effects were observed for cardiovascular prevention nor osteoporosis. Interventions did not significantly improve clinical outcomes including systolic blood pressure, low-density lipoprotein, HbA1c (after sensitivity analyses), respiratory symptoms, or hospitalization. High heterogeneity and study-level risk of bias limited certainty. Conclusion: Consultation-based interventions may modestly improve medication adherence in T2DM and chronic respiratory disease, but there is no robust evidence of clinical benefit, nor evidence of effectiveness in other conditions. Intervention feasibility is an important consideration for guiding future research and translating it into practice