Prevalence and Incidence of Epilepsy in an Elderly and Low-Income Population in the United States

Derek H. Tang,Daniel C. Malone,Terri L. Warholak,Jenny Chong,Edward P. Armstrong,Marion K. Slack,Chiu-Hsieh Hsu,David M. Labiner 대한신경과학회 2015 Journal of Clinical Neurology Vol.11 No.3

Background and Purpose Te purpose of this study was to estimate the incidence and prevalence of epilepsy among an elderly and poor population in the United States. Methods Arizona Medicaid claims data from January 1, 2008 to December 31, 2010 were used for this analysis. Subjects who were aged ≥65 years and were continuously enrolled in any Arizona Medicaid health plans (eligible to patients with low income) for ≥12 months between January 1, 2008 and December 31, 2009 were considered eligible for inclusion in the study cohort. In addition to meeting the aforementioned criteria, incident and prevalent cases must have had epilepsy-related healthcare claims. Furthermore, incident cases were required to have a 1-year “clean” period immediately preceding the index date. Negative binomial and logistic regression models were used to assess the factors associated with epilepsy incidence and prevalence. Results Te estimated epilepsy incidence and prevalence for this population in 2009 were 7.9 and 19.3 per 1,000 person-years, respectively. Te incidence and prevalence rates were signifcantly higher for patients with comorbid conditions that were potential risk factors for epilepsy and were of younger age than for their non-comorbid and older counterparts (p<0.05). Te prevalence rates were signifcantly higher for non-Hispanic Blacks and male benefciaries than for non-Hispanic Whites and female benefciaries, respectively (p<0.05). Conclusions Tis patient population had higher epilepsy incidence and prevalence compared with the general US population. Tese diferences may be at least in part attributable to their low socioeconomic status.

Optimal Smooth Paths Based on Clothoids for Car-like Vehicles in the Presence of Obstacles

Edward Derek Lambert,Richard Romano,David Watling 제어·로봇·시스템학회 2021 International Journal of Control, Automation, and Vol.19 No.6

Automated Guided Vehicles are increasingly used for material transfer in factory and warehouse environments amongst humans and human operated vehicles. Safe and efficient operation is challenging when there is a mix of human and automated traffic as fixed guide paths can become blocked more frequently. In this work we aim to show smooth and efficient paths based on clothoid curves can be used to automatically plan diversions which can be traversed at high speed by automated fork-lift vehicles, which are car-like in the sense they have a limited turning radius and angular acceleration. The approach, based on numerical optimisation within convex region constraints is described in detail, and numerical results for curvature and sharpness are compared to a cubic spline on a small number of simulated environments. The clothoid spline is less affected, in terms of its objective function, by a shift in the obstacle boundaries than a cubic spline, for obstacle shifts below 0.5m. The clothoid spline takes longer to converge for but the output path has attractive qualities like lower peak sharpness, enabling high speed operation. The method is therefore most useful for applications where path quality is important and updates are required less frequently. Changing the objective function by increasing weighting parameter b allowed the path shape to be tuned to reduce the peak sharpness, at the cost of increasing the total length. With b > 100, convergence was poor because parts of the spline were pushed outside the assigned region, an artefact arising from the constraints only being enforced at the start and end of each segment. The analytical Jacobian of the constraints was effective at reducing the number of function evaluations to reach convergence.

Phylogeographical analysis of the dominant multidrug-resistant H58 clade of Salmonella Typhi identifies inter- and intracontinental transmission events

Wong, Vanessa K,Baker, Stephen,Pickard, Derek J,Parkhill, Julian,Page, Andrew J,Feasey, Nicholas A,Kingsley, Robert A,Thomson, Nicholas R,Keane, Jacqueline A,Weill, Franç,ois-Xavier,Edwards, Dav Nature Pub. Co 2015 Nature genetics Vol.47 No.6

The emergence of multidrug-resistant (MDR) typhoid is a major global health threat affecting many countries where the disease is endemic. Here whole-genome sequence analysis of 1,832 Salmonella enterica serovar Typhi (S. Typhi) identifies a single dominant MDR lineage, H58, that has emerged and spread throughout Asia and Africa over the last 30 years. Our analysis identifies numerous transmissions of H58, including multiple transfers from Asia to Africa and an ongoing, unrecognized MDR epidemic within Africa itself. Notably, our analysis indicates that H58 lineages are displacing antibiotic-sensitive isolates, transforming the global population structure of this pathogen. H58 isolates can harbor a complex MDR element residing either on transmissible IncHI1 plasmids or within multiple chromosomal integration sites. We also identify new mutations that define the H58 lineage. This phylogeographical analysis provides a framework to facilitate global management of MDR typhoid and is applicable to similar MDR lineages emerging in other bacterial species.

The vanishing stent: Repeated fracture and dissolution of nitinol gastric stents in a long term cancer survivor

Christopher Randle Lunt,Pavan Najaran,Derek E. Edwards,Jon K Bell,Damian Mullan,Hans-Ulrich Laasch 소화기인터벤션의학회 2018 Gastrointestinal Intervention Vol.7 No.2

Nitinol self expandable metal stents are increasingly utilised for malignant obstruction in the proximal gastrointestinal tract. We describe a case in which repeated fracture of proximal duodenal stents with dissolution of the nitinol wire skeleton and covering membranes occurred in a long term cancer survivor. This necessitated placement of 4 stents for symptom control and to allow oral feeding until the patient’s death 20 months after the initial stent was inserted. Fracture of gastric and duodenal stents has rarely been described previously, some incidences of which were considered due to mechanical causes. Dissolution of stent metal skeletons has not previously been recognised in gastroduodenal stents but has been described in an oesophageal stent subject to reflux of gastric content and a biochemical mechanism has been proposed. With modern oncological treatment the prospect of patients outliving their stents is increasing and the need for repeat procedures should form part of the consent process.

The vanishing stent: Repeated fracture and dissolution of nitinol gastric stents in a long term cancer survivor

Christopher Randle Lunt,Pavan Najaran,Derek E. Edwards,Jon K Bell,Damian Mullan,Hans-Ulrich Laasch 소화기인터벤션의학회 2018 International journal of gastrointestinal interven Vol.7 No.2

Nitinol self expandable metal stents are increasingly utilised for malignant obstruction in the proximal gastrointestinal tract. We describe a case in which repeated fracture of proximal duodenal stents with dissolution of the nitinol wire skeleton and covering membranes occurred in a long term cancer survivor. This necessitated placement of 4 stents for symptom control and to allow oral feeding until the patient’s death 20 months after the initial stent was inserted. Fracture of gastric and duodenal stents has rarely been described previously, some incidences of which were considered due to mechanical causes. Dissolution of stent metal skeletons has not previously been recognised in gastroduodenal stents but has been described in an oesophageal stent subject to reflux of gastric content and a biochemical mechanism has been proposed. With modern oncological treatment the prospect of patients outliving their stents is increasing and the need for repeat procedures should form part of the consent process.

‘Radial force’ of colonic stents: A parameter without consistency, definition or standard

Hans-Ulrich Laasch,Graham D. Milward,Derek W. Edwards 소화기인터벤션의학회 2020 International journal of gastrointestinal interven Vol.9 No.3

Background: To investigate the expansion force of current colonic stents and to match these to industry standards. Methods: Samples of all colonic stents were requested from manufactures world-wide. Expansion forces were tested with an RX650 compression tool (MSI, Flagstaff, AZ, USA). Measurements were averaged over three cycles of compression and expansion, independently performed at 37°C by specialist engineers of MSI. In parallel, a survey was undertaken on standards, and tests used by manufacturers in their production process. As a labbased study, Institutional Review Board approval was not required. Results: A literature search did not identify any industry standards for testing expansion force or a suggested range for this primary stent function. Median expansion force of all stents was 24.4 N, (35.1 N for braided, 20.7 N for knitted stents) with a vast range from 5.6–130.8 N. Covering braided stents in liquid silicone increased their median force 5.5-fold, separate membranes attached to knitted stents only had a minor effect on expansion force. Five of eight manufacturers replied, describing three different test methods with three different units for expansion force. Conclusion: There are no standards on assessing expansion force, or what the ideal range should be. Consequently, the variation is remarkable, but values are not published, and even if they were, they could not be compared. Consequently, interventionists are unable to discriminate between different stents and to select the most suitable device for their patients, and no recommendation can be made on the ‘best stent’. The industry needs an agreed test standard and an acceptable range of stent forces.

Infra-colic gastrostomy: Technique and anatomical considerations

Jen-Jou Wong,Srujana Ganti,Damian Mullan,Derek Edwards,Hans-Ulrich Laasch 소화기인터벤션의학회 2021 International journal of gastrointestinal interven Vol.10 No.1

Background: Infra-colic radiologically inserted gastrostomy is not well documented, and the presence of an insertion window solely below the transverse colon is generally regarded as a contraindication to gastrostomy insertion. A perceived increased risk is due to the presence of vessels and lymphatics within the omental and peritoneal structures, such as the epiploic arteries, the arterial arcade of Barkow, and middle colic artery branches from the superior mesenteric artery. Colonic obstruction is also an additional theorised risk. We provide evidence that infra-colic insertion of a feeding tube through the greater omentum can be performed safely. Methods: A total of 1,156 gastrostomies were inserted over an 8-year period. A retrospective review of the 5 cases was conducted. Electronic patient records were reviewed including clinical consultations, procedure reports and images. Results: In all cases, barium was administered orally/per nasogastric tube the day before to delineate the colon. All patients underwent sedo-analgesia with insufflation of the stomach achieved by a temporising nasogastric/orogastric tube. Infra-colic gastropexy with three SafeTpexy T-fasteners was undertaken. Standard 12 Fr balloon retained tubes were inserted through the greater omentum with no post-procedural complications or tube malfunctions in four cases. A 16 Fr disc retained tube was inserted in a fifth case. Conclusion: Despite the perceived difficulties, we suggest that infra-colic gastrostomies can be performed with confidence, and with little deviation from standard insertion techniques. They can be inserted without an apparent increase in complications, although operators need to be aware of the anatomical differences and additional structures traversed when performing infra-colic gastrostomies.

‘Radial force’ of colonic stents: A parameter without consistency, definition or standard

Hans-Ulrich Laasch,Graham D. Milward,Derek W. Edwards 소화기인터벤션의학회 2020 Gastrointestinal Intervention Vol.9 No.3

Background: To investigate the expansion force of current colonic stents and to match these to industry standards. Methods: Samples of all colonic stents were requested from manufactures world-wide. Expansion forces were tested with an RX650 compression tool (MSI, Flagstaff, AZ, USA). Measurements were averaged over three cycles of compression and expansion, independently performed at 37°C by specialist engineers of MSI. In parallel, a survey was undertaken on standards, and tests used by manufacturers in their production process. As a labbased study, Institutional Review Board approval was not required. Results: A literature search did not identify any industry standards for testing expansion force or a suggested range for this primary stent function. Median expansion force of all stents was 24.4 N, (35.1 N for braided, 20.7 N for knitted stents) with a vast range from 5.6–130.8 N. Covering braided stents in liquid silicone increased their median force 5.5-fold, separate membranes attached to knitted stents only had a minor effect on expansion force. Five of eight manufacturers replied, describing three different test methods with three different units for expansion force. Conclusion: There are no standards on assessing expansion force, or what the ideal range should be. Consequently, the variation is remarkable, but values are not published, and even if they were, they could not be compared. Consequently, interventionists are unable to discriminate between different stents and to select the most suitable device for their patients, and no recommendation can be made on the ‘best stent’. The industry needs an agreed test standard and an acceptable range of stent forces.

Infra-colic gastrostomy: Technique and anatomical considerations

Jen-Jou Wong,Srujana Ganti,Damian Mullan,Derek Edwards,Hans-Ulrich Laasch 소화기인터벤션의학회 2021 Gastrointestinal Intervention Vol.10 No.1

Background: Infra-colic radiologically inserted gastrostomy is not well documented, and the presence of an insertion window solely below the transverse colon is generally regarded as a contraindication to gastrostomy insertion. A perceived increased risk is due to the presence of vessels and lymphatics within the omental and peritoneal structures, such as the epiploic arteries, the arterial arcade of Barkow, and middle colic artery branches from the superior mesenteric artery. Colonic obstruction is also an additional theorised risk. We provide evidence that infra-colic insertion of a feeding tube through the greater omentum can be performed safely. Methods: A total of 1,156 gastrostomies were inserted over an 8-year period. A retrospective review of the 5 cases was conducted. Electronic patient records were reviewed including clinical consultations, procedure reports and images. Results: In all cases, barium was administered orally/per nasogastric tube the day before to delineate the colon. All patients underwent sedo-analgesia with insufflation of the stomach achieved by a temporising nasogastric/orogastric tube. Infra-colic gastropexy with three SafeTpexy T-fasteners was undertaken. Standard 12 Fr balloon retained tubes were inserted through the greater omentum with no post-procedural complications or tube malfunctions in four cases. A 16 Fr disc retained tube was inserted in a fifth case. Conclusion: Despite the perceived difficulties, we suggest that infra-colic gastrostomies can be performed with confidence, and with little deviation from standard insertion techniques. They can be inserted without an apparent increase in complications, although operators need to be aware of the anatomical differences and additional structures traversed when performing infra-colic gastrostomies.