The risk of recurrence following a first-ever seizure is 40-50%, warranting driving restriction during the early period of highest risk. This restriction must be balanced against the occupational, ...educational and social limitations that result from patients being ineligible to drive. The recommended duration of non-driving after a first seizure varies widely between jurisdictions, influenced by various factors including the community perception of an acceptable relative level of risk for an accident (the accident risk ratio; ARR). Driving restrictions may be based on individualised risk assessments or across-the-board guidelines, but these approaches both require accurate data on the risk of seizure recurrence.
1386 patients with first-ever seizure were prospectively analysed. Seizure recurrence was evaluated using survival analysis. The duration of non-driving required for a range of risks of seizure recurrence and ARRs was calculated. Additionally, the actual occurrence of seizures while driving was prospectively determined during follow-up.
For a risk of seizure recurrence to fall to 2.5% per month, corresponding to a monthly risk of a seizure while driving of 1.04 per thousand and an ARR of 2.6, non-driving periods of 8 months are required for unprovoked first-ever seizure, and 5 months for provoked first-ever seizure. Of patients with a seizure recurrence, 14 (2%) occurred while driving, with the monthly risk falling to less than 1/1000 after 6 months.
Our data provide a quantitative approach to decisions regarding a return to driving in patients with first-ever provoked or unprovoked seizure.
Germline mutations in CDH1 are associated with hereditary diffuse gastric cancer; lobular breast cancer also occurs excessively in families with such condition.
To determine if CDH1 is a ...susceptibility gene for lobular breast cancer in women without a family history of diffuse gastric cancer, germline DNA was analysed for the presence of CDH1 mutations in 318 women with lobular breast cancer who were diagnosed before the age of 45 years or had a family history of breast cancer and were not known, or known not, to be carriers of germline mutations in BRCA1 or BRCA2. Cases were ascertained through breast cancer registries and high-risk cancer genetic clinics (Breast Cancer Family Registry, the kConFab and a consortium of breast cancer genetics clinics in the United States and Spain). Additionally, Multiplex Ligation-dependent Probe Amplification was performed for 134 cases to detect large deletions.
No truncating mutations and no large deletions were detected. Six non-synonymous variants were found in seven families. Four (4/318 or 1.3%) are considered to be potentially pathogenic through in vitro and in silico analysis.
Potentially pathogenic germline CDH1 mutations in women with early-onset or familial lobular breast cancer are at most infrequent.
Maya Blue is a puzzling pigment found in objects produced by the ancient Maya civilization. It is a combination of indigo and palygorskite, and it is well-known for the high chemical and ...photochemical stability of the dye promoted by the clay confined environment. This pigment has survived over 1500 years, and it was first thought to be purely inorganic. The reasons for such stability have been investigated over the past years, and it may involve hydrogen bonds, complexation, and oxidation to dehydroindigo. However, these theories are not completely understood, and more evidence about indigo/palygorskite interactions must be obtained. In this study indigo and a Maya Blue simulant pigment were, for the first time, studied by transient absorption (TA) and time-resolved infrared (TRIR) spectroscopy. From such analysis it was possible to investigate the electronic excited states of indigo and the photochemistry behavior of the dye when interacting with the palygorskite. Concerning the TRIR measurements, the shifts of the CO and N–H vibrations indicate that hydrogen bonds are formed involving the dye and the coordinated water molecules present in the clay. Furthermore, a red shift is observed in the absorption of electronic ground state (50 nm) and also in the electronic excited state (27 nm) of Maya Blue simulant, suggesting that the excited states are stabilized by the clay. Indigo in DMSO solution presents a lifetime of ca. 120 ps while in the clay it becomes much shorter, ca. 3 ps. The shorter lifetime and also the red shift observed in the TA results suggest a stabilization of the first electronic excited state, which promotes a more efficient energy relaxation through conical intersection and, as a consequence, a faster excited state decay. Such factors can be important for the Maya Blue photostability, as they are also believed to be responsible for the high photostability of DNA and melanin.
•Particle size effect on the mechanical behaviour of nanocomposites is studied.•An interphase of disturbed matrix surrounding the nanoparticles exists.•A particle size effect is introduced in ...micromechanical models.•An under-stiffening effect is observed for an interphase softer than the matrix.•A dialogue between Molecular Dynamics and micromechanics is proposed.
This paper aims at developing a method to account for a particle size effect on the mechanical behaviour of particulate nanocomposites. An introduction of specific information at the atomic scale, through Molecular Dynamics (MD) simulations, into homogenisation models of the overall mechanical behaviour of heterogeneous materials (micromechanical approaches) is proposed here. By studying virtual nanocomposites, which consist of silica inclusions embedded in a polymer matrix, MD simulations have shown the existence of an interphase of disturbed matrix surrounding the inclusions, whose thickness depends neither on the inclusion size nor on the volume fraction of inclusions. By considering this interphase of fixed thickness, a particle size effect is then deduced from a dilute micromechanical model which derives from the classical Eshelby’s inhomogeneity problem. Effective elastic moduli of the composite strongly vary with the particle size for a fixed volume fraction of particles. Nevertheless, opposite trends are observed relative to the interphase behaviour. Whereas effective moduli increase with the particle size for an interphase softer than the matrix, they decrease in the reverse case. The confrontation between MD and micromechanical approaches and the characterisation of the interphase elastic moduli by an inverse method allow the stiffening effects observed by MD to be explained in the case of an interphase softer than the pure matrix.
The growth of bismuth thin films on highly oriented pyrolitic graphite (HOPG) was studied using ultra high vacuum (UHV) scanning tunneling microscopy (STM), X-ray photoelectron spectroscopy (XPS) and ...scanning electron microscopy (SEM). The locations of the main XPS peaks, and also the plasmon energy, are in good agreement with results recorded on bulk bismuth. The shape of the Bi
4f doublet, as well as the well developed Fermi edge, indicates the metallic character of the deposited film. One of the observed shoulders is identified with a quantum-well subband characteristic of thin bismuth films. There is no evidence for the existence of Bi–C bonds, consistent with weak bonding between the Bi islands and the HOPG. The height of the islands and their crystallographic orientation were investigated as a function of surface coverage. The Bi islands grow with the (110) plane parallel to the substrate. The observed heights (3, 5, 7, 9
ML) indicate that the preferred crystal structure involves paired layers on an intermediate mono-atomic Bi layer. There is evidence both for and against the Black Phosphorus like allotrope, and the nature of both the layer pairing and the intermediate layer are yet to be resolved. The islands exhibit stripes oriented along the
<
1
1
¯
0
>
axis of the Bi crystal, which is a fast growth direction due to the existence of strongly bonded zig-zag chains of atoms. The surface unit cell and the parameters of the rhombohedral bulk unit cell are estimated based on atomic resolution images. In the case of 2
ML stripes on top of a 5
ML base, the expansion of the outer atomic rows was estimated at 27%. Asymmetries in the growth of the islands are observed. Based on low coverage depositions at reduced substrate temperatures, it is proposed that there is a second fast growth direction corresponding to preferential attachment of atoms to one of the faces of the asymmetric, rhombic cross-section of the (110) crystal.
► Metallic character of thin Bi films on graphite was confirmed. ► Layer-pairing was observed. ► Deviations from the bulk atomic arrangement was identified. ► Presence of the second fast growth direction was indicated. ► Atomic resolution images were acquired.
In this work we present a study of the plasma treatment of woven commercial natural, synthetic and mixed fabrics, using a dielectric barrier discharge run in various environments (air, argon and ...nitrogen) at atmospheric pressure. The experiments were conducted to determine the effects of the operating parameters (dielectric layer make-up, discharge energy density, gas flow, gas type and exposure time) on the measured changes to surface wettability, morphology and chemical composition. The consequences of the surface changes induced are outlined and discussed, with data derived from surface analysis by X-ray photoelectron spectroscopy (XPS), wickability measurements and imaging using scanning electron microscopy (SEM).
The behaviour of the woven textile polymers examined was found to be very similar, under DBD treatment, to that of thin-film variants of the same polymers. The surface properties, such as the wickability and the level of oxidation were increased markedly after treatment times of the order of fractions of a second, with minimal change, i.e. recovery, shown on ageing. For porous materials, such as the textile fabrics, rapid, efficient and simultaneous treatment (fractions of a second) of both sides of the sample was found to be ensured. Thereby the system regime used offers the attractive prospect of controlling the efficient modification of non-compact materials of various textures, porosities etc.
GRB 060614 is a remarkable gamma-ray burst (GRB) observed by Swift with puzzling properties, which challenge current progenitor models. In particular, the lack of any bright supernova (SN) down to ...very strict limits and the vanishing spectral lags during the whole burst are typical of short GRBs, strikingly at odds with the long (102 s) duration of this event. Here we present detailed spectral and temporal analysis of the Swift observations of GRB 060614. We show that the burst presents standard optical, ultraviolet and X-ray afterglows, detected beginning 4 ks after the trigger. An achromatic break is observed simultaneously in the optical and X-ray bands, at a time consistent with the break in the R-band light curve measured by the VLT. The achromatic behaviour and the consistent post-break decay slopes make GRB 060614 one of the best examples of a jet break for a Swift burst. The optical and ultraviolet afterglow light curves have also an earlier break at 29.7 ± 4.4 ks, marginally consistent with a corresponding break at 36.6 ± 2.4 ks observed in the X-rays. In the optical, there is strong spectral evolution around this break, suggesting the passage of a break frequency through the optical/ultraviolet band. The very blue spectrum at early times suggests this may be the injection frequency, as also supported by the trend in the light curves: rising at low frequencies, and decaying at higher energies. The early X-ray light curve (from 97 to 480 s) is well interpreted as the X-ray counterpart of the burst extended emission. Spectral analysis of the BAT and XRT data in the ~80 s overlap time interval show that the peak energy of the burst has decreased to as low as 8 keV at the beginning of the XRT observation. Spectral analysis of following XRT data shows that the peak energy of the burst continues to decrease through the XRT energy band and exits it at about 500 s after the trigger. The average peak energy Ep of the burst is likely below the BAT energy band (<24 keV at the 90% confidence level) but larger than 8 keV. The initial group of peaks observed by BAT (~5 s) is however distinctly harder than the rest of the prompt emission, with a peak energy of about 300 keV as measured by Konus Wind. Considering the time-averaged spectral properties, GRB 060614 is consistent with the $E_{\rm iso}-E_{\rm p}^{\rm rest}$, $E_{\gamma}-E_{\rm p}^{\rm rest}$, and $L_{\rm p,iso}-E_{\rm p}^{\rm rest}$ correlations.
This is a contemporary study of rapidly quenched Nd1.6X0.4Fe14B magnetic materials (where X= Nd, Y, Ce, La, Pr, Gd and Ho). A 20% substitution of the Nd component from Nd2Fe14B can bring about some ...commercial advantage. However, there will be some compromise to the magnetic performance. Light rare earth elements are definitely more abundant (Y, Ce, La) than the heavier rare earth elements, but when they are included in RE2Fe14B magnets they tend to lower magnetic performance and thermal stability. Substituting heavy rare earth elements (Gd, Ho) for Nd in Nd2Fe14B improves the thermal stability of magnets but causes a loss in magnet remanence.
Reported revision of internal fixation for undisplaced intracapsular hip fractures is between 12 and 17% at 1 year. This risk is greater for elderly patients, for whom mortality after such a fracture ...is also higher. Our purpose was to identify predictors of fixation failure and mortality for elderly patients sustaining undisplaced intracapsular hip fractures, and to assess whether their socioeconomic status affected their outcome.
During a 3-year period we prospectively compiled a consecutive series of 162 elderly (≥65 years old) patients who underwent internal fixation for an undisplaced (Garden stage I or II) intracapsular hip fracture. Patient demographics, American Society of Anesthesiologists (ASA) grade, and posterior tilt (measured on the lateral radiograph) were recorded pre-operatively. All patients were followed up for a minimum of 1 year. Each patient's socioeconomic status was assigned by use of the Scottish Index of Multiple Deprivation. Patient mortality was established by use of the General Register Office for Scotland.
There were 28 failures of fixation during the study period. In Cox regression analysis, ASA grade and the presence of posterior tilt (p < 0.0001) were significant independent predictors of fixation failure. Overall unadjusted mortality at 1 year was 19% (n = 30/162). Cox regression analysis also affirmed ASA grade to be the only significant independent predictor of 1-year mortality (p = 0.003). The standardised mortality rate for the cohort was 2.3 (p < 0.001), and was significantly greater for patients less than 80 years of age (p = 0.004). Socioeconomic status did not affect outcome, but the most deprived patients sustain their fracture at a significantly younger age (p = 0.001).
We have demonstrated that ASA grade and posterior tilt of the femoral neck are independent predictors of fixation failure of undisplaced intracapsular hip fractures in elderly patients, and ASA grade was also an independent predictor of mortality.
Androgen deprivation therapy (ADT), usually achieved with luteinising hormone releasing hormone analogues (LHRHa), is central to prostate cancer management. LHRHa reduce both testosterone and ...oestrogen and are associated with significant long-term toxicity. Previous use of oral oestrogens as ADT was curtailed because of cardiovascular toxicity. Transdermal oestrogen (tE2) patches are a potential alternative ADT, supressing testosterone without the associated oestrogen-depletion toxicities (osteoporosis, hot flushes, metabolic abnormalities) and avoiding cardiovascular toxicity, and we here describe their evaluation in men with prostate cancer.
The PATCH (NCT00303784) adaptive trials programme (incorporating recruitment through the STAMPEDE NCT00268476 platform) is evaluating the safety and efficacy of tE2 patches as ADT for men with prostate cancer. An initial randomised (LHRHa versus tE2) phase II study (n = 251) with cardiovascular toxicity as the primary outcome measure has expanded into a phase III evaluation. Those with locally advanced (M0) or metastatic (M1) prostate cancer are eligible. To reflect changes in both management and prognosis, the PATCH programme is now evaluating these cohorts separately.
Recruitment is complete, with 1362 and 1128 in the M0 and M1 cohorts, respectively. Rates of androgen suppression with tE2 were equivalent to LHRHa, with improved metabolic parameters, quality of life and bone health indices (mean absolute change in lumbar spine bone mineral density of -3.0% for LHRHa and +7.9% for tE2 with an estimated difference between arms of 9.3% (95% confidence interval 5.3-13.4). Importantly, rates of cardiovascular events were not significantly different between the two arms and the time to first cardiovascular event did not differ between treatment groups (hazard ratio 1.11, 95% confidence interval 0.80-1.53; P = 0.54). Oncological outcomes are awaited.
Efficacy results for the M0 cohort (primary outcome measure metastases-free survival) are expected in the final quarter of 2023. For M1 patients (primary outcome measure - overall survival), analysis using restricted mean survival time is being explored. Allied translational work on longitudinal samples is underway.
PDF
