Seizures and Epilepsy Johnson, Emily L
The Medical clinics of North America
103, Številka:
2
Journal Article
Recenzirano
Epilepsy affects 65 million people worldwide, and is a leading neurologic cause of loss of quality-adjusted life years. The diagnosis of seizures and epilepsy often depends on a careful history, and ...is supported with electroencephalogram and imaging. First-line treatment of epilepsy includes medical management. Antiepileptic drugs must be chosen with the patient's particular comorbidities in mind. Drug-resistant epilepsy cases should be referred to an epilepsy specialist and may be evaluated for additional medications, epilepsy surgery, neurostimulation, or dietary therapy. When caring for women, providers must take into account needs for contraception or pregnancy safety where applicable.
Diabetic kidney disease (DKD) is the leading cause of end-stage kidney disease in the United States and the world alike, and there is a great unmet need for treatments to reduce DKD development and ...progression. Inhibition of sodium/glucose co-transporter 2 (SGLT2) in the proximal tubule of the kidney has emerged as an effective antihyperglycemic treatment, leading to regulatory approval of several first-generation SGLT2 inhibitors for the treatment of type 2 diabetes. In follow-on clinical trials for the cardiovascular safety of the SGLT2 inhibitors, secondary effects to prevent or reduce albuminuria and decline in estimated glomerular filtration rate spurred further investigation into their potential application in DKD. This review summarizes the current understanding of mechanisms by which SGLT2 inhibitors block glucose reabsorption in the proximal tubule and improve systemic glucose homeostasis, the hypothesized mechanisms for kidney-protective effects of SGLT2 inhibition, and current recommendations for use of this class of antihyperglycemic agents in diabetic patients with low estimated glomerular filtration rates. Results of ongoing clinical trials in patients with DKD are eagerly awaited to expand knowledge of how SGLT2 inhibitors might be used for prevention and treatment.
Confirmatory factor analytic tests of measurement invariance (MI) based on the chi-square statistic are known to be highly sensitive to sample size. For this reason,
G. W. Cheung and R. B. Rensvold ...(2002)
recommended using alternative fit indices (AFIs) in MI investigations. In this article, the authors investigated the performance of AFIs with simulated data known to not be invariant. The results indicate that AFIs are much less sensitive to sample size and are more sensitive to a lack of invariance than chi-square-based tests of MI. The authors suggest reporting differences in comparative fit index (CFI) and
R. P. McDonald's (1989)
noncentrality index (NCI) to evaluate whether MI exists. Although a general value of change in CFI (.002) seemed to perform well in the analyses, condition specific change in McDonald's NCI values exhibited better performance than a single change in McDonald's NCI value. Tables of these values are provided as are recommendations for best practices in MI testing.
Maternal signatures are present in the eggs of some birds, but quantifying interclutch variability within populations remains challenging. Maternal assignment of eggs with distinctive appearances ...could be used to non-invasively identify renesting females, including hens returning among years, as well as to identify cases of conspecific brood parasitism. We explored whether King Rail (Rallus elegans) eggs with shared maternity could be matched based on eggshell pattern. We used NaturePatternMatch (NPM) software to match egg images taken in the field in conjunction with spatial and temporal data on nests. Since we had only a small number of marked breeders, we analyzed similar clutch images from a study of Eurasian Common Moorhens (Gallinula chloropus chloropus) with color-banded breeders for which parentage at many nests had been verified genetically to validate the method. We ran 66 King Rail clutches (n = 338 eggs) and 58 Common Moorhen clutches (n = 364 eggs) through NPM. We performed non-metric multidimensional scaling and permutational analysis of variance using the best egg match output from NPM. We also explored whether eggs could be grouped by clutch using a combination of egg dimensions and pattern data derived from NPM using linear discriminant analyses. We then scrutinized specific matches returned by NPM for King Rail eggs to determine whether multiple matches between the same clutches might reveal maternity among nests and inform our understanding of female laying behavior. To do this, we ran separate NPM analyses for clutches photographed over several years from two spatially distant parts of the site. With these narrower datasets, we were able to identify four instances where hens likely returned to breed among years, four likely cases of conspecific brood parasitism, and a within-season re-nesting attempt. Thus, the matching output was helpful in identifying congruent egg patterns among clutches when used in conjunction with spatial and temporal data, revealing previously unrecognized site fidelity, within-season movements, and reproductive interference by breeding females. Egg pattern data in combination with nest mapping can be used to inform our understanding of female reproductive effort, success, and longevity in King Rails. These methods may also be applied to other secretive birds and species of conservation concern.
Diabetic kidney disease (DKD) is now the principal cause of chronic kidney disease leading to end-stage kidney disease worldwide. As a primary contributor to the excess risk of all-cause and ...cardiovascular death in diabetes, DKD is a major contributor to the progressively expanding global burden of diabetes-associated morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a newer class of antihyperglycemic agents that exert glucose-lowering effects via glycosuric actions. Preclinical studies and clinical trials of SGLT2 inhibitors have consistently demonstrated reduction of albuminuria and preservation of kidney function. In particular, SGLT2 inhibitors lower risk of congestive heart failure, a major cardiovascular complication in DKD. This Perspective summarizes proposed mechanisms of action for SGLT2 inhibitors, integrates these data with results of recent cardiovascular outcomes trials, and discusses clinical applications for patients with DKD. The American Diabetes Association/European Association for the Study of Diabetes Consensus Report published online in October 2018 recommends SGLT inhibitors as preferred add-on therapy for patients with type 2 diabetes and established cardiovascular disease or chronic kidney disease, if kidney function is adequate. Results of the ongoing and just completed clinical trials conducted in patients with established DKD will facilitate further refinement of current guidelines.
EXECUTIVE SUMMARYHome hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative ...care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.
For wind turbines operating in cold weather conditions, ice accretion is an established issue that remains an obstacle in effective turbine operation. While the aerodynamic performance of wind ...turbine blades with ice accretion has received considerable research attention, few studies have investigated the structural impact of blade ice accretion. This work proposes an adaptable projection-based method to superimpose complex ice configurations onto a baseline structure. The proposed approach provides an efficient methodology to include ice accretion in the high-fidelity isogeometric shell analysis of a realistic wind turbine blade. Linear vibration and nonlinear deflection analyses of the blade are performed for various ice configurations to demonstrate the impact of different ice accretion distributions on structural performance. These analyses indicate decreases in the blade natural frequencies and deflection under icing conditions. Such ice-induced changes clearly reveal the need for structural design consideration for turbines operating under icing conditions.
PDF
