Background
The financial burden long-term sick leave places on society are immense and amounted to an annual cost of 180 billion NOK in Norway. Epidemiological and sociodemographic risk factors ...related to sickness absence and return to work (RTW) are well studied, less is known regarding self-perceived biopsychosocial barriers for RTW. The aim of this study was to investigate the diversity of barriers for RTW as experienced by long term sick listed employees.
Methods
The study is a large-scale qualitative interview study (n = 85), using semi-structured telephone interviews. Participants were eligible to participate if they had received sick leave benefits >6 months and <1,5 years at the time of recruitment, for at least 50% of their employed work hours. The data was analysed with a directed qualitative content analysis combined with a summative approach. A deductive approach, guided by the theoretical framework provided in Model of Human Occupation (MoHO) were used in the analysis process. In MoHO, the main categories are person specific components and environmental components.
Results
The study generated 952 coded meaning units describing barriers for RTW. Of these, we were able to deductively code 917 within the framework of MoHO. In the person specific concept, performance capacity barriers were dominant (n = 530). Volitional barriers (n = 164) were related to personal causation, hereunder self-efficacy (n = 24), and one's sense of capacity (n = 91). Barriers related to habituation (n = 64) was expressed as habits, both necessary habits and undesirable habits. Barriers related to the environmental component amounted to 388. The majority was linked to occupational environment (n = 217), including availability of adequate work tasks and barriers related to the healthcare system.
Conclusions
The experienced RTW-barriers extended beyond health-related barriers, for most of the participants the barriers were related to both person specific components and environmental components.
Key messages
* By gaining a greater understanding of the experienced RTW-barriers we could possibly provide more tailored RTW-services and help sick listed to a safe and sustainable return to work.
* The experienced RTW barriers for long term sick listed were primarily related to person specific and environmental components, and thus extended beyond health-related barriers.
Abstract
BACKGROUND
Loss of control (LOC) is a pervasive feature of binge eating, which contributes significantly to the growing epidemic of obesity; approximately 80 million US adults are obese. ...Brain-responsive neurostimulation guided by the delta band was previously found to block binge-eating behavior in mice. Following novel preclinical work and a human case study demonstrating an association between the delta band and reward anticipation, the US Food and Drug Administration approved an Investigational Device Exemption for a first-in-human study.
OBJECTIVE
To assess feasibility, safety, and nonfutility of brain-responsive neurostimulation for LOC eating in treatment-refractory obesity.
METHODS
This is a single-site, early feasibility study with a randomized, single-blinded, staggered-onset design. Six subjects will undergo bilateral brain-responsive neurostimulation of the nucleus accumbens for LOC eating using the RNS® System (NeuroPace Inc). Eligible participants must have treatment-refractory obesity with body mass index ≥ 45 kg/m2. Electrophysiological signals of LOC will be characterized using real-time recording capabilities coupled with synchronized video monitoring. Effects on other eating disorder pathology, mood, neuropsychological profile, metabolic syndrome, and nutrition will also be assessed.
EXPECTED OUTCOMES
Safety/feasibility of brain-responsive neurostimulation of the nucleus accumbens will be examined. The primary success criterion is a decrease of ≥1 LOC eating episode/week based on a 28-d average in ≥50% of subjects after 6 mo of responsive neurostimulation.
DISCUSSION
This study is the first to use brain-responsive neurostimulation for obesity; this approach represents a paradigm shift for intractable mental health disorders.
Seizure Cycles under Pharmacotherapy Friedrichs‐Maeder, Cecilia; Proix, Timothée; Tcheng, Thomas K. ...
Annals of neurology,
April 2024, 2024-Apr, 2024-04-00, 20240401, Volume:
95, Issue:
4
Journal Article
Peer reviewed
Objective
This study was undertaken to determine the effects of antiseizure medications (ASMs) on multidien (multiday) cycles of interictal epileptiform activity (IEA) and seizures and evaluate their ...potential clinical significance.
Methods
We retrospectively analyzed up to 10 years of data from 88 of the 256 total adults with pharmacoresistant focal epilepsy who participated in the clinical trials of the RNS System, an intracranial device that keeps records of IEA counts. Following adjunctive ASM trials, we evaluated changes over months in (1) rates of self‐reported disabling seizures and (2) multidien IEA cycle strength (spectral power for periodicity between 4 and 40 days). We used a survival analysis and the receiver operating characteristics to assess changes in IEA as a predictor of seizure control.
Results
Among 56 (33.3%) of the 168 adjunctive ASM trials suitable for analysis, ASM introduction was followed by an average 50 to 70% decrease in multidien IEA cycle strength and a concomitant 50 to 70% decrease in relative seizure rate for up to 12 months. Individuals with a ≥50% decrease in IEA cycle strength in the first 3 months of an ASM trial had a higher probability of remaining seizure responders (≥50% seizure rate reduction, p < 10−7) or super‐responders (≥90%, p < 10−8) over the next 12 months.
Interpretation
In this large cohort, a decrease in multidien IEA cycle strength following initiation of an adjunctive ASM correlated with seizure control for up to 12 months, suggesting that fluctuations in IEA mirror “disease activity” in pharmacoresistant focal epilepsy and may have clinical utility as a biomarker to predict treatment response. ANN NEUROL 2024;95:743–753
1. The distribution of dispersal distances (the dispersal kernel) is a major determinant of spatial population dynamics, yet little is known about the shape of the dispersal kernel for most species. ...This is partly because of the relative difficulty of measuring dispersal, exacerbated by a lack of standardized protocols. We suggest that this problem can be addressed by using modelling approaches to aid the design of studies to quantify dispersal. 2. In this study we present such an approach by optimizing seed trap sampling design using stochastic simulations. A number of alternative sampling designs (random placements, grid arrays, transects, sectors and annuli arrangements) for a point source were tested against a common kernel to assess the best methods for estimating the dispersal kernel. 3. For a given source strength and total trap area, transects and sectors of traps usually provided better data for kernel estimation than random placement, grid arrays and annuli. Kernel estimation was improved by increasing the source strength (the number of dispersing propagules) and the trap area, as expected. 4. When the 'true' kernel was unknown, transects were slightly better for identifying the thin-tailed exponential distribution, whereas sectors were better for detecting the fat-tailed half-Cauchy. 5. In the case of anisotropic dispersal (here, dispersal biased in one direction), annuli and grid arrays performed better than transects and sectors when the anisotropy was unknown. However, when the anisotropy was anticipated, and the trap arrangements were adjusted accordingly, transects and sectors were better. This was true regardless of source strength and total trap area. 6. Synthesis and applications. This study presents a simulation approach to the design of dispersal experiments. While the general results of our simulations can be used by those designing field studies for plant point sources, the simulation approach itself can be modified for a wide range of organisms, dispersal mechanisms and dispersal measurement approaches. Thus, the approach presented here facilitates improvements of dispersal study designs, which in turn will increase the precision of dispersal kernel estimates and predictions of spatial population dynamics, including modelling of rates of spread or metapopulations. This is invaluable in a range of ecological applications, such as the management of rare or invasive species, predicting species' response to climate change, or planning species reintroductions.
We describe two Norwegian children with fascioscapulohumeral muscular dystrophy in whom Coats’ disease, deafness, mental retardation and possible epilepsy were the presenting features. The children ...have a 4q35 deletion giving a small residual repeat fragment that they have inherited from their father who is a mosaic. Fundal changes consistent with bilateral Coats’ disease were found in both children. The rapid development of neovascular glaucoma necessitated removal of an eye from one child that on pathological examination showed the classical features of Coats’ disease. Cryotherapy was successful in maintaining sight in the other affected eyes.
We conjecture that the well-known oscillations (3- to 5-yr and 10-yr cycles) of northern mammals are examples of subharmonic resonance which obtains when ecological oscillators (predator-prey ...interactions) are subject to periodic forcing by the annual march of the seasons. The implications of this hypothesis are examined through analysis of a bare-bones, Hamiltonian model which, despite its simplicity, nonetheless exhibits the principal dynamical features of more realistic schemes. Specifically, we describe the genesis and destruction of resonant oscillations in response to variation in the intrinsic time scales of predator and prey. Our analysis suggests that cycle period should scale allometrically with body size, a fact first commented upon in the empirical literature some years ago. Our calculations further suggest that the dynamics of cyclic species should be phase coherent, i.e., that the intervals between successive maxima in the corresponding time series should be more nearly constant than their amplitude—a prediction which is also consistent with observation. We conclude by observing that complex dynamics in more realistic models can often be continued back to Hamiltonian limits of the sort here considered.
A major epidemic of hepatitis A virus (HAV), associated with intravenous drug abuser (IVDA) communities, was studied by molecular epidemiology using a 348 bp region of the VP1/2PA junction of the HAV ...genome. A total of 621 cases were notified during the 2-year epidemic, 492 of whom were IVDA. Serum samples, taken from 79 patients during the acute phase of infection, were selected for analysis of HAV RNA by reverse transcriptase-polymerase chain reaction (RT-PCR) and sequencing. A unique epidemic strain was detected among 49 cases thought to be associated with the epidemic, and among 10/30 patients with no apparent association to the epidemic. The other 20 HAV variants differed from the epidemic strain, and in several cases could be connected to the patient's destination of travel. These strains were mostly associated with smaller outbreaks that were soon eradicated. Our data indicate different dissemination routes of HAV, suggesting that needle sharing practises contribute to a wide spread of the virus in the IVDA communities. By early detection of an outbreak, by epidemic survey and sequence analysis, preventive measures can be applied, and thereby limit the epidemic at an early stage.
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