Volume of hippocampal activation as a determining factor for the lateralisation of the epileptogenic zone in patients with drug-resistant mesial temporal lobe epilepsy.

INTRODUCTION: Approximately 30% of patients with mesial temporal lobe epilepsy (MTLE) will develop drug resistance, which requires early surgical treatment. The success of the surgical procedure largely depends on the correct lateralisation of the epileptogenic zone, which can only be determined in 70% of patients with such conventional diagnostic tools as video electroencephalography and volumetric structural magnetic resonance imaging. We evaluated the performance of a memory functional magnetic resonance imaging (fMRI) paradigm in lateralising the epileptogenic zone in patients with drug-resistant MTLE. METHODS: We included 18 patients with MTLE attended at the Instituto Neurológico Colombiano in Medellin (Colombia) between 2018 and 2019. The volume of functional activation in both temporal lobes was determined with a memory fMRI paradigm. A concordance analysis was performed to compare the performance of fMRI against that of conventional tests. RESULTS: In patients with left MTLE, lower total activation was found in the hemisphere ipsilateral to the epileptogenic zone as compared to the contralateral hemisphere (121.15 ± 16.48 voxels vs 170.23 ± 17.8 voxels [P < .001]), showing substantial concordance with conventional tests. Patients with right MTLE displayed lower hippocampal activation ipsilateral to the epileptogenic zone (18.5 ± 3.38 voxels vs 27.8 ± 3.77 voxels in the contralateral hippocampus [P = .048]), showing moderate concordance with conventional tests. CONCLUSIONS: These findings suggest that lower functional activation as determined by a memory fMRI paradigm has a high level of concordance with conventional tests for lateralising the epileptogenic zone in patients with drug-resistant MTLE.

Estimation of carbon footprint and sources of emissions of an extensive alpaca production system.

A cradle-to-farm gate life cycle assessment was conducted following international standards (ISO 14040, 2006) to estimate sources of greenhouse gas emissions of an extensive alpaca production system in the Peruvian Andes with a focus on carbon footprint. The assessment encompasses all supply chain processes involved with the production of alpaca fiber and meat. Direct (i.e., enteric fermentation, manure, and manure management) and indirect emissions (i.e., electricity, fuel, and fertilizer) of carbon dioxide, nitrous oxide, and methane were estimated according to the (IPCC (Intergovernmental Panel on Climate Change). 2006. IPCC 2006 for National Greenhouse Gas Inventories. Volume 2, Chapter 3. Mobile Combustion. Volume 4, Chapter 10. Emissions from livestock and manure management. Chapter 11. N2O emissions from managed soils and CO2 emissions derived from the application of lime and urea. https://www.ipcc-nggip.iges.or.jp/public/2006gl/vol4.html ). Carbon footprint was calculated based on a mass, economic, and biophysical allocation. The functional unit of the economic and mass allocations was 1 kg of LW as the main product and 1 kg of white or colored fiber as co-products. The functional unit of the biophysical allocation was 1 kg of live weight and 1 kg of fiber. The largest source of greenhouse gas emissions came from enteric fermentation (67%), followed by direct and indirect nitrous oxide emissions (29%). The estimated carbon footprint of the extensive alpaca production system, considering a 20% offtake rate, was 24.0 and 29.5 kg of carbon dioxide equivalents per kg of live weight for the economic and mass allocations, respectively, while for the biophysical allocation was 22.6 and 53.0 kg of carbon dioxide equivalents per kg of alpaca live weight and alpaca fiber, respectively. The carbon footprint per area was 88.6 kg carbon dioxide equivalents per ha.

Testing e-mail content to encourage physicians to access an audit and feedback tool: a factorial randomized experiment.

Background: In Ontario, an online audit and feedback tool that provides primary care physicians with detailed information about patients who are overdue for cancer screening is underused. In the present study, we aimed to examine the effect of messages operationalizing 3 behaviour change techniques on access to the audit and feedback tool and on cancer screening rates. Methods: During May-September 2017, a pragmatic 2×2×2 factorial experiment tested 3 behaviour change techniques: anticipated regret, material incentive, and problem-solving. Outcomes were assessed using routinely collected administrative data. A qualitative process evaluation explored how and why the e-mail messages did or did not support Screening Activity Report access. Results: Of 5449 primary care physicians randomly allocated to 1 of 8 e-mail messages, fewer than half opened the messages and fewer than 1 in 10 clicked through the messages. Messages with problem-solving content were associated with a 12.9% relative reduction in access to the tool (risk ratio: 0.871; 95% confidence interval: 0.791 to 0.958; p = 0.005), but a 0.3% increase in cervical cancer screening (rate ratio: 1.003; 95% confidence interval: 1.001 to 1.006; p = 0.003). If true, that association would represent 7568 more patients being screened. No other significant effects were observed. Conclusions: For audit and feedback to work, recipients must engage with the data; for e-mail messages to prompt activity, recipients must open and review the message content. This large factorial experiment demonstrated that small changes in the content of such e-mail messages might influence clinical behaviour. Future research should focus on strategies to make cancer screening more user-centred.