Critical success index or F measure to validate the accuracy of administrative healthcare data identifying epilepsy in deceased adults in Scotland.

BACKGROUND: Methods to undertake diagnostic accuracy studies of administrative epilepsy data are challenged by lack of a way to reliably rank case-ascertainment algorithms in order of their accuracy. This is because it is difficult to know how to prioritise positive predictive value (PPV) and sensitivity (Sens). Large numbers of true negative (TN) instances frequently found in epilepsy studies make it difficult to discriminate algorithm accuracy on the basis of negative predictive value (NPV) and specificity (Spec) as these become inflated (usually >90%). This study demonstrates the complementary value of using weather forecasting or machine learning metrics critical success index (CSI) or F measure, respectively, as unitary metrics combining PPV and sensitivity. We reanalyse data published in a diagnostic accuracy study of administrative epilepsy mortality data in Scotland. METHOD: CSI was calculated as 1/[(1/PPV) + (1/Sens) - 1]. F measure was calculated as 2.PPV.Sens/(PPV + Sens). CSI and F values range from 0 to 1, interpreted as 0 = inaccurate prediction and 1 = perfect accuracy. The published algorithms were reanalysed using these and their accuracy re-ranked according to CSI in order to allow comparison to the original rankings. RESULTS: CSI scores were conservative (range 0.02-0.826), always less than or equal to the lower of the corresponding PPV (range 39-100%) and sensitivity (range 2-93%). F values were less conservative (range 0.039-0.905), sometimes higher than either PPV or sensitivity, but were always higher than CSI. Low CSI and F values occurred when there was a large difference between PPV and sensitivity, e.g. CSI was 0.02 and F was 0.039 in an instance when PPV was 100% and sensitivity was 2%. Algorithms with both high PPV and sensitivity performed best in terms of CSI and F measure, e.g. CSI was 0.826 and F was 0.905 in an instance when PPV was 90% and sensitivity was 91%. CONCLUSION: CSI or F measure can combine PPV and sensitivity values into a convenient single metric that is easier to interpret and rank in terms of diagnostic accuracy than trying to rank diagnostic accuracy according to the two measures themselves. CSI or F prioritise instances where both PPV and sensitivity are high over instances where there are large differences between PPV and sensitivity (even if one of these is very high), allowing diagnostic accuracy thresholds based on combined PPV and sensitivity to be determined. Therefore, CSI or F measures may be helpful complementary metrics to report alongside PPV and sensitivity in diagnostic accuracy studies of administrative epilepsy data.

Epilepsy-related mortality during the COVID-19 pandemic: A nationwide study of routine Scottish data.

OBJECTIVE: To examine whether epilepsy-related deaths increased during the COVID-19 pandemic and if the proportion with COVID-19 listed as the underlying cause is different between people experiencing epilepsy-related deaths and those experiencing deaths unrelated to epilepsy. METHODS: This was a Scotland-wide, population-based, cross-sectional study of routinely-collected mortality data pertaining to March-August of 2020 (COVID-19 pandemic peak) compared to the corresponding periods in 2015-2019. ICD-10-coded causes of death of deceased people of any age were obtained from a national mortality registry of death certificates in order to identify those experiencing epilepsy-related deaths (coded G40-41), deaths with COVID-19 listed as a cause (coded U07.1-07.2), and deaths unrelated to epilepsy (death without G40-41 coded). The number of epilepsy-related deaths in 2020 were compared to the mean observed through 2015-2019 on an autoregressive integrated moving average (ARIMA) model (overall, men, women). Proportionate mortality and odds ratios (OR) for deaths with COVID-19 listed as the underlying cause were determined for the epilepsy-related deaths compared to deaths unrelated to epilepsy, reporting 95% confidence intervals (CIs). RESULTS: A mean number of 164 epilepsy-related deaths occurred through March-August of 2015-2019 (of which a mean of 71 were in women and 93 in men). There were subsequently 189 epilepsy-related deaths during the pandemic March-August 2020 (89 women, 100 men). This was 25 more epilepsy-related deaths (18 women, 7 men) compared to the mean through 2015-2019. The increase in women was beyond the mean year-to-year variation seen in 2015-2019. Proportionate mortality with COVID-19 listed as the underlying cause was similar between people experiencing epilepsy-related deaths (21/189, 11.1%, CI 7.0-16.5%) and deaths unrelated to epilepsy (3,879/27,428, 14.1%, CI 13.7-14.6%), OR 0.76 (CI 0.48-1.20). Ten of 18 excess epilepsy-related deaths in women had COVID-19 listed as an additional cause. CONCLUSIONS: There is little evidence to suggest there have been any major increases in epilepsy-related deaths in Scotland during the COVID-19 pandemic. COVID-19 is a common underlying cause of both epilepsy-related and unrelated deaths.

Screening for anxiety, depression and suicidality by epilepsy specialists in adult services in Scotland.

OBJECTIVE: Clinical guidelines recommend screening people with epilepsy (PWE) regularly for mental distress, but it is unclear how guidelines are implemented. We surveyed epilepsy specialists in adult Scottish services to determine approaches used to screen for anxiety, depression, and suicidality; the perceived difficulty of screening; factors associated with intention to screen; and treatment decisions made following positive screens. METHODS: An anonymous email-based questionnaire survey of epilepsy nurses and epilepsy neurology specialists (n = 38) was conducted. RESULTS: Two in every three specialists used a systematic screening approach; a third did not. Clinical interview was employed more often than standardized questionnaire. Clinicians reported positive attitudes towards screening but found screening difficult to implement. Intention to screen was associated with favorable attitude, perceived control, and social norm. Pharmacological and non-pharmacological interventions were proposed equally often for those screening positive for anxiety or depression. CONCLUSION: Routine screening for mental distress is carried out in Scottish epilepsy treatment settings but is not universal. Attention should be paid to clinician factors associated with screening, such as intention to screen and resulting treatment decisions. These factors are potentially modifiable, offering a means of closing the gap between guideline recommendations and clinical practice.

Using Critical Success Index or Gilbert Skill Score as composite measures of positive predictive value and sensitivity in diagnostic accuracy studies: Weather forecasting informing epilepsy research.

The Critical Success Index (CSI) and Gilbert Skill score (GS) are verification measures that are commonly used to check the accuracy of weather forecasting. In this article, we propose that they can also be used to simplify the joint interpretation of positive predictive value (PPV) and sensitivity estimates across diagnostic accuracy studies of epilepsy data. This is because CSI and GS each provide a single measure that takes the weather forecasting equivalent of PPV and sensitivity into account. We have re-analysed data from our recent systematic review of diagnostic accuracy studies of administrative epilepsy data using CSI and GS. We summarise the results and benefits of this approach.

Questionnaire-based screening for mental distress in epilepsy: Outline and feasibility of an outpatient screening and intervention pathway.

OBJECTIVE: Mental distress is present in a significant proportion of people with epilepsy (PWE), with a negative impact across life domains. It is underdiagnosed and under-treated despite guidelines recommending screening for its presence (e.g., SIGN, 2015). We describe a tertiary-care epilepsy mental distress screening and treatment pathway, with a preliminary investigation of its feasibility. METHODS: We selected psychometric screening instruments for depression, anxiety, quality of life (QOL), and suicidality, establishing treatment options matched to instrument scores on the Patient Health Questionnaire 9 (PHQ-9), along 'traffic light' lines. We determined feasibility outcomes including recruitment and retention rates, resources required to run the pathway, and level of psychological need. We undertook a preliminary investigation of change in distress scores over a 9-month interval and determined PWE engagement and the perceived usefulness of pathway treatment options. RESULTS: Two-thirds of eligible PWE were included in the pathway with an 88% retention rate. At the initial screen, 45.8% of PWE required either an 'Amber-2' intervention (for moderate distress) or a 'Red' one (for severe distress). The equivalent figure at the 9-month re-screen was 36.8%, reflective of an improvement in depression and QOL scores. Online charity-delivered well-being sessions and neuropsychology were rated highly for engagement and perceived usefulness, but computerized cognitive behavioral therapy was not. The resources required to run the pathway were modest. CONCLUSION: Outpatient mental distress screening and intervention are feasible in PWE. The challenge is to optimize methods for screening in busy clinics and to determine the best (and most acceptable) interventions for screening positive PWE.

Case-control study developing Scottish Epilepsy Deaths Study Score to predict epilepsy-related death.

This study aimed to develop a risk prediction model for epilepsy-related death in adults. In this age- and sex-matched case-control study, we compared adults (aged ≥16 years) who had epilepsy-related death between 2009 and 2016 to living adults with epilepsy in Scotland. Cases were identified from validated administrative national datasets linked to mortality records. ICD-10 cause-of-death coding was used to define epilepsy-related death. Controls were recruited from a research database and epilepsy clinics. Clinical data from medical records were abstracted and used to undertake univariable and multivariable conditional logistic regression to develop a risk prediction model consisting of four variables chosen a priori. A weighted sum of the factors present was taken to create a risk index-the Scottish Epilepsy Deaths Study Score. Odds ratios were estimated with 95% confidence intervals (CIs). Here, 224 deceased cases (mean age 48 years, 114 male) and 224 matched living controls were compared. In univariable analysis, predictors of epilepsy-related death were recent epilepsy-related accident and emergency attendance (odds ratio 5.1, 95% CI 3.2-8.3), living in deprived areas (odds ratio 2.5, 95% CI 1.6-4.0), developmental epilepsy (odds ratio 3.1, 95% CI 1.7-5.7), raised Charlson Comorbidity Index score (odds ratio 2.5, 95% CI 1.2-5.2), alcohol abuse (odds ratio 4.4, 95% CI 2.2-9.2), absent recent neurology review (odds ratio 3.8, 95% CI 2.4-6.1) and generalized epilepsy (odds ratio 1.9, 95% CI 1.2-3.0). Scottish Epilepsy Deaths Study Score model variables were derived from the first four listed before, with Charlson Comorbidity Index ≥2 given 1 point, living in the two most deprived areas given 2 points, having an inherited or congenital aetiology or risk factor for developing epilepsy given 2 points and recent epilepsy-related accident and emergency attendance given 3 points. Compared to having a Scottish Epilepsy Deaths Study Score of 0, those with a Scottish Epilepsy Deaths Study Score of 1 remained low risk, with odds ratio 1.6 (95% CI 0.5-4.8). Those with a Scottish Epilepsy Deaths Study Score of 2-3 had moderate risk, with odds ratio 2.8 (95% CI 1.3-6.2). Those with a Scottish Epilepsy Deaths Study Score of 4-5 and 6-8 were high risk, with odds ratio 14.4 (95% CI 5.9-35.2) and 24.0 (95% CI 8.1-71.2), respectively. The Scottish Epilepsy Deaths Study Score may be a helpful tool for identifying adults at high risk of epilepsy-related death and requires external validation.

Physical and chemical properties of edamame during bean development and application of spectroscopy-based machine learning methods to predict optimal harvest time.

This study aims to investigate the changes in physical and chemical properties of edamame during bean development and apply a spectroscopy-based machine learning (ML) technique to determine optimal harvest time. The edamame harvested at R5 (beginning seed), R6 (full seed), and R7 (beginning maturity) growth stages were characterized for physical and chemical properties, and pods were measured for spectral reflectance (360-740 nm) using a handheld spectrophotometer. The samples were categorized into 'early', 'ready', and 'late' based on the characterized properties. The results showed that pod/bean weight and pod thickness peaked at R6 and remained stable thereafter. Sugar, starch, alanine, and glycine also peaked at R6 but proceeded to decline. The ML method (random forest classification) using pods' spectral reflectance had a high accuracy of 0.95 for classifying 'early' and 'late' samples and 0.87 for classifying 'early' and 'ready' samples. Therefore, this method can determine the optimal harvest time of edamame.

Assessing the Role of Cyberbiosecurity in Agriculture: A Case Study.

Agriculture has adopted the use of smart technology to help meet growing food demands. This increased automation and associated connectivity increases the risk of farms being targeted by cyber-attacks. Increasing frequency of cybersecurity breaches in many industries illustrates the need for securing our food supply chain. The uniqueness of biological data, the complexity of integration across the food and agricultural system, and the importance of this system to the U.S. bioeconomy and public welfare suggests an urgency as well as unique challenges that are not common across all industries. To identify and address the gaps in awareness and knowledge as well as encourage collaborations, Virginia Tech hosted a virtual workshop consisting of professionals from agriculture, cybersecurity, government, and academia. During the workshop, thought leaders and influencers discussed 1) common food and agricultural system challenges, scenarios, outcomes and risks to various sectors of the system; 2) cyberbiosecurity strategies for the system, gaps in workforce and training, and research and policy needs. The meeting sessions were transcribed and analyzed using qualitative methodology. The most common themes that emerged were challenges, solutions, viewpoints, common vocabulary. From the results of the analysis, it is evident that none of the participating groups had available cybersecurity training and resources. Participants were uncertain about future pathways for training, implementation, and outreach related to cyberbiosecurity. Recommendations include creating training and education, continued interdisciplinary collaboration, and recruiting government involvement to speed up better security practices related to cyberbiosecurity.

A national study of epilepsy-related deaths in Scotland: Trends, mechanisms, and avoidable deaths.

OBJECTIVE: This study was undertaken to investigate the trends and mechanisms of epilepsy-related deaths in Scotland, highlighting the proportion that were potentially avoidable. METHODS: This was a retrospective observational data-linkage study of administrative data from 2009-2016. We linked nationwide data encompassing mortality records, hospital admissions, outpatient attendance, antiepileptic drug (AED) prescriptions, and regional primary care attendances. Adults (aged ≥16 years) suffering epilepsy-related death were identified for study using International Classification of Diseases, 10th Revision coding combined with AED prescriptions. We reported epilepsy-related mortality rate (MR), age-specific mortality ratios, multiple cause-of-death frequencies, and the proportion of potentially avoidable deaths (identified as those with an underlying cause listed as avoidable by the Office for National Statistics). RESULTS: A total of 1921 epilepsy-related deaths were identified across Scotland; 1185 (62%) decedents were hospitalized for seizures in the years leading up to death, yet only 518 (27%) were seen in a neurology clinic during the same period. MR remained unchanged over time, ranging from 5.9 to 8.7 per 100 000 Scottish population (95% confidence interval [CI] = -.05 to .66 per 100 000 for annual change in MR). Mortality ratios were significantly increased in young adults aged 16-54 years (2.3, 95% CI = 1.8-2.8), peaking at age 16-24 years (5.3, 95% CI = 1.8-8.8). Sudden unexpected death in epilepsy (SUDEP) constituted 30% of the 553 young adult epilepsy-related deaths, with several other non-SUDEP fatal mechanisms identified including aspiration pneumonia, cardiac arrest, AED or narcotic poisoning, drowning, and alcohol dependence. Seventy-six percent of young adult epilepsy-related deaths were potentially avoidable. SIGNIFICANCE: Epilepsy-related deaths are a major public health problem in Scotland, given that they are not reducing, people are dying young, and many deaths are potentially avoidable. SUDEP is only one of several important mechanisms by which epilepsy-related deaths are occurring in young adults. Services may need to be re-evaluated to improve specialist referral following seizure-related hospital admissions.

Check-if-apply approach for consumers and utilities to communicate about drinking water aesthetics quality.

Globally, consumers judge their drinking water through its aesthetic qualities because tastes, odors, and appearances are readily detectable by untrained consumers. Consumer feedback is critical to the water industry for efficient resolution of aesthetic water quality issues, although consumer descriptions of taste and odor issues can sometimes be unfocused or confusing. A user-friendly approach can facilitate consumer communications to utilities in the challenging task of describing drinking water taste and odor issues. The purpose of this study was to develop a list of taste and odor descriptors and test a novel "check-if-apply" approach to describe drinking water quality. The final list contained 28 individual and/or groups of descriptors. 75 participants tested water samples impacted by various tastants or odorants: duplicate samples of chloraminated tap water, tap water with heptanal, tap water with 2-methylisoborneol (MIB), tap water with NaCl, bottled water, and bottled water with CuSO4. Participants used a 9-point hedonic scale (1 = 'dislike extremely'; 9 = 'like extremely') to rate overall liking of each sample, and they used the check-if-apply list to describe the taste or odor. Participants also answered a brief questionnaire and used a 5-point scale (1 = 'very difficult'; 5 = 'very easy') to evaluate their experience using the check-if-apply list. Significant differences were observed in acceptability and sensory profile of samples (p-value <0.05). Tap water with MIB had the lowest acceptability mean score (3.43 ± 1.74), while flavorless bottled water had the highest acceptability mean score (6.23 ± 1.47). 'Salty', 'metallic', 'chemical' and 'musty/earthy' were the dominant descriptors for NaCl, CuSO4, heptanal, and MIB, respectively. Most participants (81%) found the check-if-apply list as 'somewhat easy' to 'very easy' to use (mean = 3.44 ± 1.07) and suggested it as a user-friendly lexicon for consumers and utilities to communicate about water quality.

Validating the accuracy of administrative healthcare data identifying epilepsy in deceased adults: A Scottish data linkage study.

BACKGROUND: We investigate the case-ascertainment accuracy for potentially active epilepsy of four administrative healthcare datasets used to identify deceased adults in Scotland. METHODS: In this diagnostic accuracy study, unique patient identifiers were used to link administrative healthcare data for adults (aged 16 years and over) who died in Scotland between 01/01/09-01/01/16. Cases were ascertained from linking mortality records, hospital admissions, antiepileptic drug (AED) prescriptions, and primary care attendances. We assessed ICD-10 codes G40 (epilepsy), G41 (status epilepticus), and R56.8 (seizures) listed as causes of death and as hospital admission reasons, various AEDs, and F25 primary care epilepsy Read codes. These epilepsy indicators were searched through 01/01/09-01/01/16, suggesting active epilepsy during a maximal period of seven years before death. They were compared to epilepsy diagnoses made from medical records reviewed by a senior epileptologist, with a second senior epileptologist independently reviewing the medical records in a 10 % sample to check for specialist interrater agreement in epilepsy diagnoses. We validated how accurately epilepsy was identified by each dataset alone and when combined, calculating positive predictive value (PPV) and sensitivity (with 95 % confidence intervals (CIs)). RESULTS: 159,032 deceased potential epilepsy cases were captured across the four datasets. Medical records reviewed in a random sample of 936 confirmed that epilepsy was present in 614 and absent in 322. Specialist interrater diagnostic agreement was substantial (100 medical records reviewed in duplicate, kappa = 0.72, CI 0.58-0.86). G40-41 cause of death codes had a PPV of 86 % (CI 84-89 %) and sensitivity of 73 % (CI 69-76 %). Adding R56.8 lowered PPV to 69 % (CI 65-72 %) and raised sensitivity to 87 % (CI 84-90 %). The optimal algorithm combining two datasets consisted of F25 Read codes paired with AEDs (PPV 86 % (CI 80-92 %), sensitivity 93 % (CI 88-97 %)). Also effective was pairing G40-41 and/or R56.8 cause of death codes with AEDs (PPV 91 % (CI 89-94 %), sensitivity 81 % (CI 77-84 %)). Whilst algorithms combining three datasets raised PPV to as high as 93-95 %, the associated sensitivities were low (71 % at most). CONCLUSIONS: Routinely-collected Scottish data can accurately identify epilepsy in deceased adults. It may be necessary to combine the diagnostic coding used with AEDs to ensure optimal case-ascertainment. The results help inform the design of future Scottish epilepsy mortality studies recruiting from administrative data sources.

Flavor compounds in Vine Tea (Ampelopsis grossedentata) infusions.

Vine tea (Ampelopsis grossedentata) is a tea traditionally used in Chinese herbal medicine that is rich in the natural antioxidant dihydromyricetin (ampelopsin). In addition to its multiple health benefits, vine tea extracts and dihydromyricetin have been suggested as potential natural antioxidants for food applications, such as soybean oil and meat products. However, there is still little information available on vine tea chemistry, and in particular the volatile profile and sensory characteristics, which can affect product acceptability and restrict its use as a natural antioxidant. The objective of this exploratory study was to identify potential volatile components present in vine tea in order to support further research and applications in the food industry. Vine tea infusions brewed from commercial samples were characterized by acidic pH values and a dark, reddish-yellow color. Twenty-one volatile compounds were identified as potential flavor components of vine tea, including aldehydes and ketones. Further studies are suggested to quantify the volatile compounds and understand their importance to vine tea's aroma profile. Sensory studies are also suggested to access consumer's acceptability of vine tea and products containing vine tea as an ingredient.

The Facial Action Coding System for Characterization of Human Affective Response to Consumer Product-Based Stimuli: A Systematic Review.

To characterize human emotions, researchers have increasingly utilized Automatic Facial Expression Analysis (AFEA), which automates the Facial Action Coding System (FACS) and translates the facial muscular positioning into the basic universal emotions. There is broad interest in the application of FACS for assessing consumer expressions as an indication of emotions to consumer product-stimuli. However, the translation of FACS to characterization of emotions is elusive in the literature. The aim of this systematic review is to give an overview of how FACS has been used to investigate human emotional behavior to consumer product-based stimuli. The search was limited to studies published in English after 1978, conducted on humans, using FACS or its action units to investigate affect, where emotional response is elicited by consumer product-based stimuli evoking at least one of the five senses. The search resulted in an initial total of 1,935 records, of which 55 studies were extracted and categorized based on the outcomes of interest including (i) method of FACS implementation; (ii) purpose of study; (iii) consumer product-based stimuli used; and (iv) measures of affect validation. Most studies implemented FACS manually (73%) to develop products and/or software (20%) and used consumer product-based stimuli that had known and/or defined capacity to evoke a particular affective response, such as films and/or movie clips (20%); minimal attention was paid to consumer products with low levels of emotional competence or with unknown affective impact. The vast majority of studies (53%) did not validate FACS-determined affect and, of the validation measures that were used, most tended to be discontinuous in nature and only captured affect as it holistically related to an experience. This review illuminated some inconsistencies in how FACS is carried out as well as how emotional response is inferred from facial muscle activation. This may prompt researchers to consider measuring the total consumer experience by employing a variety of methodologies in addition to FACS and its emotion-based interpretation guide. Such strategies may better conceptualize consumers' experience with products of low, unknown, and/or undefined capacity to evoke an affective response such as product prototypes, line extensions, etc.

The accuracy of using administrative healthcare data to identify epilepsy cases: A systematic review of validation studies.

Our objective was to undertake a systematic review ascertaining the accuracy of using administrative healthcare data to identify epilepsy cases. We searched MEDLINE and Embase from 01/01/1975 to 03/07/2018 for studies evaluating the diagnostic accuracy of routinely collected healthcare data in identifying epilepsy cases. Any disease coding system in use since the International Classification of Diseases, Ninth Revision (ICD-9) was permissible. Two authors independently screened studies, extracted data, and quality-assessed studies. We assessed positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity. The primary analysis was a narrative synthesis of review findings. Thirty studies were included, published between 1989 and 2018. Risks of bias were low, high, and unclear in 4, 14, and 12 studies, respectively. Coding systems included ICD-9, ICD-10, and Read Codes, with or without antiepileptic drugs (AEDs). PPVs included ranges of 5.2%-100% (Canada), 32.7%-96.0% (USA), 47.0%-100% (UK), and 37.0%-88.0% (Norway). Sensitivities included ranges of 22.2%-99.7% (Canada), 12.2%-97.3% (USA), and 79.0%-94.0% (UK). Nineteen studies contained at least one algorithm with a PPV >80%. Sixteen studies contained at least one algorithm with a sensitivity >80%. PPV was highest in algorithms consisting of disease codes (ICD-10 G40-41, ICD-9 345) in combination with one or more AEDs. The addition of symptom codes to this (ICD-10 R56; ICD-9 780.3, 780.39) lowered PPV. Sensitivity was highest in algorithms consisting of symptom codes with one or more AEDs. Although using AEDs alone achieved high sensitivities, the associated PPVs were low. Most NPVs and specificities were >90%. We conclude that it is reasonable to use administrative data to identify people with epilepsy (PWE) in epidemiological research. Studies prioritizing high PPVs should focus on combining disease codes with AEDs. Studies prioritizing high sensitivities should focus on combining symptom codes with AEDs. We caution against the use of AEDs alone to identify PWE.

Interaction effect of LED color temperatures and light-protective additive packaging on photo-oxidation in milk displayed in retail dairy case.

Effect of varied LED color temperatures on photo-oxidation in 2% fat milk and protection efficiency of packaging with and without light-protective additives (LPA) under different color temperatures was firstly evaluated. Riboflavin (Rb) is one of the critical photo-sensitizers in 2% milk when exposed to LED light. Higher color temperature with higher relative intensity of Rb absorbance region resulted in lower Rb and vitamin A retention, lower dissolved oxygen content, and higher TBARS value in milk packaged with non-LPA packaging. Yellow pigmented packaging that completely blocked the Rb absorbance region of all three LED color temperatures successfully reduced the rate of degradation of milk nutrients and flavor. TiO2-added packaging partially block the destructive light wavelength; higher level of TiO2 provided a longer protection on milk freshness. Combination of appropriate LED color temperature and LPA-packaging provided a cost-effective solution for minimizing photo-oxidation in retail dairy case.

Epilepsy-related and other causes of mortality in people with epilepsy: A systematic review of systematic reviews.

BACKGROUND: This systematic review of epilepsy mortality systematic reviews evaluates comparative risks, causes, and risk factors for all-cause mortality in people with epilepsy (PWE) to specifically establish the burden of epilepsy-related deaths. METHODS: MEDLINE and Embase were searched from conception to 26/12/2018 for systematic reviews evaluating all-cause mortality in PWE of any age. Independent study selection, data extraction and quality assessment were performed. Deaths were separated into epilepsy-related and unrelated using a recently published classification system. Outcomes included standardized mortality ratio (SMR) and mortality rate (MR) in a primary analysis of comparative risks, causes, and risk factors for all-cause and epilepsy-related mortality. A narrative synthesis of review findings was used to present results, including from a secondary analysis of individual epilepsy-related death risk factors. RESULTS: Six moderate or high-quality systematic reviews were included in the primary analysis, evaluating 103 observational studies. All-cause mortality remained similarly high between 1950 and present (median SMR range 2.2-3.4). Africa had the highest SMR (median 5.4, range 2.6-7.2). SMRs were also higher for children <18 years (median 7.5, range 3.1-22.4) than adults (median 2.6, range 1.3-8.7), and for epilepsy-related (median 3.8, range 0.0-82.4,) than unrelated causes (median 1.7, range 0.7-17.6). Structural brain disease conferred the greatest risk for all-cause mortality (SMR range 24.0-41.5). Common epilepsy-related causes included alcohol, drowning, pneumonia, and suicide. In secondary analysis of nine additional systematic reviews, epilepsy-related death risk factors were reported for sudden unexpected death in epilepsy (SUDEP), drowning and suicide. CONCLUSIONS: Premature all-cause mortality remains a major problem in PWE globally, particularly in children and young adults, with most being epilepsy-related and potentially preventable. SUDEP is only one of several other common and important epilepsy-related causes of death.

Epilepsia partialis continua complicated by disseminated tuberculosis and hemophagocytic lymphohistiocytosis: a case report.

BACKGROUND: We describe a patient copresenting with epilepsia partialis continua, tuberculosis, and hemophagocytic lymphohistiocytosis. To our knowledge, this is the first documented case of this triad. CASE PRESENTATION: A 54-year-old black South African woman presented to a hospital in Scotland with an acute history of right-sided facial twitching, breathlessness, and several months of episodic night sweats. Clinical examination revealed pyrexia and continuous, stereotyped, right-sided facial contractions. These worsened with speech and continued through sleep. A clinical diagnosis of epilepsia partialis continua was made, and we provide a video of her seizures. Computed tomographic imaging of the chest and serous fluid analyses were consistent with a diagnosis of disseminated Mycobacterium tuberculosis. An additional diagnosis of hemophagocytic lymphohistiocytosis was made following the identification of pancytopenia and hyperferritinemia in peripheral blood, with hemophagocytosis evident in bone marrow investigation. We provide images of her hematopathology. The patient was extremely unwell and was hospitalized for 6 months, including two admissions to the intensive care unit for ventilatory support. She was treated successfully with high doses of antiepileptic drugs (benzodiazepines, levetiracetam, and phenytoin) and 12 months of oral antituberculosis therapy, and she underwent chemotherapy with 8 weeks of etoposide and dexamethasone for hemophagocytic lymphohistiocytosis, followed by 12 months of cyclosporine and prednisolone. CONCLUSIONS: This combination of pathologies is unusual, and this case report helps educate clinicians on how such a patient may present and be managed. A lack of evidence surrounding the coexpression of this triad may represent absolute rarity, underdiagnosis, or incomplete case ascertainment due to early death caused by untreated tuberculosis or hemophagocytic lymphohistiocytosis. Further research is needed.

Cyberbiosecurity: A New Perspective on Protecting U.S. Food and Agricultural System.

Our national data and infrastructure security issues affecting the "bioeconomy" are evolving rapidly. Simultaneously, the conversation about cyber security of the U.S. food and agricultural system (cyber biosecurity) is incomplete and disjointed. The food and agricultural production sectors influence over 20% of the nation's economy ($6.7T) and 15% of U.S. employment (43.3M jobs). The food and agricultural sectors are immensely diverse and they require advanced technologies and efficiencies that rely on computer technologies, big data, cloud-based data storage, and internet accessibility. There is a critical need to safeguard the cyber biosecurity of our bio economy, but currently protections are minimal and do not broadly exist across the food and agricultural system. Using the food safety management Hazard Analysis Critical Control Point system concept as an introductory point of reference, we identify important features in broad food and agricultural production and food systems: dairy, food animals, row crops, fruits and vegetables, and environmental resources (water). This analysis explores the relevant concepts of cyber biosecurity from food production to the end product user (such as the consumer) and considers the integration of diverse transportation, supplier, and retailer networks. We describe common challenges and unique barriers across these systems and recommend solutions to advance the role of cyber biosecurity in the food and agricultural sectors.

Efficacy of light-protective additive packaging in protecting milk freshness in a retail dairy case with LED lighting at different light intensities.

Light emitting diodes (LED) are rapidly developing as dominant lighting systems in dairy retail cases. Bright light is typically chosen to best exhibit milk products. However, high intensity LED lighting may create high potential for detrimental oxidation and destroying milk freshness. In this study, we investigated the interaction between LED light intensity, exposure time, and packaging material on limiting milk oxidation and protecting milk freshness and vitamins. Within 4 h of LED light exposure at an intensity as low as 1068 lx, light-induced oxidation occurred on 2% milkfat milk with commercial packaging including glass and translucent high-density polyethylene (HDPE) bottles. Higher light intensity (>4094 lx) and longer light exposure time (>24 h) rapidly increased the oxidation rate in milk. Polyethylene terephthalate (PET) packaging with lower oxygen permeability rate effectively reduced (P < 0.05) vitamin A degradation under low light intensity within 24 h. A combination of light-protective additive (TiO2) and oxygen barrier material (PET) successfully reduced (P < .05) the loss of dissolved oxygen and riboflavin, and decreased the formation of final oxidation products in milk, as measured by thiobarbituric reactive substances (TBARS), when exposed to high light intensity within 24 h. Lower LED light intensity in retail case was preferred by 50% of participants in a visual acceptance test; consumers are willing to consider pigmented packaging with limited visibility. Results of this study provides guidance for dairy industry in choosing appropriate LED lighting conditions and packaging to adequately display the milk products as well as minimize the degradation of milk nutrients and flavor.

Effect of lactoferrin on taste and smell abnormalities induced by chemotherapy: a proteome analysis.

Cancer patients receiving chemotherapy often experience taste and smell abnormalities (TSA). To date, the underlying molecular mechanisms of this frequent side-effect have not been determined and effective treatments are not available. This study assessed the feasibility of lactoferrin (LF) supplementation as a treatment for TSA and investigate the related mechanisms through salivary proteome analysis. Nineteen cancer patients with established TSA following chemotherapy administration were enrolled in this study. Cancer patients and additional 12 healthy subjects took LF supplements, 3 tablets per day (250 mg per tablet), for 30 days. Saliva was collected at three timepoints: baseline, 30-day LF supplementation, and 30-day post-LF supplementation. Patient's TSA level, salivary proteome, and salivary minerals at each LF treatment stage were analyzed. High TSA level was associated with high concentration of salivary Fe and loss of critical salivary immune proteins. LF supplementation significantly decreased the concentration of salivary Fe (P = 0.025), increased the abundance (P < 0.05) of salivary α-amylase and Zn-α-2-GP, and led to an overall increase of expression (≥2-fold changes) of immune proteins including immunoglobulin heavy chain, annexin A1, and proteinase inhibitor. Abundance of α-amylase and SPLUNC2 were further increased (P < 0.05) at 30-day post-LF supplementation in cancer patients. At the same time, total TSA score was significantly reduced (P < 0.001) in chemotherapy patients. This study demonstrated the feasibility of developing lactoferrin supplementation as a treatment to reduce TSA caused by chemotherapy and improve cancer patient's oral immunity.