Application of microcosm experiments for quantifying lateral flow and evapotranspiration on recovering bog ecotypes.

The importance of characterizing the ecohydrological interactions in natural, damaged/drained, and restored bogs is underscored by the importance of peatlands to global climate change and the growing need for peatland restoration. An understudied aspect of peatland ecohydrology is how shallow lateral flow impacts local hydrological conditions and water balance, which are critical for peatland restoration success. A novel method is presented using microcosms installed in the field to understand the dynamics of shallow lateral flow. Analysis of the difference in water table fluctuation inside and outside the microcosm experimental areas allowed the water balance to be constrained and the calculation of lateral flow and evapotranspiration. As an initial demonstration of this method, a series of four microcosm experiments were set up in locations with differing ecological quality and land management histories, on a raised bog complex in the midlands of Ireland. The timing and magnitude of the lateral flow differed considerably between locations with differing ecological conditions, indicating that shallow lateral flow is an important determining factor in the ecohydrological trajectory of a recovering bog system. For locations where Sphagnum spp. moss layer was present, a slow continuous net lateral input of water from the upstream catchment area supported the water table during drought periods, which was not observed in locations lacking Sphagnum. Consistent with other studies, evapotranspiration was greater in locations with a Spaghnum moss layer than in locations with a surface of peat soil.

Risk-Stratification of Children Presenting to Ambulatory Paediatrics with First-Onset Seizures: Should We Order an Urgent CT Brain?

INTRODUCTION: A computed tomography (CT) brain scan is an often-utilised emergency department imaging modality to detect emergent intra-cranial pathology in a child with a first seizure. Identifying children at low risk of having a clinically significant intra-cranial abnormality could prevent unnecessary radiation exposure and contrast/sedation-related risks. OBJECTIVES: To identify clinical variables which could predict clinically significant CT brain abnormalities and use recursive partitioning analysis to define a low-risk group of children in whom emergent CT brain can be deferred. METHODS: Retrospective cross-sectional review of 468 children who underwent emergent CT brain after presenting to a low- and middle-income paediatric emergency department following first seizure. RESULTS: In total 133/468 (28.4%) of CT brain scans had clinically significant abnormalities. Failure to return to neurological baseline and focal neurological deficit persisting >36 h had statistical significance in a multiple regression analysis. Recursive partitioning analysis, applied to a subgroup without suspected tuberculous meningitis (n = 414), classified 153 children aged between 6 months and 5 years, who had a normal neurological baseline, had returned to baseline post-seizure, and were not in status epilepticus, as non-clinically significant scans and 98% were correctly classified. CONCLUSION: Our study re-inforces the American Academy of Neurology recommendation that children with persistent post-ictal abnormal neurological status and/or post-ictal focal deficit be prioritised for emergent CT brain. Having excluded children with suspected tuberculous meningitis, the remaining subgroup aged 6 months to 5 years presenting with a non-status first seizure, normal neurological baseline and return to baseline post-seizure, are at very low risk of having a clinically significant CT brain abnormality.

Intravitreal aflibercept for neovascular age-related macular degeneration in patients aged 90 years or older: 2-year visual acuity outcomes.

PURPOSE: The purpose of this study was to investigate the efficacy of intravitreal aflibercept for neovascular age-related macular degeneration (nAMD) in very elderly patients aged 90 years or older at 2 years after treatment initiation. METHODS: In this multicentre retrospective data analysis from electronic medical record, consecutive treatment-naive patients with nAMD treated with aflibercept with at least 2 years follow-up were stratified into those aged < 90 years (Group I) and an older cohort aged 90 and over (Group II). We compared the visual acuity (EDTRS letters) outcomes at 4 weekly intervals between the two groups over a 2-year period. RESULTS: The mean visual acuity of Group I at presentation was 56.3 ETDRS letters versus 52.8 letters in Group II. Maximal visual acuity was achieved in both the groups by 6 months after initiating treatment (4.7 vs. 4.0 letters gain). By 2 years, the mean visual acuity of the older cohort fell marginally below their baseline visual acuity (0.8 letter loss), while Group I presented +2.1 letters gain. The number of injections given and the retention rate of the older cohort were no different to the rest of the patients. CONCLUSIONS: Very old patients with nAMD benefited from aflibercept, but not to the same degree as the younger patients. The study showed that, on an average, the very elderly patients were able to adhere to the intensive anti-VEGF treatment regimens.