SummaryObjectiveTo summarize the existing literature on resective epilepsy surgery (RES) in older adults (≥60 years old) and examine seizure and neuropsychological outcomes in a single‐center large cohort of older adults undergoing RES and their comparison to a consecutive, younger (25‐ to45‐year‐old) adult population who underwent RES in routine clinical practice.MethodsFirst, a comprehensive literature review was performed. Then, we identified older adults who underwent RES at our center (2000–2015). Outcome analysis was performed on patients who had ≥1 year of clinical follow‐up. A younger cohort of patients who underwent RES during the same period was selected for comparison. The 2 groups were compared with respect to demographic and disease variables as well as key clinical outcomes.ResultsSeizure outcomes on 58 older patients were reported in existing literature; 72% achieved Engel class I outcome ≥1 year postoperatively. Sixty‐four older adults underwent RES at our center, accounting for 2.8% of all RES during the study period. A total of 51 older adults (Mage = 65) among them had ≥1‐year clinical follow‐up; 80% achieved Engel I outcome after a mean follow‐up of 3.2 years. This was comparable to the 68% Engel class I outcome among 50 consecutive younger adults, despite later age of onset, longer epilepsy duration, and more comorbidities (all p < 0.001) among older adults. The majority (86%) of older adults were referred to our center after years of suffering from drug‐resistant epilepsy. There were no group differences in surgical complications. However, 1 older adult passed away post‐RES. There was no difference in post‐RES neuropsychological outcomes compared to younger adults, except significantly higher number of older adults showed a decline in confrontational naming.Significance
RES in well‐selected older adults is a safe and effective therapy, and advanced age should not preclude consideration of surgical therapy in older adults with pharmacoresistant epilepsy.
Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be offered three to six IUI cycles in technology-limited settings.
Purpose. To study factors affecting patients' compliance to antiglaucoma medications in Egypt where there are unique factors as a developing country. Patients and Methods. A cross-sectional descriptive study on 440 Egyptian patients with open angle glaucoma (OAG) recruited for over two years. The patients were thoroughly interviewed about their age, education level, duration of glaucoma, difficulty in instilling the drops, medication regimens, a family history of glaucoma, knowledge of the disease, and the presence of medical insurance. Results. 236 (53.6%) were noncompliant compared to 204 (46.4%) who were compliant. Females had a tendency for higher compliance (p=0.061). Patient age above 50 years and low level of education and negative family history of glaucoma were factors significantly associated with poor compliance (p < 0.0001). Polytherapy and lack of medical insurance could be contributing factors. Conclusion. Egyptian patients have a high rate of noncompliance compared to the average in literature. Great effort is needed in educating patients about the importance of medications and the risk and the prognosis of this disease. Economic factors must also be taken into consideration in developing countries with large number of poor patients. We recommend simplifying drug regimens, incorporating electronic dose monitors, and creating reminders for follow-up visits of glaucoma patients.
Low-cost mini-drones with advanced sensing and maneuverability enable a new class of intelligent sensing systems. To achieve the full potential of such drones, it is necessary to develop new enhanced formulations of both common and emerging sensing scenarios.Namely, several fundamental challenges in visual sensing remain unsolved including: 1) Fi ing sizable targets in camera frames; 2) E ective viewpoints matching target poses; 3) Occlusion by elements in the environment, including other targets. In this paper, we introduce Argus: an autonomous system that utilizes drones to incrementally collect target information through a two-tier architecture.To tackle the stated challenges, Argus employs a novel geometric model that captures both target shapes and coverage constraints.Recognizing drones as the scarcest resource, Argus aims to minimize the number of drones required to cover a set of targets. We prove this problem is NP-hard, and even hard to approximate, before deriving a best-possible approximation algorithm along with a competitive sampling heuristic which runs up to 100x faster according to large-scale simulations. To test Argus in action, we demonstrate and analyze its performance on a prototype implementation. Finally, we present a number of extensions to accommodate more application requirements and highlight some open problems.
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