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ObjectiveTo determine whether 1-stage, limited corticectomy controls seizures in patients with MRI-positive, bottom-of-sulcus dysplasia (BOSD).MethodsWe reviewed clinical, neuroimaging, electrocorticography (ECoG), operative, and histopathology findings in consecutively operated patients with drug-resistant focal epilepsy and MRI-positive BOSD, all of whom underwent corticectomy guided by MRI and ECoG.ResultsThirty-eight patients with a median age at surgery of 10.2 (interquartile range [IQR] 6.0–14.1) years were included. BOSDs involved eloquent cortex in 15 patients. Eighty-seven percent of patients had rhythmic spiking on preresection ECoG. Rhythmic spiking was present in 22 of 24 patients studied with combined depth and surface electrodes, being limited to the dysplastic sulcus in 7 and involving the dysplastic sulcus and gyral crown in 15. Sixty-eight percent of resections were limited to the dysplastic sulcus, leaving the gyral crown. Histopathology was focal cortical dysplasia (FCD) type IIb in 29 patients and FCDIIa in 9. Dysmorphic neurons were present in the bottom of the sulcus but not the top or the gyral crown in 17 of 22 patients. Six (16%) patients required reoperation for postoperative seizures and residual dysplasia; reoperation was not correlated with ECoG, neuroimaging, or histologic abnormalities in the gyral crown. At a median 6.3 (IQR 4.8–9.9) years of follow-up, 33 (87%) patients are seizure-free, 31 off antiseizure medication.ConclusionBOSD can be safely and effectively resected with MRI and ECoG guidance, corticectomy potentially being limited to the dysplastic sulcus, without need for intracranial EEG monitoring and functional mapping.Classification of EvidenceThis study provides Class IV evidence that 1-stage, limited corticectomy for BOSD is safe and effective for control of seizures.

IntroductionHaving a balanced gender distribution is thought to ensure the diversity of knowledge and know‐how and take better into account the different needs in society. The aim of the study is to explore and understand possible gender differences in (a) the students’ motivational spectrum to choose a dental education and (b) their prospect of a professional career in dentistry.MethodsWe conducted in‐depth interviews with male and female dental students (n = 14) followed by a theoretical reading based on Self‐Determination Theory to explore the students’ intrinsic and extrinsic motivations for entering dentistry in Denmark.ResultsRegardless gender, the dental students are motivated by role models, people orientation and strong interest in health sciences, but prefer dentistry to medicine, because of the responsibilities and working conditions. They were also motivated by the dental school's combination of theory and practice in students’ learning of craftsmanship. Moreover, students valued the prospect of job security and a good work‐life balance. However, there were markedly gender differences in motivation in relation to financial incentives as well as working life and career as a dentist, as it seemed that dental students needed gendered relatedness in relation to specialisation and employment in public versus private sector.ConclusionThe motivational spectrum varies widely, regardless of gender. In line with the standpoint feminist theory, a balanced gender distribution in dental education helps to meet the different needs in society and labour market. Consequently, a gender‐sensitive recruitment strategy reflecting the gender differences in identities, knowledge and interests will be needed.

Background End-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses’ attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe. Methods A descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania. Results Registered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient’s spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient’s relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient’s family, lack of evaluation of nurses’ opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement. Conclusions Spiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

We report a child with a history of temporal-parietal-occipital disconnection for epilepsy secondary to posterior quadrantic dysplasia who developed recurrent and prolonged bouts of distress and autonomic disturbance associated with EEG and PET evidence of status epilepticus confined to his disconnected cortex. These bouts were refractory to antiseizure medications but resolved following resection of the disconnected cortex. In the absence of synaptic connections, we hypothesise that his seizure-related symptoms were mediated either by neurochemical transmission in preserved vascular and lymphatic channels or by ephaptic transmission to trigeminal nerve fibres in overlying dura, producing symptoms akin to migraine. The case highlights potential means by which seizures may manifest clinically, without synaptic connections, and adds to the differential for symptoms post-disconnection surgery.

Purpose Neurological complications of influenza cause significant disease in children. Central nervous system inflammation, the presumed mechanism of influenza-associated encephalopathy, is difficult to detect. Characteristics of children presenting with severe neurological complications of influenza, and potential biomarkers of influenza-associated encephalopathy are described. Methods A multi-center, retrospective case-series of children with influenza and neurological complications during 2017 was performed. Enrolled cases met criteria for influenza-associated encephalopathy or had status epilepticus. Functional outcome at discharge was compared between groups using the Modified Rankin Scale (mRS). Results There were 22 children with influenza studied of whom 11/22 had encephalopathy and 11/22 had status epilepticus. Only one child had a documented influenza immunization. The biomarker CSF neopterin was tested in 10/11 children with encephalopathy and was elevated in 8/10. MRI was performed in all children with encephalopathy and was abnormal in 8 (73%). Treatment of children with encephalopathy was with corticosteroids or intravenous immunoglobulin in 9/11 (82%). In all cases oseltamivir use was low (59%) while admission to the intensive care unit was frequent (14/22, 66%). Clinical outcome at discharge was moderate to severe disability (mRS score > 2) in the majority of children with encephalopathy (7/11, 64%), including one child who died. Children with status epilepticus recovered to near-baseline function in all cases. Conclusion Raised CSF neopterin was present in most cases of encephalopathy, and along with diffusion restriction on MRI, is a useful diagnostic biomarker. Lack of seasonal influenza vaccination represents a missed opportunity to prevent illness in children, including severe neurological disease., Highlights • Elevated CSF neopterin was common in cases of IAE. • Short term outcome for IAE was poor, particularly in those with MRI diffusion restriction. • Seasonal influenza vaccination is important for all children.

ObjectiveProlonged continuous video-electroencephalography (cEEG) is recommended for neonates at risk of seizures. The cost and expertise required to provide a real-time response to detected seizures often limits its utility. We hypothesised that the first hour of cEEG could predict subsequent seizures.Design and settingRetrospective multicentre diagnostic accuracy study.Patients266 term neonates at risk of seizure or with suspected seizures.InterventionThe first hour of cEEG was graded by expert and novice interpreters as normal, mildly, moderately or severely abnormal; seizures were identified.Main outcome measuresAssociation between abnormalities in the first hour of cEEG and the presence of seizures during total cEEG monitoring.Results50/98 (51%) of neonates who developed seizures had their first seizure in the first hour of cEEG monitoring. The ‘time-to-event’ risk of seizure from 0 to 96 hours was 0.38 (95% CI 0.32 to 0.44) while the risk in the first hour was 0.19 (95% CI 0.15 to 0.24). cEEG background was normal in 48% of neonates, mildly abnormal in 30%, moderately abnormal in 13% and severely abnormal in 9%. Inter-rater agreement for determination of background was very good (weighted kappa=0.81, 95% CI 0.72 to 0.91). When neonates with seizures during the first hour were excluded, an abnormal background resulted in 2.4 times increased risk of seizures during the subsequent monitoring period (95% CI 1.3 to 4.4, pConclusionsThe first hour of cEEG in at-risk neonates is useful in identifying and predicting whether seizures occur during cEEG monitoring up to 96 hours. This finding enables identification of high-risk neonates who require closer observation.

Endovascular clot retrieval (ECR) is an emerging therapy for treatment of acute ischaemic stroke (AIS) in adults, including basilar artery occlusion (BAO). Its role in children is not well established. We report four consecutive children with AIS due to BAO treated with ECR in Sydney, Australia. We reviewed the literature to characterize the 'natural course' of AIS due to BAO in children not treated with thrombolysis or ECR, and compared their outcome with our patients and reported children with BAO treated with ECR. Despite delays in diagnosis, ECR achieved recanalization in our four children. Three children had a good outcome (Paediatric Modified Rankin Score [PedmRS] 0-2). One child with acute leukaemia suffered recurrent basilar occlusion and died of brainstem dysfunction. Literature review identified 111 children exhibiting the natural course of AIS due to BAO, among whom 42% had good outcomes (PedmRS 0-2), 48% had significant residual disability (PedmRS 3-5), and 10% died. Of 34 children treated with ECR, 28 (82%) had good outcomes (PedmRS 0-2), five (15%) had significant residual disability (PedmRS 3-5), and one (3%) died. Complications of ECR were uncommon. These observations suggest ECR may be beneficial for children with AIS due to BAO. WHAT THIS PAPER ADDS: Children with acute ischaemic stroke (AIS) due to basilar artery occlusion (BAO) experience significant morbidity and mortality. Endovascular clot retrieval may be beneficial in children with AIS due to BAO.

Defining and re-defining identity is important for any profession, particularly so for tertiary learning advisors (TLAs) in the increasingly uncertain tertiary education environment in Aotearoa New Zealand. In the past ten years, two national surveys of learning centres in tertiary institutions sketched the professional status of TLAs, based on data from managers; there has been little research, however, on individual TLAs’ perspectives of their professional status. This special issue, ‘Identity and Opportunity’, reports on a project designed to address that gap, in three parts: building a professional profile, acknowledging learning advisors’ contribution, and rewards and challenges of the role. The findings indicate that TLAs are highly qualified and experienced but – for many – their skills and experience are not adequately recognised by institutions. There are significant barriers to progression within their institution, stemming mainly from organisational policies. Despite that lack of clear career opportunities, and other frustrations, overall satisfaction with the TLA role is high. Underpinning the findings, however, are issues of identity and recognition that should be addressed to ensure a resilient profession. Keywords: professional identity, tertiary learning advisor, higher education, career, job satisfaction

An 8-week-old term infant with congenital nephrotic syndrome developed stiffening following general anesthetic. His neurologic examination and EEG were normal. MRI brain demonstrated a large mass of dysplastic brain isointense to cortex with intervening “sulcal” spaces (figure). The infant continued to have infrequent seizures.

Background Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in preschool children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups. Methods We investigated an established cohort of 6846 NZ children, born in 2009-10, with linkage to a national dataset of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children. Results In the whole cohort, factors associated with ID hospitalisation were Māori (OR=1.49, 95%CI 1.17-1.89) or Pacific (2.51, 2.00-3.15) vs. European maternal ethnicity, male gender (1.32, 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for Factors associated with ID hospitalisation for Māori infants were: high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants: delayed immunization (1.72, 1.23-2.38), maternal experience of healthcare racism (2.20, 1.29-3.70), and maternal smoking (1.59, 1.10-2.29). Conclusions: Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.

This study was undertaken as a preliminary investigation to compare cycling errors and sudden stopping distance in secondary students traversing an obstacle course on their bicycle with and without a schoolbag, to determine if further studies of cycling accident aetiology amongst children were warranted. Twenty children cycled as fast as they could around an obstacle course. Each child undertook two separate trials, about an hour apart on a morning of the same day. The children traversed the course one at a time in turn using their own bicycle and wearing their own usual school clothes. For the first trial they did not carry a schoolbag. On the second trial they carried a schoolbag weighing 6 kg. There were no significant differences in the number of cycling errors made by the children when traversing the obstacle course with and without a schoolbag. However, the children generally took longer to complete the course when carrying the schoolbag and stopping distances were greater. It was not possible to be certain that these findings were genuine or whether the effect of carrying the schoolbag was reduced by increased familiarity with the course, since all of the children first traversed the course without a schoolbag and then with one. It is concluded that there is some justification for conducting further studies to explore the implications of carrying schoolbags on cycling accident aetiology amongst children.

Victoria University offers a number of peer-support and mentoring programs for first-year students, including Te Pūtahi Atawahi (mentoring and holistic support for Māori and Pasifika students), PASS (Peer Assisted Study Support) and Campus Coaches (Orientation Week guides). In the past, despite having similar goals of providing peer-support to foster a sense of community, such programs have operated in isolation. However, a recent initiative has seen the development of a core leadership training module, jointly designed and delivered by staff from Te Pūtahi Atawhai and Student Learning Support. Seeking to equip student-leaders with an understanding of some of the holistic Māori values, Kotahitanga (unity), Ako (teaching and learning), Manaakitanga (empathy/hospitality), Whakamana (respect), Whakanui (acknowledging success), Whakawhanaungatanga (building strong networks) and Rangatiratanga (ability to bring groups together/Self-direction), this core training offers the potential to strengthen Treaty of Waitangi relationships and nurture inter-cultural awareness, developing a pan-university sense of belongingness in the process.&nbsp

Experimental investigation of the developed eye tumors diagnostic system has revealed the tasks of system improvement, like reduction of the noise level of the preamplifier. The reliable solution is selection of analogue components of the preamplifier possessing as low noise level as available in the market of electronic components supply. Simultaneously, well known techniques of noise reduction should be used during the process design also. This paper discuses the design and development of the ultra-low noise preamplifier for medical applications. For the preamplifier schematic the principle of low frequency amplification with reduced the amplifier noise by n , where n is the number of amplifiers, is proposed. Using the final design of the preamplifier the noise factor value of 0.46 dB with gain of 48 dB and bandwidth of 2-35 MHz has been achieved.

A history of fractures is a well recognised risk factor for a new clinical fracture. However, this subsequent fracture risk is not constant, but fluctuates over time, with the greatest increase in the years immediately after the initial fracture, followed by a gradual waning of risk toward the population risk. The clustering of fractures occurred regardless of age, gender and initial fracture location. It is therefore likely that fracture risk models, which take into account this fluctuation of fracture risk over time, will be more relevant in predicting an individual's subsequent fracture risk. Regardless of the cause of this clustering, these studies all strongly support the need for early action after an initial fracture to reduce the preventable risk of subsequent fractures with medical interventions that have been shown to immediately decrease the risk of fractures.

Expert information in the form of decision or evaluation is often used to solve tasks with the help of artificial intelligence theory and methods. The usage of information has strict requirements for the degree of expert consensus. Unfortunately, the format of calculation of the degree of consensus does not cover in the practice existing spectrum of the task format, so it is necessary adapt a practical task to a theoretical method format. The paper describes one of the methods and research being evaluated.

This paper outlines some of the efforts that have been taken towards the formation of a national alcohol policy in New Zealand and its relevance for prevention planning in New Zealand. Strategies on the availability, taxation, advertising, and shaping of attitudes towards alcohol are discussed from a public health perspective. Preventive advances in alcohol education and health-related promotions for adolescents are also described. A Maori perspective on health and a women's perspective on alcohol prevention are considered essential factors specific to the formulation of a New Zealand alcohol policy. The implementation of any alcohol policy will depend on the level of support achieved, not only at the national level, but also in the wider community.

Satellite oceanic remote sensing is beginning to play important roles in fishery research and fish harvesting. Spaceborne sensors make synoptic oceanic measurements for use in determining variations in ocean conditions which play key roles in causing fluctuations in stocks of fishes and in their vulnerability to harvesting.

Satellite techniques for measurement of sea surface temperature (SST) are reviewed briefly, and a discussion of satellite SST applications and recent research in oceanography is provided. These applications include the areas of climate, mesoscale oceanography, and fisheries. Examples given focus mainly on the Pacific and California Current regions. Satellite SST data are currently used operationally for fisheries applications and, in conjunction with in situ data, are providing new insights into mesoscale oceanographic phenomena. Requirements for sensor precision and calibration accuracy are more stringent in air-sea interaction studies and climate research, thus satellite data have gained only qualified acceptance for these applications. Improvements in future satellite instruments, more comprehensive in situ sensor deployments, and better data management procedures should eventually satisfy most oceanography and climate SST requirements.