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OBJECTIVE The prevalence of epilepsy in the older adult population is increasing. While surgical intervention in younger patients is supported by level I evidence, the safety and efficacy of epilepsy surgery in older individuals is less well established. The aim of this study was to evaluate seizure freedom rates and surgical outcomes in older epilepsy patients. METHODS The authors’ institutional electronic database was queried for patients older than 50 who had undergone epilepsy surgery during 2002–2018. Cases were grouped into 50–59, 60–69, and 70+ years old. Seizure freedom at the last follow-up constituted the primary outcome of interest. The institutional analysis was supplemented by a literature review and meta-analysis (random effects model) of all published studies on this topic as well as by an analysis of complication rates, mortality rates, and cost data from a nationwide administrative database (Vizient Inc., years 2016–2019). RESULTS A total of 73 patients (n = 16 for 50–59 years, n = 47 for 60–69, and n = 10 for 70+) were treated at the authors’ institution. The median age was 63 years, and 66% of the patients were female. At a median follow-up of 24 months, seizure freedom was 73% for the overall cohort, 63% for the 50–59 group, 77% for the 60–69 group, and 70% for the 70+ group. The literature search identified 15 additional retrospective studies (474 cases). Temporal lobectomy was the most commonly performed procedure (73%), and mesial temporal sclerosis was the most common pathology (52%), followed by nonspecific gliosis (19%). The pooled mean follow-up was 39 months (range 6–114.8 months) with a pooled seizure freedom rate of 65% (95% CI 59%–72%). On multivariable meta-regression analysis, an older mean age at surgery (coefficient [coeff] 2.1, 95% CI 1.1–3.1, p < 0.001) and the presence of mesial temporal sclerosis (coeff 0.3, 95% CI 0.1–0.6, p = 0.015) were the most important predictors of seizure freedom. Finally, analysis of the Vizient database revealed mortality rates of 0.5%, 1.1%, and 9.6%; complication rates of 7.1%, 10.1%, and 17.3%; and mean hospital costs of $31,977, $34,586, and $40,153 for patients aged 50–59, 60–69, and 70+ years, respectively. CONCLUSIONS While seizure-free outcomes of epilepsy surgery are excellent, there is an expected increase in morbidity and mortality with increasing age. Findings in this study on the safety and efficacy of epilepsy surgery in the older population may serve as a useful guide during preoperative decision-making and patient counseling.

Although stereotactic EEG (sEEG) has become a widely used intracranial EEG technique, the significance of subclinical seizures (SCS) recorded on sEEG is unclear and studies examining this finding on sEEG are limited. We investigated (1) the prevalence of SCS in patients undergoing sEEG and clinical factors associated with their presence, (2) how often the subclinical seizure onset zone (SOZ) colocalizes with clinical SOZ, (3) the association of SCS and surgical outcomes, and (4) the influence of resection of the subclinical SOZ on surgical outcome.We reviewed all patients who underwent intracranial monitoring with sEEG at our institution from 2015 through 2020 (n=169). Patient and seizure characteristics were recorded, as was concordance of subclinical and clinical seizures and post-surgical outcomes.SCS were observed during sEEG monitoring in 84 of 169 patients (50%). There was no difference in the prevalence of SCS based on imaging abnormalities, temporal vs extratemporal SOZ, number of electrodes, or pathology. SCS were more common in females than males (62% vs 40%, p=0.0054). SCS had complete concordance with clinical SOZ in 40% of patients, partial concordance in 29%, overlapping in 19%, and discordant in 12%. Eighty-three patients had surgery, 44 of whom had SCS. There was no difference in excellent outcome (ILAE 12 or 2) based on the presence of SCS or SCS concordance with clinical SOZ; however, there were improved outcomes in patients with complete resection of the subclinical SOZ compared with patients with incomplete resection (p =0.013).These findings demonstrate that SCS are common during sEEG and colocalize with the clinical SOZ in most patients. Discordance with clinical SOZ does not necessarily predict poor surgical outcome; rather, complete surgical treatment of the subclinical SOZ correlates with excellent outcome. For unclear reasons, subclinical seizures occurred more commonly in females than males.

Pulverised coal injection (PCI) is used in ironmaking to replace expensive and energy intensive coke with coal, reducing overall costs and greenhouse gas emissions. As the coke making process removes some of the sulphur present in coal, the utilisation of PCI results in the admission of greater levels of sulphur into the blast furnace. The increased sulphur levels could potentially lead to an increase in costs and energy usage related to hot metal sulphur removal processes. In an increasingly volatile market, the ability to make use of higher sulphur coals is also of both financial and logistical relevance.\ud\udThis work aims to produce a more thorough understanding of the transformation of sulphur introduced through PCI into the blast furnace, leading to changes in coal selection, blending, or mitigation efforts.\ud\udThe volatilisation of sulphur from four coals used in PCI was investigated using a drop tube furnace (DTF) to produce conditions similar to a blast furnace raceway. Chars and flue gases were analysed using a range of techniques, including X-ray photoelectron spectroscopy (XPS), thermogravimetric analysis, and wet chemistry methods.\ud\udThe coal’s burnout was found to be the biggest factor in coal sulphur volatilisation. It was found that a coal’s volatile matter content was a key indicator into the volatility of a coal’s sulphur content; it influences the rate of a coal’s burnout, the availability of hydrogen for the formation of H2S, and the reactivity of the produced chars. Coals with higher volatile matter contents are more likely to volatilise their sulphur component at shorter residence times than coals with lower volatile matter contents. The bonding of volatilised sulphur to nascent char was seen in coals with lower volatile matter contents. The sulphur forms present in the initial coal samples were shown to influence the sulphur forms found in the collected chars.

Net outcome‐type biodiversity policies are proliferating globally as perceived mechanisms to reconcile economic development and conservation objectives. The UK government's Environment Bill will mandate that most new developments in England demonstrate that they deliver a biodiversity net gain (BNG) to receive planning permission, representing the most wide‐ranging net outcome type policy globally. However, as with many nascent net‐outcome policies, the likely outcomes of mandatory BNG have not been explored empirically. We assemble all BNG assessments (accounting for ∼6% of England's annual housebuilding and other infrastructure) submitted from January 2020 to February 2021 in six early‐adopter councils who are implementing mandatory no net loss or BNG requirements in advance of the national adoption of mandatory BNG, and analyze the aggregate habitat changes proposed. Our sample is associated with a 34% reduction in the area of nonurban habitats, generally compensated by commitments to deliver smaller areas of higher quality habitat years later in the development project cycle. Ninety‐five percent of biodiversity units delivered in our sample come from habitats within or directly‐adjacent to the development footprint managed by the developers. However, we find that these gains fall within a governance gap whereby they risk being unenforceable, a challenge that is shared with other net outcome type policies implemented internationally.

Renewably generated ammonia offers a form of carbon-free chemical energy storage to meet the differences between uncertain renewable supply and fluctuating demand, and has the potential to support future energy requirements as a power-to-X concept. The storage and transportation characteristics of NH3 are favorable compared with H2, however there are significant combustion research challenges to enhance fuel reactivity whilst reducing harmful emissions production. The purpose of the presented work was to evaluate different fuel delivery concepts for a representative GT combustor. An experimental and numerical comparison was made between swirl-stabilized premixed and diffusion NH3-air flames at elevated inlet temperature (473 K). The exhaust NOx and unburned NH3 emissions generated from each concept were quantified to optimize operational combustor performance. High-speed OH* and NH2* chemiluminescence was employed to characterize the change in flame topology with variation in fuel-air equivalence ratio, and the resultant influence on measured emission concentrations. Chemiluminescence intensities were shown to elucidate changes in sampled exhaust emissions, enabling detailed analysis of intermediate chemistry. A comparison was made between experimental data and chemical kinetic simulations with a reactor network model, demonstrating the sensitivity of NOx emissions to premixed fuel-air equivalence ratio. A comparison was also made between exclusive primary airflow, and the staged introduction of secondary air, to quantify the change in NOx production between each configuration and improve fuel burnout. Secondary air loadings were incrementally increased through the combustor, and the change in exhaust emissions mapped. In addition, reactant humidification was employed as a secondary process for NOx reduction, having shown favorable performance with NH3/H2 mixtures to limit thermochemical NO production. The efficacy of humidification was compared for both premixed and diffusion configurations.

The majority of spinal meningiomas are grade I tumors, as defined by World Health Organization (WHO) classification making atypical (grade II) or anaplastic (grade III) tumors extremely rare lesions to encounter in clinical practice. Here, we present our institutional experience of management of grade II and III spinal meningiomas. Following IRB approval, we queried all available institutional electronic medical records for patients undergoing surgical resection of pathology-proven spinal meningiomas, with further review of patients with grade II and III. Variables of interest included age, sex, histological type, tumor size, symptoms at baseline, treatment characteristics, symptom resolution at the last follow-up, recurrence, NF-2 status, concurrent intracranial meningioma, and mortality. Kaplan Meier curves were constructed to study time to progression/recurrence. A total of 188 patients undergoing surgical resection of spinal meningioma between 1988 and 2018 were identified. Among those, 172 (91.5%) patients had grade I meningioma and 16 (8.5%) patients had high grade meningiomas [grade II (15) and III (1)]. Over a median (IQR) follow-up of 8.0 years (5.1–13.0), mortality and recurrence rates were 18.8% (n = 3) and 47.1% (n = 8), respectively. In univariate analysis, adjuvant radiotherapy and thoracic segment involvement were associated with lower rates of recurrence while male sex was associated with a higher rate of recurrence. Results showed variations in clinical outcomes for patients with high grade spinal meningiomas, especially the recurrence. Adjuvant radiotherapy and thoracic segment involvement was associated with lower rates of recurrence while recurrence ocurred at a higher rate in males.

Energy storage is one of the highest priority challenges in transitioning to a low-carbon economy. Fluctuating, intermittent primary renewable sources such as wind and solar require low-carbon storage options to enable effective load matching, ensuring security of supply. Chemical storage is one such option, with low or zero carbon fuels such as hydrogen, alcohols and ammonia having been proposed. Ammonia provides zero-carbon hydrogen storage whilst offering liquefaction at relatively low pressures and atmospheric temperatures, enabling ease of transportation in a pre-existing infrastructure. Ammonia can also be used directly as a fuel in power plants such as gas turbines to avoid complete conversion back to hydrogen. It is a relatively unreactive fuel, and so it is of interest to explore the potential utilisation of ammonia/hydrogen mixtures. Hence, the goal of this paper is to provide a first assessment of the suitability of a chosen 70%NH330%H2 (%vol) blend for utilisation within a gas turbine environment, based on primary combustion diagnostics including combustion stability – via OH chemiluminescence - and emissions (NOx and NH3). An established optical generic swirl-burner enabled studies of the influence of equivalence ratio (φ > 1), ambient temperature (

The majority of spinal meningiomas are grade I tumors, as defined by World Health Organization (WHO) classification making atypical (grade II) or anaplastic (grade III) tumors extremely rare lesions to encounter in clinical practice. Here, we present our institutional experience of management of grade II and III spinal meningiomas.Following IRB approval, we queried all available institutional electronic medical records for patients undergoing surgical resection of pathology-proven spinal meningiomas, with further review of patients with grade II and III. Variables of interest included age, sex, histological type, tumor size, symptoms at baseline, treatment characteristics, symptom resolution at the last follow-up, recurrence, NF-2 status, concurrent intracranial meningioma, and mortality. Kaplan Meier curves were constructed to study time to progression/recurrence.A total of 188 patients undergoing surgical resection of spinal meningioma between 1988 and 2018 were identified. Among those, 172 (91.5%) patients had grade I meningioma and 16 (8.5%) patients had high grade meningiomas [grade II (15) and III (1)]. Over a median (IQR) follow-up of 8.0 years (5.1-13.0), mortality and recurrence rates were 18.8% (n = 3) and 47.1% (n = 8), respectively. In univariate analysis, adjuvant radiotherapy and thoracic segment involvement were associated with lower rates of recurrence while male sex was associated with a higher rate of recurrence.Results showed variations in clinical outcomes for patients with high grade spinal meningiomas, especially the recurrence. Adjuvant radiotherapy and thoracic segment involvement was associated with lower rates of recurrence while recurrence ocurred at a higher rate in males.

Steelmaking is energy intensive, with manufacturing facilities representing some of the biggest point-source carbon dioxide (CO2) emitters in the UK. Efficiency improvements are essential with rising energy costs, driving significant investment from the UK iron and steel sector. However, the industry still finds it difficult to justify waste heat recovery (WHR) projects, as individual schemes incorporating waste heat capture and an end-use for the waste heat often incur high capital costs, resulting in long payback times. This paper describes the conceptual and numerical development of a strategy for the deployment of WHR using a large integrated steel works as a case study. An existing asset was utilised to link individual waste heat schemes together with a single end-user; thereby reducing the capital requirement for each subsequent project. The proposed strategy and its development is discussed, followed by the resultant carbon dioxide and energy savings (estimated to be 2.3 Mt and equivalent to £45 million), over the 6-year period since its implementation.