From hospital to home. The application of e-health solutions for monitoring and management of people with epilepsy

Background. In the last 10 years, there has been an explosion in the development of mobile and wearable technologies. Recent events such as Covid 19 emergency, showed the world how clinicians need to focus more on the application of these technologies to monitor and manage their patients. Despite this, the use of innovative technologies is not now a common practice in epilepsy. This thesis aims to demonstrate how people with epilepsy (PWE) are ready to use these mobile and wearable technologies and how data collected from these solutions can have a direct impact on PWE’s life. Methods. A systematic literature search was performed to provide an accurate overview of new non- invasive EEGs and their applications in epilepsy health care and an online survey was performed to fill the literature gap on this topic. To accurately study the PWE’s experience using wearable sensors, and the value of physiological and non-physiological data collected from wearable sensors, we used EEG data collected from the hospital (RADAR-CNS), and we collected original data from an at-home study (EEG@HOME). The data can be divided into two main categories: qualitative data (online survey, semi-structured interviews), and quantitative data analysis (questionnaires, EEG, and additional non-invasive physiological variables). Results. The systematic review showed us how non-invasive portable EEGs could provide valuable data for clinical purposes in epilepsy and become useful tools in different settings (i.e., rural areas, Hospitals, and homes). These are well accepted and tolerated by PWE and health care providers, especially for the easy application, cost, and comfort. The information obtained on the acceptability of repeated long-term non-invasive measures at home (EEG@HOME) showed that the use of the portable EEG cap was in general well tolerated over the 6 months but, the use of a smartwatch and the e-seizure diary was usually preferred. The level of compliance was good in most of the individuals and any barriers or issues which affected their experience or quality of the data were highlighted (i.e., life events, issues with equipment, and hairstyle of patients). Semi-structured interviews showed that participants found the combination of the three solutions very well-integrated and easy to use. The support received and the possibility to be trained and monitored remotely were well accepted and no privacy issues were reported by any of the participants. Most of the participants also suggested how they will be happy to have a mobile solution in the future to help to monitor their condition. The graph theory measures extracted from short and/or repeated EEG segments recorded from hospitals (RADAR-CNS) allowed us to explore the temporal evolution of brain activity prior to a seizure. Finally, physiological data and non-physiological data (EEG@HOME) were combined to understand and develop a model for each participant which explained a higher or lower risk of seizure over time. We also evaluated the value of repeated unsupervised resting state EEG recorded at home for seizure detection. Conclusion. The use of new technologies is well accepted by PWE in different settings. This thesis gives a detailed overview of two main points. First: PWE can be monitored in the hospital or at home using new wearable sensors or smartphone apps, and they are ready to use them after a short training and minimal supervision. Second: repeated data collection could provide a new way of a monitor, managing, and diagnosing people with epilepsy. Future studies should focus on balancing the acceptability of the solutions and the quality of the data collected. We also suggest that more studies focusing on seizure forecasting and detection using data collected from long-term monitoring need to be conducted. Digital health is the future of clinical practice and will increase PWE safety, independency, treatment, and monitoring

Governing the interregnum: state aid rules and the COVID-19 crisis

This article focuses on the transformations and changes in the area of state aid control prompted by the COVID-19 pandemic. It attempts to provide a first assessment on the European Commission Temporary Framework on state aid measures to support the economy in the outbreak. It discusses whether the measures adopted have been effective and managed to guarantee on the one side the possibility of Member States to take swift and effective action as to ensure short and long term liquidity to undertakings affected by COVID 19 and on the other to preserve fair competition respect of state aid rules control

Intercontact times in opportunistic networks and their impact on forwarding convergence

The increasing popularity of some new mobile technologies (smartphones for example) has opened new interesting scenarios in communications because of the possibility of a device to communicate with another one without using the wireless (or wired) network interfaces but taking advantages of the mobility of all the devices. In this direction, one of the most important evolution of Mobile ad hoc networks are opportunistic networks, that are self-organizing networks where there are not any guarantee of two devices to be linked with complete multi-hop path in any time. What a node has to do to deliver a certain message, is to nd a space-time multi-hop path, that is portions of path that can carry on the message during the time until it reaches the destination. We can see an example in Figure 1: the source S has to deliver a message to the destination D; the message can arrive at D at time t3, even if in [t1,t3] S and D are not directly linked. As nodes do not have any knowledges of the network topology, but only of the destination the massage have to arrive to, this way of delivering needs at any time to make some decisions, that are to whom has to be sent message and how many copies has to be sent

Smart cements : repairs and sensors for concrete assets

Smart cements offer a unique opportunity to unify our approach to the remote monitoring and repair of concrete assets. Here, we present our latest progress in manufacturing and testing smart cement sensor-repairs based on fly ash geopolymers — a novel class of cement-like binders that cure to a strong, chemically resistant, electrically conductive shell. Since chloride and moisture are two of the leading causes of degradation of reinforced concrete, we are proposing a technology that is able to monitor chloride ingress into concretes at different levels of moisture. The main task of the work was to manufacture geopolymer binders for concrete specimens, and to cure them at ambient temperatures. We have studied how practical considerations, such as the concrete substrate’s maturity, can affect how or whether smart cements can be applied, thus understanding the main limitations of the technology. By using electrical impedance measurements, we aim to demonstrate that geopolymer skin layers can provide high resolution monitoring of chloride contamination at different levels of moisture. Here we present results which show that smart cements are sensitive to changes in humidity of the surrounding environment. Our goal is to develop a robust and field-worthy technology which unifies civil monitoring and maintenance. This goal is of key national importance to the US and many countries within Europe, who now face an ageing population of reinforced concrete bridges, tunnels and support structures

Monitoring of minimal residual disease in leukemia, advantages and pitfalls.

The term 'minimal residual disease' (MRD) defines the level of disease detectable in patients in clinical remission during therapy, below the detection limit of conventional methods. Very sensitive methods can be used, able to identify one leukemic cell out of 10,000 normal lymphocytes. In vivo measurements of leukemia cytoreduction reflect the combined effect of clinical and biological variables, thus providing direct information on the effectiveness of treatment in each patient. Thus, these methods can potentially be used for tailoring treatment and personalize the cure. Although MRD studies are becoming an integral part of the modern management of patients with leukemia, several parameters are critical for the application and interpretation of MRD studies, including therapeutic context, timing of sampling, target genes and sensitivity of the polymerase chain reaction (PCR) assay, inter-laboratory standardization (particularly relevant in multicenter studies), selection of patients, retrospective or prospective nature of the study. Methodologies and pitfalls as well as results of clinical uses of MRD will be reviewed in this article by selecting significant examples of its clinical impact in the management of patients with leukemia

Seguimiento del tratamiento restaurador de primeros molares permanentes con y sin Hipomineralización Molar

La selección y estabilidad a largo plazo de los materiales de restauración en piezas afectadas por Hipomineralización Molar (HM) es en la actualidad un tema de controversia. El objetivo de este estudio fue comparar las necesidades de tratamiento y el estado de las restauraciones realizadas en primeros molares permanentes en pacientes con y sin HM. Diseño retrospectivo sobre las historias clínicas de 153 pacientes que habían recibido atención integral en 2014, en la Clínica de la Cátedra de Odontología Integral Niños (Facultad de Odontología de la Universidad de Buenos Aires) por 3 odontopediatras (Kappa HM 0,94) y que asistieron a las recitaciones periódicas durante un mínimo de 24 meses. Se registraron las necesidades de tratamiento, tipo y longevidad de los mismos en primeros molares (criterios Ryge modificados /USPHS, Kappa 0,78). Se compararon los resultados entre los pacientes con y sin HM. Se utilizó test de Kruskal Wallis para comparar tiempos de seguimiento, test asintótico de comparación de proporciones y se calculó riesgo relativo (RR) para comparar la necesidad de tratamiento. Los tiempos medios de seguimiento de las 595 piezas analizadas resultaron de 61.7±20.1 y 57.5±23.9 meses en los grupos sin HM y con HM respectivamente (p=0.0504). Los porcentajes de piezas que requirieron al menos un tratamiento fueron 7.2% en el grupo sin HM y 27.5% en el grupo con HM. (RR = 3.80, p < 0.001) De las piezas con HM tratadas, el 23.1% requirieron retratamiento, mientras que en el grupo sin HM ninguna pieza lo necesitó. La necesidad de tratamiento fue aproximadamente 4 veces mayor en los molares afectados con HM con más probabilidad de retratamiento.The selection and long-term stability of restorative materials for teeth affected by MolarHypomineralization (MH) are controversial. The aim of this study was to compare need for treatmentand status of restorations performed on first permanent molars in patients with and without MH.Retrospective design based on the clinical records of 153 patients who had received comprehensive carein 2014 at the Clinic of the Children’s Comprehensive Dentistry Department (FOUBA) by 3 pediatricdentists (Kappa MH 0.94), and who attended periodical follow-up visits for at least 24 months. Needfor treatment in first molars, and type and longevity of treatment were recorded (modified Ryge criteria/USPHS, Kappa 0.78). Results were compared between patients with MH and without MH. TheKruskal Wallis test was used to compare follow-up time, the asymptotic test was performed to compareproportions, and relative risk (RR) was calculated to compare need for treatment.Mean follow-up times for the 595 teeth analyzed were 61.7±20.1 months for Group without MH, and57.5±23.9 months for Group with MH (p=0.0504). The percentages of teeth requiring at least onetreatment were 7.2% in Group without MH and 27.5% in Group with MH (RR = 3.80, p < 0.001). Of theteeth treated in Group with MH 23.1% required retreatment, while none of the teeth in Group withoutMH did. The need for treatment was approximately 4 times higher in molars affected with MH, withgreater probability of retreatment.Fil: Biondi, Ana. Universidad de Buenos Aires. Facultad de Odontología; ArgentinaFil: Cortese, Silvina Gabriela. Universidad de Buenos Aires. Facultad de Odontología; ArgentinaFil: Babino, Lucía. Universidad de Buenos Aires. Facultad de Odontología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Ecología, Genética y Evolución de Buenos Aires. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Ecología, Genética y Evolución de Buenos Aires; ArgentinaFil: Ortolani, Andrea. Universidad de Buenos Aires. Facultad de Odontología; Argentin