Self-Reporting Technologies for Supporting Epilepsy Treatment

Epilepsy diagnosis and treatment relies heavily on patient self-reporting for informing clinical decision-making. These self-reports are traditionally collected from handwritten patient journals and tend to be either incomplete or inaccurate. Recent mobile and wearable health tracking developments stand to dramatically impact clinical practice through supporting patient and caregiver data collection activities. However, the specific types and characteristics of the data that clinicians need for patient care are not well known. In this study, we conducted interviews, a literature review, an expert panel, and online surveys to assess the availability and quality of patient-reported data that is useful but reported as being unavailable, difficult for patients to collect, or unreliable during epilepsy diagnosis and treatment, respectively. The results highlight important yet underexplored data collection and design opportunities for supporting the diagnosis, treatment, and self-management of epilepsy and expose notable gaps between clinical data needs and current patient practices

Field Validation of Toxicity Tests to Evaluate the Potential for Beneficial Use of Produced Water

This study investigated potential biological effects of produced water contamination derived from occasional surface overflow and possible subsurface intrusion at an oil production site along the shore of Skiatook Lake, Oklahoma. We monitored basic chemistry and acute toxicity to a suite of standard aquatic test species (fathead minnow-Pimephales promelas, Daphnia pulex, Daphnia magna, and Ceriodaphnia dubia) in produced water and in samples taken from shallow groundwater wells on the site. Toxicity identification evaluations and ion toxicity modeling were used to identify toxic constituents in the samples. Lake sediment at the oil production site and at a reference site were also analyzed for brine intrusion chemically and by testing sediment toxicity using the benthic invertebrates, Chironomus dilutus, and Hyallela azteca. Sediment quality was also assessed with in situ survival and growth studies with H. azteca and the Asian clam, Corbicula fluminea, and by benthic macroinvertebrate community sampling. The produced water was acutely toxic to the aquatic test organisms at concentrations ranging from 1% to 10% of the whole produced water sample. Toxicity identification evaluation and ion toxicity modeling indicated major ion salts and hydrocarbons were the primary mixture toxicants. The standardized test species used in the laboratory bioassays exhibited differences in sensitivity to these two general classes of contaminants, which underscores the importance of using multiple species when evaluating produced water toxicity. Toxicity of groundwater was greater in samples from wells near a produced water injection well and an evaporation pond. Principle component analyses (PCA) of chemical data derived from the groundwater wells indicated dilution by lake water and possible biogeochemical reactions as factors that ameliorated groundwater toxicity. Elevated concentrations of major ions were found in pore water from lake sediments, but toxicity from these ions was limited to sediment depths of 10 cm or greater, which is outside of the primary zone of biological activity. Further, exposure to site sediments did not have any effects on test organisms, and macroinvertebrate communities did not indicate impairment at the oil production site as compared to a reference site. In situ experiments with H. azteca and C. fluminea, indicated a sublethal site effect (on growth of both species), but these could not be definitively linked with produced water infiltration. Severe weather conditions (drought followed by flooding) negatively influenced the intensity of lake sampling aimed at delineating produced water infiltration. Due to the lack of clear evidence of produced water infiltration into the sub-littoral zone of the lake, it was not possible to assess whether the laboratory bioassays of produced water effectively indicate risk in the receiving system. However, the acutely toxic nature of the produced water and general lack of biological effects in the lake at the oil production site suggest minimal to no produced water infiltration into surficial lake sediments and the near-shore water column. This study was able to demonstrate the utility of ion toxicity modeling to support data from toxicity identification evaluations aimed at identifying key toxic constituents in produced water. This information could be used to prioritize options for treating produced water in order to reduce toxic constituents and enhance options for reuse. The study also demonstrated how geographic information systems, toxicity modeling, and toxicity assessment could be used to facilitate future site assessments

Multicenter clinical assessment of improved wearable multimodal convulsive seizure detectors

Objective New devices are needed for monitoring seizures, especially those associated with sudden unexpected death in epilepsy (SUDEP). They must be unobtrusive and automated, and provide false alarm rates (FARs) bearable in everyday life. This study quantifies the performance of new multimodal wrist-worn convulsive seizure detectors. Methods Hand-annotated video-electroencephalographic seizure events were collected from 69 patients at six clinical sites. Three different wristbands were used to record electrodermal activity (EDA) and accelerometer (ACM) signals, obtaining 5,928 h of data, including 55 convulsive epileptic seizures (six focal tonic–clonic seizures and 49 focal to bilateral tonic–clonic seizures) from 22 patients. Recordings were analyzed offline to train and test two new machine learning classifiers and a published classifier based on EDA and ACM. Moreover, wristband data were analyzed to estimate seizure-motion duration and autonomic responses. Results The two novel classifiers consistently outperformed the previous detector. The most efficient (Classifier III) yielded sensitivity of 94.55%, and an FAR of 0.2 events/day. No nocturnal seizures were missed. Most patients had <1 false alarm every 4 days, with an FAR below their seizure frequency. When increasing the sensitivity to 100% (no missed seizures), the FAR is up to 13 times lower than with the previous detector. Furthermore, all detections occurred before the seizure ended, providing reasonable latency (median = 29.3 s, range = 14.8–151 s). Automatically estimated seizure durations were correlated with true durations, enabling reliable annotations. Finally, EDA measurements confirmed the presence of postictal autonomic dysfunction, exhibiting a significant rise in 73% of the convulsive seizures. Significance The proposed multimodal wrist-worn convulsive seizure detectors provide seizure counts that are more accurate than previous automated detectors and typical patient self-reports, while maintaining a tolerable FAR for ambulatory monitoring. Furthermore, the multimodal system provides an objective description of motor behavior and autonomic dysfunction, aimed at enriching seizure characterization, with potential utility for SUDEP warning

Structure of the germline genome of Tetrahymena thermophila and relationship to the massively rearranged somatic genome

The germline genome of the binucleated ciliate Tetrahymena thermophila undergoes programmed chromosome breakage and massive DNA elimination to generate the somatic genome. Here, we present a complete sequence assembly of the germline genome and analyze multiple features of its structure and its relationship to the somatic genome, shedding light on the mechanisms of genome rearrangement as well as the evolutionary history of this remarkable germline/soma differentiation. Our results strengthen the notion that a complex, dynamic, and ongoing interplay between mobile DNA elements and the host genome have shaped Tetrahymena chromosome structure, locally and globally. Non-standard outcomes of rearrangement events, including the generation of short-lived somatic chromosomes and excision of DNA interrupting protein-coding regions, may represent novel forms of developmental gene regulation. We also compare Tetrahymenas germline/soma differentiation to that of other characterized ciliates, illustrating the wide diversity of adaptations that have occurred within this phylum.</p

The Role of Lifelong Learning in Political Stability and Non-Violence: Evidence from Africa

Purpose – Education as a weapon in the fight against conflict and violence remains widely debated in policy and academic circles. Against the background of growing political instability in Africa and the central role of the knowledge economy in 21st century development, this paper provides three contributions to existing literature. It assesses how political stability/ non-violence is linked to the incremental, synergy and lifelong learning effects of education. Design/methodology/approach – We define lifelong learning as the combined knowledge acquired during primary, secondary and tertiary education. Principal component analysis is used to reduce the dimensions of educational and political indicators. An endogeneity robust dynamic system Generalized Methods of Moments is used for the estimations. Findings – We establish three main findings. First, education is a useful weapon in the fight against political instability. Second, there is an incremental effect of education in the transition from secondary to tertiary schools. Third, lifelong learning also has positive and synergy effects. This means that the impact of lifelong learning is higher than the combined independent effects of various educational levels. The empirical evidence is based on 53 African countries for the period 1996-2010. Practical implications – A plethora of policy implications are discussed, inter alia: how the drive towards increasing the knowledge economy through lifelong learning can be an effective tool in the fight against violence and political insurgency in Africa. Originality/value – As the continent is nursing knowledge economy ambitions, the paper is original in investigating the determinants of political stability/non violence from three dimensions of education attainment: the incremental, the lifelong learning and a synergy effect

Who is Who in Knowledge Economy in Africa?

This study assesses the knowledge economy (KE) performance of lagging African countries vis-à-vis their frontier counterparts with regard to the four dimensions of the World Bank’s knowledge economy index (KEI). The empirical exercise is for the period 1996-2010. It consists of first establishing leading nations before suggesting policy initiatives that can be implemented by sampled countries depending on identified gaps that are provided with the sigma convergence estimation approach. The following are established frontier knowledge economy countries. (i) For the most part, North African countries are dominant in education. Tunisia is overwhelmingly dominant in 11 of the 15 years, followed by Libya which is a frontier country in two years while Cape Verde and Egypt lead in a single year each. (ii) With the exception of Morocco that is leading in the year 2009, Seychelles is overwhelmingly dominant in ICT. (iii) South Africa also indomitably leads in terms of innovation. (iv) While Botswana and Mauritius share dominance in institutional regime, economic incentives in terms of private domestic credit are most apparent in Angola (8 years), the Democratic Republic of Congo (3 years) and Tanzania, Sierra Leone and Malawi (each leading in one year)

The Comparative Economics of Knowledge Economy in Africa: Policy Benchmarks, Syndromes and Implications

The paper complements the scarce literature on knowledge economy (KE) in Africa by comparing KE dynamics within Africa in order to assess best and worst performers based on fundamental characteristics of the continent’s development. The five dimensions of the World Bank’s knowledge economy index (KEI) are employed, notably: education, information and communication technology, innovation and, economic incentives and institutional regime. The empirical evidence is based on a five-step novel approach with data from 53 African countries for the period 1996-2010. Limitations of the beta catch-up approach are complemented with the sigma convergence strategy. Based on the determined fundamental characteristics, computed dynamic benchmarks, policy syndromes and syndrome free scenarios we establish that: Landlocked, Low-income, Conflict-affected, sub-Saharan African, Non-oil-exporting and French civil law countries are generally more predisposed to lower levels of KE whereas; English common-law, Notlandlocked, Conflict-free, North African and middle-income countries are characteristics that predispose certain nations to higher KE. Broad and specific policy implications are discussed in detail

Supporting everyday self-management practices for pediatric patients with epilepsy

Everyday life presents considerable challenges for people living with epilepsy. Many patients and caregivers struggle to adopt important epilepsy self-management behaviors due to the burden of data collection and reporting. New mobile health sensing and data input capabilities could provide opportunities for facilitating aspects of these patient and caregiver data collection needs, which in turn could better inform clinical decision making and patient self-reflection within the context of self-management. In this thesis, I present my findings from five research studies. I describe each set of findings in terms of both clinical applications for supporting patient care and technical implications for informing the design of pediatric mobile and wearable tools for supporting epilepsy self-management practices.Ph.D