Toward a personalized real-time diagnosis in neonatal seizure detection

The problem of creating a personalized seizure detection algorithm for newborns is tackled in this paper. A probabilistic framework for semi-supervised adaptation of a generic patient-independent neonatal seizure detector is proposed. A system that is based on a combination of patient-adaptive (generative) and patient-independent (discriminative) classifiers is designed and evaluated on a large database of unedited continuous multichannel neonatal EEG recordings of over 800 h in duration. It is shown that an improvement in the detection of neonatal seizures over the course of long EEG recordings is achievable with on-the-fly incorporation of patient-specific EEG characteristics. In the clinical setting, the employment of the developed system will maintain a seizure detection rate at 70% while halving the number of false detections per hour, from 0.4 to 0.2 FD/h. This is the first study to propose the use of online adaptation without clinical labels, to build a personalized diagnostic system for the detection of neonatal seizures

Interobserver agreement for neonatal seizure detection using multichannel EEG

Objective To determine the interobserver agreement (IOA) of neonatal seizure detection using the gold standard of conventional, multichannel EEG. Methods A cohort of full-term neonates at risk of acute encephalopathy was included in this prospective study. The EEG recordings of these neonates were independently reviewed for seizures by three international experts. The IOA was estimated using statistical measures including Fleiss' kappa and percentage agreement assessed over seizure events (event basis) and seizure duration (temporal basis). Results A total of 4066 h of EEG recordings from 70 neonates were reviewed with an average of 2555 seizures detected. The IOA was high with temporal assessment resulting in a kappa of 0.827 (95% CI: 0.769–0.865; n = 70). The median agreement was 83.0% (interquartile range [IQR]: 76.6–89.5%; n = 33) for seizure and 99.7% (IQR: 98.9–99.8%; n = 70) for nonseizure EEG. Analysis of events showed a median agreement of 83.0% (IQR: 72.9–86.6%; n = 33) for seizures with 0.018 disagreements per hour (IQR: 0.000–0.090 per hour; n = 70). Observers were more likely to disagree when a seizure was less than 30 sec. Overall, 33 neonates were diagnosed with seizures and 28 neonates were not, by all three observers. Of the remaining nine neonates with contradictory EEG detections, seven presented with low total seizure burden. Interpretation The IOA is high among experts for the detection of neonatal seizures using conventional, multichannel EEG. Agreement is reduced when seizures are rare or have short duration. These findings support EEG-based decision making in the neonatal intensive care unit, inform EEG interpretation guidelines, and provide benchmarks for seizure detection algorithms.Peer reviewe

A standardised assessment scheme for conventional EEG in preterm infants

Objective: To develop a standardised scheme for assessing normal and abnormal electroencephalography (EEG) features of preterm infants. To assess the interobserver agreement of this assessment scheme. Methods: We created a standardised EEG assessment scheme for 6 different post-menstrual age (PMA) groups using 4 EEG categories. Two experts, not involved in the development of the scheme, evaluated this on 24 infants <32 weeks gestational age (GA) using random 2 hour EEG epochs. Where disagreements were found, the features were checked and modified. Finally, the two experts independently evaluated 2 hour EEG epochs from an additional 12 infants <37 weeks GA. The percentage of agreement was calculated as the ratio of agreements to the sum of agreements plus disagreements. Results: Good agreement in all patients and EEG feature category was obtained, with a median agreement between 80% and 100% over the 4 EEG assessment categories. No difference was found in agreement rates between the normal and abnormal features (p = 0.959). Conclusions: We developed a standard EEG assessment scheme for preterm infants that shows good interobserver agreement. Significance: This will provide information to Neonatal Intensive Care Unit (NICU) staff about brain activity and maturation. We hope this will prove useful for many centres seeking to use neuromonitoring during critical care for preterm infants

Neonatal EEG graded for severity of background abnormalities in hypoxic-ischaemic encephalopathy

This report describes a set of neonatal electroencephalogram (EEG) recordings graded according to the severity of abnormalities in the background pattern. The dataset consists of 169 hours of multichannel EEG from 53 neonates recorded in a neonatal intensive care unit. All neonates received a diagnosis of hypoxic-ischaemic encephalopathy (HIE), the most common cause of brain injury in full term infants. For each neonate, multiple 1-hour epochs of good quality EEG were selected and then graded for background abnormalities. The grading system assesses EEG attributes such as amplitude and frequency, continuity, sleep--wake cycling, symmetry and synchrony, and abnormal waveforms. Background severity was then categorised into 4 grades: normal or mildly abnormal EEG, moderately abnormal EEG, severely abnormal EEG, and inactive EEG. The data can be used as a reference set of multi-channel EEG for neonates with HIE, for EEG training purposes, or for developing and evaluating automated grading algorithms

“We’re in This Together”: Bridging and Bonding Social Capital in Elementary School PTOs

Scholarship on the links between families and schools encompasses contradictory notions about social capital and its relation to inequality. One view holds that schools can narrow inequality by generating dense relationships among families, while others suggest that advantaged parents can use these networks to hoard opportunities. This multiple case study analyzes qualitative data from diverse North Carolina elementary schools to learn how parents build and deploy social capital. We distinguish between bonding social capital, built in dense, homogeneous networks, and bridging social capital, gained through relationships across a social distance. Our analyses suggest that bonding alone is associated with opportunity hoarding; however, when schools are committed to building both bridging and bonding social capital, they can produce more equitable and inclusive schools

The ACS LCID project. X. The Star Formation History of IC 1613: Revisiting the Over-Cooling Problem

We present an analysis of the star formation history (SFH) of a field near the half light radius in the Local Group dwarf irregular galaxy IC 1613 based on deep Hubble Space Telescope Advanced Camera for Surveys imaging. Our observations reach the oldest main sequence turn-off, allowing a time resolution at the oldest ages of ~1 Gyr. Our analysis shows that the SFH of the observed field in IC 1613 is consistent with being constant over the entire lifetime of the galaxy. These observations rule out an early dominant episode of star formation in IC 1613. We compare the SFH of IC 1613 with expectations from cosmological models. Since most of the mass is in place at early times for low mass halos, a naive expectation is that most of the star formation should have taken place at early times. Models in which star formation follows mass accretion result in too many stars formed early and gas mass fractions which are too low today (the "over-cooling problem"). The depth of the present photometry of IC 1613 shows that, at a resolution of ~1 Gyr, the star formation rate is consistent with being constant, at even the earliest times, which is difficult to achieve in models where star formation follows mass assembly.Comment: 13 pages, 12 figures, accepted for publication in the Ap

Early postnatal EEG features of perinatal arterial ischaemic stroke with seizures

Background: Stroke is the second most common cause of seizures in term neonates and is associated with abnormal long-term neurodevelopmental outcome in some cases. Objective: To aid diagnosis earlier in the postnatal period, our aim was to describe the characteristic EEG patterns in term neonates with perinatal arterial ischaemic stroke (PAIS) seizures. Design: Retrospective observational study. Patients: Neonates >37 weeks born between 2003 and 2011 in two hospitals. Method: Continuous multichannel video-EEG was used to analyze the background patterns and characteristics of seizures. Each EEG was assessed for continuity, symmetry, characteristic features and sleep cycling; morphology of electrographic seizures was also examined. Each seizure was categorized as electrographic-only or electroclinical; the percentage of seizure events for each seizure type was also summarized. Results: Nine neonates with PAIS seizures and EEG monitoring were identified. While EEG continuity was present in all cases, the background pattern showed suppression over the infarcted side; this was quite marked (>50% amplitude reduction) when the lesion was large. Characteristic unilateral bursts of theta activity with sharp or spike waves intermixed were seen in all cases. Sleep cycling was generally present but was more disturbed over the infarcted side. Seizures demonstrated a characteristic pattern; focal sharp waves/spike-polyspikes were seen at frequency of 1-2 Hz and phase reversal over the central region was common. Electrographic-only seizure events were more frequent compared to electroclinical seizure events (78 vs 22%). Conclusions: Focal electrographic and electroclinical seizures with ipsilateral suppression of the background activity and focal sharp waves are strong indicators of PAIS. Approximately 80% of seizure events were the result of clinically unsuspected seizures in neonates with PAIS. Prolonged and continuous multichannel video-EEG monitoring is advocated for adequate seizure surveillance

The ISLAndS project II: The Lifetime Star Formation Histories of Six Andromeda dSphs

The Initial Star formation and Lifetimes of Andromeda Satellites (ISLAndS) project uses Hubble Space Telescope imaging to study a representative sample of six Andromeda dSph satellite companion galaxies. The main goal of the program is to determine whether the star formation histories (SFHs) of the Andromeda dSph satellites demonstrate significant statistical differences from those of the Milky Way, which may be attributable to the different properties of their local environments. Our observations reach the oldest main sequence turn-offs, allowing a time resolution at the oldest ages of ~ 1 Gyr, which is comparable to the best achievable resolution in the MW satellites. We find that the six dSphs present a variety of SFHs that are not strictly correlated with luminosity or present distance from M31. Specifically, we find a significant range in quenching times (lookback times from 9 to 6 Gyr), but with all quenching times more than ~ 6 Gyr ago. In agreement with observations of Milky Way companions of similar mass, there is no evidence of complete quenching of star formation by the cosmic UV background responsible for reionization, but the possibility of a degree of quenching at reionization cannot be ruled out. We do not find significant differences between the SFHs of the three members of the vast, thin plane of satellites and the three off-plane dSphs. The primary difference between the SFHs of the ISLAndS dSphs and Milky Way dSph companions of similar luminosities and host distances is the absence of very late quenching (< 5 Gyr ago) dSphs in the ISLAndS sample. Thus, models that can reproduce satellite populations with and without late quenching satellites will be of extreme interest.Comment: 24 pages, 11 figures, 3 tables, submitted to the Ap

The ISLANDS project I: Andromeda XVI, An Extremely Low Mass Galaxy not Quenched by Reionization

Based on data aquired in 13 orbits of HST time, we present a detailed evolutionary history of the M31 dSph satellite Andromeda XVI, including its life-time star formation history, the spatial distribution of its stellar populations, and the properties of its variable stars. And XVI is characterized by prolonged star formation activity from the oldest epochs until star formation was quenched ~6 Gyr ago, and, notably, only half of the mass in stars of And XVI was in place 10 Gyr ago. And XVI appears to be a low mass galaxy for which the early quenching by either reionization or starburst feedback seems highly unlikely, and thus, is most likely due to an environmental effect (e.g., an interaction), possibly connected to a late infall in the densest regions of the Local Group. Studying the star formation history as a function of galactocentric radius, we detect a mild gradient in the star formation history: the star formation activity between 6 and 8 Gyr ago is significantly stronger in the central regions than in the external regions, although the quenching age appears to be the same, within 1 Gyr. We also report the discovery of 9 RR Lyrae stars, 8 of which belong to And XVI. The RR Lyrae stars allow a new estimate of the distance, (m-M)0= 23.72+/-0.09 mag, which is marginally larger than previous estimates based on the tip of the red giant branch.Comment: Accepted for publication on Ap