Noninvasive estimation of the electrohysterographic action-potential conduction velocity

Electrophysiological monitoring of the fetal-heart and the uterine-muscle activity, referred to as an electrohysterogram, is essential to permit timely treatment during pregnancy. While remarkable progress is reported for fetal-cardiac-activity monitoring, the electrohysterographic (EHG) measurement and interpretation remain challenging. In particular, little attention has been paid to the analysis of the EHG propagation, whose characteristics might be predictive of the preterm delivery. Therefore, this paper focuses, for the first time, on the noninvasive estimation of the conduction velocity of the EHG-action potentials. To this end, multichannel EHG recording and surface high-density electrodes are used. A maximum-likelihood method is employed for analyzing the EHG-action-potential propagation in two dimensions. The use of different weighting strategies of the derived cost function is introduced to deal with the poor signal similarity between different channels. The presented methods were evaluated by specific simulations proving the best weighting strategy to lead to an accuracy improvement of 56.7%. EHG measurements on ten women with uterine contractions confirmed the feasibility of the method by leading to conduction velocity values within the expected physiological range

Electrohysterographic volume conductor modeling

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Electrohysterographic conduction velocity estimation

Monitoring and analysis of the fetal-heart and the uterine-muscle activity, referred to as electrohysterogram (EHG), is essential to permit timely treatment during pregnancy. While remarkable progress is reported for monitoring of the fetal cardiac activity, the EHG measurement and interpretation remains challenging, and limited knowledge is available on the underlying physiological processes. In particular, little attention has been paid to the analysis of the EHG propagation, whose characteristics might indicate the presence of coordinated uterine contractions leading to intrauterine pressure increase. Therefore, this study focuses for the first time on the noninvasive estimation of the conduction velocity of EHG action potentials by means of multichannel EHG recording and surface high-density electrodes. A maximum likelihood algorithm, initially proposed for skeletal-muscle electromyography, is modified for the required EHG analysis. The use of clustering and weighting is introduced to deal with poor signal similarity between different channels. The presented methods were evaluated by specific simulations, proving the combination of weighting and clustering to be the most accurate method. A preliminary EHG measurement during labor confirmed the feasibility of the method. An extensive clinical validation will however be necessary to optimize the method and assess the relevance of the EHG conduction velocity for pregnancy monitoring

IPS in supported housing:Fidelity and employment outcomes over a 4 year period

Background: People with severe mental illness have difficulties finding and maintaining competitive employment. This is particularly so for those living in supported housing who, by definition, have significant day-to-day support needs: in the Netherlands only 3 to 5% of people with serious mental health problems who live in supported housing are competitively employed. To support these people in finding and maintaining competitive employment, Individual Placement, and Support (IPS) was introduced within supported housing services in the Netherlands in 2015. As this is the first country that broadly implemented IPS in supported housing settings, this paper will focus on the first results regarding feasibility and effects on employment in clients of IPS in this sector. Methods: We investigated the feasibility and employment outcomes of delivering IPS in supported housing services using fidelity assessments and quarterly employment outcomes on IPS program level within eight supported housing organizations, and compared these with 21 mental health treatment organizations in the Netherlands over a 4 year period. We investigated possible reasons for our findings and their implications through qualitative evaluations of the IPS fidelity assessors' notes and additional focus groups with IPS specialists and coordinators from supported housing services and fidelity assessors. Results: The overall fidelity scores indicated reasonable implementation of the IPS model within both supported housing services and mental health services. However, there were differences between services with regard to specific fidelity items; mental health treatment organizations scored higher for team integration, whereas supported housing services scored higher for rapid job search and caseload size, diversity of jobs, and employers. Our qualitative data suggested that the difference in team integration between the two sectors was due to differences in their organizational and financial structures, as well as in the specific needs of their clients. Conversely, supported housing services had better connections with employers which facilitated more rapid job searching and greater diversity in employment opportunities. The average total client employment rate did not significantly differ; and was 25.8% per quarter in supported housing services and 29.6% in mental health treatment services. Conclusion: Implementing IPS in supported housing settings is both feasible and effective

The participatory turn in radioactive waste management:Deliberation and the social-technical divide

National policies for long-term management of radioactive waste have for decades been driven by technical experts. The pursuit of these technocratic policies led in many countries to conflict with affected communities. Since the late 1990s, however, there has been a turn to more participatory approaches. This participatory turn reflects widespread acknowledgement in the discourse of policy actors and implementing organisations of the importance of social aspects of radioactive waste management and the need to involve citizens and their representatives in the process. This appears to be an important move towards democratisation of this particular field of technological decision making but, despite these developments, technical aspects are still most often brought into the public arena only after technical experts have defined the ‘problem’ and decided upon a ‘solution’. This maintains a notional divide between the treatment of technical and social aspects of radioactive waste management and raises pressing questions about the kind of choice affected communities are given if they are not able to debate fully the technical options. The article aims to contribute to better understanding and addressing this situation by exploring the complex entanglement of the social and the technical in radioactive waste management policy and practice, analysing the contingent configurations that emerge as sociotechnical combinations. Drawing upon empirical examples from four countries that have taken the participatory turn - Belgium, Slovenia, Sweden and the United Kingdom – the article describes the different ways in which sociotechnical combinations have been constructed, and discusses their implications for future practice

Natural course of Myoclonus-Dystonia in adulthood: stable motor signs but increased psychiatry

Myoclonus‐dystonia (M‐D) is a rare hyperkinetic movement disorder characterized by upper body–predominant myoclonus and dystonia.1 A large proportion of cases are caused by autosomal‐dominant inherited mutations in the SGCE gene. In addition to the motor manifestations, psychiatric disorders are frequently reported.2 Several studies have suggested that they may form a primary component of the M‐D phenotype.3, 4 This study represents the first long‐term follow‐up study of both motor and psychiatric symptomatology in adults with M‐D (SGCE mutation), providing further insights into the natural history of M‐D and enabling more prognostic information

A generalization of the Entropy Power Inequality to Bosonic Quantum Systems

In most communication schemes information is transmitted via travelling modes of electromagnetic radiation. These modes are unavoidably subject to environmental noise along any physical transmission medium and the quality of the communication channel strongly depends on the minimum noise achievable at the output. For classical signals such noise can be rigorously quantified in terms of the associated Shannon entropy and it is subject to a fundamental lower bound called entropy power inequality. Electromagnetic fields are however quantum mechanical systems and then, especially in low intensity signals, the quantum nature of the information carrier cannot be neglected and many important results derived within classical information theory require non-trivial extensions to the quantum regime. Here we prove one possible generalization of the Entropy Power Inequality to quantum bosonic systems. The impact of this inequality in quantum information theory is potentially large and some relevant implications are considered in this work