Source-sink connectivity: A novel interictal EEG marker of the epileptic brain network

Epilepsy affects over 60 million people worldwide. Epilepsy diagnosis depends on abnormalities in scalp electroencephalography (EEG) signals but their presence varies from 29-55%, resulting in a delayed diagnosis. Additionally, artifacts mimicking abnormalities and conditions imitating epileptic seizures contribute to a misdiagnosis rate of 30%. Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment, but around 30% of patients do not respond to AEDs. Surgical treatment is a hopeful alternative but outcomes depend on precise identification of the epileptogenic zone (EZ), the brain region(s) where seizures originate, and success rates range from 20-80%. Localization of the EZ requires visual inspection of intracranial EEG (iEEG) recordings during seizures which is costly and time-consuming and, in the end, clinicians ignore most of the data captured. Diagnosis and management of epilepsy rely on detecting sporadic EEG signatures. Thus, there is a great need to more quickly and accurately identify the underlying cause and location of seizures in the brain. We developed and tested the source-sink index (SSI) as an interictal (between seizures) EEG marker of epileptogenic activity. We hypothesized that seizures are suppressed when the EZ is inhibited by neighboring regions. We developed an algorithm that identifies two groups of nodes from the EEG network: those inhibiting their neighboring nodes ("sources") and the inhibited nodes themselves ("sinks"). Specifically, dynamical network models were estimated from EEG data and their connectivity properties revealed top sources and sinks in the network. We tested and validated a twofold application of SSI, as: i) an iEEG marker of the EZ, and ii) a scalp EEG marker of epilepsy. We found that SSI highly agreed with the annotated EZ in successful outcome patients but identified untreated regions in failure patients. Further, SSI outperformed high frequency oscillations, a frequently proposed interictal EZ marker, in predicting surgical outcomes. When used to predict diagnostic outcomes, SSI showed significant improvement over the gold standard's reported sensitivity and specificity. Our results suggest that SSI captures the characteristics of regions responsible for seizure initiation. As such, it is a promising marker of epileptogenicity that could significantly improve the speed and outcomes of epilepsy management and diagnosis

Towards Automating Sleep Stage Scoring to Diagnose Sleep Disorders

Overnight polysomnography (PSG) is an important tool used to characterize sleep and the gold standard procedure for diagnosing many sleep disorders. PSG is a non-invasive procedure that collects various physiological data, such as EEG, EMG, EOG and ECG signals. The data is then scored in a subjective, laborious and time-consuming process by sleep specialists who assign a sleep stage to every 30-second window of the data according to predefined scoring rules by the American Academy of Sleep Medicine (AASM). Finally, clinicians make a diagnosis based on this annotated data. Consequently, the current process is heavily dependent upon human factors, which can result in poor agreement between expert scorers, but inter-scorer reliability has been found to be only around 82%. In this study we developed an automatic sleep stage scoring method, using a likelihood ratio decision tree classifier, with the goal of improving the speed, reliability, accuracy and cost efficiency of the current PSG scoring process. The algorithm was developed using the AASM Manual for Scoring Sleep. We extracted features from various physiological recordings of the PSG, based on the predefined rules of the AASM Manual. The features were computed for each 30-second epoch, in either the time or the frequency domain. The most useful features were selected by looking at probability distributions for each metric conditioned on the sleep stage, and identifying the features giving the greatest separation between stages. Examples of meaningful features include the power in different frequency bands of EEG signals, EMG energy per epoch, and number of spindles per epoch, to mention a few. These features were then used as inputs to the classifier which assigned each epoch one of five possible stages:; N3, N2, N1, REM or Wake. The automatic scoring was trained and tested on PSG data from 39 healthy individuals (age range: 24.2±3.1 years) with no sleep disturbances. The overall scoring accuracy was 76.97% on the test set. Some of the stages, such as stage N2, have more distinctive characteristics and thus yielded a higher per-stage scoring accuracy, whereas the other stages, for example stages N1 and REM, got confused more easily, resulting in lower per-stage accuracies. As expected, most misclassifications occurred between adjacent sleep stages. Although this accuracy may at first seem low, it is likely that the stages that the tool classified inaccurately may be sleep stages that contribute to inter-scorer reliability. Therefore, we see this tool as assisting sleep scorers to enhance efficiency with the further goal of eventually improving inter-scorer reliability. Sleep stage scoring provides an important basis for diagnosis of sleep disorders in general. However, the detection of sleep disturbances is very costly and time-consuming, and relies on subjective measures. Automating the scoring process improves the efficiency and consistency of scoring procedures and offers a way to diagnose sleeping disorders in a more robust, quantitative manner

Development and Validation of a Photographic Method to Use for Dietary Assessment in School Settings.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.To develop and validate a photographic method aimed at making assessment of dietary intake in school canteens non-obstrusive, practical and feasible.The study was conducted in two elementary schools representing two different school canteen systems; main dish being served by canteen staff (Iceland), and complete self-serving (Sweden). Food items in serving and leftovers were weighed and photographed. Trained researchers estimated weights of food items by viewing the photographs and comparing them with pictures of half and full reference portions with known weights. Plates of servings and leftovers from 48 children during five school days (n = 448 plates) and a total of 5967 food items were estimated. The researchers' estimates were then compared with the true weight of the foods and the energy content calculated.Weighed and estimated amounts correlated across meals both in grams and as total energy (0.853-0.977, p<0.001). The agreement between estimated energy content in school meals was close to the true measurement from weighed records; on average 4-19 kcal below true values. Organisation of meal service impacted the efficacy of the method as seen in the difference between countries; with Iceland (served by canteen staff) having higher rate of acceptable estimates than Sweden (self-serving), being 95% vs 73% for total amount (g) in serving. Iceland more often had serving size between or above the half and full reference plates compared with Sweden.The photographic method provides acceptable estimates of food and energy intake in school canteens. However, greater accuracy can be expected when foods are served by canteen staff compared with self-serving

Circumpolar Biodiversity Monitoring Program Framework Document - CBMP Report No. 1

The CBMP Framework Document outlines the framework behind the Circumpolar Biodiversity Monitoring Program of CAFF - endorsed by the Arctic Council Ministers in 2004 as CAFF's cornerstone program. The CBMP is being developed by CAFF to serve as a coordinating entity for currently existing biodiversity monitoring programs in the Arctic, for data gathering and data analyses, and for coordinating the communication of results

The Effect of Schooling on Basic Cognition in Selected Nordic Countries

The present study investigated schooling effects on cognition. Cognitive data were collected as part of a research project (ProMeal) that investigated school meals and measured the intake of school lunch in relation to children’s health, cognitive function, and classroom learning in four Nordic countries, among children between 10–11 years of age. It was found that Finnish pupils attending 4th grade were not, on any measure, outperformed by Norwegian and Icelandic pupils attending 5th and Swedish pupils attending 4th grade on a task measuring working memory capacity, processing speed, inhibition, and in a subsample on response- and attention control. Moreover, boys were found to perform superior to girls on tasks measuring processing speed. However, girls were found to perform better on tasks related to attention and self-control. The results are discussed in relation to the reciprocal association between cognition and schooling and whether these results reflect quality differences between schools in the four Nordic countries; most notably in comparison to Finland.</p

COVID-19 in children: analysis of the first pandemic peak in England.

OBJECTIVES: To assess disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared with adults during the first pandemic peak in England. SETTING: England. PARTICIPANTS: Children with COVID-19 between January and May 2020. MAIN OUTCOME MEASURES: Trends in confirmed COVID-19 cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity rates in children compared with adults; community prevalence of SARS-CoV-2 in children with acute respiratory infection (ARI) compared with adults, case-fatality rate in children with confirmed COVID-19 and excess childhood deaths compared with the previous 5 years. RESULTS: Children represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%-34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%-45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children. CONCLUSIONS: Children accounted for a very small proportion of confirmed cases despite the large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2

Water safety plan enhancements with improved drinking water quality detection techniques

Drinking water quality has been regulated in most European countries for nearly two decades by the drinking water directive 98/83/EC. The directive is now under revision with the goal of meeting stricter demands for safe water for all citizens, as safe water has been recognized as a human right by the United Nations. An important change to the directive is the implementation of a risk-based approach in all regulated water supplies. The European Union Framework Seventh Programme Aquavalens project has developed several new detection technologies for pathogens and indicators and tested them in water supplies in seven European countries. One of the tasks of the project was to evaluate the impact of these new techniques on water safety and on water safety management. Data were collected on risk factors to water safety for five large supplies in Denmark, Germany, Spain and the UK, and for fifteen small water supplies in Scotland, Portugal and Serbia, via a questionnaire aiming to ascertain risk factors and the stage of implementation of Water Safety Plans, and via site-specific surveys known as Sanitary Site Inspection. Samples were collected from the water supplies from all stages of water production to delivery. Pathogens were detected in around 23% of the 470 samples tested. Fecal contamination was high in raw water and even in treated water at the small supplies. Old infrastructure was considered a challenge at all the water supplies. The results showed that some of the technique, if implemented as part of the water safety management, can detect rapidly the most common waterborne pathogens and fecal pollution indicators and therefore have a great early warning potential; can improve water safety for the consumer; can validate whether mitigation methods are working as intended; and can confirm the quality of the water at source and at the tap

Independent and combined influence of healthy lifestyle factors on academic performance in adolescents: DADOS Study

BACKGROUND. Few studies have analyzed the combined effect of lifestyle factors on academic performance (AP) in adolescents. The aim of this study was to analyze the independent and combined effects of weight status, screen time, sleep quality, daily meal frequency, cardiorespiratory fitness and physical activity (PA) on AP in adolescents. METHODS. A total of 262 adolescents (13.9±0.3 years) from the DADOS study were included in the analysis. Weight status was assessed through body mass index (kg/m 2 ). Participants completed questionnaires to evaluate screen time, sleep quality and daily meal frequency. Cardiorespiratory fitness was assessed by the 20-m shuttle run test. PA was evaluated by a wrist-worn GENEActiv accelerometer. AP was assessed through the final academic grades and a validated questionnaire. RESULTS. Non-overweight status, low screen time, good sleep quality and proper meal frequency showed independent, positive influence on AP. Moreover, adolescents achieving at least 3 healthy lifestyles were more likely to be in the high-performance group for academic grades than those achieving ≤ 1 (math OR: 3.02-9.51, language OR: 3.51-6.76 and grade point average OR: 4.22-9.36). CONCLUSIONS. Although individual healthy lifestyles are independently and positively associated with AP, the cumulative effect of multiple healthy lifestyles have a stronger impact

Nurse forecasting in Europe (RN4CAST): Rationale, design and methodology

Contains fulltext : 97171.pdf (postprint version ) (Open Access)BACKGROUND: Current human resources planning models in nursing are unreliable and ineffective as they consider volumes, but ignore effects on quality in patient care. The project RN4CAST aims innovative forecasting methods by addressing not only volumes, but quality of nursing staff as well as quality of patient care. METHODS/DESIGN: A multi-country, multilevel cross-sectional design is used to obtain important unmeasured factors in forecasting models including how features of hospital work environments impact on nurse recruitment, retention and patient outcomes. In each of the 12 participating European countries, at least 30 general acute hospitals were sampled. Data are gathered via four data sources (nurse, patient and organizational surveys and via routinely collected hospital discharge data). All staff nurses of a random selection of medical and surgical units (at least 2 per hospital) were surveyed. The nurse survey has the purpose to measure the experiences of nurses on their job (e.g. job satisfaction, burnout) as well as to allow the creation of aggregated hospital level measures of staffing and working conditions. The patient survey is organized in a sub-sample of countries and hospitals using a one-day census approach to measure the patient experiences with medical and nursing care. In addition to conducting a patient survey, hospital discharge abstract datasets will be used to calculate additional patient outcomes like in-hospital mortality and failure-to-rescue. Via the organizational survey, information about the organizational profile (e.g. bed size, types of technology available, teaching status) is collected to control the analyses for institutional differences.This information will be linked via common identifiers and the relationships between different aspects of the nursing work environment and patient and nurse outcomes will be studied by using multilevel regression type analyses. These results will be used to simulate the impact of changing different aspects of the nursing work environment on quality of care and satisfaction of the nursing workforce. DISCUSSION: RN4CAST is one of the largest nurse workforce studies ever conducted in Europe, will add to accuracy of forecasting models and generate new approaches to more effective management of nursing resources in Europe

A study protocol for the evaluation of occupational mutagenic/carcinogenic risks in subjects exposed to antineoplastic drugs: a multicentric project

<p>Abstract</p> <p>Background</p> <p>Some industrial hygiene studies have assessed occupational exposure to antineoplastic drugs; other epidemiological investigations have detected various toxicological effects in exposure groups labeled with the job title. In no research has the same population been studied both environmentally and epidemiologically. The protocol of the epidemiological study presented here uses an integrated environmental and biological monitoring approach. The aim is to assess in hospital nurses preparing and/or administering therapy to cancer patients the current level of occupational exposure to antineoplastic drugs, DNA and chromosome damage as cancer predictive effects, and the association between the two.</p> <p>Methods/Design</p> <p>About 80 healthy non-smoking female nurses, who job it is to prepare or handle antineoplastic drugs, and a reference group of about 80 healthy non-smoking female nurses not occupationally exposed to chemicals will be examined simultaneously in a cross-sectional study. All the workers will be recruited from five hospitals in northern and central Italy after their informed consent has been obtained.</p> <p>Evaluation of surface contamination and dermal exposure to antineoplastic drugs will be assessed by determining cyclophosphamide on selected surfaces (wipes) and on the exposed nurses' clothes (pads). The concentration of unmetabolized cyclophosphamide as a biomarker of internal dose will be measured in end-shift urine samples from exposed nurses.</p> <p>Biomarkers of effect and susceptibility will be assessed in exposed and unexposed nurses: urinary concentration of 8-hydroxy-2-deoxyguanosine; DNA damage detected using the single-cell microgel electrophoresis (comet) assay in peripheral white blood cells; micronuclei and chromosome aberrations in peripheral blood lymphocytes. Genetic polymorphisms for enzymes involved in metabolic detoxification (i.e. glutathione <it>S</it>-transferases) will also be analysed.</p> <p>Using standardized questionnaires, occupational exposure will be determined in exposed nurses only, whereas potential confounders (medicine consumption, lifestyle habits, diet and other non-occupational exposures) will be assessed in both groups of hospital workers.</p> <p>Statistical analysis will be performed to ascertain the association between occupational exposure to antineoplastic drugs and biomarkers of DNA and chromosome damage, after taking into account the effects of individual genetic susceptibility, and the presence of confounding exposures.</p> <p>Discussion</p> <p>The findings of the study will be useful in updating prevention procedures for handling antineoplastic drugs.</p