Effect of treatment of clinical seizures vs electrographic seizures in full-term and near-term neonates : a randomized clinical trial

Importance: Seizures in the neonatal period are associated with increased mortality and morbidity. Bedside amplitude-integrated electroencephalography (aEEG) has facilitated the detection of electrographic seizures; however, whether these seizures should be treated remains uncertain. Objective: To determine if the active management of electrographic and clinical seizures in encephalopathic term or near-term neonates improves survival free of severe disability at 2 years of age compared with only treating clinically detected seizures. Design, Setting, and Participants: This randomized clinical trial was conducted in tertiary newborn intensive care units recruited from 2012 to 2016 and followed up until 2 years of age. Participants included neonates with encephalopathy at 35 weeks’ gestation or more and younger than 48 hours old. Data analysis was completed in April 2021. Interventions: Randomization was to an electrographic seizure group (ESG) in which seizures detected on aEEG were treated in addition to clinical seizures or a clinical seizure group (CSG) in which only seizures detected clinically were treated. Main Outcomes and Measures: Primary outcome was death or severe disability at 2 years, defined as scores in any developmental domain more than 2 SD below the Australian mean assessed with Bayley Scales of Neonate and Toddler Development, 3rd ed (BSID-III), or the presence of cerebral palsy, blindness, or deafness. Secondary outcomes included magnetic resonance imaging brain injury score at 5 to 14 days, time to full suck feeds, and individual domain scores on BSID-III at 2 years. Results: Of 212 randomized neonates, the mean (SD) gestational age was 39.2 (1.7) weeks and 122 (58%) were male; 152 (72%) had moderate to severe hypoxic-ischemic encephalopathy (HIE) and 147 (84%) had electrographic seizures. A total of 86 neonates were included in the ESG group and 86 were included in the CSG group. Ten of 86 (9%) neonates in the ESG and 4 of 86 (4%) in the CSG died before the 2-year assessment. The odds of the primary outcome were not significantly different in the ESG group compared with the CSG group (ESG, 38 of 86 [44%] vs CSG, 27 of 86 [31%]; odds ratio [OR], 1.83; 95% CI, 0.96 to 3.49; P = .14). There was also no significant difference in those with HIE (OR, 1.77; 95% CI, 0.84 to 3.73; P = .26). There was evidence that cognitive outcomes were worse in the ESG (mean [SD] scores, ESG: 97.4 [17.7] vs CSG: 103.8 [17.3]; mean difference, −6.5 [95% CI, −1.2 to −11.8]; P = .01). There was little evidence of a difference in secondary outcomes, including time to suck feeds, seizure burden, or brain injury score. Conclusions and Relevance: Treating electrographic and clinical seizures with currently used anticonvulsants did not significantly reduce the rate of death or disability at 2 years in a heterogeneous group of neonates with seizures

Sleep, obstructive sleep apnoea and neuropsychological function in acute quadriplegia

© 2015 Dr.Rachel SchembriObstructive sleep apnoea (OSA) is highly prevalent following spinal cord injury (SCI) and is likely caused by the injury. Beyond the devastating physical consequences of SCI, neuropsychological dysfunction is also common. OSA is known to impair many areas of neuropsychological function in both the able-bodied and chronic SCI patients. However, this has not been investigated in patients with acute SCI. The aim of this thesis was to investigate the relationship between OSA severity and neuropsychological function in patients with acute quadriplegia and OSA. To investigate this aim, participants underwent overnight polysomnography (PSG) and neuropsychological testing. Two methodological experiments were firstly carried out to ensure the accuracy and interpretability of the PSG data collected. Ambulatory PSG was conducted on spinal wards acutely, to ensure as little disruption to the patients’ care as possible. A limitation of ambulatory PSG is the inability to measure light level and calculate total dark time, the denominator for several important sleep indices. The usefulness of a prototype light sensor (LS) was investigated for use in ambulatory PSG, where light is uncontrolled and the LS is uncalibrated for use across varied settings. The LS was found to be apt and useful, particularly in patients with acute quadriplegia, where the nearest surrogate marker of the time of lights out, change from upright to lying position, was clinically irrelevant in this group who were commonly lying in bed prior to lights out. Given the results of this first experiment, the LS was implemented when investigating the primary study aims. A second methodological experiment was carried out to quantify the effect of a change in the rules for sleep staging and respiratory scoring which occurred following study commencement. This has previously been examined for other patient groups but not for patients with quadriplegia where the pathogenesis of OSA and respiratory event presentation may be different to the able-bodied. The change in AHI between the previous and current standards was quantified for participants with acute quadriplegia and OSA, and was found to more closely approximate atypical lean OSA patients than typical sleep laboratory patients. This translational information allows for current study data to be interpretable across both of the rule sets used as standard in the research timeframe. Lastly, the primary aim was investigated in 104 patients with acute quadriplegia and OSA (age M = 45.60, SD = 16.38; 10 female) across 11 international sites. Polysomnography and neuropsychological testing was performed on average two months post-injury (M = 60.70 days, SD = 39.48), with neuropsychological tests assessing attention, information processing, executive function, memory, learning, mood, and quality of life (QoL). Sleep apnoea severity was associated with attention, information processing, immediate recall, freedom from distractibility, and executive function, with more severe OSA being associated with poorer performance. Deficits largely did not extend to memory, which differs from previous literature investigating the able-bodied and patients with chronic OSA. Higher pre-injury intelligence and being younger appeared to lessen the effects of OSA on performance; however, these protective factors were insufficient to counter the damage done to attention, immediate recall, information processing, and freedom from distractibility by OSA. More widespread OSA-related deficits, including memory, may only be seen with longer exposure to OSA. These findings have important implications for neuropsychological functioning and skill acquisition during rehabilitation and, as such, highlight the importance of sleep health following SCI

Variable "subject" presence in Australian Sign Language and New Zealand Sign Language

This article reports the findings of parallel studies of variable subject presence in two closely related sign language varieties, Australian Sign Language (Auslan) and New Zealand Sign Language (NZSL). The studies expand upon research in American Sign Language (ASL) (Wulf, Dudis, Bayley, & Lucas, 2002) that found subject pronouns with nonintlecting verbs to be more frequently unexpressed than expressed. The ASL study reported that null subject use correlates with both social and linguistic factors, the strongest of which is referential congruence with an antecedent in a preceding clause. Findings from the Auslan and NZSL studies also indicated that chains of reference play a stronger role in subject presence than either morphological factors (e.g., verb type), or social factors of age, gender, ethnicity, and language background. Overall results are consistent with the view that this feature of syntactic variation may be better accounted for in terms of information structure than sociolinguistic effects.24 page(s

Sociolinguistic variation in British, Australian and New Zealand sign languages

23 page(s

Phonological variation and change in Australian and New Zealand sign languages : the location variable

In this study, we consider variation in a class of signs in Australian and New Zealand Sign Languages that includes the signs think, name, and clever. In their citation form, these signs are specified for a place of articulation at or near the signer's forehead or above, but are sometimes produced at lower locations. An analysis of 2667 tokens collected from 205 deaf signers in five sites across Australia and of 2096 tokens collected from 138 deaf signers from three regions in New Zealand indicates that location variation in these signs reflects both linguistic and social factors, as also reported for American Sign Language (Lucas, Bayley, & Valli, 2001). Despite similarities, however, we find that some of the particular factors at work, and the kinds of influence they have, appear to differ in these three signed languages. Moreover, our results suggest that lexical frequency may also play a role.39 page(s

The relationship between emotional intelligence and depression in a clinical sample

Background and Objectives: Although depression is a commonly occurring mental illness, research concerning strategies for early detection and prophylaxis has not until now focused on the possible utility of measures of Emotional Intelligence (EI) as a potential predictive factor. The current study aimed to investigate the relationship between EI and a clinical diagnosis of depression in a cohort of adults. Methods: Sixty-two patients (59.70% female) with a DSM-IV-TR diagnosis of a major affective disorder and 39 aged matched controls (56.40% female) completed self-report instruments assessing EI and depression in a cross-sectional study. Results: Significant associations were observed between severity of depression and the EI dimensions of Emotional Management (r = -0.56) and Emotional Control (r = -0.62). The results show a reduced social involvement, an increased prior institutionalization and an increased incidence of "Schizophrenic Psychosis" and "Abnormal Personalities" in the sub-group of repeated admissions. Conclusions: Measures of EI may have predictive value in terms of early identification of those at risk for developing depression. The current study points to the potential value of conducting further studies of a prospective nature

Apnoea and hypopnoea scoring for people with spinal cord injury: New thresholds for sleep disordered breathing diagnosis and severity classification

Objectives: To determine the effect of respiratory event rule-set changes on the apnoea hypopnoea index, and diagnostic and severity thresholds in people with acute and chronic spinal cord injury. Setting: Eleven acute spinal cord injury inpatient hospitals across Australia, New Zealand, Canada and England; community dwelling chronic spinal cord injury patients in their own homes. Methods: Polysomnography of people with acute (n = 24) and chronic (n = 78) tetraplegia were reanalysed from 1999 American Academy of Sleep Medicine (AASM) respiratory scoring, to 2007 AASM ‘alternative’ and 2012 AASM respectively. Equivalent cut points for published 1999 AASM sleep disordered breathing severity ranges were calculated using receiver operator curves, and results presented alongside analyses from the able-bodied. Results: In people with tetraplegia, shift from 1999 AASM to 2007 AASM ‘alternative’ resulted in a 22% lower apnoea hypopnoea index, and to 2012 AASM a 17% lower index. In people with tetraplegia, equivalent cut-points for 1999 AASM severities of 5,15 and 30 were calculated at 2.4, 8.1 and 16.3 for 2007 AASM ‘alternative’ and 3.2, 10.0 and 21.2 for 2012 AASM. Conclusion: Interpreting research, prevalence and clinical polysomnography results conducted over different periods requires knowledge of the relationship between different rule-sets, and appropriate thresholds for diagnosis of disease. Sponsorship: This project was proudly supported by the Traffic Accident Commission (Program grant) and the National Health and Medical Research Council (PhD stipend 616605).</p

The impact of nurse home visiting on the use, dose and quality of formal childcare : 3-year follow-up of a randomized trial

Objective: We investigated whether nurse home visiting (NHV) affects the uptake and quality of formal early childhood education and care (ECEC) at child ages 2 and 3 years, and reasons for using ECEC at 3 years. Methods: Design: Secondary analysis of the “right@home” randomized trial of NHV. Participants: 722 pregnant Australian, English-speaking women experiencing adversity recruited from antenatal clinics across 2 states. Intervention: 25 nurse home visits to 2 years; Control: universal well-child nursing service. Measures: Parents reported formal ECEC use (government approved and subsidized), comprising long or family day care (LDC), and reasons for use. ECEC quality was classified using the Australian government's national ratings. Eighty-three percent of parents provided data at 2 years (306 intervention/290 control); and 69% at 3 years (255 intervention/240 control). Analysis: Intention-to-treat analyses were conducted using adjusted regression models, addressing missing data using multiple imputation and inverse probability weighting. Results: There was no evidence of group differences in ECEC uptake or quality, although control families may have used more LDC at 3 years (mean difference 2.8 hours, 95% confidence interval, -0.2 to 5.8 hours). Intervention parents reported using ECEC to support their children's social development more frequently than controls (48% vs 33%) but less for work/study (39% vs 46%). Conclusions: The right@home NHV program did not impact ECEC uptake or quality, although it may influence parents’ reasons for using ECEC. If supported by policy and provision, there is an opportunity for NHV programs to promote the transition to high-quality ECEC and evaluate the synergistic benefit on children's development

Unsupervised assessment of cognition in the Healthy Brain Project:Implications for web-based registries of individuals at risk for Alzheimer's disease

Introduction: Web-based platforms are used increasingly to assess cognitive function in unsupervised settings. The utility of cognitive data arising from unsupervised assessments remains unclear. We examined the acceptability, usability, and validity of unsupervised cognitive testing in middle-aged adults enrolled in the Healthy Brain Project. Methods: A total of 1594 participants completed unsupervised assessments of the Cogstate Brief Battery. Acceptability was defined by the amount of missing data, and usability by examining error of test performance and the time taken to read task instructions and complete tests (learnability). Results: Overall, we observed high acceptability (98% complete data) and high usability (95% met criteria for low error rates and high learnability). Test validity was confirmed by observation of expected inverse relationships between performance and increasing test difficulty and age. Conclusion: Consideration of test design paired with acceptability and usability criteria can provide valid indices of cognition in the unsupervised settings used to develop registries of individuals at risk for Alzheimer's disease