Recurrence of status epilepticus: Prognostic role and outcome predictors.

OBJECTIVE: Predictors of morbidity and mortality after status epilepticus (SE) have been studied extensively in hospital- and population-based cohorts. However, little attention has been directed toward SE recurrence after an incident episode. We investigated clinical and demographic characteristics of patients presenting SE recurrence and its specific prognostic role. METHODS: In this observational cohort study, we screened our prospective registry of consecutive adults with SE between April 2006 and February 2014. Demographic and clinical data were compared between incident and recurrent SE episodes; risk of SE recurrence was assessed through survival analysis, and the prognostic role of SE recurrence with multivariable logistic regressions. RESULTS: Of the incident cohort (509 patients), 68 (13%) experienced recurrent SE. The cumulative recurrence rate over 4 years was 32%. Recurrence risk was significantly reduced after an acute SE etiology (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.31-0.82; p = 0.005), and was borderline increased in women (HR 1.59, 95% CI 0.97-2.65; p = 0.06). Although recurrent SE episodes showed lower morbidity and mortality, prognosis was independently related to Status Epilepticus Severity Score (STESS) and potentially fatal etiology, but not to SE recurrence. SIGNIFICANCE: This study provides class III evidence that SE recurrence involves a significant proportion of patients, and that recurrence risk is independently associated with chronic etiology and to a lesser extent with female gender. However, contrary to underlying cause and SE severity, SE recurrence per se does not independently correlate with outcome. Early identification of patients at higher risk of SE recurrence may influence their management during follow-up

EEG reactivity to pain in comatose patients: Importance of the stimulus type.

INTRODUCTION: Electroencephalogram (EEG) background reactivity is a potentially interesting outcome predictor in comatose patients, especially after cardiac arrest, but recent studies report only fair interrater reliability. Furthermore, there are no definite guidelines for its testing. We therefore investigated the EEG effect of standardized noxious stimuli in comatose patients not reactive to auditory stimuli. METHODS: In this prospective study we applied a protocol using three different painful stimuli (bilateral nipple pinching, pinprick at the nose base, finger-nail compression on each side), grouped in three distinct clusters with an alternated sequence, during EEG recordings in comatose patients. We only analyzed recordings showing any reactivity to pain. Fisher and χ2 tests were used as needed to assess contingency tables. RESULTS: Of 42 studies, 12 did not show any background reactivity, 2 presented SIRPIDs, and 2 had massive artefacts; we thus analyzed 26 EEGs recorded in 17 patients (4 women, 24%). Nipple pinching more frequently induced a change in EEG background activity (p<0.001), with a sensitivity of 97.4% for reactivity. Neither the order of the stimuli in the cluster (p=0.723), nor the cluster order (p=0.901) influenced the results. CONCLUSION: In this pilot study, bilateral, synchronous nipple pinching seems to be the most efficient method to test nociceptive EEG reactivity in comatose patients. This approach may enhance interrater reliability, but deserves confirmation in larger cohorts

Multimodal Outcome Prognostication After Cardiac Arrest and Targeted Temperature Management: Analysis at 36 °C.

Targeted temperature management (TTM) represents the standard of care in comatose survivors after cardiac arrest (CA) and may be applied targeting 33° or 36 °C. While multimodal prognostication has been extensively tested for 33 °C, scarce information exists for 36 °C. In this cohort study, consecutive comatose adults after CA treated with TTM at 36 °C between July 2014 and October 2016 were included. A combination of neurological examination, electrophysiological features, and serum neuron-specific enolase (NSE) was evaluated for outcome prediction at 3 months (mortality; good outcome defined as cerebral performance categories (CPC) score of 1-2, poor outcome defined as CPC 3-5). We analyzed 61 patients. The presence of two or more predictors out of, unreactive electroencephalogram (EEG) background, epileptiform EEG, absent pupillary and/or corneal reflex, early myoclonus, bilaterally absent cortical somatosensory evoked potentials, and serum NSE >75 μg/l, had a high specificity for predicting mortality (positive predictive value [PPV] = 1.00, 95% CI 0.87-1.00) and poor outcome (PPV = 1.00, 95% CI 0.80-1.00). Reactive EEG background was highly sensitive for predicting good outcome (0.95, 95% CI 0.74-0.99). Prediction of outcome after CA and TTM targeting 36 °C seems valid in adults using the same features tested at 33 °C. A reactive EEG under TTM appears highly sensitive for good outcome

Clinical outcome after a reactive hypothermic EEG following cardiac arrest.

BACKGROUND: Reactive electroencephalography (EEG) background during therapeutic hypothermia (TH) is related to favorable prognosis after cardiac arrest (CA), but its predictive value is not 100 %. The aim of this study was to investigate outcome predictors after a first reactive EEG recorded during TH after CA. METHODS: We studied a cohort of consecutive comatose adults admitted between February 2008 and November 2012, after successful resuscitation from CA, selecting patients with reactive EEG during TH. Outcome was assessed at three months, and categorized as survivors and non-survivors (no patient was in vegetative state). Demographics, clinical variables, EEG features, serum neuron-specific enolase (NSE) and procalcitonin, were compared using uni- and multivariable analyses. RESULTS: A total of 290 patients were treated with TH after cardiac arrest; 146 had an EEG during TH, which proved reactive in 90 of them; 77 (86 %) survived and 13 (14 %) died (without recovery from coma). The group of non-survivors had a higher occurrence of discontinuous EEG (p = 0.006; multivariate analysis p = 0.026), and a higher serum NSE peak (p = 0.021; multivariate analysis p = 0.014); conversely, demographics, and other clinical variables including serum procalcitonin did not differ. CONCLUSIONS: A discontinuous EEG and high serum NSE are associated with mortality after CA in patients with poor outcome despite a reactive hypothermic EEG. This suggests more severe cerebral damage, but not to higher extent of systemic disease

Clinical Outcome After a Reactive Hypothermic EEG Following Cardiac Arrest

Background: Reactive electroencephalography (EEG) background during therapeutic hypothermia (TH) is related to favorable prognosis after cardiac arrest (CA), but its predictive value is not 100%. The aim of this study was to investigate outcome predictors after a first reactive EEG recorded during TH after CA. Methods: We studied a cohort of consecutive comatose adults admitted between February 2008 and November 2012, after successful resuscitation from CA, selecting patients with reactive EEG during TH. Outcome was assessed at three months, and categorized as survivors and non-survivors (no patient was in vegetative state). Demographics, clinical variables, EEG features, serum neuron-specific enolase (NSE) and procalcitonin, were compared using uni- and multivariable analyses. Results: A total of 290 patients were treated with TH after cardiac arrest; 146 had an EEG during TH, which proved reactive in 90 of them; 77 (86%) survived and 13 (14%) died (without recovery from coma). The group of non-survivors had a higher occurrence of discontinuous EEG (p=0.006; multivariate analysis p=0.026), and a higher serum NSE peak (p=0.021; multivariate analysis p=0.014); conversely, demographics, and other clinical variables including serum procalcitonin did not differ. Conclusions: A discontinuous EEG and high serum NSE are associated with mortality after CA in patients with poor outcome despite a reactive hypothermic EEG. This suggests more severe cerebral damage, but not to higher extent of systemic diseas

Associated Factors and Prognostic Implications of Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges.

IMPORTANCE: The implications of stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) sometimes found on prolonged electroencephalographic (EEG) recordings are uncertain. OBJECTIVE: To evaluate the incidence of SIRPIDs and their clinical implications in critically ill patients. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, international retrospective study was performed from October 1, 2012, through September 30, 2014, of consecutive adult patients hospitalized in intensive care units with alteration of consciousness who underwent EEG recordings at 3 separate centers. Demographic data, including admission diagnosis, age, sex, history of epilepsy, and EEG findings, were noted. Characteristics of SIRPIDs were documented. Data were evaluated for predictors of SIRPIDs and in-hospital mortality. Data analysis was performed from January 16, 2015, to June 15, 2015. MAIN OUTCOMES AND MEASURES: Incidence of SIRPIDs, association of SIRPIDs with mortality and other EEG characteristics, and EEG and clinical predictors of mortality. RESULTS: A total of 416 patients were studied. The median age of patients was 60 years (interquartile range, 46-71 years), and 252 (60.6%) were male. A total of 104 patients (25.0%) did not survive to hospital discharge. SIRPIDs were identified in 43 patients (10.3%). The proportion of patients with SIRPIDs was not significantly different across the 3 sites (P = .34). Anoxic brain injury (odds ratio [OR], 3.80; 95% CI, 1.73-8.33; P < .001), the use of antiepileptic medications (OR, 3.24; 95% CI, 1.31-8.00; P = .01), electrographic seizures (OR, 2.85; 95% CI, 1.13-7.19; P = .03), generalized periodic discharges with triphasic morphologic features (OR, 3.66; 95% CI, 1.67-8.02; P = .001), and sporadic sharp waves and periodic discharges (OR, 2.59; 95% CI, 1.13-5.92; P = .02) were independently associated with the presence of SIRPIDs. Older age (OR, 1.02; 95% CI, 1.01-1.04; P = .005), anoxic brain injury (OR, 3.49; 95% CI, 1.96-6.21; P ≤ .001), and absence of EEG reactivity (OR, 8.14; 95% CI, 4.20-15.79; P < .001) but not SIRPIDs (OR, 1.73; 95% CI, 0.79-3.78; P = .17) were independently associated with in-hospital mortality. CONCLUSIONS AND RELEVANCE: In critically ill patients undergoing EEG recordings, SIRPIDs occurred in 43 (10.3%) and were associated with other electrographic abnormalities previously reported to indicate poor prognosis. However, SIRPIDs were not independently associated with in-hospital mortality

A New Era in Engineering Plastics: Compatibility and Perspectives of Sustainable Alipharomatic Poly(ethylene terephthalate)/Poly(ethylene 2,5-furandicarboxylate) Blends

The industrialisation of poly(ethylene 2,5-furandicarboxylate) for total replacement of poly(ethylene terephthalate) in the polyester market is under question. Preparation of high-performing polymer blends is a well-established strategy for tuning the properties of certain homopolymers and create tailor-made materials to meet the demands for a number of applications. In this work, the structure, thermal properties and the miscibility of a series of poly(ethylene terephthalate)/poly(ethylene 2,5-furandicarboxylate) (PET/PEF) blends have been studied. A number of thermal treatments were followed in order to examine the thermal transitions, their dynamic state and the miscibility characteristics for each blend composition. Based on their glass transition temperatures and melting behaviour the PET/PEF blends are miscible at high and low poly(ethylene terephthalate) (PET) contents, while partial miscibility was observed at intermediate compositions. The multiple melting was studied and their melting point depression was analysed with the Flory-Huggins theory. In an attempt to further improve miscibility, reactive blending was also investigated

Postanoxic alpha, theta or alpha-theta coma: Clinical setting and neurological outcome

Aim The aim of this study was to determine the prognosis of 26 consecutive adults with alpha coma (AC), theta coma (TC) or alpha-theta coma (ATC) following CRA and to describe the clinical setting and EEG features of these patients. Methods We retrospective analyzed a prospectively collected cohort of adult patients diagnosed as having AC, TC or ATC after CRA between January 2008 and June 2016. None of patients included in this analysis underwent therapeutic hypothermia (TH). Neurological outcome was expressed as the best score 6 months after CRA using the five-point Glasgow-Pisttsburgh Cerebral Performance Categories (CPC) Results Twenty-six patients were identified with a diagnosis of postanoxic AC, TC or ATC coma. There were 20 (77%) men and 6 (23%) women. The mean age was 63?±?16?years. The most frequent EEG pattern was TC (21 patients, 80%), followed by AC (3 patients, 12%) and ATC (2 patients, 8%). The cardiac rhythm as primary origin of the CRA was ventricular fibrillation (VF) in 16 patients (61.5%), asystole in 8 patients (34.6%) and ventricular tachycardia (VT) in one patient (3.8%). The presence of EEG reactivity was present in 8 patients (30%). The mortality rate was 85%. Of the 4 surviving patients, two (3.8%) had moderate disability (CPC 2), one (3.8%) had severe disability (CPC 3) and one (3.8%) reached a good recovery. The age was significantly lower in survivors 46.2?±?10.8 versus nonsurvivors 63.3?±?15.5 (p?=?0.04). There was increased association of EEG reactivity with survival (p?=?0.07). Conclusion Hypoxic-ischemic AC, TC and ATC are associated with a poor prognosis and a high rate of mortality. In younger patients with AC, TC and ATC and incomplete forms showing reactivity on the EEG, there is a greater probability of clinical recovery

Η θεωρία της Μετασχηματίζουσας Μάθησης και η υπόσταση του γυναικείου φύλου στην αξιοποίηση και διεργασία των εμπειριών ως προς την ένταξη στο χώρο εργασίας

Η παρούσα έρευνα με τίτλο «Η θεωρία της Μετασχηματίζουσας Μάθησης και η υπόσταση του γυναικείου φύλου στην αξιοποίηση και διεργασία των εμπειριών ως προς την ένταξη στο χώρο εργασίας» ασχολείται και εξετάζει τις νοητικές συνήθειες και τις παραδοχές των ενηλίκων αναφορικά με το ρόλο, τη θέση και την υπόσταση της γυναίκας στον χώρο εργασίας. Συγκεκριμένα στο πρώτο μέρος της εργασίας αναφέρονται τα χαρακτηριστικά των συμμετεχόντων στην εκπαίδευση ενηλίκων, τα εμπόδια και τα κίνητρα που αντιμετωπίζουν καθώς και με εκτενής περιγραφή και ανάλυση του πεδίου. Στη συνέχεια πραγματοποιείται εμβάθυνση στη θεωρία της Μετασχηματίζουσας Μάθησης, μίας από τις βασικές θεωρίες του πεδίου αυτού. Η συγκεκριμένη θεωρία βασίζεται στην εκπαίδευση των ενηλίκων μέσω του κριτικού στοχασμού επί των εμπειριών τους. Ουσιαστικά μέσω της εκπαιδευτικής διαδικασίας ο ενήλικας εντοπίζει τις δυσλειτουργικές παραδοχές που έχει αποκτήσει κατά τη διάρκεια της ζωής του, μέσω της κοινωνικοποίησης του και οι οποίες στην μετέπειτα πορεία της ζωής του πλέον δεν τον αντιπροσωπεύουν, οπότε γίνεται προσπάθεια αποβολής ή μετασχηματισμού αυτών. Στη συνέχεια η θεωρία αυτή στο σύνολο της εργασίας συναρτάται με τις λανθάνουσες αντιλήψεις και λανθάνουσες παραδοχές αναφορικά με το φύλο. Συγκεκριμένα η μελέτη διερευνά τις αντιλήψεις που έχουν οι ίδιες οι γυναίκες για την δική τους παρουσία και τον ρόλο τους στο χώρο εργασίας. Οι αντιλήψεις που έχουν οι ίδιες σχετικά με τον τρόπο αντιμετώπισης τους σε ένα εργασιακό περιβάλλον, κατά πόσο αντιμετωπίζονται ως ισάξια και ισότιμα με τον άνδρα όντα αλλά και επαγγελματίες. Κατά πόσο το εργασιακό περιβάλλον λαμβάνει υπόψη τις προσωπικές τους ανάγκες και υποχρεώσεις που δεν σχετίζονται με την εργασία τους αλλά με την γενικότερη ζωή τους. Τέλος πόσο ασφαλείς αισθάνονται οι ίδιες σε έναν τέτοιο χώρο και ποιά ή πόσο συχνά είναι αυτά τα φαινόμενα που με την παρουσία τους μπορούν να αναταράξουν και να διακόψουν αυτή την ασφάλεια. Με στόχο τη διερεύνηση των παραπάνω διεξήχθη ποσοτική έρευνα με τη χορήγηση ερωτηματολογίων σε εξήντα (60) γυναίκες οι οποίες ανήκουν σε διαφορετικές ηλικιακές ομάδες, επαγγέλματα, κοινωνική κατάσταση, καταγωγή κλπ. Τα αποτελέσματα της μελέτης δείχνουν ότι οι γυναίκες νιώθουν πως αντιμετωπίζονται με διαφορετικό τρόπο απ’ ότι οι άνδρες συνάδελφοι τους. Οι περισσότερες στο σύνολο τους, θεωρούν πως δεν μπορούν να είναι ο εαυτός τους στο επαγγελματικό τους περιβάλλον, ότι πρέπει να προσπαθούν περισσότερο να αποδείξουν την αξία, τις δυνατότητες και τις ικανότητες τους. Ταυτόχρονα βιώνουν αισθήματα φόβου και ανασφάλειας τα οποία σχετίζονται με περιστατικά σεξουαλικής παρενόχλησης είτε με την οικογενειακή τους κατάσταση, όπως για παράδειγμα η πιθανότητα μίας εγκυμοσύνης. Με στόχο τη βαθύτερη διερεύνηση των ζητημάτων που αναδείχτηκαν από την ποσοτική μελέτη, διεξήχθη ποιοτική μελέτη με την διεξαγωγή έξι (6) συνεντεύξεων, στις οποίες συμμετείχαν γυναίκες οι οποίες άνηκαν σε διαφορετική ηλικιακή ομάδα, οικογενειακή κατάσταση, καταγωγή κλπ. Η μόνη διάκριση αναφέρονταν στην εργασιακή κατάσταση των συμμετεχόντων καθώς οι μισές ήταν εργαζόμενες και οι μισές άνεργες. Λέξεις κλειδιά: Εκπαίδευση Ενηλίκων, Μετασχηματίζουσα Μάθηση, παραδοχές, στερεότυπα, έμφυλες διακρίσεις, σεξουαλική παρενόχληση.The present research entitled "Transformative Learning Theory and the Status of the Female Gender in the Utilization and Process of Experiences in Workplace Integration" deals with and examines the cognitive habits and assumptions of adults regarding the role, position and status of women in the workplace. Specifically, the first part of the paper discusses the characteristics of participants in adult education, the barriers and motivations they face, as well as an extensive description and analysis of the field. Then an in-depth study of the theory of Transformative Learning, one of the main theories of this field, is carried out. This theory is based on educating adults through critical reflection on their experiences. Essentially, through the educational process, the adult identifies the dysfunctional assumptions that he has acquired during his life through socialization and which in the later course of his life no longer represent him, so an attempt is made to eliminate or transform them. This theory in the whole work is then related to latent perceptions and latent assumptions regarding gender. Specifically, the study explores women's own perceptions of their own presence and role in the workplace. The perceptions they have about how they are treated in a work environment, whether they are treated as equal and equal to male beings and professionals. Whether the work environment takes into account their personal needs and responsibilities that are not related to their work but to their general life. Finally, how safe do they feel in such a place and what or how frequent are the phenomena that by their presence can disrupt and interrupt this security. In order to investigate the above, a quantitative survey was conducted by administering questionnaires to sixty (60) women who belong to different age groups, occupations, social status, background, etc. The results of the study show that women feel that they are treated differently from their male counterparts. Most of them, as a whole, feel that they cannot be themselves in their professional environment, that they have to try harder to prove their worth, capabilities and abilities. At the same time they experience feelings of fear and insecurity related to incidents of sexual harassment or to their family situation, such as the possibility of pregnancy. In order to further explore the issues highlighted by the quantitative study, a qualitative study was conducted by conducting six (6) interviews with women who belonged to different age groups, marital status, backgrounds, etc. The only distinction referred to the employment status of the participants as half of them were employed and half were unemployed. Key words: Adult Education, Transformative Learning, assumptions, stereotypes, gender discrimination, sexual harassment