Implantable Asynchronous Epilectic Seizure Detector

RÉSUMÉ Plusieurs algorithmes de détection à faible consommation ont été proposés pour le traitement de l'épilepsie focale. La gestion de l'énergie dans ces microsystèmes est une question importante qui dépend principalement de la charge et de la décharge des capacités parasites des transistors et des courants de court-circuit pendant les commutations. Dans ce mémoire, un détecteur asynchrone de crise pour le traitement de l'épilepsie focale est présenté. Ce système fait partie d'un dispositif implantable intégré pour stopper la propagation de la crise. L'objectif de ce travail est de réduire la dissipation de puissance en évitant les transitions inutiles de signaux grâce à la technique du « clock tree » ; en conséquence, les transistors ne changent pas d'état transitoire dans ce mode d'économie d'énergie (période de surveillance des EEG intracrâniens), sauf si un événement anormal est détecté. Le dispositif intégré proposé comporte un bio-amplificateur en amont (front-end) à faible bruit, un processeur de signal numérique et un détecteur. Un délai variable et quatre détecteurs de fenêtres de tensions variables en parallèles sont utilisés pour extraire de l’information sur le déclenchement des crises. La sensibilité du détecteur est améliorée en optimisant les paramètres variables en fonction des activités de foyers épileptiques de chaque patient lors du début des crises. Le détecteur de crises asynchrone proposé a été implémenté premièrement en tant que prototype sur un circuit imprimé circulaire, ensuite nous l’avons intégré sur une seule puce dans la technologie standard CMOS 0.13μm. La puce fabriquée a été validée in vitro en utilisant un total de 34 enregistrements EEG intracrâniens avec la durée moyenne de chaque enregistrement de 1 min. Parmi ces jeux de données, 15 d’entre eux correspondaient à des enregistrements de crises, tandis que les 19 autres provenaient d’enregistrements variables de patients tels que de brèves crises électriques, des mouvements du corps et des variations durant le sommeil. Le système proposé a réalisé une performance de détection précise avec une sensibilité de 100% et 100% de spécificité pour ces 34 signaux icEEG enregistrés. Le délai de détection moyen était de 13,7 s après le début de la crise, bien avant l'apparition des manifestations cliniques, et une consommation d'énergie de 9 µW a été obtenue à partir d'essais expérimentaux.----------ABSTRACT Several power efficient detection algorithms have been proposed for treatment of focal epilepsy. Power management in these microsystems is an important issue which is mainly dependent on charging and discharging of the parasitic capacitances in transistors and short-circuit currents during switching. In this thesis, an asynchronous seizure detector for treatment of the focal epilepsy is presented. This system is part of an implantable integrated device to block the seizure progression. The objective of this work is reducing the power dissipation by avoiding the unnecessary signal transition and clock tree; as a result, transistors do not change their transient state in power saving mode (icEEG monitoring period) unless an abnormal event detected. The proposed integrated device contains a low noise front-end bioamplifier, a digital signal processor and a detector. A variable time frame and four concurrent variable voltage window detectors are used to extract seizure onset information. The sensitivity of the detector is enhanced by optimizing the variable parameters based on specific electrographic seizure onset activities of each patient. The proposed asynchronous seizure detector was first implemented as a prototype on a PCB and then integrated in standard 0.13 μm CMOS process. The fabricated chip was validated offline using a total of 34 intracranial EEG recordings with the average time duration of 1 min. 15 of these datasets corresponded to seizure activities while the remaining 19 signals were related to variable patient activities such as brief electrical seizures, body movement, and sleep patterns. The proposed system achieved an accurate detection performance with 100% sensitivity and 100 % specificity for these 34 recorded icEEG signals. The average detection delay was 13.7 s after seizure onset, well before the onset of the clinical manifestations. Finally, power consumption of the chip is 9 µW obtained from experimental tests

Executive Function Assessment in Patients With Idiopathic Generalized Epilepsy: Applyingthe Frontal Assessment Battery

   Background: Executive dysfunction is seen in idiopathic generalized epilepsy (IGE). The Frontal Assessment Battery (FAB) is a short neuropsychological instrument designed in clinical settings to evaluate frontal lobe activity. We aimed to assess the clinical use of FAB in patients with IGE for to detect executive impairment. Method: In this study, 30 patients with IGE and 30 age- and sex-matched healthy controls were included. The presence and severity of executive dysfunction was investigated with FAB. Cognitive flexibility, decision making, working memory, and general intelligence level were examined using Wisconsin Card Sorting Task (WCST), Iowa Gambling Task (IGT), N-back, and Wechsler Adult Intelligence Scale, respectively. In patients with IGE, FAB results were related to their neuropsychological task performance. Results: The FAB score in patients with IGE was significantly lower compared to healthy participants. In motor programming tasks, patients with IGE performed substantially worse. However, no correlation was found between FAB and neuropsychological task and clinical characteristics. Conclusion: Executive dysfunction was present in patients with IGE and FAB may be used in these patients as an effective tool for evaluating frontal lobe function

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Mental health stigma among Middle Eastern adolescents: a protocol for a systematic review

Introduction: Although many epidemiological and interventional investigations regarding improving mental health among youth in the Middle East have been performed, there is no systematic review specifically analyzing the studies on stigma among adolescents with mental disorders (A-MDs) across all Middle East countries despite their common historical roots, similar cultural backgrounds, and recent widespread problems in the area. Purpose: We will aim to systematically review and analyze the English-language studies on stigma among A-MDs in the Middle East published between 2000 and 2019. Method: The Web of Knowledge, Science Direct, PsycINFO and MEDLINE are electronic databases that will be included in this study. Furthermore, the bibliography lists of eligible articles will be manually searched for additional included articles. Descriptive statistics will be represented by mean score and standard deviation for continuous data and number/percentage for categorical data. Discussion: This study may act as a resource for future studies attempting to assess and/or reduce stigma among children and adolescents with mental health issues specifically in the Middle East. Implications: It is important for health care providers, including nursing professional, to improve their knowledge and vision towards stigma in their community. The outcomes of this study can be a shortcut reaching this information

Evaluation the relationship between psychological profile and salivary cortisol in patients with recurrent aphthous stomatitis

Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases which are diagnosed with recurrent and painful ulcers. The possible association between psychological factors and salivary stress related factors in patients with aphthous ulcers has been discussed in various studies. The aim of this study was to evaluate salivary cortisol level, anxiety, and depression in patients with RAS. Materials and Methods: In this case control study, 30 patients with RAS and 30 healthy individuals were enrolled by matching their age and sex. Anxiety and depression were assessed by beck anxiety inventory and beck depression inventory. Unstimulated saliva of both groups were collected and then tested by DiaMetra kit and the ELISA method. Data were analyzed by SPSS using an Independent t-test and Mann–Whitney test. A statistical significance level of <0.05 was considered. Results: The mean salivary cortisol in the case group was 5.35 ng/ml and in the control group was 4.73 ng/ml which was not statistically significant (P > 0.05). There was no significant difference in anxiety and depression level between the two groups (P > 0.05). According to Spearman correlation coefficient, there was an average, negative, and significant correlation between salivary cortisol and anxiety and depression scores in the case group (P < 0.05). Conclusion: This study shows that, although the mean salivary cortisol was slightly higher in patients with aphthous lesions, anxiety, and depression were not possible factors for RAS. There was a moderate, negative correlation between salivary cortisol level and stress and anxiety in patients with RAS

Diagnostic Accuracy of Growth Rate in Differentiating Etiologies of Short Stature in Children

Background  Short stature is a manifestation of a wide variety of conditions that some of which may be amenable to timely treatment and a suboptimal growth rate may be an early marker pointing to the cause of growth retardation. This study was conducted to evaluate the diagnostic utility of growth rate in differential diagnosis of children with short stature. Materials and Methods All children between the ages of 2 and 18 years who visited in pediatric endocrinology clinic in a five years period were recruited in a prospective cohort study. Children with standing height Results One hundred forty three patients fulfilled the inclusion criteria. Mean follow up period was 14.4±10.9 months. Etiologies of short stature were: constitutional growth delay (CGD) 46.9%, familial short stature (FSS) 28.7%, hypothyroidism 4.2%, growth hormone deficiency (GHD) 4.2% and miscellaneous causes in 16% of patients.  Mean Z- score for children with constitutional growth delay was -2.3±0.69, in familial short stature was -2.3±0.65 and for other condition was -2.7±1.49. There was a meaningful statistical correlation between growth rate and etiology of short stature (P0.05). Conclusion There was significant difference in growth rate between children with constitutional growth delay and familial short stature in comparing to short stature due to endocrine problem and other etiologies. Assessment of growth rate has some utility in diagnosing the etiology of short stature

Balance of Wisdom: A Mechanical Balance From the 12th Century

The “Balance of Wisdom” (or “comprehensive balance) is a name for one of the most sophisticated and advanced balances designed and manufactured after the establishment of Islam. Designer of this balance is Abdol Rahmaan Al-Khazini who also presented this balance in a book titled “Al-Kitab Mizan Al-Hikma “or “The Balance of Wisdom”. Of the prominences of this balance to others, one can point out; its precision, triple complex action, number of pans, which enabled the balance to be applied for recognition of constituent substances of twofold alloys, and their weight percentage in the alloy. It was also capable of measuring the weight and density of substances or alloys, precisely. It was mainly used at the treasuries of kings to have control upon the treasurer, by measuring the gold carat of the items kept in the treasury. The balance is a hydrostatic balance of standard form with five scale pans, a rather complicated polyfilar suspension, and a sensitive indicator tongue. It was first designed and manufactured in the twelfth century A.C, after which there are no signs of remanufacturing, or development of this balance. The balance was redesigned according to the book, “ Al-Kitab Mizan Al-Hikma “ , manufactured and tested as a part of a research project called “ Designing and manufacturing of innovations and inventions of the Iranian scientist”, undertaken by the Mechanical Engineering Research Center of the Iranian Research Organization for Science and Technology (IROST

Knowledge, Perspectives, and Priorities Regarding Self-Care Activities: A Population-Based Qualitative Study among Iranian Adolescents

This qualitative study aimed to investigate knowledge, perspectives, and priorities related to self-care among Iranian adolescents. Through snowball sampling, the link to the questionnaire was shared in available social media apps. The results showed that 192 of 294 participants reported that they had heard about “self-care”. Parents/family and school were the most frequent sources of learning about self-care among the male and female respondents, respectively. Analyzing the participants’ statements regarding their own understanding of self-care activities, three major terms—“taking care of”, “avoid”, and “respect” were identified. When being ask about what they do for their own self-care, the results showed spending time on the Internet had the highest repetition rate among boys’ responses, followed by “going to gym”, “video games”, and “listening to music”. Regarding the desired activities, both girls’ and boys’ statements indicated that among leisure activities, “traveling” was the most frequent word, followed by being with friends. The girls showed more interest in attending night clubs or spending time outside the home late at night. Insights from this study identifying preferences in self-care activities can be used to develop intervention programs for Iranian adolescents to improve their lifestyle and, consequently, their well-being based on their needs and situation

Information Literacy Among Undergraduate Students Of Health Services Administration In Ahvaz Jundishapur University Of Medical Sciences Based On SCONUL Seven Pillars Model: 2013

Background and Aim: Information literacy is a set of skills required to identify rightful information resources and access to them. These skills are empowering goal oriented use of information resources. This study aimed to determine the ability rate of information literacy among health services administration students in Jundishapur University of Medical Sciences based on SCONUL seven pillars model.   Materials and Methods: This cross-sectional descriptive-analytic study was conducted using a questionnaire developed based on SCONUL information literacy seven pillars model. Validity of the questionnaire was confirmed through content analysis and coefficient of Chronbach’s alpha was 0.93. The study population included students of health services administration in Ahvaz Jundishapur University of Medical Sciences in 2013. The sample size included 40 cases collected randomly. Data analyzed through SPSS descriptive statistics and non-parametric statistical tests. Results: The mean score for the studied components of information literacy abilities among the study population was 0.5±0.43. Information Literacy score among freshmen was significantly different from other students (P<0.03). Students who passed Computer Basics and Research Methodology educational courses showed significant differences from other students in the information management (P<0.01). Conclusion: Given the increasing development in information technology, the need to develop information literacy skills is considerable especially among those who are going to be engaged in the health sector. Although studied students’ information literacy estimated relatively well, it seems necessary to take measures to improve their information literacy in all components