Ambulatory Recordings Research Articles

Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use.

ObjectiveThe COVID-19 pandemic changed clinician electronic health record (EHR) work in a multitude of ways. To evaluate how, we measure ambulatory clinician EHR use in the United States throughout the COVID-19 pandemic.Materials and MethodsWe use EHR meta-data from ambulatory care clinicians in 366 health systems using the Epic EHR system in the United States from December 2019 to December 2020. We used descriptive statistics for clinician EHR use including active-use time across clinical activities, time after-hours, and messages received. Multivariable regression to evaluate total and after-hours EHR work adjusting for daily volume and organizational characteristics, and to evaluate the association between messages and EHR time.ResultsClinician time spent in the EHR per day dropped at the onset of the pandemic but had recovered to higher than prepandemic levels by July 2020. Time spent actively working in the EHR after-hours showed similar trends. These differences persisted in multivariable models. In-Basket messages received increased compared with prepandemic levels, with the largest increase coming from messages from patients, which increased to 157% of the prepandemic average. Each additional patient message was associated with a 2.32-min increase in EHR time per day (P < .001).DiscussionClinicians spent more total and after-hours time in the EHR in the latter half of 2020 compared with the prepandemic period. This was partially driven by increased time in Clinical Review and In-Basket messaging.ConclusionsReimbursement models and workflows for the post-COVID era should account for these demands on clinician time that occur outside the traditional visit.

Abstract 13995: Proarrhythmic Electromechanical Heterogeneities in Patients With KCNJ2 Mutations

Introduction: Loss-of-function mutations of the KCNJ2 gene encoding the inward-rectifier potassium channel, I K1 , are associated with QT prolongation, prominent U waves, abnormal impulse formation and ventricular tachycardia (VT), besides non-cardiac manifestations. The electromechanical consequences of genetic I K1 dysfunction are unknown. Hypothesis: We hypothesize that I K1 dysfunction leads to increased electrical and mechanical dispersion and electromechanical (EMW) negativity. Dynamic heterogeneity of these functional parameters may conspire to arrhythmia. Methods: High-resolution mapping using ECG imaging, speckle-tracking echocardiography and/or tissue-phase mapping CMR were performed in genotyped KCNJ2 -mutation carriers, besides standard 12-lead and ambulatory recording. Results: Five patients (44±13 years; 2 females) were included; KCNJ2 p.(Val93Ile), p.(Arg218Gln), p.(Thr75Arg), p.(Lys49Arg), p.(Gly144Ala). Three had experienced polymorphic VT/VF. Multifocal ventricular ectopic burden averaged 13%. Mean QTc/QTUc were 446±42/610±78 ms, with U-waves of 149±18 ms and 0.087±0.045 mV. ECG-imaging revealed increased epicardial recovery time gradients (168±58 ms/cm), with LV- and RV-contractile heterogeneities by strain: Delta contraction duration (CD) LV 213±77 ms, standard deviation (SD) 58±14 ms; RV Delta CD 30±22 ms, SD 13±9 ms. Abnormal postsystolic shortenings (Fig.), prolonged isovolumic relaxation times (103±25 ms) and reduced diastolic peak velocities (-7.2±1.7 cm/s) indicated impaired early relaxation. The EMW was -51±35 ms with more pronounced negativity in symptomatic patients (-74 vs. -17 ms). Conclusions: Genetic I K1 dysfunction underlies nonuniform mechanical heterogeneities in contraction and relaxation, besides repolarization and resting membrane-potential instability. Significant EMW negativity further promotes ventricular ectopy, potentially precipitating VT.

Abstract 11737: Higher Frequency of Ventricular Ectopy is Associated With Incident Dementia in Older Adults Without Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Excessive ventricular ectopy (VE) is a risk factor for stroke. It is unclear whether higher frequency of VE is associated with the risk of dementia. Hypothesis: Higher frequency of VE, including ventricular tachycardias (VT) and premature ventricular contractions (PVC), are associated with a higher risk of dementia. Methods: We included 2167 participants without adjudicated dementia, stroke or atrial fibrillation (mean age, 79 years, 60% female, 26% Black). We measured burden of VT and PVC over 2 weeks at baseline (2016-17) with Zio XT patch: an ambulatory ECG recorder (iRhythm Technologies, Inc.). We quantified PVC burden as: 1) natural log of frequency in episodes/day (due to skewed distribution) and 2) dichotomously, split at the median level of frequency. We quantified VT burden as: 1) presence of any VT, 2) frequency of VT (episodes/day) split at the median, and 3) duration of the longest VT episode split at the median, using ‘no VT’ group as the referent in each case. We adjudicated dementia events through 2019 using cognitive testing at study visits, telephone cognitive interviews, and medical records. We calculated relative risk of incident dementia by Poisson regression with robust error variance. Results: At baseline, PVC and VT were present in 99% and 27% of participants, respectively. Over 2 years of follow-up, 66 (3.0%) participants developed dementia. Higher frequency of PVCs and VTs (≥ median vs none), and longer duration of the longest VT episode (≥ median vs none) were associated with a higher risk of dementia independent of cardiovascular (CV) disease and risk factors (Table). These associations were attenuated after adjusting for incident stroke. Conclusions: In older adults, higher VE frequency is associated with a higher dementia risk independent of CV risk factors. Our novel findings broaden the scope of “vascular contribution to cognitive impairment and dementia” to include ventricular arrhythmias as novel risk factors for dementia.

Abstract 12116: Sex Differences in Arrhythmia Prevalence in a Large Patient Cohort Examined With Mobile Cardiac Telemetry

Introduction: The frequency of clinically relevant arrhythmia on long-term ambulatory ECG recordings is not sufficiently well described. We aimed to address this in a large patient cohort monitored with mobile cardiac telemetry. Methods: All patients 18-100 years who were monitored in the USA in 2017 (n=27.203, 58% female) with the PocketECG device (MediLynx), which registers and transmits a full-disclosure ECG for ≤30 days with beat-to-beat analysis, were included. Frequent premature ventricular complexes (PVCs) and frequent premature atrial complexes (PACs) were defined as ≥200 PVCs or ≥500 PACs in any recording day. Supraventricular tachycardia (SVT) episodes were defined as both any SVT &gt;3 beats, and SVT ≥30 seconds. AV-blocks II and III were not differentiated. Results: In the 18-40-year age group the overall prevalence of any arrhythmia was low (Figure 1 a-f). Frequent PACs, atrial fibrillation, AV-blocks and ventricular arrhythmias were more common in men than women (all p&lt;0.0001), and SVTs, both &gt;3 beats and &gt;30 seconds, were more common in women (p&lt;0.001 and p&lt;0.004, respectively). The overall prevalence of any VT event was 22.9% in women and 40.8% in men (p&lt;0.0001) and the mean age at onset of VT was lower in women (71.9 vs 72.6 years, 95%CI for difference (-1.3; -0.3). Conclusions: Most arrhythmias are more prevalent among men of all ages, but SVTs are more prevalent among women. VT events are common in a patient population, and the age at onset of ventricular tachycardia is lower among women.

Temporal relationship between sleep-time masseter muscle activity and apnea-hypopnea events: A pilot study.

Obstructive sleep apnea (OSA) is the most common sleep disorder due mainly to peripheral causes, characterized by repeated episodes of obstruction of the upper airways, associated with arousals and snoring. Sleep bruxism (SB) is a masticatory muscle activity during sleep that is characterized as rhythmic (phasic) or nonrhythmic (tonic) and is not a movement disorder or a sleep disorder in otherwise healthy individuals. Given the potentially severe consequences and complications of apnea, the concurrent high prevalence of SB in daily dental practice, getting deeper into the correlation between these phenomena is worthy of interest.. The aim of this study was to investigate the correlation between SB-related masseter muscle activity (MMA) and apnea-hypopnea events as well as to assess their temporal sequence. Thirty (N=30) patients with sleep respiratory disorders and clinical suspicion of sleep bruxism (SB) were recruited. Ambulatory polygraphic recording was performed to detect apnea-hypopnea events (AHEs) and sleep bruxism episodes (SBEs). Pearson test was used to assess the correlation between apnea-hypopnea index (AHI) and SB index (SBI). A 5-s time window with respect to the respiratory events was considered to describe the temporal distribution of SBEs. Furthermore, SBI was compared between groups of patients with different AHI severity (i.e., mild, moderate and severe) using ANOVA. On average, AHI was 27.1±21.8 and SBI 9.1±7.5. No correlation was shown between AHI and SBI. Most of SBEs (66.8%) occurred without a temporal relationship with respiratory events. Considering OSA, 65.7% of SBEs occurred within 5s after AHEs, while in the case of central apnea (CA) 83.8% of SBEs occurred before the respiratory event. The participants with severe apnea (N=9) show a tendency to have higher bruxism indexes when compared to patients with mild (N=11) and moderate apnea (N=10). Findings suggest that: 1. At the study population level, there is no correlation between AHI and SBI, as well as any temporal relationship between SBEs and respiratory events. 2. Specific patterns of temporal relationship might be identified with future studies focusing on the different types of apnea-hypopnea events and bruxism activities.

Relationships Among Personality, Daily Speaking Voice Use, and Phonotrauma in Adult Female Singers.

Purpose:This study sought to determine whether personality traits related to extraversion and impulsivity are more strongly associated with singers with nodules compared to vocally healthy singers and to understand the relationship between personality and the types of daily speaking voice use.Method:Weeklong ambulatory voice recordings and personality inventories were obtained for 47 female singers with nodules and 47 vocally healthy female singers. Paired t tests investigated trait differences between groups. Relationships between traits and weeklong speaking voice measures (vocal dose, sound pressure level [SPL], neck surface acceleration magnitude [NSAM], fundamental frequency, cepstral peak prominence [CPP], and the ratio of the first two harmonic magnitudes [H 1 –H 2]) were examined using pairwise Pearson r coefficients. Multiple regressions were performed to estimate voice parameters that correlated with two or more traits.Results:Singers with nodules scored higher on the Social Potency scale (reflecting a tendency toward social dominance) and lower on the Control scale (reflecting impulsivity) compared to the vocally healthy singers. In vocally healthy singers, vocal dose measures were positively correlated with a combination of Wellbeing (i.e., happiness) and Social Potency, mean SPL was positively correlated with Wellbeing, SPL variability was positively correlated with Social Potency and negatively with Harm Avoidance, and CPP mean was positively correlated with Wellbeing. Singers with nodules had a negative correlation between NSAM skewness and Social Potency. Both groups had negative correlations between H 1 –H 2 mean and Social Potency and Social Closeness.Conclusions:Singers with nodules are more socially dominant and impulsive than vocally healthy singers. Personality traits are related to daily speaking voice use, particularly in vocally healthy singers. Individuals with higher levels of traits related to happiness and social dominance and lower Harm Avoidance tended to speak more, with higher laryngeal forces, with more SPL variability, and with more pressed glottal closure, which could increase risk of phonotrauma.

Hippocampal-ANT connectivity and ANT DBS: Circadian trends and response to stimulation

Abstract Although hippocampal (HC)-anterior nucleus of the thalamus (ANT) interactions are implicated in limbic epilepsy, their dynamics over the circadian cycle and following ANT deep brain stimulation (DBS) remain unclear. We used ultra-long, ambulatory, HC and ANT intracranial electroencephalographic recordings to describe HC-ANT connectivity in a patient with bilateral temporal lobe epilepsy. The patient was implanted with the investigational Medtronic Summit RC+S ™ sensing and stimulating DBS device. Electrodes were implanted into the long axis of the hippocampus and ANT bilaterally. Therapeutic stimulation was delivered to the ANT. HC-ANT coherence was calculated in the Berger bands (4-125 Hz) in 10 second segments from one month of baseline recordings and from a three week period of night-off stimulation that followed a month of continuous low frequency ANT stimulation (2Hz). Only coherence measurements wherein both contacts had spectral peaks in the relevant band, without seizures, spikes, or stimulation, were analyzed. Coherence values over the circadian cycle were compared across hemispheres and between baseline and post-stimulation periods. At baseline, concurrent spectral peaks in HC and ANT occurred across the circadian cycle, primarily in the high beta and low gamma frequency bands bilaterally, with the less epileptogenic, right hemisphere showing significantly greater high beta coherence (Wilcoxon Rank-Sum, n1 = 2638, n2 = 2515, p < 0.0001). Post-stimulation, nighttime left HC-ANT high beta coherence did not change, but the central frequency of coherent high beta peaks did increase significantly (Wilcoxon Rank-Sum, n1 = 368, n2 = 492, p < 0.0001). Our finding that HC-ANT high beta coherence was decreased in the more epileptogenic hemisphere is consistent with reports of functional isolation of epileptogenic zone. The stimulation-associated change in central frequency at which beta peaks occurred, but not in overall magnitude of HC-ANT coherence, suggests that low frequency ANT-DBS influences the spectral composition of HC-ANT connectivity. Keywords: Deep brain stimulation, Connectivity, Epilepsy, Anterior nucleus of the thalamus

Audio-based cough counting using independent subspace analysis.

In this paper, an algorithm designed to detect characteristic cough events in audio recordings is presented, significantly reducing the time required for manual counting. Using time-frequency representations and independent subspace analysis (ISA), sound events that exhibit characteristics of coughs are automatically detected, producing a summary of the events detected without the need for a pre-trained model. Using a dataset created from publicly available audio recordings, this algorithm has been tested on a variety of synthesized audio scenarios representative of those likely to be encountered by subjects undergoing an ambulatory cough recording, achieving a true positive rate of 76% with an average of 2.85 false positives per minute.

Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests.

The clinical performance of home sleep apnea tests (HSATs) can be described by their (diagnostic) accuracy, defined as the percentage agreement with the obstructive sleep apnea severity category (normal, mild, moderate, and severe) based on polysomnography. Rather than reporting on accuracy, there has been a strong reliance in the literature to report correlation coefficients between the apnea-hypopnea index of HSATs and polysomnography to support claims of diagnostic performance. This is surprising, as it has been well described that correlation coefficients are inadequate to evaluate equivalence between 2 parameters. The aim of this study was to systematically investigate the magnitude of the discrepancies between correlation coefficients and diagnostic accuracy reported in or retrievable from HSAT validation studies. We compared the discrepancy between accuracy and apnea-hypopnea index correlation coefficients of all validation papers that met the inclusion criteria. A total of 20 papers were retained, representing a participant pool of 1,652. The weighted average apnea-hypopnea index correlation across all 20 papers was 0.82 and the weighted average accuracy was 0.61, highlighting a discrepancy of 0.21 and an overall misdiagnosis rate of 39%. The results of our study confirm the need for increased scientific rigor in selecting primary performance endpoints to support clinical performance claims of HSATs. Massie F, Van Pee B, Bergmann J. Correlations between home sleep apnea tests and polysomnography outcomes do not fully reflect the diagnostic accuracy of these tests. J Clin Sleep Med. 2022;18(3):871-876.

Night-to-night variability of sleep apnea detected by cyclic variation of heart rate during long-term continuous ECG monitoring.

BackgroundSleep apnea is common in patients with cardiovascular disease and is a factor that worsens prognosis. Holter 24‐h ECG screening for sleep apnea is beneficial in the care of these patients, but due to high night‐to‐night variability of sleep apnea, it can lead to misdiagnosis and misclassification of disease severity.MethodsTo investigate the long‐term dynamic behavior of sleep apnea, seven‐day ECGs recorded with a patch ECG recorder in 120 patients were analyzed for the cyclic variation of heart rate (CVHR) during sleep periods as determined by a built‐in three‐axis accelerometer.ResultsThe frequency of CVHR (Fcv) showed considerable night‐to‐night variability (coefficient of variance, 66 ± 35%), which was consistent with the night‐to‐night variability in apnea‐hypopnea index and oxygen desaturation index reported in earlier studies. In patients with presumed moderate‐to‐severe sleep apnea (Fcv > 15 cph at least one night), it was missed on 62% of nights, and on at least one night in 88% of patients. The CV of Fcv was negatively correlated with the average of Fcv, suggesting that patients with mild sleep apnea show greater night‐to‐night variability and would benefit from long‐term assessment. The average Fcv was higher in the supine position, but the night‐to‐night variability was not explained by the night‐to‐night variability of time spent in the supine position.ConclusionsCVHR analysis of long‐term ambulatory ECG recordings is useful for improving the reliability of screening for sleep apnea without placing an extra burden on patients with cardiovascular disease and their care.

HEART RATE VARIABILITY ON 10-SECOND ECG AND RISK OF ACUTE EXACERBATIONS OF COPD: A SECONDARY ANALYSIS OF BLOCK COPD

HEART RATE VARIABILITY ON 10-SECOND ECG AND RISK OF ACUTE EXACERBATIONS OF COPD: A SECONDARY ANALYSIS OF BLOCK COPD

Nonconvulsive Status Epilepticus: Current Status and Future Perspectives

AbstractIntroduction Nonconvulsive status epilepticus is defined as a state of impaired consciousness with subtle motor manifestations and ongoing seizure activity in the electroencephalogram (EEG) for at least 30 minutes.Objectives and Methods This study of nonconvulsive status epilepticus and its outcomes was a retrospective analysis of the continuous bedside EEG recordings of 100 patients over 2 years (Aug 2017–July 2019) at the Neurophysiology Department in Sir Ganga Ram Hospital, New Delhi. There were two groups of patients in the study comprising of adults (72) and children (28). A comparison between the two groups was made based on the clinical presentation, etiology, EEG, MRI findings, treatment, and the consequences.Results and Conclusions In adults, nonconvulsive status had a high mortality rate, while in children, the associated comorbidities dominated and contributed to residual neurological sequelae. Early diagnosis and treatment at any age is essential to prevent cognitive decline and psychomotor retardation. Presently, bedside and ambulatory EEG recordings are used to capture the dynamic and rhythmic features of the ictal EEG. Continuous EEG monitoring enables bedside assessment of the effectiveness of treatment.

PD27-02 WIRELESS CATHETER-FREE AMBULATORY URODYNAMICS FOR BLADDER PHYSIOLOGY RESEARCH

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Basic Research & Pathophysiology (PD27)1 Sep 2021PD27-02 WIRELESS CATHETER-FREE AMBULATORY URODYNAMICS FOR BLADDER PHYSIOLOGY RESEARCH Maxx Caveney, Steve Majerus, Kangli Deng, Brett Hanzlicek, Binit Panda, James Mrowca, Dennis Bourbeau, and Margot Damaser Maxx CaveneyMaxx Caveney More articles by this author , Steve MajerusSteve Majerus More articles by this author , Kangli DengKangli Deng More articles by this author , Brett HanzlicekBrett Hanzlicek More articles by this author , Binit PandaBinit Panda More articles by this author , James MrowcaJames Mrowca More articles by this author , Dennis BourbeauDennis Bourbeau More articles by this author , and Margot DamaserMargot Damaser More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002020.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As with clinical urodynamics, investigations into lower urinary tract physiology using animal models require catheter-based systems to measure bladder pressure while filling the bladder, often under anesthesia. However, anesthesia, catheters and filling of the bladder can affect filling pressures, urinary leakage and voiding reflexes. To enable recordings more representative of normal physiology, we developed a catheter-free, wireless, intravesical sensor which is implanted in the feline bladder lumen and wirelessly transmits bladder pressure and volume data. We validated sensor function by recording volume and pressure over 4-week implantations in felines. METHODS: The Urological Monitor of Conscious Activity (UroMOCA) measures 18x12x5.6 mm and wirelessly transmits data to a radio and antenna placed in an animal backpack. The UroMOCA battery can be recharged wirelessly via a charging mat placed under the subject. Platinum electrodes measuring urine concentration and conductance estimate urine volume and are paired with an onboard pressure sensor. Under anesthesia, a UroMOCA was implanted into the bladder lumen via cystotomy in male felines. Baseline cystometry was performed and CT imaged the UroMOCA in the bladder. Anesthetized cystometry with UroMOCA recording and imaging were repeated 2 and 4 weeks post-implantation. Ambulatory recordings were performed multiple times for up to two hours per session during the four weeks prior to device explantation. Sham surgeries and sham devices were implanted in some animals to assess the impact of the UroMOCA on the bladder. RESULTS: 10 feline cats were enrolled: 3 were sham implants (no device), 1 received an inactive device, and 6 received a functional UroMOCA. Non-anesthetized recordings were performed for a total 2,899 minutes over 33 ambulatory sessions. After 2 weeks, all animals resumed normal voiding volume. Urinary retention requiring intermittent catheterization was seen in 1 feline; there was no evidence of obstruction. Wireless pressure data linearly correlated with anesthetized cystometry (R2=0.96). Volume measurement was variable but decreased during voiding and increased during filling. Histology showed normal bladder tissue. CONCLUSIONS: A small, wireless, catheter-free, intravesical sensor enabled conscious recordings of bladder function in felines during natural bladder filling over 4 weeks. The volume sensor enabled differentiation of an empty from a full bladder. Source of Funding: This work was funded by the NIH Stimulating Peripheral Activity to Relieve Conditions (SPARC) program, NIH grant number OT2OD023873 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e443-e444 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maxx Caveney More articles by this author Steve Majerus More articles by this author Kangli Deng More articles by this author Brett Hanzlicek More articles by this author Binit Panda More articles by this author James Mrowca More articles by this author Dennis Bourbeau More articles by this author Margot Damaser More articles by this author Expand All Advertisement Loading ...

The effect of sleep restriction therapy for insomnia on sleep pressure and arousal: a randomized controlled mechanistic trial.

Sleep restriction therapy (SRT) effectively treats insomnia but mechanisms are poorly understood. Theoretical models suggest that potentiation of sleep pressure and reduction of arousal are key mechanisms of action. To our knowledge, this has never been directly tested. We designed a randomized controlled trial with embedded mechanistic measurement to investigate if SRT causally modifies multidimensional assessments of sleep pressure and arousal. Participants aged 25-55 who met DSM-5 diagnostic criteria for insomnia disorder were randomized to four weeks of SRT or time in bed regularization (TBR), a control intervention that involves prescription of a regular but not reduced time in bed. Sleep pressure was assessed through daily diary appraisal of morning and evening sleepiness, weekly Epworth sleepiness scale (ESS) scores, psychomotor vigilance, and non-rapid eye movement (NREM) delta power (0.75-4.5 Hz) from ambulatory polysomnographic recordings. Arousal was assessed through daily diary appraisal of cognitive arousal, the pre-sleep arousal scale (PSAS), and NREM beta power (15-32 Hz). Outcomes were assessed at baseline (2-week period prior to randomization), during the intervention phase (1-4 weeks post-randomization), and at 12-week follow-up. We performed intention-to-treat analyses using linear mixed models. For continuous daily measures, the treatment period was split into early (weeks 1-2) and late (weeks 3-4) treatment. Fifty-six participants (39 females, mean age = 40.78 ± 9.08) were assigned to SRT (n = 27) or TBR (n = 29). The SRT group showed enhanced sleep pressure relative to TBR, reflected in (1) enhanced sleepiness in the evening during early (d = 1.17) and late treatment (d = 0.92), and in the morning during early treatment (d = 0.47); (2) higher daytime sleepiness on the ESS at weeks-1 and -2 (d = 0.54, d = 0.45); and (3) reduced psychomotor vigilance at week-1 (d = 0.34). The SRT group also showed reduced arousal relative to TBR, reflected in lower levels of daily-monitored cognitive arousal during early treatment (d = 0.53) and decreased PSAS total score at week-4 and week-12 (ds ≥ 0.39). Power spectral analysis of all night NREM sleep revealed an increase in relative, but not absolute, EEG delta power at week-1 and week-4 (ds ≥ 0.52) and a decrease of relative EEG beta power at week-4 (d = 0.11). For the first time, we show that SRT increases sleep pressure and decreases arousal during acute implementation, providing support for mechanism-of-action.

Prolonged and short epileptiform discharges have an opposite relationship with the sleep–wake cycle in patients with JME: Implications for EEG recording protocols

In a recent study, we found that during 20.55 ± 1.60 h of artifact-free ambulatory EEG recordings, epileptiform discharges (EDs) longer than 2.68 s occurred exclusively in patients with Juvenile Myoclonic Epilepsy (JME) who experienced seizure recurrence within a year after the EEG. Here we expanded this analysis, exploring whether long EDs (>2.68 s), and short ones, were uniformly distributed during the day. Lastly, we evaluated the temporal distribution of seizure relapses.By Friedman test, we demonstrated that hourly frequencies of both short and long EDs were dependent on the hours of day and sleep–wake cycle factors, with an opposite trend. Short EDs were found mostly during the night (with two peaks at 1 AM and 6 AM), and sleep, dropping at the wake onset (p < 0.001). Conversely, long EDs surged at the wake onset (0.001), remaining frequent during the whole wake period, when compared to sleep (p = 0.002). Of note, this latter pattern mirrored that of seizures, which occurred exclusively during the wake period, and in 9 out of 13 cases at the wake onset.We therefore suggested that short and long EDs could reflect distinct pathophysiological phenomena. Extended wake EEG recordings, possibly including the awakening, could be extremely useful in clinical practice, as well as in further studies, with the ambitious goal of predicting seizure recurrences.

Moving average and standard deviation thresholding (MAST): a novel algorithm for accurate R-wave detection in the murine electrocardiogram.

Advances in implantable radio-telemetry or diverse biologging devices capable of acquiring high-resolution ambulatory electrocardiogram (ECG) or heart rate recordings facilitate comparative physiological investigations by enabling detailed analysis of cardiopulmonary phenotypes and responses in vivo. Two priorities guiding the meaningful adoption of such technologies are: (1) automation, to streamline and standardize large dataset analysis, and (2) flexibility in quality-control. The latter is especially relevant when considering the tendency of some fully automated software solutions to significantly underestimate heart rate when raw signals contain high-amplitude noise. We present herein moving average and standard deviation thresholding (MAST), a novel, open-access algorithm developed to perform automated, accurate, and noise-robust single-channel R-wave detection from ECG obtained in chronically instrumented mice. MAST additionally and automatically excludes and annotates segments where R-wave detection is not possible due to artefact levels exceeding signal levels. Customizable settings (e.g. window width of moving average) allow for MAST to be scaled for use in non-murine species. Two expert reviewers compared MAST's performance (true/false positive and false negative detections) with that of a commercial ECG analysis program. Both approaches were applied blindly to the same random selection of 270 3-min ECG recordings from a dataset containing varying amounts of signal artefact. MAST exhibited roughly one quarter the error rate of the commercial software and accurately detected R-waves with greater consistency and virtually no false positives (sensitivity, Se: 98.48% ± 4.32% vs. 94.59% ± 17.52%, positive predictivity, +P: 99.99% ± 0.06% vs. 99.57% ± 3.91%, P < 0.001 and P = 0.0274 respectively, Wilcoxon signed rank; values are mean ± SD). Our novel, open-access approach for automated single-channel R-wave detection enables investigators to study murine heart rate indices with greater accuracy and less effort. It also provides a foundational code for translation to other mammals, ectothermic vertebrates, and birds.

Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation.

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.

How much time is enough? Establishing an optimal duration of recording for ambulatory video EEG.

ObjectiveAmbulatory video EEG allows for extended recording of EEG in the comfort of a patient's home. However, the optimal duration of recording to capture clinical events is yet to be established. The current study uses retrospective analyses to identify an optimal recording duration for at‐home video EEG.MethodsA retrospective review was performed utilizing an anonymized database of ambulatory video EEG recordings performed between March and September 2020 with a national in‐home EEG provider. Only completed assessments with neurologists' reads of raw data were reviewed, resulting in 3644 unique studies divided into three age cohorts: pediatrics (n = 941), adult (n = 2020), and geriatric (n = 683). Cohorts were characterized by assessment yield and time to first typical clinical event, as well as subsequent typical events over duration of recording.ResultsFrequency distributions reveal over half of first events are captured within 12 hours, but longer recording durations capture a much wider majority of both first typical events, as well as the mean number of subsequent events (5 clinical events). In 72 hours, over 97% of first events were observed in adult and geriatric patients, as well as over 95% of the mean number of subsequent events. In children, time to first event was significantly earlier than either adult or geriatric samples, with 98% of first events, and 92.8% of the mean number of subsequent events being observed in 48 hours.SignificanceThese results from a large‐scale, national dataset of patients using in‐home EEG monitoring suggests recording at least 48 hours in duration for children, and at least 72 hours in duration for adult and geriatric samples, is optimal to maximize the likelihood of observing typical clinical events to facilitate diagnosis.

Real-World Diagnosis and Treatment of Diabetic Kidney Disease.

People with type2 diabetes mellitus (T2DM) and diabetic kidney disease (DKD) have increased morbidity and mortality risk. Angiotensin-converting enzyme inhibitors (ACEi) or angiotensinII receptor blockers (ARB) are recommended to slow kidney function decline in DKD. This representative, real-world data analysis of patients with T2DM was performed to detect onset of DKD and determine methods and timing of DKD diagnosis and time to initiation of ACEi/ARB therapy. Patients diagnosed with T2DM before January1, 2016 who developed DKD between January1, 2017 and June30, 2019 were identified from a longitudinal ambulatory electronic health record (EHR) dataset (Veradigm Inc). Each record was analyzed using the CLinical INTelligence engine (CLINT™, HealthPals, Inc.) to identify delays and gaps in diagnosing DKD. DKD was diagnosed through two reduced estimated glomerular filtration rate (eGFR; < 60mL/min/1.73m2) measurements at least 90days apart, a single elevated urine albumin-to-creatinine ratio (UACR; > 30mg/g) measurement, or ICD-9/10 diagnosis codes for DKD and/or albuminuria. Time to diagnose (TTD), time to treat (TTT), and diagnosis to treatment time were assessed. Of 6,499,409 patients with T2DM before January 2016, 245,978 developed DKD between January1, 2017 and June30, 2019. In this DKD cohort, ca. 50% were first identified through EHR diagnosis and ca. 50% by UACR or eGFR lab-based diagnosis. In patients who had UACR/eGFR assessed, more than 90% exhibited DKD-level results on the first diagnostic test. Average TTD after eGFR labs was 2years; average TTT with ACEi/ARB was 6-9months after DKD lab evidence. The majority of patients who developed DKD received ACEi/ARB therapy 6-7months after diagnosis. In a contemporary, large national cohort of patients with T2DM, progression to DKD was common but likely underrepresented. The low rate of DKD-screening labs, along with sizable delays in diagnosis of DKD and initiation of ACEi/ARB therapy, indicates that many patients who progress to DKD are not being properly treated.

A dataset of daily ambulatory psychological and physiological recording for emotion research

To better understand the psychological and physiological basis of human emotion, increasing interest has been drawn towards ambulatory recordings of emotion-related data beyond the laboratories. By employing smartphones-based ambulatory assessment and wrist-worn physiological recording devices, the Daily Ambulatory Psychological and Physiological recording for Emotion Research (DAPPER) dataset provides momentary self-reports and physiological data of people’s emotional experiences in their daily life. The dataset consists of ambulatory psychological recordings from 142 participants and physiological recordings from 88 of them over five days. Both the experience sampling method (ESM) and the day reconstruction method (DRM) were employed to have a comprehensive description of the participants’ daily emotional experiences. Heart rate, galvanic skin response, and three-axis acceleration were recorded during the day time. By including multiple types of physiological and self-report data at a scale of five days with 100+ participants, the present dataset is expected to promote emotion researches in real-life, daily settings.