Monitoring Unit Research Articles

EEG microstates show different features in focal epilepsy and psychogenic nonepileptic seizures.

Electroencephalography (EEG) microstate analysis seeks to cluster the scalp's electric field into semistable topographical EEG activity maps at different time points. Our study aimed to investigate the features of EEG microstates in subjects with focal epilepsy and psychogenic nonepileptic seizures (PNES). We included 62 adult subjects with focal epilepsy or PNES who received video-EEG monitoring at the epilepsy monitoring unit. The subjects (mean age = 42.8 ± 21.2 years) were distributed equally between epilepsy and PNES groups. We extracted microstates from a 4.4 ± 1.0-min, 21-channel resting-state EEG. We excluded subjects with interictal epileptiform discharges during resting-state EEGs. After preprocessing, we derived five main EEG microstates-MS1 to MS5-for the full frequency band (1-30 Hz) and frequency subbands (delta, 1-4 Hz; theta, 4-8 Hz; alpha, 8-12 Hz; beta, 12-30 Hz), using the MATLAB-based EEGLAB toolkit. Statistical features of microstates (duration, occurrence, contribution, global field power [GFP]) were compared between the groups, using logistic regression corrected for age and sex. We detected no differences in microstate parameters in the full frequency band. We found a longer duration (delta: B = -7.680, p = .046; theta: B = -16.200, p = .043) and a higher contribution (delta: B = -7.414, p = .035; theta: B = -7.509, p = .031) of MS4 in lower frequency bands in the epilepsy group. The PNES group showed a higher occurrence of MS5 in the delta subband (B = 3.283, p = .032). In the theta subband, a higher GFP of MS1 was associated with the PNES group (B = 5.674, p = .025), whereas a higher GFP of MS2 was associated with the epilepsy group (B = -6.579, p = .026). Microstate features show differences between patients with focal epilepsy and PNES. EEG microstates could be a promising parameter, helping to understand changes in brain dynamics in subjects with epilepsy, and should be explored as a potential biomarker.

Hypertension and other vascular risk factors in patients with functional seizures

ObjectiveRecent literature has suggested that functional seizures are associated with an elevated risk for vascular disease and mortality. We investigated the prevalence of risk factors for vascular disease in patients who were admitted to the epilepsy monitoring unit. MethodsPatients who were admitted to the epilepsy monitoring unit and received a definitive diagnosis of either functional seizures or epilepsy were identified. Data collected included demographic, clinical characteristics, medication list, comorbidities, and scheduled blood pressure measurements that occurred every 12 h during the admission. The mean blood pressures were calculated and if they were above the American College of Cardiology and the American Heart Association guideline cutoff of 130/80 mm Hg or the patient had a documented history of hypertension the patient was counted as having the condition. A multiple logistic regression model was developed to evaluate the independent association of the patient’s diagnosis (i.e., epilepsy or functional seizures) and vascular risk factors that controlled for the number of blood pressure measurements, age, sex, and if the patient was taking antihypertensive medications. Results270 patients were included in this study of which 147 patients had epilepsy and 123 had functional seizures. Among those with functional seizures, 57.72 % had either a history of hypertension or a mean blood pressure above 130/80 compared to 38.78 % of those with epilepsy (p = 0.0022). In addition, 30.89 % of functional seizures patients had hyperlipidemia and 63.41 % were obese. The logistic regression model indicated that functional seizures were independently associated with high blood pressure (OR: 2.47, 95 % CI 1.10–5.69), hyperlipidemia (OR: 3.38, 95 % CI 1.35–8.86), and obesity (OR: 4.25, 95 % CI 2.22–8.36) compared to those with epilepsy. There was no significant difference in the prevalence of diabetes (OR: 0.81, 95 % CI 0.24–2.77) or current tobacco use (OR: 1.04, 95 % CI 0.48–2.25) between the groups. SignificancePatients with functional seizures had an elevated prevalence of several vascular risk factors. These findings may partially account for complications associated with functional seizures and have implications related to their pathophysiology.

Technical Tips: The Role of the Charge Neurodiagnostic Technologist

ABSTRACT The purpose of this strategic staffing study was to retrospectively evaluate the impact of the charge neurodiagnostic technologist (NDT) within a 24/7 pediatric NAEC Level IV, ABRET LAB-LTM accredited epilepsy monitoring unit (EMU) during a 4-month pilot. The association between a high-reliability organization (HRO), Lean thinking, and organizational strategic goals were utilized as guiding principles. This paper reviews the operational need to further develop frontline neurodiagnostic leadership roles within Ann & Robert H. Lurie Children’s Hospital of Chicago along with the design and implementation, training, and competencies required.

Stereotactic Awake Basal Ganglia Electrophysiological Recording and Stimulation (SABERS): A Novel Staged Procedure for Personalized Targeting of Deep Brain Stimulation in Pediatric Movement and Neuropsychiatric Disorders.

Selection of targets for deep brain stimulation (DBS) has been based on clinical experience, but inconsistent and unpredictable outcomes have limited its use in patients with heterogeneous or rare disorders. In this large case series, a novel staged procedure for neurophysiological assessment from 8 to 12 temporary depth electrodes is used to select targets for neuromodulation that are tailored to each patient's functional needs. Thirty children and young adults underwent deep brain stimulation target evaluation with the new procedure: Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation (SABERS). Testing is performed in an inpatient neuromodulation monitoring unit over 5-7 days, and results guide the decision to proceed and the choice of targets for permanent deep brain stimulation implantation. Results were evaluated 3-6 months postoperatively with the Burke-Fahn-Marsden Dystonia Rating Scale and the Barry-Albright Dystonia Scale. Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation testing allowed modulation to be tailored to specific neurologic deficits in a heterogeneous population, including subjects with primary dystonia, secondary dystonia, and Tourette syndrome. All but one subject were implanted with 4 permanent deep brain stimulation leads. Results showed significant improvement on both scales at postoperative follow-up. No significant adverse events occurred. Use of the Stereotactic Awake Basal ganglia Electrophysiological Recording and Stimulation protocol with evaluation in the neuromodulation monitoring unit is feasible and results in significant patient benefit compared with previously published results in these populations. This new technique supports a significant expansion of functional neurosurgery to predict effective stimulation targets in a wide range of disorders of brain function, including those for which the optimal target is not yet known.

Measuring quality and safety of epilepsy monitoring units in Brazil: Adoption of quality indicators

PurposeDrug-resistant epilepsy affects a substantial proportion (30–40 %) of patients with epilepsy, often necessitating video-electroencephalography (video-EEG) monitoring. In 2016, Sauro et al. introduced a set of measures aimed at improving the quality and safety indicators reported in video-EEG evaluations. This study aims to report our experience with the implementation of these measures. MethodsWe analyzed video-EEG data regarding quality and safty from a period spanning January 2016 to January 2018, involving a total of 101 patients monitored in our video-EEG unit. ResultsAmong the patients included in the study, a definitive diagnosis was attainable for 92.1 %, with 36.6 % experiencing a change in diagnosis and 65.3 % undergoing a change in treatment as a result of the video-EEG evaluation. Additionally, the referral question was fully addressed in 60.4 % of admissions, and video-EEG was considered to be very useful or extremely useful in 66.4 % of cases. Adverse events were observed in 26.7 % of patients, with the most common being the progression of focal seizures to bilateral tonic-clonic seizures (11.9 %) and the occurrence of seizure clusters (5.9 %). ConclusionOur findings support the implementation of Sauro et al.'s set of measures, as they provide valuable criteria for improving the reporting of video-EEG quality and safety indicators. However, challenges may arise due to variations in terminology across studies and the lack of standardized criteria for defining essential questions in video-EEG evaluations. Further research utilizing these measures is necessary to enhance their effectiveness and encourage consistent reporting of results from epilepsy monitoring units.

The Value of Long-term Video EEG Monitoring to Diagnose and Track Childhood Epilepsy.

Long-term video-EEG monitoring (LTM) is a new technique to assess and track fluctuations, classify seizures, identify epileptic syndromes, and determine the number of seizures and epilepsy-simulating disorders. The present study aims to evaluate the concordance of traditional EEG and LTM in assessing childhood epilepsy. This cross-sectional before-after study was performed on 120 children with epilepsy who were referred to the Epilepsy Monitoring Unit (EMU) at the Children's Medical Center between September 2021 and September 2022 and were monitored for at least eight hours in this unit. The source of the study information collection was the patients' recorded files. A neurologist reviewed the primary EEGs, and two experts blindly reviewed and interpreted the patients' LTMs under a clinical neurophysiologist's supervision. The diagnoses changed after employing LTM in most children with epilepsy. Based on the diagnostic agreement analysis between EEG and LTM, the coefficient value for LTM was calculated at -0.37 (p= 0.229), showing that LTM has significantly expanded patients' diagnoses and care plans. The use of LTM improves the diagnosis, classification, and monitoring of epilepsy in affected children and can be a reliable supplement to EEG in some instances.

An automatic dried shrimp peeling system

This study focuses on designing an automatic dried shrimp peeling system. The system has two operating modes: manual and automatic. The process is from feeding dried shrimp into the beating cage, peeling the shrimp and floor to remove broken shrimp shells from shrimp meat, and peeling dried shrimp shells to form a complete system. Construction system with automatic packaging and vacuum function. The solution is to use the Programmable Logic Controller (PLC) to communicate with the inverter to control the 3-phase motor to run at many speed levels to suit the peeling of different types of shrimp and the output of the system is dried shrimp packaged and vacuum sealed. The HMI control and monitoring unit will be applied to set parameters on the number of dried shrimps in each batch and the type of shrimp that needs to be evaluated and quantified in the package.

A DESCRIPTIVE STUDY SURVEY ON: IMPORTANCE OF MONITORING AND EVALUATION SYSTEM AT NGOs

The Monitoring and Evaluation Department is considered one of the most important departments that can help business organizations measure the organizations’ progress and evaluate their efficiency in implementing strategies. Monitoring and evaluation systems allow project activities to be measured and analyzed. Moreover, it helps to identify problems early and adopt the necessary solutions. In addition, the Monitoring and Evaluation Department helps identify the resources needed for the project. A monitoring and evaluation (M&E) system is important for (NGOs), as it helps improve programs and determine whether they meet set objectives. This work is typically performed through data collection, analysis, and reporting. Furthermore, the monitoring and evaluation system helps achieve transparency and accountability, and provides donors, community members, and beneficiaries with key evidence for making decisions and actions throughout the duration of the project. The M&E system also helps determine whether the funds allocated to the project have been used effectively in achieving the desired Goals. The purpose of the survey paper was to highlight the importance of strengthening monitoring and evaluation systems in non-governmental organizations for the sake of integrated work between the systems and the workers in this unit within the organizations. This research aims to help employees in the monitoring and evaluation unit to complete the work in the fastest time, with less effort, and with more transparency and accuracy. By examining the different methodologies, tools and procedures of the system that helps this sector. This system also gives a comprehensive overview of current methodologies and best practices for monitoring and evaluation. Unfortunately, there is a gap in systems design, M&E through the planning process.

Touch-screen automatisms in the digital age

ObjectiveTo describe a novel set of gestural automatisms related to the use of digital screens on smartphones and tablets in patients with epilepsy. MethodsRepresentative patients were selected from among those admitted to the Epilepsy Monitoring Unit at the Toronto Western Hospital between April 2016 and January 2020, and included if they exhibited automatisms clearly related to or mimicking digital device use. ResultsIn total 5 patients were included, 4 female. All had temporal lobe epilepsy: 2 had left mesial temporal sclerosis and 3 had normal imaging. Nearly equal numbers of seizures began with right (5/9) and left (4/9) temporal onsets, with most automatisms occurring after seizure propagation to bilateral temporal involvement (6/9). Left-handed automatisms were most common (8/9). The majority of the automatisms (7/9) were perseverative on device usage prior to the seizure. ConclusionGestural automatisms appear related to the contemporary lived experience, culture, and habitual behaviour of patients with epilepsy. In the modern era, the use of smartphones and tablets are both common and habitual for many, and this case series shows that touch-screen automatisms may be added to the semiological panoply of temporal lobe seizures.

A Case Study on an Evaluation of the Annual Activity Plan 2019 of Health Promotion Bureau Sri Lanka

The Health Promotion Bureau is the centre of excellence in Sri Lanka for health education, health promotion, and publicity of health information. The main achievement gained during the last few years is empowering and mobilising communities to improve their quality of life through health promotion principles. Public awareness aiming for healthy behaviour changes in the community through mass media is a unique service provided for years by the Health Promotion Bureau and appraised by all sectors. The government of Sri Lanka, the United Nations Populations Fund, the World Bank and the World Health Organization were the leading funding agencies in 2019 for Health Promotion Bureau activities. The activity plan aligns with the health master plan of the Ministry of Health. According to the Ministry of Health's Annual Action Plan 2019, the total estimated cost for all the HPB activities was Rs. 162.66 million. At the end of 2019, the total amount allocated by the Government of Sri Lanka was Rs. 75.01 million. It is 46% of the initial estimation. There were 98 activities planned for 2019 by the HPB. However, only 19 activities were accomplished in 2019. Among them, 17 were fully completed. The other two were completed 93% and 22%. Some of the activities conducted in 2019 were not planned for the year. There were many reasons for the poor performance of the annual activity plan 2019. Lack of monitoring and evaluation on the performance of the annual activity plan, planning unit combined with monitoring and evaluation, no specialised personnel on monitoring and evaluation, budget cuts on planned activities and different funding agencies are some of them. The recommendation is to develop an independent monitoring and evaluation unit separated from the planning unit. The HPB units should be strengthened with adequate staff, and their capacity for planning, monitoring and evaluation should be developed. Provision of proper guidelines for planning activities, involving all the stakeholders and incorporating their views in the planning process, incorporating information and communication technologies in planning and monitoring activities, and regular review of activities and annual activity plan of the Health Promotion Bureau also must be considered for improvement of achievement of HPB annual action plan. Keywords: Health Promotion Bureau, annual activity plan, monitoring and evaluation

Monitoring the quality of ground water in pipelines using deep neural network model

Monitoring the water quality in pipelines is crucial to guaranteeing that consumers receive safe and hygienic water. Conventional monitoring techniques rely on labor-intensive, time-consuming laboratory testing and physical sampling. This study aims to introduce an integrated LSTM-BP neural network model for real-time water quality monitoring in pipelines, showcasing improved predictions for parameters like dissolved oxygen and pH. This paper investigated the results of real-time Water Quality (WQ) monitoring in pipelines using several Deep Neural Network (DNN) models and pre-processing techniques for the information being provided. This paper proposes an integrated long-short-term memory (LSTM) and backpropagation (BP) neural network to offer an I-LSTM-BP model for Monitoring Water Quality in Pipelines (MWQP). The performance of predictions has been enhanced through the integration of LSTM and BP neural networks, particularly for time-series forecasting applications like MWQP. The model may use the LSTM network’s memory and adaptability while still keeping the BP network’s capacity to simulate non-linear interactions and enhance performance during generalization. Dissolved oxygen (DO; mg/L) and hydrogen (pH) potential are the parameters considered during the MWQP process. Information collected from China’s autonomous water quality monitoring units has been used to examine the water quality characteristics thoroughly. The forecasting model has been trained and evaluated using data collected from monitoring stations from June 2018 to December 2022. Statistical measures such as the correlation coefficient, root mean square error (RMSE), mean absolute error (MAE), and their normalized equivalents have been used to evaluate the DNN model’s performance throughout the training and testing stages. The results of this work demonstrate the viability and efficiency of using the proposed I-LSTM-BP-based DNN for MWQP applications. These results show the I-LSTM-BP model’s significant performance benefit, which makes it the model of choice for precise MWQP parameter prediction and WQ evaluation.

Comparison of the incidence of severe outcomes in outpatients with COVID-19 or seasonal influenza without risk factors: Retrospective analysis of a health insurance claims-database

BackgroundTo evaluate disease severity for coronavirus disease of 2019 (COVID-19), seasonal influenza (FLU) is often used as a control group for comparison. However, evidence regarding outpatients without risk factors for severe disease is insufficient to consider future treatment policies for these patients. ObjectivesTo compare the risk of severe disease in patients without risk factors for severe disease who are diagnosed with COVID-19 or FLU. Study designThis was a retrospective study analyzing a health insurance claims database (data collection: COVID-19, January 2020 through August 2022; FLU, October 2017 through September 2019). Outcome measures were incidences of severe events of hospitalization, respiratory and heart rate monitoring, oxygen therapy, ventilator use, and intensive care unit admission (within 28 days from diagnosis), and death (within the following month). ResultsData from 575,293 patients were included in the COVID-19 group and from 1,095,698 patients in the FLU group, without risk factors. Adjusted odds ratios for all study outcomes were significantly higher for patients with COVID-19 than with FLU (>3 times greater odds ratio for all severe events). For the population aged ≥18 years, there was also a significantly higher risk for all severe events with COVID-19 versus FLU. The incidence of severe events with COVID-19 among the population aged <18 years was greatly reduced (versus ≥18 years), and risk for severe events was not significantly different with COVID-19 versus FLU. ConclusionsThese findings suggest that the medical need for specific treatment for patients with COVID-19 may be as high as for FLU.

A pilot study on non-invasive in situ detection of phytochemicals and plant endogenous status using fiber optic infrared spectroscopy

Traditional methods for assessing plant health often lack the necessary attributes for continuous and non-destructive monitoring. In this pilot study, we present a novel technique utilizing a customized fiber optic probe based on attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) with a contact force control unit for non-invasive and continuous plant health monitoring. We also developed a normalized difference mid-infrared reflectance index through statistical analysis of spectral features, enabling differentiation of drought and age conditions in plants. Our research aims to characterize phytochemicals and plant endogenous status optically, addressing the need for improved analytical measurement methods for in situ plant health assessment. The probe configuration was optimized with a triple-loop tip and a 3 N contact force, allowing sensitive measurements while minimizing leaf damage. By combining polycrystalline and chalcogenide fiber probes, a comprehensive wavenumber range analysis (4000–900 cm−1) was achieved. Results revealed significant variations in phytochemical composition among plant species, for example, red spinach with the highest polyphenolic content and green kale with the highest lignin content. Petioles displayed higher lignin and cellulose absorbance values compared to veins. The technique effectively monitored drought stress on potted green bok choy plants in situ, facilitating the quantification of changes in water content, antioxidant activity, lignin, and cellulose levels. This research represents the first demonstration of the potential of fiber optic ATR-FTIR probes for non-invasive and rapid plant health measurements, providing insights into plant health and advancements in quantitative monitoring for indoor farming practices, bioanalytical chemistry, and environmental sciences.

Optimization of lung ultrasound in ultrafast-track anesthesia for non-cyanotic congenital heart disease surgery

ObjectiveWe aimed to explore the feasibility of lung ultrasound for perioperative assessment and the optimal effect of lung ultrasound in reducing lung complications during non-cyanotic congenital heart disease (CHD) surgery using ultrafast-track anesthesia. MethodsSixty patients were treated at Shenzhen Children's Hospital between 2019 and 2020. Of these, 30 patients in group N had an indication for extubation and ultrafast-track anesthesia after congenital heart surgery; the tracheal catheter was removed, and the patients were sent to the cardiac intensive care unit (CICU) for further monitoring and treatment. Another 30 patients were in group L and also had an indication for extubation and ultrafast-track anesthesia; in addition we compared lung ultrasound score (LUS) before and after surgery, when we found the cases that LUS ≥ 15, for whom targeted optimization treatment would be carried out. The tracheal catheter was removed after LUS <15 days before the patients were sent to the CICU. In all cases, the LUS and PaO2/FiO2 ratios (P/F) of both groups were recorded at the time of anesthesia induction (T0), before extubation (T1), and 5 min (T2), 1 h (T3), and 24 h (T4) after extubation. The incidence of pulmonary complications, LUS, and P/F were compared between the two groups. ResultsThere was great consistency between LUS and radiographic findings. Comparing the data of the two groups at T2, T3 and T4, the P/F was higher and the LUS was lower in group L than in group N. The incidence of lung complications in group L (18 cases, 60 %) was lower than that in group N (26 cases, 86.7 %, χ2 = 5.46, P = 0.02); comparing LUS between T0 and T3, LUS decreased in a greater number of cases in group L (15, 50 %) than in group N (7 cases, 23.3 %, χ2 = 4.59, P = 0.032). ConclusionLung ultrasonography can effectively help assess lung conditions. Optimization guided by lung ultrasound in ultrafast track anesthesia can significantly reduce postoperative lung complications.

Epilepsy monitoring unit practices and safety among NAEC epilepsy centers: A census survey

ObjectiveAn epilepsy monitoring unit (EMU) is a specialized unit designed for capturing and characterizing seizures and other paroxysmal events with continuous video electroencephalography (vEEG). Nearly 260 epilepsy centers in the United States are accredited by the National Association of Epilepsy Centers (NAEC) based on adherence to specific clinical standards to improve epilepsy care, safety, and quality. This study examines EMU staffing, safety practices, and reported outcomes. MethodWe analyzed NAEC annual report data and results from a supplemental survey specific to EMU practices reported in 2019 from 341 pediatric or adult center directors. Data on staffing, resources, safety practices and complications were collated with epilepsy center characteristics. We summarized using frequency (percentage) for categorical variables and median (inter-quartile range) for continuous variables. We used chi-square or Fisher’s exact tests to compare staff responsibilities. ResultsThe supplemental survey response rate was 100%. Spell classification (39%) and phase 1 testing (28%) were the most common goals of the 91,069 reported admissions. The goal ratio of EEG technologist to beds of 1:4 was the most common during the day (68%) and off-hours (43%). Compared to residents and fellows, advanced practice providers served more roles in the EMU at level 3 or pediatric-only centers. Status epilepticus (SE) was the most common reported complication (1.6% of admissions), while cardiac arrest occurred in 0.1% of admissions. SignificanceEMU staffing and safety practices vary across US epilepsy centers. Reported complications in EMUs are rare but could be further reduced, such as with more effective treatment or prevention of SE. These findings have potential implications for improving EMU safety and quality care.

Alcohol for seizure induction in the epilepsy monitoring unit

Rationale: Seizure induction techniques are used in the epilepsy monitoring unit (EMU) to increase diagnostic yield and reduce length of stay. There are insufficient data on the efficacy of alcohol as an induction technique. MethodsWe performed a retrospective cohort study using six years of EMU data at our institution. We compared cases who received alcohol for seizure induction to matched controls who did not. The groups were matched on the following variables: age, reason for admission, length of stay, number of antiseizure medications (ASM) at admission, whether ASMs were tapered during admission, and presence of interictal epileptiform discharges. We used both propensity score and exact matching strategies. We compared the likelihood of epileptic seizures and nonepileptic events in cases versus controls using Kaplan-Meier time-to-event analysis, as well as odds ratios for these outcomes occurring at any time during the admission. ResultsWe analyzed 256 cases who received alcohol (median dose 2.5 standard drinks) and 256 propensity score-matched controls. Cases who received alcohol were no more likely than controls to have an epileptic seizure (X2(1) = 0.01, p = 0.93) or nonepileptic event (X2(1) = 2.1, p = 0.14) in the first 48 h after alcohol administration. For the admission overall, cases were no more likely to have an epileptic seizure (OR 0.89, 95 % CI 0.61–1.28, p = 0.58), nonepileptic event (OR 0.97, CI 0.62–1.53, p = 1.00), nor require rescue benzodiazepine (OR 0.63, CI 0.35–1.12, p = 0.15). Stratified analyses revealed no increased risk of epileptic seizure in any subgroups. Sensitivity analysis using exact matching showed that results were robust to matching strategy. ConclusionsAlcohol was not an effective induction technique in the EMU. This finding has implications for counseling patients with epilepsy about the risks of drinking alcohol in moderation in their daily lives.

Accuracy of patient-reported spell duration: A comparative study

Clinicians rely heavily on patient histories to make medical diagnoses, most of which are inherently subjective and prone to inaccuracies. The aim of this study is to compare the subjective versus objective duration of spells through a retrospective chart review of patients admitted to the epilepsy monitoring unit at our tertiary care medical center. One hundred patients were analyzed. Differences in the accuracy of subjective estimations versus objective duration were compared by age, sex, focal versus generalized, location (frontal versus non-frontal), and spell type (focal aware versus impaired awareness and epileptic versus non-epileptic). Our data show that patients are poor subjective estimators, with 73% of patients overestimating the duration of their spells. We did not find differences in estimated duration by age, sex, seizure location or spell type. A notable exception was patients with generalized convulsive seizures, who accurately reported spell duration to within 17 s. This is likely because these seizures are stereotypical, and patients/family time them. Moreover, patients with non-epileptic spells were worse estimators of their spell duration than those with epileptic spells. In addition, although the prefrontal lobe plays a role in time estimation, we did not find that patients with frontal lobe seizures were worse estimators than those with non-frontal seizures, but invasive monitoring can more precisely localize seizures within areas of the frontal lobe responsible for time estimation. Our data emphasize the importance of not relying solely on patient-reported time estimation in diagnosing and developing treatment plans and instead instructing patients to time their spells.

The Environmental Impacts of Radio Frequency and Power Line Communication for Advanced Metering Infrastructures in Smart Grids.

In the neighborhood area network (NAN), the advanced metering infrastructure (AMI) enables a bidirectional connection between the smart meter (SM) and the data concentrator (DC). Sensors, such as smart meter nodes or environmental sensor nodes, play a crucial role in measuring and transmitting data to central units for advanced monitoring, management, and analysis of energy consumption. Wired and wireless communication technologies are used to implement the AMI-NAN. This paper delves into a novel approach for optimizing the choice of communication medium, air for radio frequency (RF) or power lines for power line communication (PLC), between the SM and DC in the context of the AMI-NAN. The authors methodically select the specific technologies, RF and NB-PLC (narrowband power line communication), and meticulously characterize their attributes. Then, a comparative analysis spanning rural, urban, and industrial settings is conducted to evaluate the proposed method. The overall reliability performance of the AMI-NAN system requires a packet error rate (PER) lower than 10%. To this end, an efficient approach is introduced to assess and enhance the reliability of NB-PLC and RF for AMI-NAN applications. Simulation results demonstrate that wireless communication is the optimal choice for the rural scenario, especially for a signal-to-noise ratio (SNR) lower than 25 dB. However, in urban environments characterized by higher SNR values and moderately dense networks, NB-PLC gains prominence. In denser networks, it outperforms wireless communication, exhibiting a remarkable 10 dB gain for a bit error rate (BER) of 10-3. Moreover, in industrial zones characterized by intricate network topologies and non-linear loads, the power line channel emerges as the optimal choice for data transmission.

Multi-Objective Optimization Driven Application of Micro Phasor Measurement Units for Efficient Monitoring of Power Distribution System

Multi-Objective Optimization Driven Application of Micro Phasor Measurement Units for Efficient Monitoring of Power Distribution System

Prognostic Value of Diaphragmatic Ultrasound in Patients Admitted for COVID-19 Pneumonia

IntroductionCOVID-19 pneumonia results in an impairment of the diaphragmatic musculature that influences the development of respiratory failure during the patient's hospitalization. Diaphragmatic ultrasound is a useful, non-invasive, and accessible tool for measuring the function of this muscle. ObjectiveAssessing the morphological and functional ultrasound status of the diaphragm in patients admitted within the first 24h for COVID-related pneumonia and its association with hospital morbidity and mortality (NCT05805579). Material and methodsObservational, prospective cohort study that included 68 patients admitted for COVID-19 pneumonia with respiratory failure. Diaphragmatic ultrasound was performed within the first 24h of admission to the pulmonology ward. Clinical, analytical, and ultrasound variables were collected: excursion, thickness, and diaphragmatic shortening fraction (DSF). DSF<20% was used to define diaphragmatic dysfunction (DD). Patients who showed favorable progression and were managed on the ward (HCONV) were compared to those who required admission to the respiratory monitoring unit (RMU). ResultsA total of 68 patients were included, of which 22 (32.35%) were admitted to the RMU. Diaphragmatic excursion at maximum volume was higher in the HCONV group compared to the RMU group (58.41±17.83 vs. 50.03±16.23; p=0.123). Diaphragmatic dysfunction (DD) was observed in 21 (30.88%) patients, with a higher prevalence in the RMU group than in the HCONV group (15 (68.18%) vs. 6 (13.04%); p=0.0001). In the multivariate analysis, age and DSF at admission were the best predictors of failure to discharge. ConclusionsPerforming diaphragmatic ultrasound to assess mobility and DSF within the first 24h of admission for COVID-19 pneumonia proves valuable in determining short-term progression and the need for admission to a respiratory monitoring unit.