A recent retrospective study evaluating continuous electroencephalography (cEEG) of children in intensive care units (ICUs) found a higher than anticipated number of seizures. The work also identified several conditions closely associated with the seizures, and suggests that cEEG monitoring may be a valuable tool for helping to identify and treat neurological problems in patients who are 14 months old or younger.
“The retrospective analysis was conducted by a team of engineers, who were able to make use of robust statistical methodologies to control for observational bias,” says Julie Swann, co-author of a paper on the work. “It was possible due to a long-standing partnership with institutions such as Children’s Healthcare of Atlanta and Emory University, which had been collecting data on a large cohort of pediatric patients receiving continuous monitoring. Among other things, this allowed us to identify a risk threshold of 14 months. Patients younger than 14 months were at much higher risk of having seizures.” Swann is department head and A. Doug Allison Distinguished Professor of the Fitts Department of Industrial and Systems Engineering at North Carolina State University.
EEGs measure electrical activity in the brain, and are often used to detect potential neurological problems. Conventional EEGs usually last less than an hour, but cEEGs allow healthcare providers to monitor brain activity for hours or days. However, cEEGs are not in widespread use, due to the expense of related hardware and software and costs associated with having the skilled personnel needed to monitor and interpret cEEG data.
“One reason for the study is that there has been very little research to determine whether cEEG would be a worthwhile investment for monitoring young children,” says Pinar Keskinocak, Ph.D., who co-authored the paper. “Even harder is to determine whom to monitor, where our results suggest some of the risk factors to consider.
“Our main finding is the unexpectedly high prevalence of mostly non-symptomatic seizures in very young children,” says Keskinocak, the William W. George Chair and Professor in Georgia Tech’s Stewart School of Industrial Engineering and the director of the Center for Health and Humanitarian Systems at Georgia Tech. “Non-symptomatic seizures are those that can be detected with an EEG, but that do not present any outward, physical symptoms. Children over the age of 14 months had an overall seizure rate of 18 percent. However, we found that children aged 14 months and younger had an overall seizure rate of 45 percent.”
“In addition, we found that – for these younger patients – seizures were often associated with one of the following conditions: hypoxic-ischemic encephalopathy, intracranial hemorrhage or central nervous system infection,” says Dr. Larry Olson of Children’s Healthcare of Atlanta and Emory University.
“In fact, those conditions were associated with 61 percent of the seizure patients we identified who were under 14 months old,” says Dr. Atul Vats, also of Children’s Healthcare of Atlanta and Emory University.
“All of this is important because it means that cEEG may have value in helping to diagnose neurological problems in young patients,” Swann says. “And early diagnosis could help ensure that patients get treatment in a timely way, which would – hopefully – improve outcomes. Only an interventional study could demonstrate that. Maybe these findings will pave the way for that work.”
The retrospective study analysed data on 517 children who were monitored by cEEG. All of the children were ICU patients. Because the children had been selected for cEEG monitoring, they likely presented a higher risk of neurological problems than the general population, which should be taken into account when evaluating the seizure prevalence data.
“Hospitals have started recognizing the value of detecting and preventing seizures to improve patient outcomes,” Keskinocak says. “The investment needed towards cEEG monitoring may be substantial. This study indicates that those expenditures may be warranted. We hope that it encourages researchers to pursue studies that could determine whether cEEG monitoring could improve health outcomes for the youngest ICU patients.”

NC Statehttps://tinyurl.com/y9sv2pcm

When a loved one has been hospitalized in intensive care for a critical illness, many family members experience anxiety, depression, post-traumatic stress or other negative effects lasting months, according to new research led by Intermountain Medical Center.
The new research suggests that determining which family members are likely to suffer long-term effects could offer guidance to caregivers about how to help them.
The study is believed to be the first research of its kind to investigate the link between cortisol levels of family members of adult ICU patients and subsequent anxiety.
Participants in the study were family members of patients who’d been admitted to Intermountain Medical Center’s medical/surgical intensive care unit. Family members were followed by researchers for three months.
Three months after the patient was discharged, researchers found that 32 percent of the family members studied were anxious, 16 percent had symptoms of depression, and 15 percent reported signs of post-traumatic stress.
Researchers also found an increase of about 50 percent in family members’ cortisol levels after they woke up in the morning, which was associated with anxiety in family members three months after hospital discharge.
Cortisol is sometimes called the “stress hormone” because it can spike during periods of stress, such as when a loved one is critically ill. Unlike the surge in cortisol shortly after awakening, general cortisol levels weren’t found to predict long-term symptoms of mood disorders among participants in the study.          
Family members were studied because an ICU admission can affect the entire family. Family members experience new challenges, including caring for a loved one, learning details of providing medical care, and a reduction or break from employment.
“Family members need time to adjust to these new roles, situations and responsibilities,” said Ellie L. Hirshberg, MD, MS, a critical care physician at Intermountain Medical Center, who led the study, and who co-directs the Center for Humanizing Critical Care at the hospital.
“This study confirms the long-held belief that family members are experiencing stress during an ICU stay. This is important,” said Dr. Hirshberg. “The next step we hope to take in the future is to study support interventions that can reduce this stress and the associated anxiety, depression, and PTSD that may follow.”
Researchers targeted family members because they’re an important part of a patient’s recovery team and often have their own unmet needs. “There’s likely a link between family member wellness and a patient’s trajectory for recovery,” Dr. Hirshberg said.

Intermountain Healthcarehttps://tinyurl.com/y8fzhwls

€7.4 billion was raised at the Coronavirus Global Response pledging event on 4 May to kick-start an unprecedented global cooperation between scientists and regulators, industry and governments, international organisations, foundations and health care professionals to ensure the collaborative development and universal deployment of diagnostics, treatments and vaccines against coronavirus.
The pledging event was co-convened by the European Union, Canada, France, Germany, Italy, Japan, the Kingdom of Saudi Arabia, Norway, Spain and the United Kingdom. It builds on the commitment made by G20 leaders on 26 March and follows a call by the WHO on 24 April for a global collaboration for the accelerated development, production and equitable global access to new coronavirus essential health technologies.
Commenting on the success of the event, President of the European Commission, Ursula von der Leyen, said: “The world showed extraordinary unity for the common good. Governments and global health organisations joined forces against coronavirus. With such commitment, we are on track for developing, producing and deploying a vaccine for all. However, this is only the beginning. We need to sustain the effort and to stand ready to contribute more. The pledging marathon will continue. After governments, civil society and people worldwide need to join in, in a global mobilisation of hope and resolve.”
The funds raised will be channelled primarily through recognised global health organisations such as CEPI, Gavi, the Vaccines Alliance, as well as the Global Fund and Unitaid into developing and deploying as quickly as possible, for as many as possible, the diagnostics, treatments and vaccines that will help the world overcome the pandemic.
The Coronavirus Global Response Initiative is comprised of three partnerships for testing, treating and preventing underpinned by health systems strengthening. The three partnerships will work as autonomously as possible, with a transversal work stream on enhancing the capacity of health systems and knowledge and data sharing.
The European Commission will register and keep track of pledges up until end of May but will not receive any payments into its accounts. Funds go directly to the recipients. Recipients will, however, not decide alone on the use of the donation, but deploy it in concert with the partnership. The commitment is for all new vaccines, diagnostics and treatments against coronavirus to be made available globally for an affordable price, regardless of where they were developed.
The Global Vaccines Summit that Gavi, the Vaccine Alliance, will organise on 4 June will mobilise additional funding to protect the next generation with vaccines. As the world relies on Gavi’s work for making vaccination available everywhere, the success of Gavi’s replenishment will be crucial to the success of the Coronavirus Global Response.
In an Op-ed ahead of the pledging event, co-authored by Giuseppe Conte, President of the Government of the Italian Republic, Emmanuel Macron, President of the French Republic, Angela Merkel, Federal Chancellor of the Federal Republic of Germany, Charles Michel, President of the European Council, Erna Solberg, Prime Minister of the Kingdom of Norway, Justin Trudeau, Prime Minister of Canada and Ursula von der Leyen, President of the European Commission, they said: “None of us is immune to the pandemic and none of us can beat the virus alone. In fact, we will not truly be safe until all of us are safe – across every village, city, region and country in the world. In our interconnected world, the global health system is as strong as its weakest part. We will need to protect each other to protect ourselves.
“This poses a unique and truly global challenge. And it makes it imperative that we give ourselves the best chance to defeat it. This means bringing together the world’s best – and most prepared – minds to find the vaccines, treatments and therapies we need to make our world healthy again
“This is our generation’s duty and we know we can make this happen. High quality and low-cost health technologies are not a daydream. And we have seen how public-private partnerships have managed to make many life-saving vaccines available to the poorest people on earth over the last two decades.
“This is a defining moment for the global community. By rallying around science and solidarity today we will sow the seeds for greater unity tomorrow. Guided by the Sustainable Development Goals, we can redesign the power of community, society and global collaboration, to make sure that nobody is left behind.”
Coronavirus Global Response https://global-response.europa.eu

A multicentre international study has demonstrated for the first time that diagnosis of obstructive coronary artery disease can be improved by using deep learning analysis of upright and supine single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).
According to the Centers for Disease Control and Prevention, coronary artery disease is the most common type of heart disease, killing more than 370,000 people in the United States annually. SPECT MPI, which is widely used for its diagnosis, shows how well the heart muscle is pumping and examines blood flow through the heart during exercise and at rest. On new cameras with a patient imaged in sitting position, two positions (semi-upright and supine) are routinely used to mitigate attenuation artifacts. The current quantitative standard for analysing MPI data is to calculate the combined total perfusion deficit (TPD) from these 2 positions. Visually, physicians need to reconcile information available from 2 views. 
Deep convolutional neural networks, often referred to as deep learning (DL), go beyond machine learning using algorithms. They directly analyse visual data, learn from them, and make intelligent findings based on the image information.
For this study, DL analysis of data from the two-position stress MPI was compared with the standard TPD analysis of 1,160 patients without known coronary artery disease. Patients underwent stress MPI with the nuclear medicine radiotracer technetium (99mTc) sestamibi. New-generation solid-state SPECT scanners in four different centres were used, and images were quantified at the Cedars-Sinai Medical Centre in Los Angeles, California. All patients had on-site clinical reads and invasive coronary angiography correlations within six months of MPI.
Obstructive disease was defined as at least 70 percent narrowing of the three major coronary arteries and at least 50 percent for the left main coronary artery. During the validation procedure, four different DL models were trained (each using data from three centers) and then were evaluated on the one center left aside. Predictions for 4 centers were merged to have an overall estimation of the multicenter performance.
The study revealed that 718 (62 percent) patients and 1,272 of 3,480 (37 percent) arteries had obstructive disease. Per-patient sensitivity improved from 61.8 percent with TPD to 65.6 percent with DL, and per-vessel sensitivity improved from 54.6 percent with TPD to 59.1 percent with DL. In addition, DL had a sensitivity of 84.8 percent, versus 82.6 percent for an on-site clinical read.
The results clearly show that DL improves MPI interpretation over current methods.
“These findings were demonstrated for the first time in a rigorous, repeated external validation,” points out Piotr J. Slomka, PhD, at Cedars-Sinai Medical Center, affirming that “the latest developments in artificial intelligence can be efficiently leveraged to enhance the accuracy of existing nuclear medicine techniques.”
Society of Nuclear Medicine and Molecular Imaging https://tinyurl.com/y5q537lm