[Perstimulus asystole during electroconvulsive therapy: Clinical case and critical literature review].

PubMed

Roche, N C; Raynaud, L; Bompaire, F; Lucas, J-J; Auxéméry, Y

2016-02-01

Electroconvulsive therapy (ECT) is most frequently indicated for episodes of melancholic depression, but is also useful in the treatment of maniac syndrome and some schizophrenia subtypes. ECT is part of the treatment of movement disorders, neuroleptic malignant syndrome and even in the treatment of severe conversions. Although the therapeutic results are excellent when used appropriately, the mortality rate is estimated between 2 and 4 for 100,000 shocks. Despite this mortality rate, the benefit-risk ratio remains very positive and serious complications are extremely rare. ECT results in a biphasic cardiological effect: firstly a perstimulus parasympathetic hypertonia contemporary to the seizure's tonic phase, then a phase of contemporary sympathetic hypertonia during the epileptic clonic movement. We will focus on the perstimulus asystole as it is by far the most frequent. Very few cases and even less studies have been referenced in the literature; here, we present a clinical case followed by a discussion. The patient is in his fifties and has been treated for many years for a unipolar mood disorder with recurrent melancholic depressive episodes. With each new depressive episode, the clinical evolution is rapidly positive after a few sessions of ECT. Maintenance ECT was not retained due to the supra-annual periodicity of the melancholic depressive episodes and rapid recovery after electric treatment. Then, this patient developed another depressive decline in mood comparable to the previous one, despite adapted blood lithium levels associated with a new generation antidepressant treatment. According to his history, a hospitalisation was programmed to carry out a new course of ECT. Considering the short duration of the first seizures, the intensity of the stimulus was progressively increased. At 180 joules, the patient presented an immediate per-stimulus asystole of 20seconds which ceased spontaneously. The specialized cardiologic consultation following the

Ictal verbal help-seeking: Occurrence and the underlying etiology.

PubMed

Asadi-Pooya, Ali A; Asadollahi, Marjan; Bujarski, Krzysztof; Rabiei, Amin H; Aminian, Narsis; Wyeth, Dale; Sperling, Michael R

2016-11-01

Ictal verbal help-seeking has never been systematically studied before. In this study, we evaluated a series of patients with ictal verbal help-seeking to characterize its frequency and underlying etiology. We retrospectively reviewed all the long-term video-EEG reports from Jefferson Comprehensive Epilepsy Center over a 12-year period (2004-2015) for the occurrence of the term "help" in the text body. All the extracted reports were reviewed and patients with at least one episode of documented ictal verbal help-seeking in epilepsy monitoring unit (EMU) were studied. For each patient, the data were reviewed from the electronic medical records, EMU report, and neuroimaging records. During the study period, 5133 patients were investigated in our EMU. Twelve patients (0.23%) had at least one episode of documented ictal verbal help-seeking. Nine patients (six women and three men) had epilepsy and three patients (two women and one man) had psychogenic nonepileptic seizures (PNES). Seven out of nine patients with epilepsy had temporal lobe epilepsy; six patients had right temporal lobe epilepsy. Ictal verbal help-seeking is a rare finding among patients evaluated in epilepsy monitoring units. Ictal verbal help-seeking may suggest that seizures arise in or propagate to the right temporal lobe. Copyright © 2016 Elsevier Inc. All rights reserved.

Role of ictal baseline shifts and ictal high-frequency oscillations in stereo-electroencephalography analysis of mesial temporal lobe seizures.

PubMed

Wu, Shasha; Kunhi Veedu, Hari Prasad; Lhatoo, Samden D; Koubeissi, Mohamad Z; Miller, Jonathan P; Lüders, Hans O

2014-05-01

To assess the role of ictal baseline shifts (IBS) and ictal high-frequency oscillations (iHFOs) in intracranial electroencephalography (EEG) presurgical evaluation by analysis of the spatial and temporal relationship of IBS, iHFOs with ictal conventional stereo-electroencephalography (icEEG) in mesial temporal lobe seizures (MTLS). We studied 15 adult patients with medically refractory MTLS who underwent monitoring with depth electrodes. Seventy-five ictal EEG recordings at 1,000 Hz sampling rate were studied. Visual comparison of icEEG, IBS, and iHFOs were performed using Nihon-Kohden Neurofax systems (acquisition range 0.016-300 Hz). Each recorded ictal EEG was analyzed with settings appropriate for displaying icEEG, IBS, and iHFOs. IBS and iHFOs were observed in all patients and in 91% and 81% of intracranial seizures, respectively. IBS occurred before (22%), at (57%), or after (21%) icEEG onset. In contrast, iHFOs occurred at (30%) or after (70%) icEEG onset. The onset of iHFOs was 11.5 s later than IBS onset (p < 0.0001). All of the earliest onset of IBS and 70% of the onset of iHFOs overlapped with the ictal onset zone (IOZ). Compared with iHFOs, interictal HFOs (itHFOs) were less correlated with IOZ. In contrast to icEEG, IBS and iHFOs had smaller spatial distributions in 70% and 100% of the seizures, respectively. An IBS dipole was observed in 66% of the seizures. Eighty-seven percent of the dipoles had a negative pole at the anterior/medial part of amygdala/hippocampus complex (A-H complex) and a positive pole at the posterior/lateral part of the A-H complex. The results suggest that evaluation of IBS and iHFOs, in addition to routine icEEG, helps in more accurately defining the IOZ. This study also shows that the onset and the spatial distribution of icEEG, IBS, and iHFOs do not overlap, suggesting that they reflect different cellular or network dynamics. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

Scalp EEG Ictal Gamma and Beta Activity during Infantile Spasms: Evidence of Focality

PubMed Central

Nariai, Hiroki; Beal, Jules; Galanopoulou, Aristea S.; Mowrey, Wenzhu B.; Bickel, Stephan; Sogawa, Yoshimi; Jehle, Rana; Shinnar, Shlomo; Moshé, Solomon L.

2017-01-01

Objective We investigated temporal and spatial characteristics of ictal gamma and beta activity on scalp EEG during spasms in patients with West syndrome (WS) to evaluate potential focal cortical onset. Methods A total of 1033 spasms from 34 patients with WS of various etiologies were analyzed in video-EEG using time-frequency analysis. Ictal gamma (35–90 Hz) and beta (15–30 Hz) activities were correlated with visual symmetry of spasms, objective EMG (electromyography) analysis, and etiology of WS. Results Prior to the ictal motor manifestation, focal ictal gamma activity emerged from one hemisphere (71%, 24/34) or from midline (26%, 9/34), and was rarely simultaneously bilateral (3%, 1/34). Focal ictal beta activity emerged from either one hemisphere (68%, 23/34) or from midline (32%, 11/34). Onsets of focal ictal gamma and beta activity were most commonly observed around the parietal areas. Focal ictal gamma activity propagated faster than ictal beta activity to adjacent electrodes (median: 65 vs. 170 ms, p<0.01), and to contralateral hemisphere (median: 100 vs. 170 ms, p=0.01). Asymmetric peak amplitude of ictal gamma activity in the centroparietal areas (C3-P3 vs. C4-P4) correlated with asymmetric semiology. On the other hand, the majority of visually symmetric spasms showed asymmetry in peak amplitude and interhemispheric onset latency difference in both ictal gamma and beta activity. Significance Spasms may be a seizure with focal electrographic onset regardless of visual symmetry. Asymmetric involvement of ictal gamma activity to the centroparietal areas may determine the motor manifestations in WS. Scalp EEG ictal gamma and beta activity may be useful to demonstrate localized seizure onset in infants with WS. PMID:28397999

Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs).

PubMed

Johnson, Emily L; Kaplan, Peter W; Ritzl, Eva K

2018-05-01

Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are a relatively common phenomenon found on prolonged electroencephalogram (EEG) monitoring that captures state changes and stimulation of critically ill patients. Common causes include hypoxic injury, traumatic brain injury, and hemorrhage, as well as toxic-metabolic disturbances. Some studies have shown an association between SIRPIDs and the presence of spontaneous electrographic seizures. Although the degree to which SIRPIDs should be treated with antiepileptic medications is unknown, the rare cases of functional imaging obtained in patients with SIRPIDs have not shown an increase in cerebral blood flow to suggest an active ictal process. Stimulus-induced rhythmic, periodic, or ictal discharges may reflect dysregulation of thalamo-cortical projections into abnormal or hyperexcitable cortex.

Prolonged ictal aphasia: a diagnosis to consider.

PubMed

Herskovitz, Moshe; Schiller, Yitzhak

2012-11-01

Aphasia is a common symptom encountered by clinical neurologists. It is usually caused by strokes or lesions involving language regions of the brain, yet prolonged aphasia is rarely the sole manifestation of a simple partial status epilepticus. We report six patients, who suffered from prolonged ictal aphasia. All but one patient had a structural lesion in the left hemisphere, only three suffered from clinical seizures during or shortly prior to the aphasic episode. All patients had ictal patterns on the electroencephalogram (EEG), four of whom had periodic lateralized epileptiform discharges, and five showed frequent recurrent electrographic seizures during the aphasic state. The aphasia lasted several days in all patients, and it resolved after administration of antiepileptic drug treatment. In conclusion, prolonged ictal aphasia is a rare but important treatable cause of aphasia. Surface EEG recordings should be obtained in all patients with unexplained prolonged aphasia to diagnose this rare but treatable entity. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Long-term subdural strip electrocorticographic monitoring of ictal déjà vu.

PubMed

Weinand, M E; Hermann, B; Wyler, A R; Carter, L P; Oommen, K J; Labiner, D; Ahern, G; Herring, A

1994-01-01

We report a series of 8 patients with ictal déjà vu. Subdural strip electrocorticographic (ECoG) monitoring localized the ictal epileptogenic focus as follows: right (n = 6) and left (n = 2) mesiotemporal lobe. In all 8 patients, the left hemisphere was dominant for language function based on intracarotid amytal testing. In 6 right-handed patients, ictal déjà vu was associated with a right temporal lobe focus. However, in the 2 left-handed patients, the ictal focus was left temporal lobe. Although ictal déjà vu localizes the epileptic focus to temporal lobe, this experimental phenomenon appears to lateralize to the hemisphere nondominant for handedness.

Ictal fear: Associations with age, gender, and other experiential phenomena.

PubMed

Chong, Derek J; Dugan, Patricia

2016-09-01

The aim of this study was to determine the relationship of fear to other auras and to gender and age using a large database. The Epilepsy Phenome/Genome Project (EPGP) is a multicenter, multicontinental cross-sectional study in which ictal symptomatology and other data were ascertained in a standardized series of questionnaires then corroborated by epilepsy specialists. Auras were classified into subgroups of symptoms, with ictal fear, panic, or anxiety as a single category. Of 536 participants with focal epilepsy, 72 were coded as having ictal fear/panic/anxiety. Reviewing raw patient responses, 12 participants were deemed not to have fear, and 24 had inadequate data, leaving 36 (7%) of 512 with definite ictal fear. In univariate analyses, fear was significantly associated with auras historically considered temporal lobe in origin, including cephalic, olfactory, and visceral complaints; déjà vu; and derealization. On both univariate and multivariate stepwise analyses, fear was associated with jamais vu and auras with cardiac symptoms, dyspnea, and chest tightening. Expressive aphasia was associated with fear on univariate analysis only, but the general category of aphasias was associated with fear only in the multivariate model. There was no age or gender relationship with fear when compared to the overall population with focal epilepsy that was studied under the EPGP. Patients with ictal fear were more likely to have a right hemisphere seizure focus. Ictal fear was strongly associated with other auras considered to originate from the limbic system. No relationship of fear with age or gender was observed. Copyright © 2016 Elsevier Inc. All rights reserved.

Time-Varying Networks of Inter-Ictal Discharging Reveal Epileptogenic Zone.

PubMed

Zhang, Luyan; Liang, Yi; Li, Fali; Sun, Hongbin; Peng, Wenjing; Du, Peishan; Si, Yajing; Song, Limeng; Yu, Liang; Xu, Peng

2017-01-01

The neuronal synchronous discharging may cause an epileptic seizure. Currently, most of the studies conducted to investigate the mechanism of epilepsy are based on EEGs or functional magnetic resonance imaging (fMRI) recorded during the ictal discharging or the resting-state, and few studies have probed into the dynamic patterns during the inter-ictal discharging that are much easier to record in clinical applications. Here, we propose a time-varying network analysis based on adaptive directed transfer function to uncover the dynamic brain network patterns during the inter-ictal discharging. In addition, an algorithm based on the time-varying outflow of information derived from the network analysis is developed to detect the epileptogenic zone. The analysis performed revealed the time-varying network patterns during different stages of inter-ictal discharging; the epileptogenic zone was activated prior to the discharge onset then worked as the source to propagate the activity to other brain regions. Consistence between the epileptogenic zones detected by our proposed approach and the actual epileptogenic zones proved that time-varying network analysis could not only reveal the underlying neural mechanism of epilepsy, but also function as a useful tool in detecting the epileptogenic zone based on the EEGs in the inter-ictal discharging.

Magnetoencephalography and ictal SPECT in patients with failed epilepsy surgery.

PubMed

El Tahry, Riёm; Wang, Z Irene; Thandar, Aung; Podkorytova, Irina; Krishnan, Balu; Tousseyn, Simon; Guiyun, Wu; Burgess, Richard C; Alexopoulos, Andreas V

2018-06-06

Selected patients with intractable focal epilepsy who have failed a previous epilepsy surgery can become seizure-free with reoperation. Preoperative evaluation is exceedingly challenging in this cohort. We aim to investigate the diagnostic value of two noninvasive approaches, magnetoencephalography (MEG) and ictal single-photon emission computed tomography (SPECT), in patients with failed epilepsy surgery. We retrospectively included a consecutive cohort of patients who failed prior resective epilepsy surgery, underwent re-evaluation including MEG and ictal SPECT, and had another surgery after the re-evaluation. The relationship between resection and localization from each test was determined, and their association with seizure outcomes was analyzed. A total of 46 patients were included; 21 (46%) were seizure-free at 1-year followup after reoperation. Twenty-seven (58%) had a positive MEG and 31 (67%) had a positive ictal SPECT. The resection of MEG foci was significantly associated with seizure-free outcome (p = 0.002). Overlap of ictal SPECT hyperperfusion zones with resection was significantly associated with seizure-free outcome in the subgroup of patients with injection time ≤20 seconds(p = 0.03), but did not show significant association in the overall cohort (p = 0.46) although all injections were ictal. Patients whose MEG and ictal SPECT were concordant on a sublobar level had a significantly higher chance of seizure freedom (p = 0.05). MEG alone achieved successful localization in patients with failed epilepsy surgery with a statistical significance. Only ictal SPECT with early injection (≤20 seconds) had good localization value. Sublobar concordance between both tests was significantly associated with seizure freedom. SPECT can provide essential information in MEG-negative cases and vice versa. Our results emphasize the importance of considering a multimodal presurgical evaluation including MEG and SPECT in all patients with a

Ictal connectivity in childhood absence epilepsy: Associations with outcome.

PubMed

Tenney, Jeffrey R; Kadis, Darren S; Agler, William; Rozhkov, Leonid; Altaye, Mekibib; Xiang, Jing; Vannest, Jennifer; Glauser, Tracy A

2018-05-01

The understanding of childhood absence epilepsy (CAE) has been revolutionized over the past decade, but the biological mechanisms responsible for variable treatment outcomes are unknown. Our purpose in this prospective observational study was to determine how pretreatment ictal network pathways, defined using a combined electroencephalography (EEG)-functional magnetic resonance imaging (EEG-fMRI) and magnetoencephalography (MEG) effective connectivity analysis, were related to treatment response. Sixteen children with newly diagnosed and drug-naive CAE had 31 typical absence seizures during EEG-fMRI and 74 during MEG. The spatial extent of the pretreatment ictal network was defined using fMRI hemodynamic response with an event-related independent component analysis (eICA). This spatially defined pretreatment ictal network supplied prior information for MEG-effective connectivity analysis calculated using phase slope index (PSI). Treatment outcome was assessed 2 years following diagnosis and dichotomized to ethosuximide (ETX)-treatment responders (N = 11) or nonresponders (N = 5). Effective connectivity of the pretreatment ictal network was compared to the treatment response. Patterns of pretreatment connectivity demonstrated strongest connections in the thalamus and posterior brain regions (parietal, posterior cingulate, angular gyrus, precuneus, and occipital) at delta frequencies and the frontal cortices at gamma frequencies (P < .05). ETX treatment nonresponders had pretreatment connectivity, which was decreased in the precuneus region and increased in the frontal cortex compared to ETX responders (P < .05). Pretreatment ictal connectivity differences in children with CAE were associated with response to antiepileptic treatment. This is a possible mechanism for the variable treatment response seen in patients sharing the same epilepsy syndrome. Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

Ictal high frequency oscillations distinguish two types of seizure territories in humans

PubMed Central

Weiss, Shennan A.; Banks, Garrett P.; McKhann, Guy M.; Goodman, Robert R.; Emerson, Ronald G.; Trevelyan, Andrew J.

2013-01-01

High frequency oscillations have been proposed as a clinically useful biomarker of seizure generating sites. We used a unique set of human microelectrode array recordings (four patients, 10 seizures), in which propagating seizure wavefronts could be readily identified, to investigate the basis of ictal high frequency activity at the cortical (subdural) surface. Sustained, repetitive transient increases in high gamma (80–150 Hz) amplitude, phase-locked to the low-frequency (1–25 Hz) ictal rhythm, correlated with strong multi-unit firing bursts synchronized across the core territory of the seizure. These repetitive high frequency oscillations were seen in recordings from subdural electrodes adjacent to the microelectrode array several seconds after seizure onset, following ictal wavefront passage. Conversely, microelectrode recordings demonstrating only low-level, heterogeneous neural firing correlated with a lack of high frequency oscillations in adjacent subdural recording sites, despite the presence of a strong low-frequency signature. Previously, we reported that this pattern indicates a failure of the seizure to invade the area, because of a feedforward inhibitory veto mechanism. Because multi-unit firing rate and high gamma amplitude are closely related, high frequency oscillations can be used as a surrogate marker to distinguish the core seizure territory from the surrounding penumbra. We developed an efficient measure to detect delayed-onset, sustained ictal high frequency oscillations based on cross-frequency coupling between high gamma amplitude and the low-frequency (1–25 Hz) ictal rhythm. When applied to the broader subdural recording, this measure consistently predicted the timing or failure of ictal invasion, and revealed a surprisingly small and slowly spreading seizure core surrounded by a far larger penumbral territory. Our findings thus establish an underlying neural mechanism for delayed-onset, sustained ictal high frequency oscillations, and

Neuronal network model of interictal and recurrent ictal activity

NASA Astrophysics Data System (ADS)

Lopes, M. A.; Lee, K.-E.; Goltsev, A. V.

2017-12-01

We propose a neuronal network model which undergoes a saddle node on an invariant circle bifurcation as the mechanism of the transition from the interictal to the ictal (seizure) state. In the vicinity of this transition, the model captures important dynamical features of both interictal and ictal states. We study the nature of interictal spikes and early warnings of the transition predicted by this model. We further demonstrate that recurrent seizures emerge due to the interaction between two networks.

Secondary ventricular fibrillation or pulseless ventricular tachycardia during cardiac arrest and epinephrine dosing.

PubMed

Straznitskas, Andrew D; Wong, Sylvia; Kupchik, Nicole; Carlbom, David

2015-05-01

Development of ventricular fibrillation or pulseless ventricular tachycardia after an initial rhythm of pulseless electrical activity or asystole is associated with significantly increased cardiac arrest mortality. To examine differences in epinephrine administration during cardiac arrest between patients who had a secondary ventricular fibrillation or ventricular tachycardia develop and patients who did not. Data were collected for 2 groups of patients with in-hospital cardiac arrest and an initial rhythm of pulseless electrical activity or asystole: those who had a secondary ventricular fibrillation or ventricular tachycardia develop (cases) and those who did not (controls). Dosing of epinephrine during cardiac arrest and other variables were compared between cases and controls. Of the 215 patients identified with an initial rhythm of pulseless electrical activity or asystole, 51 (23.7%) had a secondary ventricular fibrillation or ventricular tachycardia develop. Throughout the total duration of arrest, including periods of return of spontaneous circulation, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.4 minutes compared with 1 mg every 5 minutes in controls (P= .001). For the total duration of pulselessness, excluding periods of return of spontaneous circulation during the arrest, the dosing interval for epinephrine in patients who had a secondary ventricular fibrillation or ventricular tachycardia develop was 1 mg every 3.1 minutes versus 1 mg every 4.3 minutes in controls (P= .001). More frequent administration of epinephrine during cardiac arrest is associated with development of secondary ventricular fibrillation or ventricular tachycardia. ©2015 American Association of Critical-Care Nurses.

Unilateral Eye Blinking Arising From the Ictal Ipsilateral Occipital Area.

PubMed

Falsaperla, Raffaele; Perciavalle, Valentina; Pavone, Piero; Praticò, Andrea Domenico; Elia, Maurizio; Ruggieri, Martino; Caraballo, Roberto; Striano, Pasquale

2016-07-01

We report on an 18-month-old boy with unilateral left eye blinking as a single ictal manifestation without facial twitching. The clinical onset of this phenomenon was first recorded (as an occasional event) at age 3 months, and it was overlooked. By age 6 months, the child's blinking increased to almost daily occurrence in clusters: during blinking the infant showed intact awareness and occasional jerks in the upper limbs and right leg. A video-electroencephalography (video-EEG) documented clinical correlation with a focal pattern arising from the left occipital region, and brain magnetic resonance imaging (MRI) revealed severe brain damage, consisting in poroencephalic hollows and increased spaces in the convexities involving a large area of the left cerebral hemisphere. The boy was prescribed sodium valproate (30 mg/kg/d), resulting in drastic reduction of his clinical seizures. Follow-up to his current age documented good general status, with persistent partial right hemilateral seizures. The blinking progressively disappeared, and is no longer recorded. The pathogenic hypotheses of the unilateral ictal blinking include involvement of the ipsilateral cerebral hemisphere and/or the cerebellar pathways. Review of previous reports of unilateral eye blinking, arising from the ictal ipsilateral brain, revealed that different damaged regions may give rise to blinking ictal phenomena, likely via the trigeminal fibres innervating the subdural intracranial structures and the pial vessels in the ipsilateral affected brain. The eye blinking in the present child represents a further example of an ictal phenomenon, which is predictive of the damaged brain region. © EEG and Clinical Neuroscience Society (ECNS) 2014.

Source localization of rhythmic ictal EEG activity: a study of diagnostic accuracy following STARD criteria.

PubMed

Beniczky, Sándor; Lantz, Göran; Rosenzweig, Ivana; Åkeson, Per; Pedersen, Birthe; Pinborg, Lars H; Ziebell, Morten; Jespersen, Bo; Fuglsang-Frederiksen, Anders

2013-10-01

Although precise identification of the seizure-onset zone is an essential element of presurgical evaluation, source localization of ictal electroencephalography (EEG) signals has received little attention. The aim of our study was to estimate the accuracy of source localization of rhythmic ictal EEG activity using a distributed source model. Source localization of rhythmic ictal scalp EEG activity was performed in 42 consecutive cases fulfilling inclusion criteria. The study was designed according to recommendations for studies on diagnostic accuracy (STARD). The initial ictal EEG signals were selected using a standardized method, based on frequency analysis and voltage distribution of the ictal activity. A distributed source model-local autoregressive average (LAURA)-was used for the source localization. Sensitivity, specificity, and measurement of agreement (kappa) were determined based on the reference standard-the consensus conclusion of the multidisciplinary epilepsy surgery team. Predictive values were calculated from the surgical outcome of the operated patients. To estimate the clinical value of the ictal source analysis, we compared the likelihood ratios of concordant and discordant results. Source localization was performed blinded to the clinical data, and before the surgical decision. Reference standard was available for 33 patients. The ictal source localization had a sensitivity of 70% and a specificity of 76%. The mean measurement of agreement (kappa) was 0.61, corresponding to substantial agreement (95% confidence interval (CI) 0.38-0.84). Twenty patients underwent resective surgery. The positive predictive value (PPV) for seizure freedom was 92% and the negative predictive value (NPV) was 43%. The likelihood ratio was nine times higher for the concordant results, as compared with the discordant ones. Source localization of rhythmic ictal activity using a distributed source model (LAURA) for the ictal EEG signals selected with a standardized method

Resection of ictal high-frequency oscillations leads to favorable surgical outcome in pediatric epilepsy

PubMed Central

Fujiwara, Hisako; Greiner, Hansel M.; Lee, Ki Hyeong; Holland-Bouley, Katherine D.; Seo, Joo Hee; Arthur, Todd; Mangano, Francesco T.; Leach, James L.; Rose, Douglas F.

2012-01-01

Summary Purpose Intracranial electroencephalography (EEG) is performed as part of an epilepsy surgery evaluation when noninvasive tests are incongruent or the putative seizure-onset zone is near eloquent cortex. Determining the seizure-onset zone using intracranial EEG has been conventionally based on identification of specific ictal patterns with visual inspection. High-frequency oscillations (HFOs, >80 Hz) have been recognized recently as highly correlated with the epileptogenic zone. However, HFOs can be difficult to detect because of their low amplitude. Therefore, the prevalence of ictal HFOs and their role in localization of epileptogenic zone on intracranial EEG are unknown. Methods We identified 48 patients who underwent surgical treatment after the surgical evaluation with intracranial EEG, and 44 patients met criteria for this retrospective study. Results were not used in surgical decision making. Intracranial EEG recordings were collected with a sampling rate of 2,000 Hz. Recordings were first inspected visually to determine ictal onset and then analyzed further with time-frequency analysis. Forty-one (93%) of 44 patients had ictal HFOs determined with time-frequency analysis of intracranial EEG. Key Findings Twenty-two (54%) of the 41 patients with ictal HFOs had complete resection of HFO regions, regardless of frequency bands. Complete resection of HFOs (n = 22) resulted in a seizure-free outcome in 18 (82%) of 22 patients, significantly higher than the seizure-free outcome with incomplete HFO resection (4/19, 21%). Significance Our study shows that ictal HFOs are commonly found with intracranial EEG in our population largely of children with cortical dysplasia, and have localizing value. The use of ictal HFOs may add more promising information compared to interictal HFOs because of the evidence of ictal propagation and followed by clinical aspect of seizures. Complete resection of HFOs is a favorable prognostic indicator for surgical outcome. PMID

Post-ictal psychosis in adolescent Niemann-Pick disease type C.

PubMed

Walterfang, Mark; Kornberg, Andrew; Adams, Sophia; Fietz, Michael; Velakoulis, Dennis

2010-12-01

We describe the presentation of an adolescent with juvenile-onset Niemann-Pick disease type C (NPC) who presented with post-ictal psychosis in the context of a developing seizure disorder. After demonstrating mild gait disturbance beginning at the age of 4 years, he was diagnosed with NPC at age 12 on the basis of 95% of cultured fibroblasts staining positive for filipin and a reduced fibroblast cholesterol esterification rate. He then developed a seizure disorder at age 15, where clusters of seizures produced typical psychotic symptoms, including hallucinations and delusions. His seizure disorder responded to valproate, which resulted in a settling of his psychotic symptoms. Whilst post-ictal psychosis is rarely reported prior to the age of 16, NPC in adolescents and adults is particularly psychotogenic and may increase the risk for post-ictal psychosis in the pediatric population.

Non ictal onset zone: A window to ictal dynamics.

PubMed

Afra, Pegah; Hanrahan, Sara J; Kellis, Spencer Sterling; House, Paul

2017-01-01

The focal and network concepts of epilepsy present different aspects of electroclinical phenomenon of seizures. Here, we present a 23-year-old man undergoing surgical evaluation with left fronto-temporal electrocorticography (ECoG) and microelectrode-array (MEA) in the middle temporal gyrus (MTG). We compare action-potential (AP) and local field potentials (LFP) recorded from MEA with ECoG. Seizure onset in the mesial-temporal lobe was characterized by changes in the pattern of AP-firing without clear changes in LFP or ECoG in MTG. This suggests simultaneous analysis of neuronal activity in differing spatial scales and frequency ranges provide complementary insights into how focal and network neurophysiological activity contribute to ictal activity.

Alterations of network synchrony after epileptic seizures: An analysis of post-ictal intracranial recordings in pediatric epilepsy patients.

PubMed

Tomlinson, Samuel B; Khambhati, Ankit N; Bermudez, Camilo; Kamens, Rebecca M; Heuer, Gregory G; Porter, Brenda E; Marsh, Eric D

2018-07-01

Post-ictal EEG alterations have been identified in studies of intracranial recordings, but the clinical significance of post-ictal EEG activity is undetermined. The purpose of this study was to examine the relationship between peri-ictal EEG activity, surgical outcome, and extent of seizure propagation in a sample of pediatric epilepsy patients. Intracranial EEG recordings were obtained from 19 patients (mean age = 11.4 years, range = 3-20 years) with 57 seizures used for analysis (mean = 3.0 seizures per patient). For each seizure, 3-min segments were extracted from adjacent pre-ictal and post-ictal epochs. To compare physiology of the epileptic network between epochs, we calculated the relative delta power (Δ) using discrete Fourier transformation and constructed functional networks based on broadband connectivity (conn). We investigated differences between the pre-ictal (Δ pre , conn pre ) and post-ictal (Δ post , conn post ) segments in focal-network (i.e., confined to seizure onset zone) versus distributed-network (i.e., diffuse ictal propagation) seizures. Distributed-network (DN) seizures exhibited increased post-ictal delta power and global EEG connectivity compared to focal-network (FN) seizures. Following DN seizures, patients with seizure-free outcomes exhibited a 14.7% mean increase in delta power and an 8.3% mean increase in global connectivity compared to pre-ictal baseline, which was dramatically less than values observed among seizure-persistent patients (29.6% and 47.1%, respectively). Post-ictal differences between DN and FN seizures correlate with post-operative seizure persistence. We hypothesize that post-ictal deactivation of subcortical nuclei recruited during seizure propagation may account for this result while lending insights into mechanisms of post-operative seizure recurrence. Copyright © 2018 Elsevier B.V. All rights reserved.

Infantile ictal apneas in a child with williams-beuren syndrome.

PubMed

Myers, Kenneth A; McLeod, D Ross; Bello-Espinosa, Luis

2013-02-01

Williams-Beuren syndrome is a genetic disorder rarely associated with seizures. The few described cases of Williams-Beuren syndrome and epilepsy have primarily involved infantile spasms and deletions extending beyond the common deletion region for this disorder. We present the case of a 5-week-old child with ictal apneas and typical Williams-Beuren syndrome deletion. Diagnosis was challenging, because the child had cardiac, respiratory, and gastrointestinal abnormalities typically associated with Williams-Beuren syndrome, which are also associated with cyanotic episodes. The results of interictal electroencephalography were normal, illustrating that prolonged electroencephalography is often essential in evaluation of suspected ictal apneas. Seizure freedom was achieved with carbamazepine. Sudden death is seen in Williams-Beuren syndrome, and this case raises the question whether some of these cases may be related to ictal apneas and could potentially be preventable with appropriate pharmaceutical intervention. Copyright © 2013 Elsevier Inc. All rights reserved.

Paradoxical ictal EEG lateralization in children with unilateral encephaloclastic lesions.

PubMed

Garzon, Eliana; Gupta, Ajay; Bingaman, William; Sakamoto, Americo C; Lüders, Hans

2009-09-01

Describe an ictal EEG pattern of paradoxical lateralization in children with unilateral encephaloclastic hemispheric lesion acquired early in life. Of 68 children who underwent hemispherectomy during 2003-2005, scalp video-EEG and brain MRI of six children with an ictal scalp EEG pattern discordant to the clinical and imaging data were reanalyzed. Medical charts were reviewed for clinical findings and seizure outcome. Age of seizure onset was 1 day-4 years. The destructive MRI lesion was an ischemic stroke in 2, a post-infectious encephalomalacia in 2, and a perinatal trauma and hemiconvulsive-hemiplegic syndrome in one patient each. Ictal EEG pattern was characterized by prominent ictal rhythms with either 3-7 Hz spike and wave complexes or beta frequency sharp waves (paroxysmal fast) over the unaffected (contralesional) hemisphere. Scalp video-EEG was discordant, however, other findings of motor deficits (hemiparesis; five severe, one mild), seizure semiology (4/6), interictal EEG abnormalities (3/6), and unilateral burden of MRI lesion guided the decision for hemispherectomy. After 12-39 months of post-surgery follow up, five of six patients were seizure free and one has brief staring spells. We describe a paradoxical lateralization of the EEG to the "good" hemisphere in children with unihemispheric encephaloclastic lesions. This EEG pattern is compatible with seizure free outcome after surgery, provided other clinical findings and tests are concordant with origin from the abnormal hemisphere.

Assessment of the Utility of Ictal Magnetoencephalography in the Localization of the Epileptic Seizure Onset Zone.

PubMed

Alkawadri, Rafeed; Burgess, Richard C; Kakisaka, Yosuke; Mosher, John C; Alexopoulos, Andreas V

2018-06-11

Literature on ictal magnetoencephalography (MEG) in clinical practice and the relationship to other modalities is limited because of the brevity of routine studies. To investigate the utility and reliability of ictal MEG in the localization of the epileptogenic zone. A retrospective medical record review and prospective analysis of a novel ictal rhythm analysis method was conducted at a tertiary epilepsy center with a wide base of referrals for epilepsy surgery evaluation and included consecutive cases of patients who experienced epileptic seizures during routine MEG studies from March 2008 to February 2012. A total of 377 studies screened. Data were analyzed from November 2011 to October 2015. Presurgical workup and interictal and ictal MEG data were reviewed. The localizing value of using extended-source localization of a narrow band identified visually at onset was analyzed. Of the 44 included patients, the mean (SD) age at the time of recording was 19.3 (14.9) years, and 25 (57%) were male. The mean duration of recording was 51.2 minutes. Seizures were provoked by known triggers in 3 patients and were spontaneous otherwise. Twenty-five patients (57%) had 1 seizure, 6 (14%) had 2, and 13 (30%) had 3 or more. Magnetoencephalography single equivalent current dipole analysis was possible in 29 patients (66%), of whom 8 (28%) had no clear interictal discharges. Sublobar concordance between ictal and interictal dipoles was seen in 18 of 21 patients (86%). Three patients (7%) showed clear ictal MEG patterns without electroencephalography changes. Ictal MEG dipoles correlated with the lobe of onset in 7 of 8 patients (88%) who underwent intracranial electroencephalography evaluations. Reasons for failure to identify ictal dipoles included diffuse or poor dipolar ictal patterns, no MEG changes, and movement artifact. Resection of areas containing a minimum-norm estimate of a narrow band at onset, not single equivalent current dipole, was associated with sustained

Peri-ictal water drinking and other ictal vegetative symptoms: Localizing and lateralizing the epileptogenic zone in temporal lobe epilepsy? Two case reports and review of the literature.

PubMed

Errguig, L; Lahjouji, F; Belaidi, H; Jiddane, M; Elkhamlichi, A; Dakka, T; Ouazzani, R

2013-11-01

Peri-ictal behavior disorders can be helpful in localizing and lateralizing seizure onset in partial epilepsies, especially those originating in the temporal lobe. In this paper, we present the case of two right-handed women aged 36 and 42 years who presented with partial seizures of mesial temporal type. Both of the patients had drug resistant epilepsy and undergone presurgical evaluation tests including brain magnetic resonance imaging, video-EEG monitoring and neuropsychological testing. The two patients had hippocampal sclerosis in the right temporal lobe and exhibited PIWD behavior concomitant with right temporal lobe discharges documented during video-EEG recordings. Anterior temporal lobectomy was performed in one case with an excellent outcome after surgery. The patient was free of seizures at 3 years follow-up. We reviewed other publications of peri-ictal autonomic symptoms considered to have a lateralizing significance, such as peri-ictal vomiting, urinary urge, ictal pilo-erection. Clinicians should search for these symptoms, even if not spontaneously reported by the patient, because they are often under-estimated, both by the patients themselves and by physicians. Additionally, patients with lateralizing auras during seizures have a significantly better outcome after epilepsy surgery than those without lateralizing features. Copyright © 2013. Published by Elsevier Masson SAS.

Measuring the level and content of consciousness during epileptic seizures: the Ictal Consciousness Inventory.

PubMed

Cavanna, A E; Mula, M; Servo, S; Strigaro, G; Tota, G; Barbagli, D; Collimedaglia, L; Viana, M; Cantello, R; Monaco, F

2008-07-01

Ictal alterations of the level of general awareness and subjective content of consciousness play a pivotal role in the clinical phenomenology of epilepsy, and reflect the pathological involvement of different neurobiological substrates. However, no self-reported measures have been proposed for patients experiencing altered conscious states during seizures. This study describes the development and validation of a new scale for the quantitative assessment of the level and content of ictal consciousness, the Ictal Consciousness Inventory (ICI). The ICI is a 20-item questionnaire generated on the basis of interviews with patients, literature review, and consultation with experts. It was tested on a sample of 110 patients attending three different epilepsy clinics in Northern Italy, who also completed standardized clinical scales. Standard psychometric methods were used to demonstrate that this scale satisfies criteria for acceptability, reliability, and validity. The ICI is proposed as a user-friendly and clinically sound instrument for the measurement of ictal alterations of consciousness in patients with epilepsy.

Mapping human preictal and ictal haemodynamic networks using simultaneous intracranial EEG-fMRI

PubMed Central

Chaudhary, Umair J.; Centeno, Maria; Thornton, Rachel C.; Rodionov, Roman; Vulliemoz, Serge; McEvoy, Andrew W.; Diehl, Beate; Walker, Matthew C.; Duncan, John S.; Carmichael, David W.; Lemieux, Louis

2016-01-01

Accurately characterising the brain networks involved in seizure activity may have important implications for our understanding of epilepsy. Intracranial EEG-fMRI can be used to capture focal epileptic events in humans with exquisite electrophysiological sensitivity and allows for identification of brain structures involved in this phenomenon over the entire brain. We investigated ictal BOLD networks using the simultaneous intracranial EEG-fMRI (icEEG-fMRI) in a 30 year-old male undergoing invasive presurgical evaluation with bilateral depth electrode implantations in amygdalae and hippocampi for refractory temporal lobe epilepsy. One spontaneous focal electrographic seizure was recorded. The aims of the data analysis were firstly to map BOLD changes related to the ictal activity identified on icEEG and secondly to compare different fMRI modelling approaches. Visual inspection of the icEEG showed an onset dominated by beta activity involving the right amygdala and hippocampus lasting 6.4 s (ictal onset phase), followed by gamma activity bilaterally lasting 14.8 s (late ictal phase). The fMRI data was analysed using SPM8 using two modelling approaches: firstly, purely based on the visually identified phases of the seizure and secondly, based on EEG spectral dynamics quantification. For the visual approach the two ictal phases were modelled as ‘ON’ blocks convolved with the haemodynamic response function; in addition the BOLD changes during the 30 s preceding the onset were modelled using a flexible basis set. For the quantitative fMRI modelling approach two models were evaluated: one consisting of the variations in beta and gamma bands power, thereby adding a quantitative element to the visually-derived models, and another based on principal components analysis of the entire spectrogram in attempt to reduce the bias associated with the visual appreciation of the icEEG. BOLD changes related to the visually defined ictal onset phase were revealed in the medial

Mapping human preictal and ictal haemodynamic networks using simultaneous intracranial EEG-fMRI.

PubMed

Chaudhary, Umair J; Centeno, Maria; Thornton, Rachel C; Rodionov, Roman; Vulliemoz, Serge; McEvoy, Andrew W; Diehl, Beate; Walker, Matthew C; Duncan, John S; Carmichael, David W; Lemieux, Louis

2016-01-01

Accurately characterising the brain networks involved in seizure activity may have important implications for our understanding of epilepsy. Intracranial EEG-fMRI can be used to capture focal epileptic events in humans with exquisite electrophysiological sensitivity and allows for identification of brain structures involved in this phenomenon over the entire brain. We investigated ictal BOLD networks using the simultaneous intracranial EEG-fMRI (icEEG-fMRI) in a 30 year-old male undergoing invasive presurgical evaluation with bilateral depth electrode implantations in amygdalae and hippocampi for refractory temporal lobe epilepsy. One spontaneous focal electrographic seizure was recorded. The aims of the data analysis were firstly to map BOLD changes related to the ictal activity identified on icEEG and secondly to compare different fMRI modelling approaches. Visual inspection of the icEEG showed an onset dominated by beta activity involving the right amygdala and hippocampus lasting 6.4 s (ictal onset phase), followed by gamma activity bilaterally lasting 14.8 s (late ictal phase). The fMRI data was analysed using SPM8 using two modelling approaches: firstly, purely based on the visually identified phases of the seizure and secondly, based on EEG spectral dynamics quantification. For the visual approach the two ictal phases were modelled as 'ON' blocks convolved with the haemodynamic response function; in addition the BOLD changes during the 30 s preceding the onset were modelled using a flexible basis set. For the quantitative fMRI modelling approach two models were evaluated: one consisting of the variations in beta and gamma bands power, thereby adding a quantitative element to the visually-derived models, and another based on principal components analysis of the entire spectrogram in attempt to reduce the bias associated with the visual appreciation of the icEEG. BOLD changes related to the visually defined ictal onset phase were revealed in the medial and

Age-related gender differences in reporting ictal fear: analysis of case histories and review of the literature.

PubMed

Chiesa, Valentina; Gardella, Elena; Tassi, Laura; Canger, Raffaele; Lo Russo, Giorgio; Piazzini, Ada; Turner, Katherine; Canevini, Maria Paola

2007-12-01

To determine if there are age or gender-related differences in reporting fear as a symptom of epileptic seizure, all clinical charts of patients evaluated at the "C. Munari - Epilepsy Surgery Center" of Milan from 1990 to June 2005 were analyzed, looking for patients with ictal fear. Among the 2,530 clinical charts examined (1,330 male and 1,200 female), 265 patients were found with ictal fear (100 men, 165 women). The gender difference in reporting ictal fear was not so marked in the pediatric age group (98 girls, 74 boys), whereas in adult patients the difference was significant (158 women, 83 men). Interestingly, more men than women (14:3) had ictal fear during childhood that disappeared during adulthood. The literature review confirmed that ictal fear is significantly more common in women, though there is no gender difference in the pediatric age group.

Automatic and remote controlled ictal SPECT injection for seizure focus localization by use of a commercial contrast agent application pump.

PubMed

Feichtinger, Michael; Eder, Hans; Holl, Alexander; Körner, Eva; Zmugg, Gerda; Aigner, Reingard; Fazekas, Franz; Ott, Erwin

2007-07-01

In the presurgical evaluation of patients with partial epilepsy, the ictal single photon emission computed tomography (SPECT) is a useful noninvasive diagnostic tool for seizure focus localization. To achieve optimal SPECT scan quality, ictal tracer injection should be carried out as quickly as possible after the seizure onset and under highest safety conditions possible. Compared to the commonly used manual injection, an automatic administration of the radioactive tracer may provide higher quality standards for this procedure. In this study, therefore, we retrospectively analyzed efficiency and safety of an automatic injection system for ictal SPECT tracer application. Over a 31-month period, 26 patients underwent ictal SPECT by use of an automatic remote-controlled injection pump originally designed for CT-contrast agent application. Various factors were reviewed, including latency of ictal injection, radiation safety parameters, and ictal seizure onset localizing value. Times between seizure onset and tracer injection ranged between 3 and 48 s. In 21 of 26 patients ictal SPECT supported the localization of the epileptogenic focus in the course of the presurgical evaluation. In all cases ictal SPECT tracer injection was performed with a high degree of safety to patients and staff. Ictal SPECT by use of a remote-controlled CT-contrast agent injection system provides a high scan quality and is a safe and confirmatory presurgical evaluation technique in the epilepsy-monitoring unit.

Source localization of temporal lobe epilepsy using PCA-LORETA analysis on ictal EEG recordings.

PubMed

Stern, Yaki; Neufeld, Miriam Y; Kipervasser, Svetlana; Zilberstein, Amir; Fried, Itzhak; Teicher, Mina; Adi-Japha, Esther

2009-04-01

Localizing the source of an epileptic seizure using noninvasive EEG suffers from inaccuracies produced by other generators not related to the epileptic source. The authors isolated the ictal epileptic activity, and applied a source localization algorithm to identify its estimated location. Ten ictal EEG scalp recordings from five different patients were analyzed. The patients were known to have temporal lobe epilepsy with a single epileptic focus that had a concordant MRI lesion. The patients had become seizure-free following partial temporal lobectomy. A midinterval (approximately 5 seconds) period of ictal activity was used for Principal Component Analysis starting at ictal onset. The level of epileptic activity at each electrode (i.e., the eigenvector of the component that manifest epileptic characteristic), was used as an input for low-resolution tomography analysis for EEG inverse solution (Zilberstain et al., 2004). The algorithm accurately and robustly identified the epileptic focus in these patients. Principal component analysis and source localization methods can be used in the future to monitor the progression of an epileptic seizure and its expansion to other areas.

Effects of Marijuana on Ictal and Interictal EEG Activities in Idiopathic Generalized Epilepsy.

PubMed

Sivakumar, Sanjeev; Zutshi, Deepti; Seraji-Bozorgzad, Navid; Shah, Aashit K

2017-01-01

Marijuana-based treatment for refractory epilepsy shows promise in surveys, case series, and clinical trials. However, literature on their EEG effects is sparse. Our objective is to analyze the effect of marijuana on EEG in a 24-year-old patient with idiopathic generalized epilepsy treated with cannabis. We blindly reviewed 3 long-term EEGs-a 24-hour study while only on antiepileptic drugs, a 72-hour EEG with Cannabis indica smoked on days 1 and 3 in addition to antiepileptic drugs, and a 48-hour EEG with combination C indica/sativa smoked on day 1 plus antiepileptic drugs. Generalized spike-wave discharges and diffuse paroxysmal fast activity were categorized as interictal and ictal, based on duration of less than 10 seconds or greater, respectively. Data from three studies concatenated into contiguous time series, with usage of marijuana modeled as time-dependent discrete variable while interictal and ictal events constituted dependent variables. Analysis of variance as initial test for significance followed by time series analysis using Generalized Autoregressive Conditional Heteroscedasticity model was performed. Statistical significance for lower interictal events (analysis of variance P = 0.001) was seen during C indica use, but not for C indica/sativa mixture (P = 0.629) or ictal events (P = 0.087). However, time series analysis revealed a significant inverse correlation between marijuana use, with interictal (P < 0.0004) and ictal (P = 0.002) event rates. Using a novel approach to EEG data, we demonstrate a decrease in interictal and ictal electrographic events during marijuana use. Larger samples of patients and EEG, with standardized cannabinoid formulation and dosing, are needed to validate our findings.

Endorphin mediation of post-ictal effects of kindled seizures in rats.

PubMed

Kelsey, J E; Belluzzi, J D

1982-12-16

Brief electrical stimulation of the enkephalin-rich globus pallidus at 1-h intervals produced kindled, clonic seizures in rats as rapidly as similar stimulation of the amygdala. Massing the kindling trials at 10-min intervals inhibited the occurrence of subsequent seizures, especially following globus pallidus stimulation. Naloxone (20 mg/kg), an opiate receptor antagonist, reversed this post-ictal inhibition of seizures following massed trials, but had no effect on seizures kindled at 1-h intervals. Thus, endorphin-released during seizures do not appear to mediate the production of kindled seizures, but do appear to mediate the transient posts ictal inhibition of seizures.

Palilalia, echolalia, and echopraxia-palipraxia as ictal manifestations in a patient with left frontal lobe epilepsy.

PubMed

Cho, Yang-Je; Han, Sang-Don; Song, Sook Keun; Lee, Byung In; Heo, Kyoung

2009-06-01

Palilalia is a relatively rare pathologic speech behavior and has been reported in various neurologic and psychiatric disorders. We encountered a case of palilalia, echolalia, and echopraxia-palipraxia as ictal phenomena of left frontal lobe epilepsy. A 55-year-old, right-handed man was admitted because of frequent episodes of rapid reiteration of syllables. Video-electroencephalography monitoring revealed stereotypical episodes of palilalia accompanied by rhythmic head nodding and right-arm posturing with ictal discharges over the left frontocentral area. He also displayed echolalia or echopraxia-palipraxia, partially responding to an examiner's stimulus. Magnetic resonance imaging revealed encephalomalacia on the left superior frontal gyrus and ictal single photon emission computed tomography showed hyperperfusion just above the lesion, corresponding to the left supplementary motor area (SMA), and subcortical nuclei. This result suggests that the neuroanatomic substrate involved in the generation of these behaviors as ictal phenomena might exist in the SMA of the left frontal lobe.

Status gelasticus after temporal lobectomy: ictal FDG-PET findings and the question of dual pathology involving hypothalamic hamartomas.

PubMed

Palmini, Andre; Van Paesschen, Wim; Dupont, Patrick; Van Laere, Koen; Van Driel, Guido

2005-08-01

To present the first ictal fluorodeoxyglucose-positron emission tomography (FDG-PET) evidence of the hypothalamic origin of gelastic seizures in a patient with a hypothalamic hamartoma (HH) and to raise the issue of true dual pathology related to this entity. Ictal FDG-PET was acquired during an episode of status gelasticus with preserved consciousness, in a patient previously operated on for complex partial seizures (CPSs) due to a temporal lobe epileptogenic cyst. Ictal hypermetabolism was localized to the region of the HH during the status gelasticus. CPSs had been completely eliminated after temporal lobe surgery. Ictal FDG-PET independently confirmed that gelastic seizures in patients with HH do originate in the diencephalic lesion. An HH may coexist with another epileptogenic lesion, in a context of dual pathology.

Electromagnetic interference may cause false asystole alarms in certain Philips IntelliVue monitoring products.

PubMed

2011-09-01

Electromagnetic interference (EMI) may cause some Philips Healthcare IntelliVue MMS, MP2, MP5, and X2 patient monitoring products to incorrectly display a flat electrocardiogram (ECG) waveform and generate a false asystole alarm. This occurs while the devices' pace pulse rejection feature is enabled. Facilities that suspect such behavior in their inventories should contact Philips to discuss whether installation of firmware version D.02.05 will help address the problem.

Orbital Floor Fracture with Atypical Extraocular Muscle Entrapment Pattern and Intraoperative Asystole in an Adult

PubMed Central

Merali, Farhan I.; Grant, Michael P.; Mahoney, Nicholas R.

2015-01-01

Extraocular muscle entrapment in a nondisplaced orbital fracture, although a well-known entity in pediatric trauma, is atypical in adults. It can present with a triad of bradycardia, nausea, and in rare cases, syncope, and result in severe fibrosis of damaged and incarcerated muscle. We present a case of muscle entrapment in a partially nondisplaced two-wall orbital fracture with accompanying preoperative bradycardia and intraoperative asystole in an adult PMID:26576246

Peri-ictal water drinking: a rare automatic behaviour in temporal lobe epilepsy.

PubMed

Pietrafusa, Nicola; Trivisano, Marina; de Palma, Luca; Serino, Domenico; Moavero, Romina; Benvenga, Antonella; Cappelletti, Simona; Boero, Giovanni; Vigevano, Federico; La Neve, Angela; Specchio, Nicola

2015-12-01

Peri-ictal water drinking (PIWD) has been reported as the action of drinking during or within two minutes of an electroclinical seizure. It is considered a peri-ictal vegetative symptom, evident both during childhood and adulthood epilepsy. The aim of this paper was to describe the clinical and electroencephalographic features of two new adult subjects suffering from symptomatic temporal lobe epilepsy with episodes of PIWD recorded by VIDEO-EEG and to review literature data in order to better define this peculiar event during seizures, a rare and probably underestimated semiological sign. To date, 51 cases with focal epilepsy and seizures associated with PIWD have been reported. All patients presented with temporal lobe epilepsy. All cases but one had symptomatic epilepsy. Most of the patients had an involvement of the right hemisphere. Water drinking was reported as an ictal sign in the majority of patients, and less frequently was reported as postictal. We believe that PIWD might be considered a rare automatic behaviour, like other automatisms. Automatisms are more frequently described in patients with temporal lobe epilepsy. PIWD was reported also to have lateralizing significance in the non-dominant temporal lobe, however, because of its rarity, this finding remains unclear.

Unfavorable surgical outcomes in partial epilepsy with secondary bilateral synchrony: Intracranial electroencephalography study.

PubMed

Sunwoo, Jun-Sang; Byun, Jung-Ick; Moon, Jangsup; Lim, Jung-Ah; Kim, Tae-Joon; Lee, Soon-Tae; Jung, Keun-Hwa; Park, Kyung-Il; Chu, Kon; Kim, Manho; Chung, Chun-Kee; Jung, Ki-Young; Lee, Sang Kun

2016-05-01

Secondary bilateral synchrony (SBS) indicates bilaterally synchronous epileptiform discharges arising from a focal cortical origin. The present study aims to investigate SBS in partial epilepsy with regard to surgical outcomes and intracranial EEG findings. We retrospectively reviewed consecutive patients who underwent epilepsy surgery following extraoperative intracranial electroencephalography (EEG) study from 2008 to 2012. The presence of SBS was determined based upon the results of scalp EEG monitoring performed for presurgical evaluations. We reviewed scalp EEG, neuroimaging, intracranial EEG findings, and surgical outcomes in patients with SBS. We found 12 patients with SBS who were surgically treated for intractable partial epilepsy. Nine (75%) patients had lateralized ictal semiology and only two (16.6%) patients showed localized ictal onset in scalp EEG. Brain MRI showed epileptogenic lesion in three (25%) patients. Intracranial EEG demonstrated that ictal onset zone was widespread or non-localized in six (50%) patients. Low-voltage fast activity was the most common ictal onset EEG pattern. Rapid propagation of ictal onset was noted in 10 (83.3%) patients. Eleven patients underwent resective epilepsy surgery and only two patients (18.2%) achieved seizure-freedom (median follow-up 56 months). MRI-visible brain lesions were associated with favorable outcomes (p=0.024). Patients with SBS, compared to frontal lobe epilepsy without SBS, showed lesser localization in ictal onset EEG (p=0.029) and more rapid propagation during evolution of ictal rhythm (p=0.015). The present results suggested that resective surgery for partial epilepsy with SBS should be decided carefully, especially in case of nonlesional epilepsy. Poor localization and rapid spread of ictal onset were prominent in intracranial EEG, which might contribute to incomplete resection of the epileptogenic zone and poor surgical outcomes. Copyright © 2016 Elsevier B.V. All rights reserved.

Cerebral perfusion alterations in epileptic patients during peri-ictal and post-ictal phase: PASL vs DSC-MRI.

PubMed

Pizzini, Francesca B; Farace, Paolo; Manganotti, Paolo; Zoccatelli, Giada; Bongiovanni, Luigi G; Golay, Xavier; Beltramello, Alberto; Osculati, Antonio; Bertini, Giuseppe; Fabene, Paolo F

2013-07-01

Non-invasive pulsed arterial spin labeling (PASL) MRI is a method to study brain perfusion that does not require the administration of a contrast agent, which makes it a valuable diagnostic tool as it reduces cost and side effects. The purpose of the present study was to establish the viability of PASL as an alternative to dynamic susceptibility contrast (DSC-MRI) and other perfusion imaging methods in characterizing changes in perfusion patterns caused by seizures in epileptic patients. We evaluated 19 patients with PASL. Of these, the 9 affected by high-frequency seizures were observed during the peri-ictal period (within 5hours since the last seizure), while the 10 patients affected by low-frequency seizures were observed in the post-ictal period. For comparison, 17/19 patients were also evaluated with DSC-MRI and CBF/CBV. PASL imaging showed focal vascular changes, which allowed the classification of patients in three categories: 8 patients characterized by increased perfusion, 4 patients with normal perfusion and 7 patients with decreased perfusion. PASL perfusion imaging findings were comparable to those obtained by DSC-MRI. Since PASL is a) sensitive to vascular alterations induced by epileptic seizures, b) comparable to DSC-MRI for detecting perfusion asymmetries, c) potentially capable of detecting time-related perfusion changes, it can be recommended for repeated evaluations, to identify the epileptic focus, and in follow-up and/or therapy-response assessment. Copyright © 2013 Elsevier Inc. All rights reserved.

Ictal semiology in hippocampal versus extrahippocampal temporal lobe epilepsy.

PubMed

Gil-Nagel, A; Risinger, M W

1997-01-01

We have analysed retrospectively the clinical features and electroencephalograms in 35 patients with complex partial seizures of temporal lobe origin who were seizure-free after epilepsy surgery. Two groups were differentiated for statistical analysis: 16 patients had hippocampal temporal lobe seizures (HTS) and 19 patients had extrahippocampal temporal lobe seizures (ETS) associated with a small tumour of the lateral or inferior temporal cortex. All patients in the HTS group had ictal onset verified with intracranial recordings (depth or subdural electrodes). In the ETS group, extrahippocampal onset was verified with intracranial recordings in eight patients and assumed, because of failure of a previous amygdalohippocampectomy, in one patient. Historical information, ictal semiology and ictal EEG of typical seizures were analysed in each patient. The occurrence of early and late oral automatisms and dystonic posturing of an upper extremity was analysed separately. A prior history of febrile convulsions was obtained in 13 HTS patients (81.3%) but in none with ETS (P < 0.0001, Fisher's exact test). An epigastric aura preceded seizures in five patients with HTS (31.3%) and none with ETS (P = 0.0135, Fisher's exact test), while an aura with experiential content was recalled by nine patients with ETS (47.4%) and none with HTS (P = 0.0015), Fisher's exact test). Early oral automatisms occurred in 11 patients with HTS (68.8%) and in two with ETS (10.5%) (P = 0.0005, Fisher's exact test). Early motor involvement of the contralateral upper extremity without oral automatisms occurred in three patients with HTS (18.8%) and in 10 with ETS (52.6%) (P = 0.0298, Fisher's exact test). Arrest reaction, vocalization, speech, facial grimace, postictal cough, late oral automatisms and late motor involvement of the contralateral arm and hand occurred with similar frequency in both groups. These observations show that the early clinical features of HTS and ETS are different.

Asystole and increased serum myoglobin levels associated with 'packing blackout' in a competitive breath-hold diver.

PubMed

Andersson, Johan P A; Linér, Mats H; Jönsson, Henrik

2009-11-01

Many competitive breath-hold divers use 'glossopharyngeal insufflation', also called 'lung packing', to overfill their lungs above normal total lung capacity. This increases intrathoracic pressure, decreases venous return, compromises cardiac pumping, and reduces arterial blood pressure, possibly resulting in a syncope breath-hold divers call 'packing blackout'. We report a case with a breath-hold diver who inadvertently experienced a packing blackout. During the incident, an electrocardiogram (ECG) and blood pressure were recorded, and blood samples for determinations of biomarkers of cardiac muscle perturbation (creatine kinase-MB isoenzyme (CK-MB), cardiac troponin-T (TnT), and myoglobin) were collected. The ECG revealed short periods of asystole during the period of 'packing blackout', simultaneous with pronounced reductions in systolic, diastolic, and pulse pressures. Serum myoglobin concentration was elevated 40 and 150 min after the incident, whereas there were no changes in CK-MB or TnT. The ultimate cause of syncope in this diver probably was a decrease in cerebral perfusion following glossopharyngeal insufflation. The asystolic periods recorded in this diver could possibly indicate that susceptible individuals may be put at risk of a serious cardiac incident if the lungs are excessively overinflated by glossopharyngeal insufflation. This concern is further substantiated by the observed increase in serum myoglobin concentration after the event.

Paramedic Checklists do not Accurately Identify Post-ictal or Hypoglycaemic Patients Suitable for Discharge at the Scene.

PubMed

Tohira, Hideo; Fatovich, Daniel; Williams, Teresa A; Bremner, Alexandra; Arendts, Glenn; Rogers, Ian R; Celenza, Antonio; Mountain, David; Cameron, Peter; Sprivulis, Peter; Ahern, Tony; Finn, Judith

2016-06-01

The objective of this study was to assess the accuracy and safety of two pre-defined checklists to identify prehospital post-ictal or hypoglycemic patients who could be discharged at the scene. A retrospective cohort study of lower acuity, adult patients attended by paramedics in 2013, and who were either post-ictal or hypoglycemic, was conducted. Two self-care pathway assessment checklists (one each for post-ictal and hypoglycemia) designed as clinical decision tools for paramedics to identify patients suitable for discharge at the scene were used. The intention of the checklists was to provide paramedics with justification to not transport a patient if all checklist criteria were met. Actual patient destination (emergency department [ED] or discharge at the scene) and subsequent events (eg, ambulance requests) were compared between patients who did and did not fulfill the checklists. The performance of the checklists against the destination determined by paramedics was also assessed. Totals of 629 post-ictal and 609 hypoglycemic patients were identified. Of these, 91 (14.5%) and 37 (6.1%) patients fulfilled the respective checklist. Among those who fulfilled the checklist, 25 (27.5%) post-ictal and 18 (48.6%) hypoglycemic patients were discharged at the scene, and 21 (23.1%) and seven (18.9%) were admitted to hospital after ED assessment. Amongst post-ictal patients, those fulfilling the checklist had more subsequent ambulance requests (P=.01) and ED attendances with seizure-related conditions (P=.04) within three days than those who did not. Amongst hypoglycemic patients, there were no significant differences in subsequent events between those who did and did not meet the criteria. Paramedics discharged five times more hypoglycemic patients at the scene than the checklist predicted with no significant differences in the rate of subsequent events. Four deaths (0.66%) occurred within seven days in the hypoglycemic cohort, and none of them were attributed directly

Do ictal EEG characteristics predict treatment outcomes in schizophrenic patients undergoing electroconvulsive therapy?

PubMed

Simsek, Gulnihal Gokce; Zincir, Selma; Gulec, Huseyin; Eksioglu, Sevgin; Semiz, Umit Basar; Kurtulmus, Yasemin Sipka

2015-08-01

The aim of this study is to investigate the relationship between features of electroencephalography (EEG), including seizure time, energy threshold level and post-ictal suppression time, and clinical variables, including treatment outcomes and side-effects, among schizophrenia inpatients undergoing electroconvulsive therapy (ECT). This is a naturalistic follow-up study on schizophrenia patients, diagnosed using DSM-IV-TR criteria, treated by a psychosis inpatient service. All participants completed the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF) scale, the Frontal Assessment Battery (FAB) and a Data Collection Form. Assessments were made before treatment, during ECT and after treatment. Statistically significant improvements in both clinical and cognitive outcome were noted after ECT in all patients. Predictors of improvement were sought by evaluating electrophysiological variables measured at three time points (after the third, fifth and seventh ECT sessions). Logistic regression analysis showed that clinical outcome/improvement did not differ by seizure duration, threshold energy level or post-ictal suppression time. We found that ictal EEG parameters measured at several ECT sessions did not predict clinical recovery/outcomes. This may be because our centre defensively engages in "very specific patient selection" when ECT is contemplated. ECT does not cause short-term cognitive functional impairment and indeed improves cognition, because symptoms of the schizophrenic episode are alleviated.

Peri-ictal ECG changes in childhood epilepsy: implications for detection systems.

PubMed

Jansen, Katrien; Varon, Carolina; Van Huffel, Sabine; Lagae, Lieven

2013-10-01

Early detection of seizures could reduce associated morbidity and mortality and improve the quality of life of patients with epilepsy. In this study, the aim was to investigate whether ictal tachycardia is present in focal and generalized epileptic seizures in children. We sought to predict in which type of seizures tachycardia can be identified before actual seizure onset. Electrocardiogram segments in 80 seizures were analyzed in time and frequency domains before and after the onset of epileptic seizures on EEG. These ECG parameters were analyzed to find the most informative ones that can be used for seizure detection. The algorithm of Leutmezer et al. was used to find the temporal relationship between the change in heart rate and seizure onset. In the time domain, the mean RR shows a significant difference before compared to after onset of the seizure in focal seizures. This can be observed in temporal lobe seizures as well as frontal lobe seizures. Calculation of mean RR interval has a high specificity for detection of ictal heart rate changes. Preictal heart rate changes are observed in 70% of the partial seizures. Ictal heart rate changes are present only in partial seizures in this childhood epilepsy study. The changes can be observed in temporal lobe seizures as well as in frontal lobe seizures. Heart rate changes precede seizure onset in 70% of the focal seizures, making seizure detection and closed-loop systems a possible therapeutic alternative in the population of children with refractory epilepsy. © 2013.

Interictal to Ictal Phase Transition in a Small-World Network

NASA Astrophysics Data System (ADS)

Nemzer, Louis; Cravens, Gary; Worth, Robert

Real-time detection and prediction of seizures in patients with epilepsy is essential for rapid intervention. Here, we perform a full Hodgkin-Huxley calculation using n 50 in silico neurons configured in a small-world network topology to generate simulated EEG signals. The connectivity matrix, constructed using a Watts-Strogatz algorithm, admits randomized or deterministic entries. We find that situations corresponding to interictal (non-seizure) and ictal (seizure) states are separated by a phase transition that can be influenced by congenital channelopathies, anticonvulsant drugs, and connectome plasticity. The interictal phase exhibits scale-free phenomena, as characterized by a power law form of the spectral power density, while the ictal state suffers from pathological synchronization. We compare the results with intracranial EEG data and show how these findings may be used to detect or even predict seizure onset. Along with the balance of excitatory and inhibitory factors, the network topology plays a large role in determining the overall characteristics of brain activity. We have developed a new platform for testing the conditions that contribute to the phase transition between non-seizure and seizure states.

Rhythmic ictal nonclonic hand (RINCH) motions in temporal lobe epilepsy: invasive EEG findings, incidence, and lateralizing value.

PubMed

Kuba, Robert; Musilová, Klára; Vojvodič, Nikola; Tyrlíková, Ivana; Rektor, Ivan; Brázdil, Milan

2013-10-01

The main purpose of this retrospective analysis was to evaluate the incidence and lateralization value of rhythmic ictal nonclonic hand (RINCH) motions in patients with temporal lobe epilepsy (TLE), who were classified as Engel I at least 2 years after epilepsy surgery. We analyzed the distribution of ictal activity at the time of RINCH appearance in patients in whom RINCH motions were present during invasive EEG monitoring. A group of 120 patients was included in this study. In total, we reviewed 491 seizures: 277 seizures in patients with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (TLE-HS group) and 214 in TLE caused by other lesions (TLE-OTH group). We analyzed 29 patients (79 of the seizures) during invasive EEG monitoring. Fisher's exact test and binomial test were used for the statistical analysis. RINCH motions were observed in 24 out of 120 patients (20%) and in 48 out of 491 seizures (9.8%). There was no significant difference between the occurrence of RINCH motions in patients with TLE-HS and in patients with TLE-OTH, or between gender, right/left-sided TLE, and language dominant/nondominant TLE. RINCH motions were contralateral to the seizure onset in 83.3% of patients and 91.7% of seizures (p=0.0015; p<0.001, respectively). There were no differences in the lateralizing value of RINCH motions in patients with TLE-HS or TLE-OTH. We analyzed RINCH motions in 5 patients/7 seizures during invasive EEG. In all 7 seizures with RINCH motions, we observed the widespread activation of the temporal lobe (mesial and lateral, opercular and polar regions) contralateral to the side of RINCH motions. In all 7 seizures, we observed that at the time of RINCH motion onset, at least 1 explored region of the frontal lobe was affected by the ictal activity. In 3 seizures, we observed time-locked epileptic activation associated with the appearance of RINCH motions, i.e., in the orbitofrontal cortex in 2 seizures and in both the orbitofrontal cortex and

Characterization of ictal slow waves in epileptic spasms.

PubMed

Honda, Ryoko; Saito, Yoshiaki; Okumura, Akihisa; Abe, Shinpei; Saito, Takashi; Nakagawa, Eiji; Sugai, Kenji; Sasaki, Masayuki

2015-12-01

We characterized the clinico-neurophysiological features of epileptic spasms, particularly focusing on high-voltage slow waves during ictal EEG. We studied 22 patients with epileptic spasms recorded during digital video-scalp EEG, including five individuals who still had persistent spasms after callosotomy. We analysed the duration, amplitude, latency to onset of electromyographic bursts, and distribution of the highest positive and negative peaks of slow waves in 352 spasms. High-voltage positive slow waves preceded the identifiable muscle contractions of spasms. The mean duration of these positive waves was 569±228 m, and the mean latency to electromyographic onset was 182±127 m. These parameters varied markedly even within a patient. The highest peak of the positive component was distributed in variable regions, which was not consistent with the location of lesions on MRI. The peak of the negative component following the positivity was distributed in the neighbouring or opposite areas of the positive peak distribution. No changes were evident in the pre- or post-surgical distributions of the positive peak, or in the interhemispheric delay between both hemispheres, in individuals with callosotomy. Our data imply that ictal positive slow waves are the most common EEG changes during spasms associated with a massive motor component. Plausible explanations for these widespread positive slow waves include the notion that EEG changes possibly reflect involvement of both cortical and subcortical structures.

Presurgical evaluation for partial epilepsy: Relative contributions of chronic depth-electrode recordings versus FDG-PET and scalp-sphenoidal ictal EEG

DOE Office of Scientific and Technical Information (OSTI.GOV)

Engel, J. Jr.; Henry, T.R.; Risinger, M.W.

1990-11-01

One hundred fifty-three patients with medically refractory partial epilepsy underwent chronic stereotactic depth-electrode EEG (SEEG) evaluations after being studied by positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) and scalp-sphenoidal EEG telemetry. We carried out retrospective standardized reviews of local cerebral metabolism and scalp-sphenoidal ictal onsets to determine when SEEG recordings revealed additional useful information. FDG-PET localization was misleading in only 3 patients with temporal lobe SEEG ictal onsets for whom extratemporal or contralateral hypometabolism could be attributed to obvious nonepileptic structural defects. Two patients with predominantly temporal hypometabolism may have had frontal epileptogenic regions, but ultimate localization remains uncertain. Scalp-sphenoidalmore » ictal onsets were misleading in 5 patients. For 37 patients with congruent focal scalp-sphenoidal ictal onsets and temporal hypometabolic zones, SEEG recordings never demonstrated extratemporal or contralateral epileptogenic regions; however, 3 of these patients had nondiagnostic SEEG evaluations. The results of subsequent subdural grid recordings indicated that at least 1 of these patients may have been denied beneficial surgery as a result of an equivocal SEEG evaluation. Weighing risks and benefits, it is concluded that anterior temporal lobectomy is justified without chronic intracranial recording when specific criteria for focal scalp-sphenoidal ictal EEG onsets are met, localized hypometabolism predominantly involves the same temporal lobe, and no other conflicting information has been obtained from additional tests of focal functional deficit, structural imaging, or seizure semiology.« less

Ictal affective symptoms in temporal lobe epilepsy are related to gender and age.

PubMed

Toth, Vanda; Fogarasi, Andras; Karadi, Kazmer; Kovacs, Norbert; Ebner, Alois; Janszky, Jozsef

2010-07-01

We systematically analyzed the video-recorded and patient-reported, as well as positive and negative ictal affective symptoms (IAS) in temporal lobe epilepsy (TLE). Our aim was to assess (1) frequency, (2) gender effect, (3) lateralizing significance, (4) localizing value, and (5) prognostic significance in epilepsy surgery of IAS in patients with video-registered seizures. We reviewed ictal video recordings of 184 patients (99 women, aged 16-63). All patients had surgery for intractable TLE with video-recorded complex partial seizures (CPS) due to temporal lobe lesions visualized by high-resolution magnetic resonance imaging (MRI). Affective auras (AAs) were categorized into two groups: positive or negative. We registered AAs in 18% of patients: positive in 3%, negative in 15%. We saw ictal affective behavior (IAB) in 22% of patients; 10% had positive, whereas 14% had negative IAB. Two patients had both positive and negative IAB. AAs showed an association with IAB in case of fear expression versus fear auras (p = 0.018). IAB, especially negative IAB, occurred more often in women than in men. Patients with negative IAB were younger than others. We could not demonstrate an association between IAS and the localization, lateralization, or hemispheric dominance. Surgical outcome did not associate with IAS. Patient-reported and video-recorded negative-but not positive-affective signs are related to each other. Video-recorded negative AAs occur more often in women and young patients.

Ictal 18F-FDG PET/MRI in a Patient With Cortical Heterotopia and Focal Epilepsy.

PubMed

Calabria, Ferdinando F; Cascini, Giuseppe Lucio; Gambardella, Antonio; Labate, Angelo; Cherubini, Andrea; Gullà, Domenico; Tafuri, Benedetta; Sabatini, Umberto; Vescio, Virginia; Quattrone, Aldo

2017-10-01

A 19-year-old man with epilepsy underwent ictal F-FDG PET/MRI, showing a 5 mm heterotopic nodule in the periventricular white matter, adjacent to the frontal horn of the left lateral ventricle (SUVmax, 5.5; glucidic cerebral metabolic rate, 0.317 μmol/mL). A repeated F-FDG PET/MRI, during seizure freedom, showed, at visual analysis, subtle decrease of the nodule metabolism. SUVmax and glucidic cerebral metabolic rate were clearly reduced to 3.7 and 0.226, respectively. Ictal F-FDG PET/MRI could be useful in epilepsy because of the added value of SUVmax and cerebral metabolic rate of glucose analysis to understand the relationship between heterotopy and epilepsy.

Neural network underlying ictal pouting ("chapeau de gendarme") in frontal lobe epilepsy.

PubMed

Souirti, Zouhayr; Landré, Elisabeth; Mellerio, Charles; Devaux, Bertrand; Chassoux, Francine

2014-08-01

In order to determine the anatomical neural network underlying ictal pouting (IP), with the mouth turned down like a "chapeau de gendarme", in frontal lobe epilepsy (FLE), we reviewed the video-EEG recordings of 36 patients with FLE who became seizure-free after surgery. We selected the cases presenting IP, defined as a symmetrical and sustained (>5s) lowering of labial commissures with contraction of chin, mimicking an expression of fear, disgust, or menace. Ictal pouting was identified in 11 patients (8 males; 16-48 years old). We analyzed the clinical semiology, imaging, and electrophysiological data associated with IP, including FDG-PET in 10 and SEEG in 9 cases. In 37 analyzed seizures (2-7/patient), IP was an early symptom, occurring during the first 10s in 9 cases. The main associated features consisted of fear, anguish, vegetative disturbances, behavioral disorders (sudden agitation, insults, and fighting), tonic posturing, and complex motor activities. The epileptogenic zone assessed by SEEG involved the mesial frontal areas, especially the anterior cingulate cortex (ACC) in 8 patients, whereas lateral frontal onset with an early spread to the ACC was seen in the other patient. Ictal pouting associated with emotional changes and hypermotor behavior had high localizing value for rostroventral "affective" ACC, whereas less intense facial expressions were related to the dorsal "cognitive" ACC. Fluorodeoxyglucose positron emission tomography demonstrated the involvement of both the ACC and lateral cortex including the anterior insula in all cases. We propose that IP is sustained by reciprocal mesial and lateral frontal interactions involved in emotional and cognitive processes, in which the ACC plays a pivotal role. Copyright © 2014 Elsevier Inc. All rights reserved.

Classification of ictal and seizure-free HRV signals with focus on lateralization of epilepsy.

PubMed

Behbahani, Soroor; Dabanloo, Nader Jafarnia; Nasrabadi, Ali Motie; Dourado, Antonio

2016-01-01

Epileptic onsets often affect the autonomic function of the body during a seizure, whether it is in ictal, interictal or post-ictal periods. The different effects of localization and lateralization of seizures on heart rate variability (HRV) emphasize the importance of autonomic function changes in epileptic patients. On the other hand, the detection of seizures is of primary interests in evaluating the epileptic patients. In the current paper, we analyzed the HRV signal to develop a reliable offline seizure-detection algorithm to focus on the effects of lateralization on HRV. We assessed the HRV during 5-min segments of continuous electrocardiogram (ECG) recording with a total number of 170 seizures occurred in 16 patients, composed of 86 left-sided and 84 right-sided focus seizures. Relatively high and low-frequency components of the HRV were computed using spectral analysis. Poincaré parameters of each heart rate time series considered as non-linear features. We fed these features to the Support Vector Machines (SVMs) to find a robust classification method to classify epileptic and non-epileptic signals. Leave One Out Cross-Validation (LOOCV) approach was used to demonstrate the consistency of the classification results. Our obtained classification accuracy confirms that the proposed scheme has a potential in classifying HRV signals to epileptic and non-epileptic classes. The accuracy rates for right-sided and left-sided focus seizures were obtained as 86.74% and 79.41%, respectively. The main finding of our study is that the patients with right-sided focus epilepsy showed more reduction in parasympathetic activity and more increase in sympathetic activity. It can be a marker of impaired vagal activity associated with increased cardiovascular risk and arrhythmias. Our results suggest that lateralization of the seizure onset zone could exert different influences on heart rate changes. A right-sided seizure would cause an ictal tachycardia whereas a left

Intrinsic connections within the pedunculopontine tegmental nucleus are critical to the elaboration of post-ictal antinociception.

PubMed

Mazzei-Silva, Elaine Cristina; de Oliveira, Rithiele Cristina; dos Anjos Garcia, Tayllon; Falconi-Sobrinho, Luiz Luciano; Almada, Rafael Carvalho; Coimbra, Norberto Cysne

2014-08-01

This study investigated the intrinsic connections of a key-structure of the endogenous pain inhibitory system, the pedunculopontine tegmental nucleus (PPTN), in post-ictal antinociceptive process through synaptic inactivation of the PPTN with cobalt chloride. Male Wistar rats (n = 6 or 7 per group), weighing 250-280 g, had the tail-flick baseline recorded and were submitted to a stereotaxic surgery for the introduction of a guide-cannula aiming at the PPTN. After 5 days of postoperative recovery, cobalt chloride (1 mM/0.2 µL) or physiological saline (0.2 µL) were microinjected into the PPTN and after 5 min, the tail-withdrawal latency was measured again at 0, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, 110, and 120 min after seizures evoked by intraperitoneal injection of pentylenetetrazole (64 mg/kg). The synaptic inactivation of PPTN decreased the post-ictal antinociceptive phenomenon, suggesting the involvement of PPTN intrinsic connections in the modulation of pain, during tonic-clonic seizures. These results showed that the PPTN may be crucially involved in the neural network that organizes the post-ictal analgesia. © 2014 Wiley Periodicals, Inc.

The promise of subtraction ictal SPECT co-registered to MRI for improved seizure localization in pediatric epilepsies: Affecting factors and relationship to the surgical outcome

PubMed Central

Stamoulis, Catherine; Verma, Nishant; Kaulas, Himanshu; Halford, Jonathan J.; Duffy, Frank H.; Pearl, Phillip L.; Treves, S. Ted

2016-01-01

Objective Ictal SPECT is promising for accurate non-invasive localization of the epileptogenic brain tissue in focal epilepsies. However, high quality ictal scans require meticulous attention to the seizure onset. In a relatively large cohort of pediatric patients, this study investigated the impact of the timing of radiotracer injection, MRI findings and seizure characteristics on ictal SPECT localizations, and the relationship between concordance of ictal SPECT, scalp EEG and resected area with seizure freedom following epilepsy surgery. Methods Scalp EEG and ictal SPECT studies from 95 patients (48 males and 47 females, median age = 11 years, (25th, 75th) quartiles = (6.0, 14.75) years) with pharmacoresistant focal epilepsy and no prior epilepsy surgery were reviewed. The ictal SPECT result was examined as a function of the radiotracer injection delay, seizure duration, epilepsy etiology, cerebral lobe of seizure onset identified by EEG and MRI findings. Thirty two patients who later underwent epilepsy surgery had postoperative seizure freedom data at <1, 6 and 12 months. Results Sixty patients (63.2%) had positive SPECT localizations - 51 with a hyperperfused region that was concordant with the cerebral lobe of seizure origin identified by EEG and 9 with discordant localizations. Of these, 35 patients (58.3%) had temporal and 25 (41.7%) had extratemporal seizures. The ictal SPECT result was significantly correlated with the injection delay (p<0.01) and cerebral lobe of seizure onset (specifically frontal versus temporal; p = 0.02) but not MRI findings (p = 0.33), epilepsy etiology (p ≥ 0.27) or seizure duration (p = 0.20). Concordance of SPECT, scalp EEG and resected area was significantly correlated with seizure freedom at 6 months after surgery (p=0.04). Significance Ictal SPECT holds promise as a powerful source imaging tool for presurgical planning in pediatric epilepsies. To optimize the SPECT result the radiotracer injection delay should be minimized to

The promise of subtraction ictal SPECT co-registered to MRI for improved seizure localization in pediatric epilepsies: Affecting factors and relationship to the surgical outcome.

PubMed

Stamoulis, Catherine; Verma, Nishant; Kaulas, Himanshu; Halford, Jonathan J; Duffy, Frank H; Pearl, Phillip L; Treves, S Ted

2017-01-01

Ictal SPECT is promising for accurate non-invasive localization of the epileptogenic brain tissue in focal epilepsies. However, high quality ictal scans require meticulous attention to the seizure onset. In a relatively large cohort of pediatric patients, this study investigated the impact of the timing of radiotracer injection, MRI findings and seizure characteristics on ictal SPECT localizations, and the relationship between concordance of ictal SPECT, scalp EEG and resected area with seizure freedom following epilepsy surgery. Scalp EEG and ictal SPECT studies from 95 patients (48 males and 47 females, median age=11years, (25th, 75th) quartiles=(6.0, 14.75) years) with pharmacoresistant focal epilepsy and no prior epilepsy surgery were reviewed. The ictal SPECT result was examined as a function of the radiotracer injection delay, seizure duration, epilepsy etiology, cerebral lobe of seizure onset identified by EEG and MRI findings. Thirty two patients who later underwent epilepsy surgery had postoperative seizure freedom data at <1, 6 and 12 months. Sixty patients (63.2%) had positive SPECT localizations - 51 with a hyperperfused region that was concordant with the cerebral lobe of seizure origin identified by EEG and 9 with discordant localizations. Of these, 35 patients (58.3%) had temporal and 25 (41.7%) had extratemporal seizures. The ictal SPECT result was significantly correlated with the injection delay (p<0.01) and cerebral lobe of seizure onset (specifically frontal versus temporal; p=0.02) but not MRI findings (p=0.33), epilepsy etiology (p≥0.27) or seizure duration (p=0.20). Concordance of SPECT, scalp EEG and resected area was significantly correlated with seizure freedom at 6 months after surgery (p=0.04). Ictal SPECT holds promise as a powerful source imaging tool for presurgical planning in pediatric epilepsies. To optimize the SPECT result the radiotracer injection delay should be minimized to≤25s, although the origin of seizure onset

Trigemino-cardiac reflex: occurrence of asystole during trans-sphenoidal adenomectomy: a case report.

PubMed

Jeon, Dae Geun; Kang, Bong Jin; Hur, Tae Won

2014-09-01

The trigemino-cardiac reflex has been reported to occur during various craniofacial surgeries or procedures including manipulation of the trigeminal ganglion, tumor resection in the cerebellopontine angle, various facial reconstructions and trans-sphenoidal adenomectomy. Regarding risk factors during trans-sphenoidal adenomectomy, invasiveness closely related to the size of tumor and the degree of manipulation of cavernous sinus wall have been reported. We report the case of a 40-year-old female patient who had a relatively small-sized (< 10 mm) pituitary adenoma. Repetitive asystoles occurred during microscopic trans-sphenoidal operation of the wall of the cavernous sinus, which strongly suggests the importance of careful manipulation of the cavernous sinus wall. In addition to reporting this rare complication of trans-sphenoidal adenomectomy, we reviewed its clinical management by performing a literature search.

Carotid Space Mass Proximal to Vagus Nerve Causing Asystole and Syncope.

PubMed

Leviter, Julie; Wiznia, Daniel H

2016-01-01

Manipulation of vagal nerve rootlets, whether surgical or through mass effect of a neoplasm, can result in asystole and hypotension, accompanied by ST depression and right bundle branch block. There are few case reports of a neoplasm causing these effects, and this case describes a patient with such a mass presenting with syncopal episodes. A 43-year-old man with a past medical history of HIV, bipolar disorder, and epilepsy was admitted to the neurology service for a video electroencephalogram (vEEG) to characterize syncopal episodes that were felt to be epileptic in origin. During the study, he experienced symptoms of his typical aura, which correlated with a transient symptomatic high degree AV block on telemetry, and an absence of epileptic findings on vEEG. Magnetic Resonance Imaging (MRI) of the brain showed a mass in the left posterior carotid space at the skull base. The patient underwent permanent dual chamber MRI-compatible pacemaker placement for his heart block. His syncopal episodes resolved, but presyncopal symptoms persisted. We discuss the presentation and treatment of vagal neoplasms.

Nursing benefits of using an automated injection system for ictal brain single photon emission computed tomography.

PubMed

Vonhofen, Geraldine; Evangelista, Tonya; Lordeon, Patricia

2012-04-01

The traditional method of administering radioactive isotopes to pediatric patients undergoing ictal brain single photon emission computed tomography testing has been by manual injections. This method presents certain challenges for nursing, including time requirements and safety risks. This quality improvement project discusses the implementation of an automated injection system for isotope administration and its impact on staffing, safety, and nursing satisfaction. It was conducted in an epilepsy monitoring unit at a large urban pediatric facility. Results of this project showed a decrease in the number of nurses exposed to radiation and improved nursing satisfaction with the use of the automated injection system. In addition, there was a decrease in the number of nursing hours required during ictal brain single photon emission computed tomography testing.

A self-adapting system for the automated detection of inter-ictal epileptiform discharges.

PubMed

Lodder, Shaun S; van Putten, Michel J A M

2014-01-01

Scalp EEG remains the standard clinical procedure for the diagnosis of epilepsy. Manual detection of inter-ictal epileptiform discharges (IEDs) is slow and cumbersome, and few automated methods are used to assist in practice. This is mostly due to low sensitivities, high false positive rates, or a lack of trust in the automated method. In this study we aim to find a solution that will make computer assisted detection more efficient than conventional methods, while preserving the detection certainty of a manual search. Our solution consists of two phases. First, a detection phase finds all events similar to epileptiform activity by using a large database of template waveforms. Individual template detections are combined to form "IED nominations", each with a corresponding certainty value based on the reliability of their contributing templates. The second phase uses the ten nominations with highest certainty and presents them to the reviewer one by one for confirmation. Confirmations are used to update certainty values of the remaining nominations, and another iteration is performed where ten nominations with the highest certainty are presented. This continues until the reviewer is satisfied with what has been seen. Reviewer feedback is also used to update template accuracies globally and improve future detections. Using the described method and fifteen evaluation EEGs (241 IEDs), one third of all inter-ictal events were shown after one iteration, half after two iterations, and 74%, 90%, and 95% after 5, 10 and 15 iterations respectively. Reviewing fifteen iterations for the 20-30 min recordings 1 took approximately 5 min. The proposed method shows a practical approach for combining automated detection with visual searching for inter-ictal epileptiform activity. Further evaluation is needed to verify its clinical feasibility and measure the added value it presents.

A Self-Adapting System for the Automated Detection of Inter-Ictal Epileptiform Discharges

PubMed Central

Lodder, Shaun S.; van Putten, Michel J. A. M.

2014-01-01

Purpose Scalp EEG remains the standard clinical procedure for the diagnosis of epilepsy. Manual detection of inter-ictal epileptiform discharges (IEDs) is slow and cumbersome, and few automated methods are used to assist in practice. This is mostly due to low sensitivities, high false positive rates, or a lack of trust in the automated method. In this study we aim to find a solution that will make computer assisted detection more efficient than conventional methods, while preserving the detection certainty of a manual search. Methods Our solution consists of two phases. First, a detection phase finds all events similar to epileptiform activity by using a large database of template waveforms. Individual template detections are combined to form “IED nominations”, each with a corresponding certainty value based on the reliability of their contributing templates. The second phase uses the ten nominations with highest certainty and presents them to the reviewer one by one for confirmation. Confirmations are used to update certainty values of the remaining nominations, and another iteration is performed where ten nominations with the highest certainty are presented. This continues until the reviewer is satisfied with what has been seen. Reviewer feedback is also used to update template accuracies globally and improve future detections. Key Findings Using the described method and fifteen evaluation EEGs (241 IEDs), one third of all inter-ictal events were shown after one iteration, half after two iterations, and 74%, 90%, and 95% after 5, 10 and 15 iterations respectively. Reviewing fifteen iterations for the 20–30 min recordings 1took approximately 5 min. Significance The proposed method shows a practical approach for combining automated detection with visual searching for inter-ictal epileptiform activity. Further evaluation is needed to verify its clinical feasibility and measure the added value it presents. PMID:24454813

Measurement of the efficacy of 2% lipid in reversing bupivacaine- induced asystole in isolated rat hearts

PubMed Central

2014-01-01

Background The reversal efficacy of 2% lipid emulsion in cardiac asystole induced by different concentrations of bupivacaine is poorly defined and needs to be determined. Methods Forty-two male Sprague–Dawley rats were randomly divided into seven groups: B40, B60, B80, B100, B120, B140 and B160, n = 6. The Langendorff isolated heart perfusion model was used, which consisted of a balanced perfusion with Krebs-Henseleit solution for 25 minutes and a continuous infusion of 100 μmol/L bupivacaine until asystole had been induced for 3 minutes. The hearts in the seven groups were perfused with Krebs-Henseleit solution containing a 2% lipid emulsion, and 40, 60, 80, 100, 120, 140 or 160 μmol/L bupivacaine, respectively. Cardiac recovery was defined as a spontaneous and regular rhythm with a rate-pressure product > 10% of the baseline value for more than 1 minute. Our primary outcome was the rate-pressure product 25 minutes after cardiac recovery. Other cardiac function parameters were also recorded. Results All groups demonstrated cardiac recovery. During the recovery phase, heart rate, rate-pressure product, the maximum left ventricular pressure rise and decline in heart rate in the B120-B160 groups was significantly lower than those in the B40-B80 groups (P < 0.05). The concentration of bupivacaine and the reversal effects of a 2% lipid emulsion showed a typical transoid S-shaped curve, R2 = 0.9983, IC50 value was 102.5 μmol/L (95% CI: 92.44 - 113.6). Conclusions There is a concentration-response relationship between the concentrations of bupivacaine and the reversal effects of 2% lipid emulsion. PMID:25089118

Long term prognosis of symptomatic occipital lobe epilepsy secondary to neonatal hypoglycemia.

PubMed

Montassir, Hesham; Maegaki, Yoshihiro; Ohno, Kousaku; Ogura, Kaeko

2010-02-01

To report on long-term clinical course in patients with symptomatic occipital lobe epilepsy secondary to neonatal hypoglycemia. Six patients with neonatal hypoglycemia and symptomatic occipital lobe epilepsy were studied in our hospital through reviewing their medical records retrospectively. The median onset age of epilepsy was 2 years 8 months and median follow-up period was 12 years and 4 months. Initial seizure types were generalized convulsions in 4 patients, hemiconvulsion in 1, and infantile spasms in 1. Ictal manifestations of main seizures were identical to occipital lobe seizures, such as eye deviation, eye blinking, ictal vomiting, and visual hallucination. Seizure frequency was maximum during infancy and early childhood and decreased thereafter with no seizure in 2 patients, a few seizures a year in 3, and once a month in 1. All patients had status epilepticus in the early course of epilepsy. EEGs showed parieto-occipital spikes in all patients. MRI revealed cortical atrophy and T2 prolongation parieto-occipitally in 4 patients, hippocampal atrophy in 1, and unremarkable in 1. This study indicates that epilepsy secondary to neonatal hypoglycemia is intractable during infancy and early childhood with frequent status epilepticus but tends to decrease in older age.

Prolonged bradycardia, asystole and outcome of high spinal cord injury patients: Risk factors and management

PubMed Central

Shaikh, Nissar; Rhaman, M. A.; Raza, Ali; Shabana, Adel; Malstrom, Mahommad Faisal; Al-Sulaiti, Ghanem

2016-01-01

Background: High spinal cord injury (HSCI) is one of the devastating traumatic injuries. 80% of these patients are young male, and 93% will have major neurological disabilities. There is a paucity of literature about prolonged bradycardia in HSCI patients. The aim of this study was to know the prevalence, risk factors, precipitating factors for prolonged bradycardia in the HSCI patients. Materials and Methods: All patients who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital, with spinal cord injury above level of dorsal (D4) were enrolled in this study prospectively. Patient's demographic data, mechanism, level and type of spinal injury, associated injuries, injury severity score (ISS), spinal shock, vasopressors used, time of occurrence of bradycardia, treatment for bradycardia, precipitating as well as risk factors and outcome were recorded. Results: During the study period, a total of 138 patients were admitted to the ICU with HSCI. Majority of patients were male. The most frequently associated injury in these patients was skeletal fractures (38.4%). Most common complication was pneumonia 56 (41%). Forty-five (33%) of the total patients had prolonged bradycardia; 87% of these patients had pneumonia when bradycardia occurred. 53.4% had cardiac asystole. 29 (21%) patients had bradycardia at the time of endotracheal suctioning, whereas 27 (20%) patients developed bradycardia at the time of positioning. Majority of the patients were managed conservatively. Those HSCI patients who developed prolonged bradycardia, their ISS score was statistically higher, ICU and hospital stay was significantly higher compared with those HSCI patient who did not have prolonged bradycardia. Multivariate analysis revealed that hypotension on admission; pneumonia, and tracheostomy were risk factors for the development of prolonged bradycardia in HSCI patients. Conclusion: Prolonged bradycardia was associated with significantly higher incidence of asystole

Nicotinic and muscarinic cholinergic receptors are recruited by acetylcholine-mediated neurotransmission within the locus coeruleus during the organisation of post-ictal antinociception.

PubMed

de Oliveira, Rithiele Cristina; de Oliveira, Ricardo; Biagioni, Audrey Franceschi; Falconi-Sobrinho, Luiz Luciano; Dos Anjos-Garcia, Tayllon; Coimbra, Norberto Cysne

2016-10-01

Post-ictal antinociception is characterised by an increase in the nociceptive threshold that accompanies tonic and tonic-clonic seizures (TCS). The locus coeruleus (LC) receives profuse cholinergic inputs from the pedunculopontine tegmental nucleus. Different concentrations (1μg, 3μg and 5μg/0.2μL) of the muscarinic cholinergic receptor antagonist atropine and the nicotinic cholinergic receptor antagonist mecamylamine were microinjected into the LC of Wistar rats to investigate the role of cholinergic mechanisms in the severity of TCS and the post-ictal antinociceptive response. Five minutes later, TCS were induced by systemic administration of pentylenetetrazole (PTZ) (64mg/kg). Seizures were recorded inside the open field apparatus for an average of 10min. Immediately after seizures, the nociceptive threshold was recorded for 130min using the tail-flick test. Pre-treatment of the LC with 1μg, 3μg and 5μg/0.2μL concentrations of both atropine and mecamylamine did not cause a significant effect on seizure severity. However, the same treatments decreased the post-ictal antinociceptive phenomenon. In addition, mecamylamine caused an earlier decrease in the post-ictal antinociception compared to atropine. These results suggest that muscarinic and mainly nicotinic cholinergic receptors of the LC are recruited to organise tonic-clonic seizure-induced antinociception. Copyright © 2016 Elsevier Inc. All rights reserved.

Involvement of 5-HT(2) serotonergic receptors of the nucleus raphe magnus and nucleus reticularis gigantocellularis/paragigantocellularis complex neural networks in the antinociceptive phenomenon that follows the post-ictal immobility syndrome.

PubMed

de Oliveira, Rithiele Cristina; de Oliveira, Ricardo; Ferreira, Célio Marcos Dos Reis; Coimbra, Norberto Cysne

2006-09-01

The post-ictal immobility syndrome is followed by a significant increase in the nociceptive thresholds in animals and men. In this interesting post-ictal behavioral response, endogenous opioid peptides-mediated mechanisms, as well as cholinergic-mediated antinociceptive processes, have been suggested. However, considering that many serotonergic descending pathways have been implicated in antinociceptive reactions, the aim of the present work is to investigate the involvement of 5-HT(2)-serotonergic receptor subfamily in the post-ictal antinociception. The analgesia was measured by the tail-flick test in seven or eight Wistar rats per group. Convulsions were followed by statistically significant increase in the tail-flick latencies (TFL), at least for 120 min of the post-ictal period. Male Wistar rats were submitted to stereotaxic surgery for introduction of a guide-cannula in the rhombencephalon, aiming either the nucleus raphe magnus (NRM) or the gigantocellularis complex. In independent groups of animals, these nuclei were neurochemically lesioned with a unilateral microinjection of ibotenic acid (1.0 microg/0.2 microL). The neuronal damage of either the NRM or nucleus reticularis gigantocellularis/paragigantocellularis complex decreased the post-ictal analgesia. Also, in other independent groups, central administration of ritanserin (5.0 microg/0.2 microL) or physiological saline into each of the reticular formation nuclei studied caused a statistically significant decrease in the TFL of seizing animals, as compared to controls, in all post-ictal periods studied. These results indicate that serotonin input-connected neurons of the pontine and medullarly reticular nuclei may be involved in the post-ictal analgesia.

Two magneto-encephalographic epileptic foci did not coincide with the electrocorticographic ictal onset zone in a patient with temporal lobe epilepsy.

PubMed

Hisada, K; Morioka, T; Nishio, S; Yamamoto, T; Fukui, M

2001-12-01

To evaluate the usefulness and limitations of magneto-encephalography (MEG) for epilepsy surgery, we compared 'interictal' epileptic spike fields on MEG with ictal electrocorticography (ECoG) using invasive chronic subdural electrodes in a patient with intractable medial temporal lobe epilepsy (MTLE) associated with vitamin K deficiency intracerebral hemorrhage. A 19-year-old male with an 8-year history of refractory complex partial seizures, secondarily generalized, and right hemispheric atrophy and porencephaly in the right frontal lobe on MRI, was studied with MEG to define the interictal paroxysmal sources based on the single-dipole model. This was followed by invasive ECoG monitoring to delineate the epileptogenic zone. MEG demonstrated two paroxysmal foci, one each on the right lateral temporal and frontal lobes. Ictal ECoG recordings revealed an ictal onset zone on the right medial temporal lobe, which was different from that defined by MEG. Anterior temporal lobectomy with hippocampectomy was performed and the patient has been seizure free for two years. Our results indicate that interictal MEG does not always define the epileptogenic zone in patients with MTLE.

Ictal time-irreversible intracranial EEG signals as markers of the epileptogenic zone.

PubMed

Schindler, Kaspar; Rummel, Christian; Andrzejak, Ralph G; Goodfellow, Marc; Zubler, Frédéric; Abela, Eugenio; Wiest, Roland; Pollo, Claudio; Steimer, Andreas; Gast, Heidemarie

2016-09-01

To show that time-irreversible EEG signals recorded with intracranial electrodes during seizures can serve as markers of the epileptogenic zone. We use the recently developed method of mapping time series into directed horizontal graphs (dHVG). Each node of the dHVG represents a time point in the original intracranial EEG (iEEG) signal. Statistically significant differences between the distributions of the nodes' number of input and output connections are used to detect time-irreversible iEEG signals. In 31 of 32 seizure recordings we found time-irreversible iEEG signals. The maximally time-irreversible signals always occurred during seizures, with highest probability in the middle of the first seizure half. These signals spanned a large range of frequencies and amplitudes but were all characterized by saw-tooth like shaped components. Brain regions removed from patients who became post-surgically seizure-free generated significantly larger time-irreversibilities than regions removed from patients who still had seizures after surgery. Our results corroborate that ictal time-irreversible iEEG signals can indeed serve as markers of the epileptogenic zone and can be efficiently detected and quantified in a time-resolved manner by dHVG based methods. Ictal time-irreversible EEG signals can help to improve pre-surgical evaluation in patients suffering from pharmaco-resistant epilepsies. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Orgasm-induced seizures: male studied with ictal electroencephalography.

PubMed

Sengupta, Anshuman; Mahmoud, Ali; Tun, Shwe Z; Goulding, Peter

2010-06-01

Reflex seizures can occur in response to a variety of stimuli, both sensory and emotional. Common triggers include light and music; however, in a growing number of case reports, the phenomenon of sexual activity triggering epileptic seizures is described. The majority of these case reports have been in women so far, and most have been found to localise to the right cerebral hemisphere on interictal electroencephalography (EEG). We report the case of a 34-year-old male with orgasm-induced seizures, recorded on ictal EEG. This gentleman's electrophysiology localised his seizure focus to the left cerebral hemisphere, making his case atypical in comparison with the majority of previous reports. Orgasm-induced seizures are an increasingly well-described phenomenon and we suggest that this should be taken into account when assessing patients with possible reflex seizures. Copyright 2010 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Swift onset of central nervous system depression and asystole followingan overdose of Guaifenesin.

PubMed

Okic, Merisa; Johnson, Tom; Crifasi, Joseph A; Long, Christopher; Mitchell, Erik K

2013-06-01

Guaifenesin is an over-the-counter expectorant used for chest congestion and is available both in single-ingredient formulations and in combination with antihistamines, cough suppressants and decongestants. The documented side-effects of guaifenesin are generally mild. We present the case of a 23-year-old female who committed suicide by ingestion of guaifenesin along with small amounts of cetirizine, ethanol and sertraline. Approximately 2 h after ingestion, the patient experienced central nervous system depression followed by asystole. No anatomic cause of death could be determined at autopsy. The initial toxicology detected only ethanol, which was found at a concentration insufficient to cause death. Upon further analysis, guaifenesin was detected in femoral blood at 25.0 μg/mL, urine at >50.0 μg/mL, vitreous fluid at 9.2 μg/mL, brain at 17.0 μg/g and liver at 25.0 μg/g. This is the first reported human case that can be considered a death to which guaifenesin was the significant pharmacologic contributor. Guaifenesin is not detected by the primary screening methods employed by some labs and may be missed in toxicological analyses of overdoses unless specifically suspected.

[Ictal Speech Manifesting as Sleep Talking: A Case Report].

PubMed

Suzuki, Takehiro; Kakisaka, Yosuke; Kitazawa, Yu; Jin, Kazutaka; Sato, Shiho; Iwasaki, Masaki; Fujikawa, Mayu; Nishio, Yoshiyuki; Kanno, Akitake; Nakasato, Nobukazu

2017-02-01

We present a 28-year-old female patient whose epilepsy started at the age of 19. MRI showed right perisylvian polymicrogyria. She exhibited various seizure symptoms, such as somatosensory aura involving the left leg, dyscognitive seizures, and amnesic seizures. Her mother indicated that the patient sometimes had "sleep talking", which was associated with presence of epileptic seizures of the next day. Long-term video electroencephalography (EEG) revealed that her episodes of "sleep talking" were epileptic events, specifically ictal speech, originating in the right hemisphere. The present case demonstrates the importance of considering "sleep talk" as an epileptic symptom. Careful history taking is fundamental to carry patients with possibly pathological "sleep talk" to the long-term video EEG, which will contribute correct diagnosis and treatment. (Received August 16, 2016; Accepted September 9, 2016; Published February 1, 2017).

Ictal visual hallucinations due to frontal lobe epilepsy in a patient with bipolar disorder☆

PubMed Central

Manfioli, Valeria; Saladini, Marina; Cagnin, Annachiara

2013-01-01

In ictal psychosis with complex visual hallucinations (VHs), widespread functional changes of cortical networks have been suggested. We describe the clinical and EEG findings of a patient with bipolar disorder who manifested complex VHs associated with intense emotional symptoms caused by frontal epileptic seizures. This description highlights the challenges of diagnosing the epileptic nature of new psychotic phenomena in patients with previous psychiatric disorders and shines light into the role of the frontal cortex in the genesis of complex VHs. PMID:25667849

Ictal alterations of consciousness during ecstatic seizures.

PubMed

Picard, Fabienne; Kurth, Florian

2014-01-01

Patients with ecstatic epileptic seizures report an altered consciousness, which they describe as a sense of heightened perception of themselves – they “feel very present” – and an increased vividness of sensory perceptions. Recently, the anterior insula has been proposed as the region where these seizures originate, based on the results of ictal nuclear imaging in three patients, the first induction of ecstatic auras by electrical stimulation, and the functional characteristics of the anterior insula in neuroimaging literature. Specifically, the anterior insula is thought to play a key role in integrating information from within the body, the external world, as well as the emotional states. In addition, the anterior insula is thought to convert this integrated information into successive global emotional moments, thus enabling both the construct of a sentient self as well as a mechanism for predictive coding. As part of the salience network, this region is also involved in switching from mind wandering toward attentional and executive processing. In this review, we will summarize previous patient reports and recap how insular functioning may be involved in the phenomenon of ecstatic seizures. Furthermore, we will relate these hypotheses to the results from research on meditation and effects of drug abuse.

Dynamic Neurovascular Coupling and Uncoupling during Ictal Onset, Propagation, and Termination Revealed by Simultaneous In Vivo Optical Imaging of Neural Activity and Local Blood Volume

PubMed Central

Zhao, Mingrui; Schwartz, Theodore H.

2013-01-01

Traditional models of ictal propagation involve the concept of an initiation site and a progressive outward march of activation. The process of neurovascular coupling, whereby the brain supplies oxygenated blood to metabolically active neurons presumably results in a similar outward cascade of hyperemia. However, ictal neurovascular coupling has never been assessed in vivo using simultaneous measurements of membrane potential change and hyperemia with wide spatial sampling. In an acute rat ictal model, using simultaneous intrinsic optical signal (IOS) and voltage-sensitive dye (VSD) imaging of cerebral blood volume and membrane potential changes, we demonstrate that seizures consist of multiple dynamic multidirectional waves of membrane potential change with variable onset sites that spread through a widespread network. Local blood volume evolves on a much slower spatiotemporal scale. At seizure onset, the VSD waves extend beyond the IOS signal. During evolution, spatial correlation with hemodynamic signal only exists briefly at the maximal spread of the VSD signal. At termination, the IOS signal extends spatially and temporally beyond the VSD waves. Hence, vascular reactivity evolves in a separate but parallel fashion to membrane potential changes resulting in a mechanism of neurovascular coupling and uncoupling, which is as dynamic as the seizure itself. PMID:22499798

Inhibition of adenosine metabolism induces changes in post-ictal depression, respiration, and mortality in genetically epilepsy prone rats.

PubMed

Kommajosyula, Srinivasa P; Randall, Marcus E; Faingold, Carl L

2016-01-01

A major cause of mortality in epilepsy patients is sudden unexpected death in epilepsy (SUDEP). Post-ictal respiratory dysfunction following generalized convulsive seizures is most commonly observed in witnessed cases of human SUDEP. DBA mouse models of SUDEP are induced by audiogenic seizures (AGSz) and show high incidences of seizure-induced death due to respiratory depression. The relatively low incidence of human SUDEP suggests that it may be useful to examine seizure-associated death in an AGSz model that rarely exhibits sudden death, such as genetically epilepsy-prone rats (GEPR-9s). Adenosine is released extensively during seizures and depresses respiration, which may contribute to seizure-induced death. The present study examined the effects of inhibiting adenosine metabolism on the durations of post-ictal depression (PID) and respiratory distress (RD), changes in blood oxygen saturation (% SpO2), and the incidence of post-seizure mortality in GEPR-9s. Systemic administration of adenosine metabolism inhibitors, erythro-9-(2-hydroxy-3-nonyl) adenine (EHNA, 30 mg/kg) with 5-Iodotubericidin (5-ITU, 3mg/kg) in GEPR-9s resulted in significant changes in the duration of AGSz-induced PID as compared to vehicle in both genders. These agents also significantly increased the duration of post-seizure RD and significantly decreased the mean% SpO2 after AGSz, as compared to vehicle but only in females. Subsequently, we observed that the incidences of death in both genders 12-48 h post-seizure were significantly greater in drug vs. vehicle treatment. The incidence of death in females was also significantly higher than in males, which is consistent with the elevated seizure sensitivity of female GEPR-9s developmentally. These results support a potentially important role of elevated adenosine levels following generalized seizures in the increased incidence of death in GEPR-9s induced by adenosine metabolism inhibitors. These findings may also be relevant to human SUDEP, in

Multivariate regression methods for estimating velocity of ictal discharges from human microelectrode recordings

NASA Astrophysics Data System (ADS)

Liou, Jyun-you; Smith, Elliot H.; Bateman, Lisa M.; McKhann, Guy M., II; Goodman, Robert R.; Greger, Bradley; Davis, Tyler S.; Kellis, Spencer S.; House, Paul A.; Schevon, Catherine A.

2017-08-01

Objective. Epileptiform discharges, an electrophysiological hallmark of seizures, can propagate across cortical tissue in a manner similar to traveling waves. Recent work has focused attention on the origination and propagation patterns of these discharges, yielding important clues to their source location and mechanism of travel. However, systematic studies of methods for measuring propagation are lacking. Approach. We analyzed epileptiform discharges in microelectrode array recordings of human seizures. The array records multiunit activity and local field potentials at 400 micron spatial resolution, from a small cortical site free of obstructions. We evaluated several computationally efficient statistical methods for calculating traveling wave velocity, benchmarking them to analyses of associated neuronal burst firing. Main results. Over 90% of discharges met statistical criteria for propagation across the sampled cortical territory. Detection rate, direction and speed estimates derived from a multiunit estimator were compared to four field potential-based estimators: negative peak, maximum descent, high gamma power, and cross-correlation. Interestingly, the methods that were computationally simplest and most efficient (negative peak and maximal descent) offer non-inferior results in predicting neuronal traveling wave velocities compared to the other two, more complex methods. Moreover, the negative peak and maximal descent methods proved to be more robust against reduced spatial sampling challenges. Using least absolute deviation in place of least squares error minimized the impact of outliers, and reduced the discrepancies between local field potential-based and multiunit estimators. Significance. Our findings suggest that ictal epileptiform discharges typically take the form of exceptionally strong, rapidly traveling waves, with propagation detectable across millimeter distances. The sequential activation of neurons in space can be inferred from clinically

Ictal SPECT in patients with rapid eye movement sleep behaviour disorder.

PubMed

Mayer, Geert; Bitterlich, Marion; Kuwert, Torsten; Ritt, Philipp; Stefan, Hermann

2015-05-01

Rapid eye movement sleep behaviour disorder is a rapid eye movement parasomnia clinically characterized by acting out dreams due to disinhibition of muscle tone in rapid eye movement sleep. Up to 80-90% of the patients with rapid eye movement sleep behaviour disorder develop neurodegenerative disorders within 10-15 years after symptom onset. The disorder is reported in 45-60% of all narcoleptic patients. Whether rapid eye movement sleep behaviour disorder is also a predictor for neurodegeneration in narcolepsy is not known. Although the pathophysiology causing the disinhibition of muscle tone in rapid eye movement sleep behaviour disorder has been studied extensively in animals, little is known about the mechanisms in humans. Most of the human data are from imaging or post-mortem studies. Recent studies show altered functional connectivity between substantia nigra and striatum in patients with rapid eye movement sleep behaviour disorder. We were interested to study which regions are activated in rapid eye movement sleep behaviour disorder during actual episodes by performing ictal single photon emission tomography. We studied one patient with idiopathic rapid eye movement sleep behaviour disorder, one with Parkinson's disease and rapid eye movement sleep behaviour disorder, and two patients with narcolepsy and rapid eye movement sleep behaviour disorder. All patients underwent extended video polysomnography. The tracer was injected after at least 10 s of consecutive rapid eye movement sleep and 10 s of disinhibited muscle tone accompanied by movements registered by an experienced sleep technician. Ictal single photon emission tomography displayed the same activation in the bilateral premotor areas, the interhemispheric cleft, the periaqueductal area, the dorsal and ventral pons and the anterior lobe of the cerebellum in all patients. Our study shows that in patients with Parkinson's disease and rapid eye movement sleep behaviour disorder-in contrast to wakefulness

On the optimal z-score threshold for SISCOM analysis to localize the ictal onset zone.

PubMed

De Coster, Liesbeth; Van Laere, Koen; Cleeren, Evy; Baete, Kristof; Dupont, Patrick; Van Paesschen, Wim; Goffin, Karolien E

2018-04-17

In epilepsy patients, SISCOM or subtraction ictal single photon emission computed tomography co-registered to magnetic resonance imaging has become a routinely used, non-invasive technique to localize the ictal onset zone (IOZ). Thresholding of clusters with a predefined number of standard deviations from normality (z-score) is generally accepted to localize the IOZ. In this study, we aimed to assess the robustness of this parameter in a group of patients with well-characterized drug-resistant epilepsy in whom the exact location of the IOZ was known after successful epilepsy surgery. Eighty patients underwent preoperative SISCOM and were seizure free in a postoperative period of minimum 1 year. SISCOMs with z-threshold 2 and 1.5 were analyzed by two experienced readers separately, blinded from the clinical ground truth data. Their reported location of the IOZ was compared with the operative resection zone. Furthermore, confidence scores of the SISCOM IOZ were compared for the two thresholds. Visual reporting with a z-score threshold of 1.5 and 2 showed no statistically significant difference in localizing correspondence with the ground truth (70 vs. 72% respectively, p = 0.17). Interrater agreement was moderate (κ = 0.65) at the threshold of 1.5, but high (κ = 0.84) at a threshold of 2, where also reviewers were significantly more confident (p < 0.01). SISCOM is a clinically useful, routinely used modality in the preoperative work-up in many epilepsy surgery centers. We found no significant differences in localizing value of the IOZ using a threshold of 1.5 or 2, but interrater agreement and reader confidence were higher using a z-score threshold of 2.

A testbed to explore the optimal electrical stimulation parameters for suppressing inter-ictal spikes in human hippocampal slices.

PubMed

Min-Chi Hsiao; Pen-Ning Yu; Dong Song; Liu, Charles Y; Heck, Christi N; Millett, David; Berger, Theodore W

2014-01-01

New interventions using neuromodulatory devices such as vagus nerve stimulation, deep brain stimulation and responsive neurostimulation are available or under study for the treatment of refractory epilepsy. Since the actual mechanisms of the onset and termination of the seizure are still unclear, most researchers or clinicians determine the optimal stimulation parameters through trial-and-error procedures. It is necessary to further explore what types of electrical stimulation parameters (these may include stimulation frequency, amplitude, duration, interval pattern, and location) constitute a set of optimal stimulation paradigms to suppress seizures. In a previous study, we developed an in vitro epilepsy model using hippocampal slices from patients suffering from mesial temporal lobe epilepsy. Using a planar multi-electrode array system, inter-ictal activity from human hippocampal slices was consistently recorded. In this study, we have further transferred this in vitro seizure model to a testbed for exploring the possible neurostimulation paradigms to inhibit inter-ictal spikes. The methodology used to collect the electrophysiological data, the approach to apply different electrical stimulation parameters to the slices are provided in this paper. The results show that this experimental testbed will provide a platform for testing the optimal stimulation parameters of seizure cessation. We expect this testbed will expedite the process for identifying the most effective parameters, and may ultimately be used to guide programming of new stimulating paradigms for neuromodulatory devices.

Ear-EEG detects ictal and interictal abnormalities in focal and generalized epilepsy - A comparison with scalp EEG monitoring.

PubMed

Zibrandtsen, I C; Kidmose, P; Christensen, C B; Kjaer, T W

2017-12-01

Ear-EEG is recording of electroencephalography from a small device in the ear. This is the first study to compare ictal and interictal abnormalities recorded with ear-EEG and simultaneous scalp-EEG in an epilepsy monitoring unit. We recorded and compared simultaneous ear-EEG and scalp-EEG from 15 patients with suspected temporal lobe epilepsy. EEGs were compared visually by independent neurophysiologists. Correlation and time-frequency analysis was used to quantify the similarity between ear and scalp electrodes. Spike-averages were used to assess similarity of interictal spikes. There were no differences in sensitivity or specificity for seizure detection. Mean correlation coefficient between ear-EEG and nearest scalp electrode was above 0.6 with a statistically significant decreasing trend with increasing distance away from the ear. Ictal morphology and frequency dynamics can be observed from visual inspection and time-frequency analysis. Spike averages derived from ear-EEG electrodes yield a recognizable spike appearance. Our results suggest that ear-EEG can reliably detect electroencephalographic patterns associated with focal temporal lobe seizures. Interictal spike morphology from sufficiently large temporal spike sources can be sampled using ear-EEG. Ear-EEG is likely to become an important tool in clinical epilepsy monitoring and diagnosis. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs): an intriguing EEG phenomenon.

PubMed

Silveira, Mariana Ribeiro Marcondes da; Andrade, Joaquina; Garzon, Eliana

2013-12-01

SIRPIDs, an acronym for stimulus-induced rhythmic, periodic, or ictal discharges, were first named in 2004. This is a pattern observed in continuous electroencephalogram (CEEG) consistently elicited by stimulation in comatose patients. The pathophysiology of SIRPIDs probably involves dysregulation of subcortico-cortical projections, particularly thalamocortical circuit, in a markedly abnormal brain with hyperexci-table cortex. This may explain some studies found an association of prolonged periodic epileptiform discharges (PEDs) activity and a higher incidence of concurrent electrographic seizures and SIRPIDs. An association of SIRPIDs and poor prognosis has already been described. However, it is not yet possible to assert whether these discharges can cause neuronal injury or if they are simply a marker of severe brain injury. Objective of this paper is to review clinical relevance and pathophysiology of SIRPIDs, as well as its role as a brain response in the critically ill patient.

Lateralizing value of unilateral relative ictal immobility in patients with refractory focal seizures--Looking beyond unilateral automatisms.

PubMed

Agarwal, Priya; Kaul, Bhavna; Shukla, Garima; Srivastava, Achal; Singh, Mamta Bhushan; Goyal, Vinay; Behari, Madhuri; Suri, Ashish; Gupta, Aditya; Garg, Ajay; Gaikwad, Shailesh; Bal, C S

2015-12-01

Ictal motor phenomena play a crucial role in the localization of seizure focus in the management of refractory focal epilepsy. While the importance of unilateral automatisms is well established, little attention is paid to the contralateral relatively immobile limb. In cases where automatisms mimic clonic or dystonic movements and in the absence of previously well-established signs, unilateral relative ictal immobility (RII) is potentially useful as a lateralizing sign. This study was carried out to examine the lateralizing value of this sign and to define its characteristics among patients of refractory focal epilepsy. VEEGs of 69 consecutive patients of refractory focal epilepsy who had undergone epilepsy surgery at our center over last four years were reviewed and analyzed for the presence of RII. Unilateral RII was defined as a paucity of movement in one limb lasting for at least 10s while the contralateral limb showed purposive or semi-purposive movements (in the absence of tonic or dystonic posturing or clonic movements in the involved limb). The findings were seen in the light of VEEG, radiological and nuclear imaging data, and with post-surgical outcome. Unilateral RII as a lateralizing sign was found in 24 of 69 patients (34.78%), consisting of both temporal and extra temporal epilepsy, with 100% concordance with VEEG and MRI data. All patients demonstrating this sign had a good post-surgical outcome. RII, when well characterized is a frequent and reliable lateralizing sign in patients of refractory focal epilepsy. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

A new epileptic seizure classification based exclusively on ictal semiology.

PubMed

Lüders, H; Acharya, J; Baumgartner, C; Benbadis, S; Bleasel, A; Burgess, R; Dinner, D S; Ebner, A; Foldvary, N; Geller, E; Hamer, H; Holthausen, H; Kotagal, P; Morris, H; Meencke, H J; Noachtar, S; Rosenow, F; Sakamoto, A; Steinhoff, B J; Tuxhorn, I; Wyllie, E

1999-03-01

Historically, seizure semiology was the main feature in the differential diagnosis of epileptic syndromes. With the development of clinical EEG, the definition of electroclinical complexes became an essential tool to define epileptic syndromes, particularly focal epileptic syndromes. Modern advances in diagnostic technology, particularly in neuroimaging and molecular biology, now permit better definitions of epileptic syndromes. At the same time detailed studies showed that there does not necessarily exist a one-to-one relationship between epileptic seizures or electroclinical complexes and epileptic syndromes. These developments call for the reintroduction of an epileptic seizure classification based exclusively on clinical semiology, similar to the seizure classifications which were used by neurologists before the introduction of the modern diagnostic methods. This classification of epileptic seizures should always be complemented by an epileptic syndrome classification based on all the available clinical information (clinical history, neurological exam, ictal semiology, EEG, anatomical and functional neuroimaging, etc.). Such an approach is more consistent with mainstream clinical neurology and would avoid the current confusion between the classification of epileptic seizures (which in the International Seizure Classification is actually a classification of electroclinical complexes) and the classification of epileptic syndromes.

Severe peri-ictal respiratory dysfunction is common in Dravet syndrome

PubMed Central

Kim, YuJaung; Bravo, Eduardo; Thirnbeck, Caitlin K.; Smith-Mellecker, Lori A.; Kim, Se Hee; Gehlbach, Brian K.; Laux, Linda C.; Zhou, Xiuqiong; Nordli, Douglas R.

2018-01-01

Dravet syndrome (DS) is a severe childhood-onset epilepsy commonly due to mutations of the sodium channel gene SCN1A. Patients with DS have a high risk of sudden unexplained death in epilepsy (SUDEP), widely believed to be due to cardiac mechanisms. Here we show that patients with DS commonly have peri-ictal respiratory dysfunction. One patient had severe and prolonged postictal hypoventilation during video EEG monitoring and died later of SUDEP. Mice with an Scn1aR1407X/+ loss-of-function mutation were monitored and died after spontaneous and heat-induced seizures due to central apnea followed by progressive bradycardia. Death could be prevented with mechanical ventilation after seizures were induced by hyperthermia or maximal electroshock. Muscarinic receptor antagonists did not prevent bradycardia or death when given at doses selective for peripheral parasympathetic blockade, whereas apnea, bradycardia, and death were prevented by the same drugs given at doses high enough to cross the blood-brain barrier. When given via intracerebroventricular infusion at a very low dose, a muscarinic receptor antagonist prevented apnea, bradycardia, and death. We conclude that SUDEP in patients with DS can result from primary central apnea, which can cause bradycardia, presumably via a direct effect of hypoxemia on cardiac muscle. PMID:29329111

Temporal Sequence of Ictal discharges Propagation in the Corticolimbic Basal Ganglia System during Amygdala Kindled Seizures in Freely Moving Rats

PubMed Central

Shi, Li-Hong; Luo, Fei; Woodward, Donald J.; McIntyre, Dan C.; Chang, Jing-Yu

2007-01-01

We used a multiple channel, single unit recording technique to investigate the neural activity in different corticolimbic and basal ganglia regions in freely moving rats before and during generalized amygdala kindled seizures. Neural activity was recorded simultaneously in the sensorimotor cortex (Ctx), hippocampus, amygdala, substantia nigra pars reticulata (SNr) and the subthalamic nucleus (STN). We observed massive synchronized activity among neurons of different brain regions during seizure episodes. Neurons in the kindled amygdala led other regions in synchronized firing, revealed by time lags of neurons in other regions in crosscorrelogram analysis. While there was no obvious time lag between Ctx and SNr, the STN and hippocampus did lag behind the Ctx and SNr in correlated firing. Activity in the amygdala and SNr contralateral to the kindling stimulation site lagged behind their ipsilateral counterparts. However no time lag was found between the kindling and contralateral sides of Ctx, hippocampus and STN. Our data confirm that the amygdala is an epileptic focus that emits ictal discharges to other brain regions. The observed temporal pattern indicates that ictal discharges from the amygdala arrive first at Ctx and SNr, and then spread to the hippocampus and STN. The simultaneous activation of both sides of the Ctx suggests that the neocortex participates in kindled seizures as a unisonant entity to provoke the clonic motor seizures. Early activation of the SNr (before the STN and hippocampus) points to an important role of the SNr in amygdala kindled seizures and supports the view that different SNr manipulations may be effective ways to control seizures. PMID:17049434

Correspondence between large-scale ictal and interictal epileptic networks revealed by single photon emission computed tomography (SPECT) and electroencephalography (EEG)-functional magnetic resonance imaging (fMRI).

PubMed

Tousseyn, Simon; Dupont, Patrick; Goffin, Karolien; Sunaert, Stefan; Van Paesschen, Wim

2015-03-01

Epilepsy is increasingly recognized as a network disorder, but the spatial relationship between ictal and interictal networks is still largely unexplored. In this work, we compared hemodynamic changes related to seizures and interictal spikes on a whole brain scale. Twenty-eight patients with refractory focal epilepsy (14 temporal and 14 extratemporal lobe) underwent both subtraction ictal single photon emission computed tomography (SPECT) coregistered to magnetic resonance imaging (MRI) (SISCOM) and spike-related electroencephalography (EEG-functional MRI (fMRI). SISCOM visualized relative perfusion changes during seizures, whereas EEG-fMRI mapped blood oxygen level-dependent (BOLD) changes related to spikes. Similarity between statistical maps of both modalities was analyzed per patient using the following two measures: (1) correlation between unthresholded statistical maps (Pearson's correlation coefficient) and (2) overlap between thresholded images (Dice coefficient). Overlap was evaluated at a regional level, for hyperperfusions and activations and for hypoperfusions and deactivations separately, using different thresholds. Nonparametric permutation tests were applied to assess statistical significance (p ≤ 0.05). We found significant and positive correlations between hemodynamic changes related to seizures and spikes in 27 (96%) of 28 cases (median correlation coefficient 0.29 [range -0.12 to 0.62]). In 20 (71%) of 28 cases, spatial overlap between hyperperfusion on SISCOM and activation on EEG-fMRI was significantly larger than expected by chance. Congruent changes were not restricted to the territory of the presumed epileptogenic zone, but could be seen at distant sites (e.g., cerebellum and basal ganglia). Overlap between ictal hypoperfusion and interictal deactivation was statistically significant in 22 (79%) of 28 patients. Despite the high rate of congruence, discrepancies were observed for both modalities. We conclude that hemodynamic changes

Ictal SPECT in a case of pure musicogenic epilepsy.

PubMed

Gelisse, Philippe; Thomas, Pierre; Padovani, Raymond; Hassan-Sebbag, Nathalie; Pasquier, Jacques; Genton, Pierre

2003-09-01

A 39-year-old, right-handed woman had seizures for two years which were always triggered by exposure to various types of music: the first occurred while she listened to a tune she particularly liked, Con Te Partiro, by Andrea Boccelli. Other triggering factors were various types of music such as supermarket background music and polyphonic singing or instrumental music played by family members. The seizures had a stereotyped course: she felt anxious, tearful, then occurred slight obtundation, during which she smacked her lips and moved restlessly. There was no complete loss of consciousness, but some degree of amnesia. She never experienced a generalized tonic-clonic seizure, but reported rare spontaneous feelings of déjà-vu that had begun at the same time as the induced seizures. There were no other spontaneous attacks; only one seizure was apparently provoked, not by music but by a loud background noise in her office. She was a music lover and a singer. Interictal EEG showed independent slow waves over the temporal regions. Several seizures with EEG localisation over the right temporal region were elicited after several minutes of exposure to music. Monoauricular stimulation with the same music produced a seizure when applied to the left ear but was ineffective when applied to the right ear. Ictal SPECT demonstrated right temporal hyperperfusion. MRI was normal. On high dose of carbamazepine, seizure frequency decreased. The addition of topiramate resulted in full seizure control. Musicogenic epilepsy is a rare form of reflex epilepsy. Pure cases, when patients do not experience unprovoked seizures, are exceptional. Our report confirms the implication of the right temporal lobe in this epilepsy. Copyright John Libbey Eurotext 2003

Asystole During Onyx Embolization of a Pediatric Arteriovenous Malformation: A Severe Case of the Trigeminocardiac Reflex.

PubMed

Khatibi, Kasra; Choudhri, Omar; Connolly, Ian D; McTaggart, Ryan A; Do, Huy M

2017-02-01

Trigeminal-cardiac reflex (TCR) from the stimulation of sensory branches of trigeminal nerve can lead to hemodynamic instability. This phenomenon has been described during ophthalmologic, craniofacial, and skull base surgeries. TCR has been reported rarely with endovascular onyx embolization of dural arteriovenous fistulas. We report a case of TCR during endovascular Onyx embolization of an arteriovenous malformation (AVM). A 16-year-old boy presented with a large cerebellar AVM with arterial feeders from the external carotid artery and posterior cerebral artery branches. The middle meningeal artery was catheterized, through which dimethyl sulfoxide was injected, followed by Onyx, into the nidus and the feeders. Near the completion of embolization, patient became bradycardic and proceeded to asystole; he was resuscitated with chest compression, atropine, and vasopressors. We used PubMed to identify the reported cases of Onyx and other endovascular embolizations complicated by hemodynamic instability. We found 16 cases of endovascular onyx embolization complicated by clinically significant hemodynamic changes in the treatment of dural arteriovenous fistula, cavernous carotid fistula, and juvenile nasopharygeal angiofibroma but not with AVMs. In these cases, arterial supply to the nidus involved the sensory receptive field of trigeminal nerve. Hemodynamic changes have been reported during the injection of dimethyl sulfoxide before the introduction of Onyx, as well as Onyx injection and cast formation. TCR can lead to significant hemodynamic changes during endovascular Onyx embolization of vascular malformations (both pial AVM and dural arteriovenous fistulas) involving receptive field of trigeminal nerve. Therefore, the anesthesiologist should be made aware of treatment approach before intervention and appropriate precautions taken. Copyright © 2016 Elsevier Inc. All rights reserved.

Endogenous opioid peptide-mediated neurotransmission in central and pericentral nuclei of the inferior colliculus recruits μ1-opioid receptor to modulate post-ictal antinociception.

PubMed

Felippotti, Tatiana Tocchini; de Freitas, Renato Leonardo; Coimbra, Norberto Cysne

2012-02-01

The aim of the present work was to investigate the involvement of the μ1-endogenous opioid peptide receptor-mediated system in post-ictal antinociception. Antinociceptive responses were determined by the tail-flick test after pre-treatment with the selective μ1-opioid receptor antagonist naloxonazine, peripherally or centrally administered at different doses. Peripheral subchronic (24 h) pre-treatment with naloxonazine antagonised the antinociception elicited by tonic-clonic seizures. Acute (10 min) pre-treatment, however, did not have the same effect. In addition, microinjections of naloxonazine into the central, dorsal cortical and external cortical nuclei of the inferior colliculus antagonised tonic-clonic seizure-induced antinociception. Neither acute (10-min) peripheral pre-treatment with naloxonazine nor subchronic intramesencephalic blockade of μ1-opioid receptors resulted in consistent statistically significant differences in the severity of tonic-clonic seizures shown by Racine's index (1972), although the intracollicular specific antagonism of μ1-opioid receptor decreased the duration of seizures. μ1-Opioid receptors and the inferior colliculus have been implicated in several endogenous opioid peptide-mediated responses such as antinociception and convulsion. The present findings suggest the involvement of μ1-opiate receptors of central and pericentral nuclei of the inferior colliculus in the modulation of tonic-clonic seizures and in the organisation of post-ictal antinociception. Copyright © 2011 Elsevier Ltd. All rights reserved.

Ictal EEG fractal dimension in ECT predicts outcome at 2 weeks in schizophrenia.

PubMed

Abhishekh, Hulegar A; Thirthalli, Jagadisha; Manjegowda, Anusha; Phutane, Vivek H; Muralidharan, Kesavan; Gangadhar, Bangalore N

2013-09-30

Studies of electroconvulsive therapy (ECT) have found an association between ictal electroencephalographic (EEG) measures and clinical outcome in depression. Such studies are lacking in schizophrenia. Consenting schizophrenia patients receiving ECT were assessed using the Brief Psychiatric Rating Scale (BPRS) before and 2 weeks after the start of ECT. The patients' seizure was monitored using EEG. In 26 patients, completely artifact-free EEG derived from the left frontal-pole (FP1) channel and electrocardiography (ECG) were available. The fractal dimension (FD) was computed to assess 4-s EEG epochs, and the maximal value from the earliest ECT session (2nd, 3rd or 4th) was used for analysis. There was a significant inverse correlation between the maximum FD and the total score following 6th ECT. An inverse Inverse correlation was also observed between the maximum FD and the total number of ECTs administered as well as the maximum heart rate (HR) and BPRS scores following 6th ECT. In patients with schizophrenia greater intensity of seizures (higher FD) during initial sessions of ECT is associated with better response at the end of 2 weeks. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Focal epilepsy recruiting a generalised network of juvenile myoclonic epilepsy: a case report.

PubMed

Khaing, Myo; Lim, Kheng-Seang; Tan, Chong-Tin

2014-09-01

We report a patient with juvenile myoclonic epilepsy who subsequently developed temporal lobe epilepsy, which gradually became clinically dominant. Video telemetry revealed both myoclonic seizures and temporal lobe seizures. The temporal lobe seizures were accompanied by a focal recruiting rhythm with rapid generalisation on EEG, in which the ictal EEG pattern during the secondary generalised phase was morphologically similar to the ictal pattern during myoclonic seizures. The secondary generalised seizures of the focal epilepsy responded to sodium valproate, similar to the myoclonic epilepsy. In this rare case of coexistent Juvenile Myoclonic Epilepsy and Temporal lobe epilepsy, the possibility of focal epilepsy recruiting a generalised epileptic network was proposed and discussed.

Inter-ictal spike detection using a database of smart templates.

PubMed

Lodder, Shaun S; Askamp, Jessica; van Putten, Michel J A M

2013-12-01

Visual analysis of EEG is time consuming and suffers from inter-observer variability. Assisted automated analysis helps by summarizing key aspects for the reviewer and providing consistent feedback. Our objective is to design an accurate and robust system for the detection of inter-ictal epileptiform discharges (IEDs) in scalp EEG. IED Templates are extracted from the raw data of an EEG training set. By construction, the templates are given the ability to learn by searching for other IEDs within the training set using a time-shifted correlation. True and false detections are remembered and classifiers are trained for improving future predictions. During detection, trained templates search for IEDs in the new EEG. Overlapping detections from all templates are grouped and form one IED. Certainty values are added based on the reliability of the templates involved. For evaluation, 2160 templates were used on an evaluation dataset of 15 continuous recordings containing 241 IEDs (0.79/min). Sensitivities up to 0.99 (7.24fp/min) were reached. To reduce false detections, higher certainty thresholds led to a mean sensitivity of 0.90 with 2.36fp/min. By using many templates, this technique is less vulnerable to variations in spike morphology. A certainty value for each detection allows the system to present findings in a more efficient manner and simplifies the review process. Automated spike detection can assist in visual interpretation of the EEG which may lead to faster review times. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Rhythms and outcomes of adult in-hospital cardiac arrest.

PubMed

Meaney, Peter A; Nadkarni, Vinay M; Kern, Karl B; Indik, Julia H; Halperin, Henry R; Berg, Robert A

2010-01-01

To determine the relationship of electrocardiographic rhythm during cardiac arrest with survival outcomes. Prospective, observational study. Total of 411 hospitals in the National Registry of Cardiopulmonary Resuscitation. Total of 51,919 adult patients with pulseless cardiac arrests from April 1999 to July 2005. Registry data collected included first documented rhythm, patient demographics, pre-event data, event data, and survival and neurologic outcome data. Of 51,919 indexed cardiac arrests, first documented pulseless rhythm was ventricular tachycardia (VT) in 3810 (7%), ventricular fibrillation (VF) in 8718 (17%), pulseless electrical activity (PEA) in 19,262 (37%) and asystole 20,129 (39%). Subsequent VT/VF (that is, VT or VF occurring during resuscitation for PEA or asystole) occurred in 5154 (27%), with first documented rhythm of PEA and 4988 (25%) with asystole. Survival to hospital discharge rate was not different between those with first documented VF and VT (37% each, adjusted odds ratio [OR]) 1.08; 95% confidence interval [CI] 0.95-1.23). Survival to hospital discharge was slightly more likely after PEA than asystole (12% vs. 11%, adjusted OR 1.1; 95% CI 1.00-1.18), Survival to discharge was substantially more likely after first documented VT/VF than PEA/asystole (adjusted OR 1.68; 95% CI 1.55-1.82). Survival to discharge was also more likely after PEA/asystole without subsequent VT/VF compared with PEA/asystole with subsequent VT/VF (14% vs. 7% for PEA without vs. with subsequent VT/VF; 12% vs. 8% for asystole without vs. with subsequent VT/VF; adjusted OR 1.60; 95% CI, 1.44-1.80). Survival to hospital discharge was substantially more likely when the first documented rhythm was shockable rather than nonshockable, and slightly more likely after PEA than asystole. Survival to hospital discharge was less likely following PEA/asystole with subsequent VT/VF compared to PEA/asystole without subsequent VT/VF.

Uncontrolled Donors with Controlled Reperfusion after Sixty Minutes of Asystole: A Novel Reliable Resource for Kidney Transplantation

PubMed Central

Reznik, Oleg N.; Skvortsov, Andrei E.; Reznik, Alexander O.; Ananyev, Alexey N.; Tutin, Alexey P.; Kuzmin, Denis O.; Bagnenko, Sergey F.

2013-01-01

Background Organ shortage leads to usage of kidneys from donors after sudden cardiac death, or uncontrolled donors (UDCD). Ischemic injury due to cessation of circulation remains a crucial problem that limits adoption of UDCD. Our clinical investigation was to determine the applicability of kidneys obtained from UDCD and resuscitated by extracorporeal perfusion in situ after 60 minutes of asystole. Methods In 2009–2011, organ procurement service of St. Petersburg, obtained kidneys from 22 UDCD with critically expanded warm ischemic time (WIT). No patients were considered as potential organ donors initially. All donors died after sudden irreversible cardiac arrest. Mean WIT was 61.4±4.5 minutes. For kidney resuscitation, the subnormothermic extracorporeal abdominal perfusion with thrombolytics and leukocyte depletion was employed. Grafts were transplanted into 44 recipients. The outcomes of transplantation of resuscitated kidneys were compared to outcomes of 87 KTx from 74 brain death donors (BDDs). Results Immediate functioning of kidney grafts was observed in 21 of the 44 recipients, with no cases of primary non function. By the end of the first post-transplant year there was an acute rejection rate of 9.1% (4 episodes of rejection) in the UDCD group versus 14.2% (13 episodes of rejection) in the BDD group. The actual 1-year graft survival rate was 95.5% (n = 42) in UDCD group, and 94.6% (n = 87) in BDD group. Creatinine levels at the end of the first year were 0.116±0.008 and 0.115±0.004 mmol/l in UDCD and BDD groups, respectively. Conclusions UDCD kidneys with critically expanded WIT could be succefully used for transplantation if in situ organ “resuscitation” perfusion is included into procurement protocol. The results of 1-year follow-up meet the generally accepted criteria for graft survival and function. In situ reperfusion may exert a therapeutic effect on grafts before procurement. This approach could substantially expand the organ donors

Ictal and interictal electric source imaging in presurgical evaluation: a prospective study.

PubMed

Sharma, Praveen; Scherg, Michael; Pinborg, Lars H; Fabricius, Martin; Rubboli, Guido; Pedersen, Birthe; Leffers, Anne-Mette; Uldall, Peter; Jespersen, Bo; Brennum, Jannick; Mølby Henriksen, Otto; Beniczky, Sándor

2018-05-11

Accurate localization of the epileptic focus is essential for surgical treatment of patients with drug- resistant epilepsy. EEG source imaging (ESI) is increasingly used in presurgical evaluation. However, most previous studies analysed interictal discharges. Prospective studies comparing feasibility and accuracy of interictal (II) and ictal (IC) ESI are lacking. We prospectively analysed long-term video EEG recordings (LTM) of patients admitted for presurgical evaluation. We performed ESI of II and IC signals, using two methods: equivalent current dipole (ECD) and distributed source model (DSM). LTM recordings employed the standard 25-electrode array (including inferior temporal electrodes). An age-matched template head-model was used for source analysis. Results were compared with intracranial recordings (ICR), conventional neuroimaging methods (MRI, PET, SPECT) and outcome one year after surgery. Eighty-seven consecutive patients were analysed. ECD gave a significantly higher proportion of patients with localised focal abnormalities (94%) compared to MRI (70%), PET (66%) and SPECT (64%). Agreement between the ESI methods and ICR was moderate to substantial (k=0.56-0.79). Fifty-four patients were operated (47 for more than one year ago) and 62% of them became seizure-free. Localization accuracy of II-ESI was 51% for DSM and 57% for ECD; for IC-ESI this was 51% (DSM) and 62% (ECD). The differences between the ESI methods were not significant. Differences in localization accuracy between ESI and MRI (55%), PET (33%) and SPECT (40%) were not significant. II and IC ESI of LTM-data have high feasibility and their localisation accuracy is similar to the conventional neuroimaging methods. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Reflex anoxic seizures ('white breath-holding'): nonepileptic vagal attacks.

PubMed Central

Stephenson, J B

1978-01-01

From clinical history 58 children were diagnosed as having reflex anoxic seizures secondary to provoked cardioinhibition (also known as white breath-holding attacks). Before referral, these seizures were commonly misdiagnosed as epileptic either because the provocation was ignored, not recognised, or was a febrile illness, or because there was no crying, no obvious breath-holding, little cyanosis, and often no pallor to suggest syncope and cerebral ischaemia. The duration of cardiac asystole after ocular compression was measured in these children and in 60 additional children with other paroxysmal disorders. In 45 (78%) of the 58 with reflex anoxic seizures asystole was 2 seconds or over, and in 32 (55%) it was 4 seconds or greater, an abnormal response. Review of the literature supports the concept that these seizures result from vagal-mediated reflex cardiac arrest which can if necessary be prevented by atropine. The simple name 'vagal attack' is proposed. Ocular compression under EEG and ECG control supports the clinical diagnosis if asystole and/or an anoxic seizure is induced; the procedure described is safe and should be routine in seizure or syncope evaluation, when a meticulous history still leaves room for doubt. Images Figs. 1-8 p194-b p194-c p194-d p194-e p194-f p194-g p194-h PMID:348123

Clinical characterization of the pre-ictal state in the pediatric population: A caretaker's perspective.

PubMed

Patel, Puja; Ferastraoaru, Victor; Gold, Dov; Lipnick, Andrew; Jehle, Rana; Haut, Sheryl R

2017-05-01

The unpredictability of seizures causes distress to patients with epilepsy and their caretakers. To date, no studies have explored seizure prediction specifically in the pediatric population. If the period of time preceding a seizure can be reliably identified, either by child or caretaker, there may be a role for pre-emptive interventions. The aim of this study was to investigate caretaker seizure prediction. A questionnaire was distributed to caretakers of patients with epilepsy. The patients were 0-21years old and experienced ≥1 seizure within the past year. We excluded patients with non-epileptic seizures or daily seizures. One hundred and fifty of 240 questionnaires met criteria. Of these, 32 (21.6%) caretakers indicated a positive report of seizure prediction. Age of seizure onset was earlier in the positive predictive group (3.3±3.3years) than in the non-predictor group (5.3±4.8years) (p=0.01). The most common pre-ictal symptoms reported were being tired, hazy look, and sleepiness. A total of 76.6% of caretakers reported at least one seizure precipitant. The prevalence of positive caretaker seizure prediction in this study is similar to that of seizure self-prediction in adult studies. These findings will be used to design prospective online or electronic diary studies to further investigate the caretaker's, as well as children's, perspectives on seizure prediction. We anticipate that this investigation may lead to novel treatments during times of high seizure risk. Copyright © 2017 Elsevier Inc. All rights reserved.

Resting-state EEG power and coherence vary between migraine phases.

PubMed

Cao, Zehong; Lin, Chin-Teng; Chuang, Chun-Hsiang; Lai, Kuan-Lin; Yang, Albert C; Fuh, Jong-Ling; Wang, Shuu-Jiun

2016-12-01

Migraine is characterized by a series of phases (inter-ictal, pre-ictal, ictal, and post-ictal). It is of great interest whether resting-state electroencephalography (EEG) is differentiable between these phases. We compared resting-state EEG energy intensity and effective connectivity in different migraine phases using EEG power and coherence analyses in patients with migraine without aura as compared with healthy controls (HCs). EEG power and isolated effective coherence of delta (1-3.5 Hz), theta (4-7.5 Hz), alpha (8-12.5 Hz), and beta (13-30 Hz) bands were calculated in the frontal, central, temporal, parietal, and occipital regions. Fifty patients with episodic migraine (1-5 headache days/month) and 20 HCs completed the study. Patients were classified into inter-ictal, pre-ictal, ictal, and post-ictal phases (n = 22, 12, 8, 8, respectively), using 36-h criteria. Compared to HCs, inter-ictal and ictal patients, but not pre- or post-ictal patients, had lower EEG power and coherence, except for a higher effective connectivity in fronto-occipital network in inter-ictal patients (p < .05). Compared to data obtained from the inter-ictal group, EEG power and coherence were increased in the pre-ictal group, with the exception of a lower effective connectivity in fronto-occipital network (p < .05). Inter-ictal and ictal patients had decreased EEG power and coherence relative to HCs, which were "normalized" in the pre-ictal or post-ictal groups. Resting-state EEG power density and effective connectivity differ between migraine phases and provide an insight into the complex neurophysiology of migraine.

Asystole caused by Hydroxycut Hardcore: A case report and literature review.

PubMed

Zaidan, Julie; Tabet, Rabih; Karam, Boutros; Daneshvar, Farshid; Raza, Mohammed; Bekheit, Soad

2018-05-01

Obesity is a rising epidemic worldwide driving people to search for remedy through nonconventional therapies. Hydroxycut products are popular supplements used as weight loss aids. Many reports revealed serious adverse effects related to their ingestion. We report the case of a 37-year-old healthy male patient who presented following an episode of syncope. On telemetry, he manifested recurrent sinus node arrests, including a symptomatic 24 s sinus pause. The patient admitted to taking Hydroxycut Hardcore for 10 days previously. After discontinuation of the drug, his symptoms completely resolved. This is the first case of Hydroxycut-associated syncope secondary to bradyarrhythmia. © 2017 Wiley Periodicals, Inc.

Terminal echocardiographic findings during death process in man and dogs.

PubMed

Wang, F S; Lien, W P; Fong, T E

1991-01-01

Serial echocardiographic imaging was performed to assess terminal mechanical changes of cardiac chambers and valves, as well as sequential echocardiographic features of blood stasis, inside the heart after mechanical asystole in 7 hospitalized adults who died without apparent cardiac disease and in 7 experimental dogs sacrificed by a means of asphyxia. Marked reduction of wall motion became manifest shortly after the electrocardiograms had generated into a slow junctional rhythm with intraventricular conduction defect, an idioventricular rhythm, or an extreme sinus bradycardia. Total cessation of cardiac wall and valve motion followed; the aortic valve remained closed, with mitral and tricuspid valves semiopen after total cardiac asystole. Liquid whole blood inside the heart became echogenic shortly before mechanical asystole had approached, and homogenous echogenicity usually first appeared on the right side of the heart. As the death process progressed and total asystole persisted, the acoustic intensity of the intracavitary echoes increased, tending to form amorphous masses, with some showing rather well-defined borders. Such echocardiographic features were noted to indicate red thrombi in experimental dogs. The cardiac dimensions (left ventricle and aorta) decreased after total cardiac asystole.

Contralateral interictal and ictal EEG epileptiform activity accentuate memory impairment in unilateral mesial temporal sclerosis patients.

PubMed

Pinto, Lecio F; Adda, Carla C; Silva, Liliane C A; Banaskiwitz, Natalie H C; Passarelli, Valmir; Jorge, Carmen L; Valerio, Rosa M; Castro, Luiz H

2017-03-01

Memory impairment is a recognized complication of mesial temporal sclerosis (MTS). Epileptiform activity may negatively impact on cognition. We evaluated the impact of contralateral EEG involvement on memory in unilateral MTS (uMTS) patients. Retrospective review of 121 right-handed uMTS patients (69 left) evaluated with prolonged video-EEG and verbal and nonverbal memory tests (Rey Auditory Verbal Learning Test and Rey-Osterrieth Complex figure), with additional very delayed trials. Patients were classified according to ictal/interictal EEG findings and MTS side as left or right concordant or discordant. Thirty-nine normal individuals who underwent the same neuropsychological battery served as controls. Demographic, disease, and treatment features did not differ among groups. On the 7-day verbal memory free recall, left discordant performed significantly worse than controls and right concordant, recognized fewer words, and had more recognition errors than all other groups, including left concordant. For nonverbal memory, right discordant performed significantly worse than controls on delayed recall, and attained lower scores than other groups on immediate and 7-day recall, but this difference did not reach statistical significance. Left discordant had higher scores of memory complaints than controls and disclosed a trend toward accentuated memory impairment compared with the other groups over time. Our results suggest that contralateral electrographic involvement in uMTS was associated with more pronounced memory impairment for verbal material in left discordant patients, and to a lesser extent, for nonverbal material in right discordant patients. Left discordant group also had increased memory complaints. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A system for automatic artifact removal in ictal scalp EEG based on independent component analysis and Bayesian classification.

PubMed

LeVan, P; Urrestarazu, E; Gotman, J

2006-04-01

To devise an automated system to remove artifacts from ictal scalp EEG, using independent component analysis (ICA). A Bayesian classifier was used to determine the probability that 2s epochs of seizure segments decomposed by ICA represented EEG activity, as opposed to artifact. The classifier was trained using numerous statistical, spectral, and spatial features. The system's performance was then assessed using separate validation data. The classifier identified epochs representing EEG activity in the validation dataset with a sensitivity of 82.4% and a specificity of 83.3%. An ICA component was considered to represent EEG activity if the sum of the probabilities that its epochs represented EEG exceeded a threshold predetermined using the training data. Otherwise, the component represented artifact. Using this threshold on the validation set, the identification of EEG components was performed with a sensitivity of 87.6% and a specificity of 70.2%. Most misclassified components were a mixture of EEG and artifactual activity. The automated system successfully rejected a good proportion of artifactual components extracted by ICA, while preserving almost all EEG components. The misclassification rate was comparable to the variability observed in human classification. Current ICA methods of artifact removal require a tedious visual classification of the components. The proposed system automates this process and removes simultaneously multiple types of artifacts.

Is 'burned-out hippocampus' syndrome a distinct electro-clinical variant of MTLE-HS syndrome?

PubMed

Nair, Pradeep P; Menon, Ramshekhar N; Radhakrishnan, Ashalatha; Cherian, Ajit; Abraham, Mathew; Vilanilam, George; Kesavadas, C; Thomas, Bejoy; Alexander, Aley; Thomas, Sanjeev V

2017-04-01

To study the clinical, electrophysiological and imaging characteristics of patients with unilateral mesial temporal lobe epilepsy (MTLE) with contralateral ictal onset on scalp EEG, viz. 'burned-out hippocampus' syndrome (MTLE-BHS). MTLE-BHS was defined as TLE with unilateral hippocampal sclerosis (HS) without any dual pathology on MRI and contralateral ictal onset on scalp EEG, unlike in classical hippocampal sclerosis (HS). Consecutive "MTLE-BHS" patients evaluated at our Centre for Comprehensive Epilepsy Care from January 2005 to July 2014 were studied. Twenty-five cases of classic MTLE-HS operated during the same period were also analyzed for comparison. Seventeen patients were diagnosed to have MTLE-BHS. Mean age of seizure onset was 9.5±7.7years and the mean duration of epilepsy was18.2±7.3years. Epigastric aura was more common in MTLE-HS and fear, secondary generalized seizures and temporal polar changes on MRI were more prevalent in the MTLE-BHS subgroup. In the latter group, five (29%) exhibited seizure semiology and 2 (12%) had interictal discharges discordant to the side of MTS. Eight (47%) patients in the MTLE-BHS sub-group had normal medial temporal volume on Scheltens scale. Eight patients among MTLE-BHS underwent surgery (4 following intracranial monitoring that localized to the side of HS) with Engel class I outcome at 1year follow-up in 6 and Engel class II outcome in 2. Attenuation of ipsilateral fast ictal rhythms on scalp EEG as well as neocortical changes are likely to be deterministic factors for MTLE-BHS as opposed to the severity of hippocampal atrophy. Considering good post-operative outcomes, intracranial monitoring for surgical selection is not mandatory in MTLE-BHS despite discordant semiology and ictal onset, in the presence of inter-ictal, functional imaging and neuropsychology data concordant to the side of HS. Copyright © 2017 Elsevier Inc. All rights reserved.

Cardiac complications in a metamizole-induced type I Kounis syndrome.

PubMed

Juste, Jose F Martínez; Garces, Tomas Ruiz; Enguita, Rafael Gonzalez; Blasco, Pedro Cia; Trallero, Jara Altemir

2016-01-01

Kounis syndrome is defined as the coincidental occurrence of allergic reaction and acute coronary syndrome secondary to vasospasm. Anti-inflammatory drugs are included as one of the multiple causes. Current data available about this syndrome come from case reports. We present the case of a patient who suffered Kounis syndrome with cardiogenic shock and asystole after intravenous infusion of Metamizole, and in which no lesions were observed in coronariography. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Postictal aphasia and paresis: a clinical and intracerebral EEG study.

PubMed

Adam, C; Adam, C; Rouleau, I; Saint-Hilaire, J M

2000-02-01

We examined the lateralizing value of postictal language and motor deficits and studied their underlying mechanisms. The total sample consisted of 35 patients (26 temporals, 8 frontals, 1 parietal) with a good postsurgical outcome (Engel's class I and II). Postictal examination was blindly reviewed on videotapes. In 15 cases (29 seizures), postictal language manifestations were analyzed in relation with the diffusion of the epileptic discharge recorded by intracerebral EEG. Language dominance was determined by the intracarotid amobarbital test. Postictal aphasia was observed only when (1) seizure originated in the dominant hemisphere and (2) ictal activity spread to language areas (Wernicke and/or Broca areas). When the epileptic focus was in the nondominant hemisphere, no postictal aphasia was observed even if there was secondary generalization of ictal activity affecting the language areas of the dominant hemisphere. Postictal motor deficits also had a strong lateralizing value even when seizures were secondarily generalized. Postictal aphasia in temporal epilepsies and postical motor deficits in temporal and extra temporal epilepsies provided excellent lateralizing information. Postictal deficits appear to be the result of inhibitory mechanisms induced by previous ictal activity of the structures related to these functions.

[Atrial fibrillation and prolonged nocturnal cardiac arrests in a patient with obstructive sleep apnea syndrome. Successful correction of disorders by CPAP therapy].

PubMed

Bairambekov, E Sh; Pevzner, A V; Litvin, A Yu; Fomicheva, O A

The case history of a 46-year-old patient with obstructive sleep apnea syndrome was analyzed. The examination revealed fourth-degree obesity, prior myocardial infarction, persistent atrial fibrillation with nocturnal asystoles lasting as long as 14.3 sec. During selected drug therapy and regular application of secondary ventilation (continuous positive airway pressure (CPAP) therapy) used to correct breathing problems, there was a reduction in the signs of circulatory deficiency, cessation of cardiac pauses, and recovery of sinus rhythm. The therapeutic effect persisted during a 24-month follow-up.

Dancing with a seizure, a case report.

PubMed

Kim, Keun Tae; Chu, Kon; Lee, Sang Kun

2017-01-25

Dancing is a very rare seizure semiology, and has only few case reports so far. Moreover, no case regarded as dancing with both description and video was presented. A 42-year-old woman with medical intractable epilepsy showed a typical semiology of right temporal lobe epilepsy: right hand automatism and ictal speech. The following semiology, appeared during ictal and post-ictal stage, was complex, rhythmical and sequential movement. It was enough to be called dancing. We hereby report the most plausible dancing in the ictal and post-ictal state, documented by simultaneous video and electroencephalography.

Is pulseless electrical activity a reason to refuse cardiopulmonary resuscitation with ECMO support?

PubMed

Pabst, Dirk; Brehm, Christoph E

2018-04-01

Cardiopulmonary resuscitation with ECMO support (ECPR) has shown to improve outcome in patients after cardiac arrest under resuscitation. Most current recommendations for ECPR do not include patients with a non-shockable rhythm such as PEA and asystole. The aim of this study was to investigate the outcome of 3 patient groups separated by initial rhythm at time of ECMO placement during CPR: asystole, PEA and shockable rhythm. We made a retrospective single-center study of adults who underwent ECPR for in-hospital cardiac arrest between June 2008 and January 2017. Outcome and survival were identified in 3 groups of patients regarding to the heart rhythm at the time decision for ECMO support was made: 1. patients with asystole, 2. patients with pulseless electrical activity, 3. patients with a shockable rhythm. 63 patients underwent ECPR in the mentioned time frame. Five patients were excluded due to incomplete data. Under the 58 included patients the number of cases for asystole, PEA, shockable rhythm was 7, 21 and 30 respectively. The means of CPR-time in these groups were 37, 41 and 37min. Survival to discharge was 0.0%, 23.8% and 40.0% respectively (p=0.09). All survivors to discharge had a good neurological outcome, defined as cerebral performance category 1or 2. Survival to discharge in patients with PEA as initial rhythm at the time of decision for ECPR is 23.8% while no patients with asystole as initial rhythm survived discharge. Patients with PEA should be carefully considered for ECPR. Copyright © 2017 Elsevier Inc. All rights reserved.

Apnoea and bradycardia during epileptic seizures: relation to sudden death in epilepsy.

PubMed Central

Nashef, L; Walker, F; Allen, P; Sander, J W; Shorvon, S D; Fish, D R

1996-01-01

OBJECTIVE--To record non-invasively ictal cardiorespiratory variables. METHODS--Techniques employed in polysomnography were used in patients with epilepsy undergoing EEG-video recording at a telemetry unit. RESULTS--Apnoea (> 10, range > 10-63, mean 24 s) was seen in 20 of 47 clinical seizures (three secondary generalised, 16 complex partial, and one tonic) and 10 of 17 patients. Apnoea was central in 10 patients, but obstructive apnoea was also recorded in three of 10. Oxyhaemoglobin saturation (SpO2) dropped to less than 85% in 10 seizures (six patients). An increase in heart rate was common (91% of seizures). Bradycardia/sinus arrest was documented in four patients (mean maximum RR interval 5.36, range 2.8-8.6 s) but always in the context of a change in respiratory pattern. CONCLUSION--Ictal apnoea was often seen. The occurrence of bradycardia in association with apnoea suggests the involvement of cardiorespiratory reflexes. Similar mechanisms may operate in cases of sudden death in epilepsy. PMID:8609507

Sensitivity and Specificity of Interictal EEG-fMRI for Detecting the Ictal Onset Zone at Different Statistical Thresholds

PubMed Central

Tousseyn, Simon; Dupont, Patrick; Goffin, Karolien; Sunaert, Stefan; Van Paesschen, Wim

2014-01-01

There is currently a lack of knowledge about electroencephalography (EEG)-functional magnetic resonance imaging (fMRI) specificity. Our aim was to define sensitivity and specificity of blood oxygen level dependent (BOLD) responses to interictal epileptic spikes during EEG-fMRI for detecting the ictal onset zone (IOZ). We studied 21 refractory focal epilepsy patients who had a well-defined IOZ after a full presurgical evaluation and interictal spikes during EEG-fMRI. Areas of spike-related BOLD changes overlapping the IOZ in patients were considered as true positives; if no overlap was found, they were treated as false-negatives. Matched healthy case-controls had undergone similar EEG-fMRI in order to determine true-negative and false-positive fractions. The spike-related regressor of the patient was used in the design matrix of the healthy case-control. Suprathreshold BOLD changes in the brain of controls were considered as false positives, absence of these changes as true negatives. Sensitivity and specificity were calculated for different statistical thresholds at the voxel level combined with different cluster size thresholds and represented in receiver operating characteristic (ROC)-curves. Additionally, we calculated the ROC-curves based on the cluster containing the maximal significant activation. We achieved a combination of 100% specificity and 62% sensitivity, using a Z-threshold in the interval 3.4–3.5 and cluster size threshold of 350 voxels. We could obtain higher sensitivity at the expense of specificity. Similar performance was found when using the cluster containing the maximal significant activation. Our data provide a guideline for different EEG-fMRI settings with their respective sensitivity and specificity for detecting the IOZ. The unique cluster containing the maximal significant BOLD activation was a sensitive and specific marker of the IOZ. PMID:25101049

Dynamic interneuron-principal cell interplay leads to a specific pattern of in vitro ictogenesis.

PubMed

Lévesque, Maxime; Chen, Li-Yuan; Hamidi, Shabnam; Avoli, Massimo

2018-07-01

Ictal discharges induced by 4-aminopyridine in the in vitro rodent entorhinal cortex present with either low-voltage fast or sudden onset patterns. The role of interneurons in initiating low-voltage fast onset ictal discharges is well established but the processes leading to sudden onset ictal discharges remain unclear. We analysed here the participation of interneurons (n = 75) and principal cells (n = 13) in the sudden onset pattern by employing in vitro tetrode wire recordings in the entorhinal cortex of brain slices from Sprague-Dawley rats. Ictal discharges emerged from a background of frequently occurring interictal spikes that were associated to a specific interneuron/principal cell interplay. High rates of interneuron firing occurred 12 ms before interictal spike onset while principal cells fired later during low interneuron firing. In contrast, the onset of sudden ictal discharges was characterized by increased firing from principal cells 627 ms before ictal onset whereas interneurons increased their firing rates 161 ms before ictal onset. Our data show that sudden onset ictogenesis is associated with frequently occurring interictal spikes resting on the interplay between interneurons and principal cells while ictal discharges stem from enhanced principal cell firing leading to increased interneuron activity. These findings indicate that specific patterns of interactions between interneurons and principal cells shape interictal and ictal discharges with sudden onset in the rodent entorhinal cortex. We propose that specific neuronal interactions lead to the generation of distinct onset patterns in focal epileptic disorders. Copyright © 2018 Elsevier Inc. All rights reserved.

Factors associated with out-of-hospital cardiac arrest with pulseless electric activity: A population-based study.

PubMed

Ko, Dennis T; Qiu, Feng; Koh, Maria; Dorian, Paul; Cheskes, Sheldon; Austin, Peter C; Scales, Damon C; Wijeysundera, Harindra C; Verbeek, P Richard; Drennan, Ian; Ng, Tiffany; Tu, Jack V; Morrison, Laurie J

2016-07-01

Many patients with out-of-hospital cardiac arrest present with pulseless electric activity (PEA) rather than shockable rhythm. Despite improvements in resuscitation care, survival of PEA patients remains dismal. Our main objective was to characterize out-of-hospital cardiac arrest patients by initial presenting rhythm and to evaluate independent determinants of PEA. A population-based study was conducted using the Toronto Rescu Epistry database with linkage to administrative data in Ontario, Canada. We included patients older than 20 years who had nontraumatic cardiac arrests from 2005 to 2010. Multivariable logistic regression models were constructed to determine factors predicting the occurrence of PEA vs shockable rhythm vs asystole. Of the 9,882 included patients who received treatment, 24.5% had PEA, 26.3% had shockable rhythm, and 49.2% had asystole. Patients with PEA had a mean age of 72 years, 41.2% were female and had multiple comorbidities, and 53.4% were hospitalized in the past year. As compared with shockable rhythm, PEA patients were older, were more likely to be women, and had more comorbidities. As compared with asystole, PEA patients had similar baseline and clinical characteristics, but were substantially more likely to have an arrest witnessed by emergency medical services (odds ratio 13) or by bystander (odds ratio 3.24). Mortality at 30 days was 95.5%, 77.9%, and 98.9% for patients with PEA, shockable rhythm, asystole, respectively. Patient characteristics differed substantially in those presenting with PEA and shockable rhythm. In contrast, the main distinguishing factor between PEA and asystole cardiac arrest related mainly to factors at the time of the cardiac arrest. Copyright © 2016 Elsevier Inc. All rights reserved.

Using max entropy ratio of recurrence plot to measure electrocorticogram changes in epilepsy patients

NASA Astrophysics Data System (ADS)

Yan, Jiaqing; Wang, Yinghua; Ouyang, Gaoxiang; Yu, Tao; Li, Xiaoli

2016-02-01

A maximum entropy ratio (MER) method is firstly adapted to investigate the high-dimensional Electrocorticogram (ECoG) data from epilepsy patients. MER is a symbolic analysis approach for the detection of recurrence domains of complex dynamical systems from time series. Data were chosen from eight patients undergoing pre-surgical evaluation for drug-resistant temporal lobe epilepsy. MERs for interictal and ictal data were calculated and compared. A statistical test was performed to evaluate the ability of MER to separate the interictal state from the ictal state. MER showed significant changes from the interictal state into the ictal state, where MER was low at the ictal state and is significantly different with that at the interictal state. These suggest that MER is able to separate the ictal state from the interictal state based on ECoG data. It has the potential of detecting the transition between normal brain activity and the ictal state.

Automatic Vagus Nerve Stimulation Triggered by Ictal Tachycardia: Clinical Outcomes and Device Performance--The U.S. E-37 Trial.

PubMed

Fisher, Robert S; Afra, Pegah; Macken, Micheal; Minecan, Daniela N; Bagić, Anto; Benbadis, Selim R; Helmers, Sandra L; Sinha, Saurabh R; Slater, Jeremy; Treiman, David; Begnaud, Jason; Raman, Pradheep; Najimipour, Bita

2016-02-01

The Automatic Stimulation Mode (AutoStim) feature of the Model 106 Vagus Nerve Stimulation (VNS) Therapy System stimulates the left vagus nerve on detecting tachycardia. This study evaluates performance, safety of the AutoStim feature during a 3-5-day Epilepsy Monitoring Unit (EMU) stay and long- term clinical outcomes of the device stimulating in all modes. The E-37 protocol (NCT01846741) was a prospective, unblinded, U.S. multisite study of the AspireSR(®) in subjects with drug-resistant partial onset seizures and history of ictal tachycardia. VNS Normal and Magnet Modes stimulation were present at all times except during the EMU stay. Outpatient visits at 3, 6, and 12 months tracked seizure frequency, severity, quality of life, and adverse events. Twenty implanted subjects (ages 21-69) experienced 89 seizures in the EMU. 28/38 (73.7%) of complex partial and secondarily generalized seizures exhibited ≥20% increase in heart rate change. 31/89 (34.8%) of seizures were treated by Automatic Stimulation on detection; 19/31 (61.3%) seizures ended during the stimulation with a median time from stimulation onset to seizure end of 35 sec. Mean duty cycle at six-months increased from 11% to 16%. At 12 months, quality of life and seizure severity scores improved, and responder rate was 50%. Common adverse events were dysphonia (n = 7), convulsion (n = 6), and oropharyngeal pain (n = 3). The Model 106 performed as intended in the study population, was well tolerated and associated with clinical improvement from baseline. The study design did not allow determination of which factors were responsible for improvements. © 2015 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals, Inc. on behalf of International Neuromodulation Society.

Hippocampal effective synchronization values are not pre-seizure indicator without considering the state of the onset channels

PubMed Central

Shayegh, Farzaneh; Sadri, Saeed; Amirfattahi, Rassoul; Ansari-Asl, Karim; Bellanger, Jean-Jacques; Senhadji, Lotfi

2014-01-01

In this paper, a model-based approach is presented to quantify the effective synchrony between hippocampal areas from depth-EEG signals. This approach is based on the parameter identification procedure of a realistic Multi-Source/Multi-Channel (MSMC) hippocampal model that simulates the function of different areas of hippocampus. In the model it is supposed that the observed signals recorded using intracranial electrodes are generated by some hidden neuronal sources, according to some parameters. An algorithm is proposed to extract the intrinsic (solely relative to one hippocampal area) and extrinsic (coupling coefficients between two areas) model parameters, simultaneously, by a Maximum Likelihood (ML) method. Coupling coefficients are considered as the measure of effective synchronization. This work can be considered as an application of Dynamic Causal Modeling (DCM) that enables us to understand effective synchronization changes during transition from inter-ictal to pre -ictal state. The algorithm is first validated by using some synthetic datasets. Then by extracting the coupling coefficients of real depth-EEG signals by the proposed approach, it is observed that the coupling values show no significant difference between ictal, pre-ictal and inter-ictal states, i.e., either the increase or decrease of coupling coefficients has been observed in all states. However, taking the value of intrinsic parameters into account, pre-seizure state can be distinguished from inter-ictal state. It is claimed that seizures start to appear when there are seizure-related physiological parameters on the onset channel, and its coupling coefficient toward other channels increases simultaneously. As a result of considering both intrinsic and extrinsic parameters as the feature vector, inter-ictal, pre-ictal and ictal activities are discriminated from each other with an accuracy of 91.33% accuracy. PMID:25061815

L-carnitine reduces susceptibility to bupivacaine-induced cardiotoxicity: an experimental study in rats.

PubMed

Wong, Gail K; Pehora, Carolyne; Crawford, Mark W

2017-03-01

The primary aim of this study was to evaluate the effect of acute administration of L-carnitine 100 mg·kg -1 iv on susceptibility to bupivacaine-induced cardiotoxicity in rats. In the first of two experiments, L-carnitine 100 mg·kg -1 iv (n = 10) or saline iv (n = 10) was administered to anesthetized and mechanically ventilated Sprague-Dawley rats following which an infusion of bupivacaine 2.0 mg·kg -1 ·min -1 iv was given until asystole occurred. The primary outcome was the probability of survival. Secondary outcomes included times to asystole, first dysrhythmia, and to 50% reductions in heart rate (HR) and mean arterial pressure (MAP). To determine whether the same dose of L-carnitine is effective in treating established bupivacaine cardiotoxicity, we also conducted a second experiment in which bupivacaine 20 mg·kg -1 iv was infused over 20 sec. Animals (n = 10 per group) received one of four iv treatments: 30% lipid emulsion 4.0 mL·kg -1 , L-carnitine 100 mg·kg -1 , 30% lipid emulsion plus L-carnitine, or saline. The primary outcome was the return of spontaneous circulation (ROSC) during resuscitation. In the first study, L-carnitine 100 mg·kg -1 increased the probability of survival during bupivacaine infusion (hazard ratio, 12.0; 95% confidence interval, 3.5 to 41.5; P < 0.001). In L-carnitine-treated animals, the times to asystole, first dysrhythmia, and to 50% reductions in HR and MAP increased by 33% (P < 0.001), 65% (P < 0.001), 71% (P < 0.001), and 63% (P < 0.001), respectively. In the second study, no animal in the control or L-carnitine alone groups achieved ROSC when compared with the lipid emulsion groups (P < 0.01). These findings suggest that acute administration of L-carnitine 100 mg·kg -1 decreases susceptibility to bupivacaine cardiotoxicity, but is ineffective during resuscitation from bupivacaine-induced cardiac arrest.

Different Impacts of Time From Collapse to First Cardiopulmonary Resuscitation on Outcomes After Witnessed Out-of-Hospital Cardiac Arrest in Adults.

PubMed

Hara, Masahiko; Hayashi, Kenichi; Hikoso, Shungo; Sakata, Yasushi; Kitamura, Tetsuhisa

2015-05-01

It is well known that cardiopulmonary resuscitation (CPR) should be attempted as early as possible after out-of-hospital cardiac arrest (OHCA). However, it is unclear about the impact of time to CPR on OHCA outcome by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electric activity [PEA], and asystole). We enrolled 257,354 adult witnessed OHCA patients between 2007 and 2012 from a prospective nationwide population-based cohort database in Japan. We evaluated relationships between time from collapse to first CPR and neurologically favorable 1-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm after witnessed OHCA. We used logistic model for the estimation of prognosis. The number of OHCA patients with pVT/VF, PEA, and asystole were 38,661, 96,906, and 121,787, respectively. The overall neurologically favorable 1-month survival rates were 21.3% in patients with pVT/VF, 2.7% PEA, and 0.6% asystole. The proportion of asystole increased as the time from collapse to CPR delayed, whereas those of pVT/VF and PEA decreased (trend P<0.001). Estimated incidences of end-point after OHCA became lower as first CPR delayed irrespective of type of first documented rhythm, but were different by the rhythm. The average percentage point decreases in neurologically favorable 1-month survival probability for each incremental minute of CPR delay were 8.3%, 4.4%, and 6.4% for patients with pVT/VF, PEA, and asystole, respectively. The OHCA outcome differed by time to first CPR and first documented rhythm. Shortening of time to first CPR is crucial for improving the OHCA outcome. © 2015 American Heart Association, Inc.

Arrhythmogenic epilepsy and pacing need: A matter of controversy

PubMed Central

Kepez, Alper; Erdogan, Okan

2015-01-01

There is increasing awareness among the cardiology community regarding ictal bradyarrhythmias as a cause of loss of consciousness. A high degree of suspicion is necessary when diagnosing ictal bradyarrhythmias, and delay in diagnosing this condition may lead to morbidity associated with falls and trauma. Ictal bradyarrhythmias have also been suggested to be associated with sudden unexplained death in epilepsy, although evidence related to this association is limited. There is no guideline-directed therapy for symptomatic ictal bradyarrhythmias due to a lack of randomized, controlled trials. Cardiac pacemaker therapy is commonly used for these patients; however, currently, there is no universal agreement on the pacing indications for these patients. In this review, we focus on the pathophysiology and clinical presentation of ictal bradyarrhythmias and then discuss the pacing need based on the available literature data. PMID:26488022

Patterns of human local cerebral glucose metabolism during epileptic seizures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Engel, J. Jr.; Kuhl, D.E.; Phelps, M.E.

1982-10-01

Ictal patterns of local cerebral metabolic rate have been studied in epileptic patients by positron computed tomography with /sup 18/F-labeled 2-fluoro-2-deoxy-D-glucose. Partial seizures were associated with activation of anatomic structures unique to each patient studied. Ictal increases and decreases in local cerebral metabolism were observed. Scans performed during generalized convulsions induced by electroshock demonstrated a diffuse ictal increase and postictal decrease in cerebral metabolism. Petit mal absences were associated with a diffuse increase in cerebral metabolic rate. The ictal fluorodeoxyglucose patterns obtained from patients do not resemble autoradiographic patterns obtained from common experimental animal models of epilepsy.

Secondary Hypertension

MedlinePlus

Secondary hypertension Overview Secondary hypertension (secondary high blood pressure) is high blood pressure that's caused by another medical condition. Secondary hypertension can be caused by conditions that affect your kidneys, ...

Earlier tachycardia onset in right than left mesial temporal lobe seizures.

PubMed

Kato, Kazuhiro; Jin, Kazutaka; Itabashi, Hisashi; Iwasaki, Masaki; Kakisaka, Yosuke; Aoki, Masashi; Nakasato, Nobukazu

2014-10-07

To clarify whether the presence and timing of peri-ictal heart rate (HR) change is a seizure lateralizing sign in patients with mesial temporal lobe epilepsy (mTLE). Long-term video EEGs were retrospectively reviewed in 21 patients, 7 men and 14 women aged 13 to 67 years, diagnosed as mTLE with MRI lesions in the mesial temporal structures (hippocampal sclerosis in 20 cases, amygdala hypertrophy in 1 case). Seventy-seven partial seizures without secondary generalization were extracted. Peri-ictal HR change was compared between 29 right seizures (9 patients) and 48 left seizures (12 patients). HR abruptly increased in all 29 right seizures and 42 of 48 left seizures. Onset time of HR increase in relation to ictal EEG onset was significantly earlier in right seizures than in left seizures (mean ± SD, -11.5 ± 14.8 vs 9.2 ± 21.7 seconds; p < 0.0001). Time of maximum HR was also significantly earlier in right seizures than in left seizures (36.0 ± 18.1 vs 58.0 ± 28.7 seconds; p < 0.0001). Maximum HR changes from baseline showed no significant difference between right and left seizures (47.5 ± 19.1 vs 40.8 ± 20.0/min). Significantly earlier tachycardia in right than left mTLE seizures supports previous hypotheses that the right cerebral hemisphere is dominant in the sympathetic network. No HR change, or delayed tachycardia possibly due to seizure propagation to the right hemisphere, may be a useful lateralizing sign of left mTLE seizures. © 2014 American Academy of Neurology.

The long-term course of temporal lobe epilepsy: From unilateral to bilateral interictal epileptiform discharges in repeated video-EEG monitorings.

PubMed

Gollwitzer, Stephanie; Scott, Catherine A; Farrell, Fiona; Bell, Gail S; de Tisi, Jane; Walker, Matthew C; Wehner, Tim; Sander, Josemir W; Hamer, Hajo M; Diehl, Beate

2017-03-01

Bilateral interictal epileptiform discharges (IED) and ictal patterns are common in temporal lobe epilepsy (TLE) and have been associated with decreased chances of seizure freedom after epilepsy surgery. It is unclear whether secondary epileptogenesis, although demonstrated in experimental models, exists in humans and may account for progression of epilepsy. We reviewed consecutive video-EEG recordings from 1992 to 2014 repeated at least two years apart (mean interval 6.14years) in 100 people diagnosed with TLE. Ictal EEG patterns and IED remained restricted to one hemisphere in 36 people (group 1), 46 exhibited bilateral abnormalities from the first recording (group 2), 18 progressed from unilateral to bilateral EEG pathology over time (group 3). No significant differences between the three groups were seen with respect to age at epilepsy onset, duration, or underlying pathology. Extra-temporal IED during the first EEG recording were associated with an increased risk of developing bilateral epileptiform changes over time (hazard ratio 3.67; 95% CI 1.4, 9.4). Our findings provide some support of progression in TLE and raise the possibility of secondary epileptogenesis in humans. The development of an independent contra-lateral epileptogenic focus is known to be associated with a less favorable surgical outcome. We defined reliable EEG markers for an increased risk of progression to more widespread or independent bitemporal epileptogenicity at an early stage, thus allowing for individualized pre-surgical counselling. Copyright © 2016 Elsevier Inc. All rights reserved.

[Secondary hypertension].

PubMed

Yoshida, Yuichi; Shibata, Hirotaka

2015-11-01

Hypertension is a common disease and a crucial predisposing factor of cardiovascular diseases. Approximately 10% of hypertensive patients are secondary hypertension, a pathogenetic factor of which can be identified. Secondary hypertension consists of endocrine, renal, and other diseases. Primary aldosteronism, Cushing's syndrome, pheochromocytoma, hyperthyroidism, and hypothyroidism result in endocrine hypertension. Renal parenchymal hypertension and renovascular hypertension result in renal hypertension. Other diseases such as obstructive sleep apnea syndrome are also very prevalent in secondary hypertension. It is very crucial to find and treat secondary hypertension at earlier stages since most secondary hypertension is curable or can be dramatically improved by specific treatment. One should keep in mind that screening of secondary hypertension should be done at least once in a daily clinical practice.

Differential neurophysiological effects of magnetic seizure therapy (MST) and electroconvulsive shock (ECS) in non-human primates.

PubMed

Cycowicz, Yael M; Luber, Bruce; Spellman, Timothy; Lisanby, Sarah H

2008-07-01

Magnetic seizure therapy (MST) is under development as a means of reducing the side effects of electroconvulsive therapy (ECT) through enhanced control over patterns of seizure induction and spread. We previously reported that chronic treatment with MST resulted in less impairment in cognitive function than electroconvulsive shock (ECS) in a non-human primate model of convulsive therapy. Here we present quantitative analyses of ictal expression and post-ictal suppression following ECS, MST, and anesthesia-alone sham in the same model to test whether differential neurophysiological characteristics of the seizures could be identified. Rhesus monkeys received 4 weeks of daily treatment with ECS, MST, and anesthesia-alone sham in a counterbalanced order separated by a recovery period. Both ECS and MST were given bilaterally at 2.5 x seizure threshold. Neurophysiological characteristics were derived from two scalp EEG electrode recording sites during and immediately following the ictal period, and were compared to sham treatment. EEG power within four frequencies (delta, theta, alpha and beta) was calculated. Our results support earlier findings from intracerebral electrode recordings demonstrating that MST- and ECS- induced seizures elicit differential patterns of EEG activation. Specifically, we found that ECS shows significantly more marked ictal expression, and more intense post-ictal suppression than MST in the theta, alpha, and beta frequency bands (Ps < .05). However, the ECS and MST were indistinguishable in the delta frequency band during both ictal and post-ictal periods. These results demonstrate that magnetic seizure induction can result in seizures that differ in some neurophysiological respects compared with ECS, but that these modalities share some aspects of seizure expression. The clinical significance of these similarities and differences awaits clinical correlation.

Focal BOLD-fMRI changes in bicuculline-induced tonic-clonic seizures in the rat

PubMed Central

DeSalvo, Matthew N.; Schridde, Ulrich; Mishra, Asht M.; Motelow, Joshua E.; Purcaro, Michael J.; Danielson, Nathan; Bai, Xiaoxiao; Hyder, Fahmeed; Blumenfeld, Hal

2010-01-01

Generalized tonic-clonic seizures cause widespread physiological changes throughout the cerebral cortex and subcortical structures in the brain. Using combined blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) at 9.4 T and electroencephalography (EEG) these changes can be characterized with high spatiotemporal resolution. We studied BOLD changes in anesthetized Wistar rats during bicuculline-induced tonic-clonic seizures. Bicuculline, a GABAA receptor antagonist, was injected systemically and seizure activity was observed on EEG as high amplitude, high-frequency polyspike discharges followed by clonic paroxysmal activity of lower frequency, with mean electrographic seizure duration of 349 s. Our aim was to characterize the spatial localization, direction, and timing of BOLD signal changes during the pre-ictal, ictal and post-ictal periods. Group analysis was performed across seizures using paired t-maps of BOLD signal superimposed on high resolution anatomical images. Regional analysis was then performed using volumes of interest to quantify BOLD timecourses. In the pre-ictal period we found focal BOLD increases in specific areas of somatosensory cortex (S1, S2) and thalamus several seconds before seizure onset. During seizures we observed BOLD increases in cortex, brainstem and thalamus and BOLD decreases in the hippocampus. The largest ictal BOLD increases remained in the focal regions of somatosensory cortex showing pre-ictal increases. During the post-ictal period we observed widespread BOLD decreases. These findings support a model in which “generalized” tonic-clonic seizures begin with focal changes before electrographic seizure onset, which progress to non-uniform changes during seizures, possibly shedding light on the etiology and pathophysiology of similar seizures in humans. PMID:20079442

Ictal lack of binding to brain parenchyma suggests integrity of the blood-brain barrier for 11C-dihydroergotamine during glyceryl trinitrate-induced migraine.

PubMed

Schankin, Christoph J; Maniyar, Farooq H; Seo, Youngho; Kori, Shashidar; Eller, Michael; Chou, Denise E; Blecha, Joseph; Murphy, Stephanie T; Hawkins, Randall A; Sprenger, Till; VanBrocklin, Henry F; Goadsby, Peter J

2016-07-01

SEE DREIER DOI 101093/AWW112 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: For many decades a breakdown of the blood-brain barrier has been postulated to occur in migraine. Hypothetically this would facilitate access of medications, such as dihydroergotamine or triptans, to the brain despite physical properties otherwise restricting their entry. We studied the permeability of the blood-brain barrier in six migraineurs and six control subjects at rest and during acute glyceryl trinitrate-induced migraine attacks using positron emission tomography with the novel radioligand (11)C-dihydroergotamine, which is chemically identical to pharmacologically active dihydroergotamine. The influx rate constant Ki, average dynamic image and time activity curve were assessed using arterial blood sampling and served as measures for receptor binding and thus blood-brain barrier penetration. At rest, there was binding of (11)C-dihydroergotamine in the choroid plexus, pituitary gland, and venous sinuses as expected from the pharmacology of dihydroergotamine. However, there was no binding to the brain parenchyma, including the hippocampus, the area with the highest density of the highest-affinity dihydroergotamine receptors, and the raphe nuclei, a postulated brainstem site of action during migraine, suggesting that dihydroergotamine is not able to cross the blood-brain barrier. This binding pattern was identical in migraineurs during glyceryl trinitrate-induced migraine attacks as well as in matched control subjects. We conclude that (11)C-dihydroergotamine is unable to cross the blood-brain barrier interictally or ictally demonstrating that the blood-brain barrier remains tight for dihydroergotamine during acute glyceryl trinitrate-induced migraine attacks. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved.

Characteristics and generation of secondary jets and secondary gigantic jets

NASA Astrophysics Data System (ADS)

Lee, Li-Jou; Huang, Sung-Ming; Chou, Jung-Kung; Kuo, Cheng-Ling; Chen, Alfred B.; Su, Han-Tzong; Hsu, Rue-Rou; Frey, Harald U.; Takahashi, Yukihiro; Lee, Lou-Chuang

2012-06-01

Secondary transient luminous events (TLEs) recorded by the ISUAL-FORMOSAT2 mission can either be secondary jets or secondary gigantic jets (GJs), depending on their terminal altitudes. The secondary jets emerge from the cloud top beneath the preceding sprites and extend upward to the base of the sprites at ˜50 km. The secondary jets likely are negative electric discharges with vertically straight luminous columns, morphologically resembling the trailing jet of the type-I GJs. The number of luminous columns in a secondary jet seems to be affected by the size of the effective capacitor plate formed near the base of the preceding sprites and the charge distribution left behind by the sprite-inducing positive cloud-to-ground discharges. The secondary GJs originate from the cloud top under the shielding area of the preceding sprites, and develop upward to reach the lower ionosphere at ˜90 km. The observed morphology of the secondary GJs can either be the curvy shifted secondary GJs extending outside the region occupied by the preceding sprites or the straight pop-through secondary GJs developing through the center of the preceding circular sprites. A key factor in determining the terminal height of the secondary TLEs appears to be the local ionosphere boundary height that established by the preceding sprites. The abundance and the distribution of the negative charge in the thundercloud following the sprite-inducing positive cloud-to-ground discharges may play important role in the generation of the secondary TLEs.

Evaluation of clinical and electrocardiographic changes during the euthanasia of horses.

PubMed

Buhl, R; Andersen, L O F; Karlshøj, M; Kanters, J K

2013-06-01

The objective of this prospective field study was to investigate whether commonly used criteria for clinical death occurred at the same time as cardiac death, as determined by electrocardiography. Specific ECG changes during euthanasia were also studied. Twenty-nine horses were euthanized with pentobarbital at two different dose rates and 15 of the 29 horses also received detomidine hydrochloride for sedation. ECG was recorded prior to and during euthanasia. Time to collapse, cessation of reflexes, heart sounds and asystole were recorded. ECG recordings were used to calculate RR intervals, PQ duration, QRS duration, distance from QRS complex to end of T wave corrected for HR (QTc interval), duration of T-wave from peak to end (TpeakTend) and amplitudes of T wave (Tpeak) before and during euthanasia. Differences between groups and ECG changes were evaluated using analysis of variance. Clinical determination of death occurred before cardiac death (P<0.05). Sedated horses took longer to collapse than unsedated horses (P<0.0001), but asystole occurred faster in sedated horses (P<0.0001). No significant changes in QRS duration were observed, but RR, PQ, QTc, TpeakTend and Tpeak were influenced by both pentobarbital dose and sedation (P<0.05-<0.0001). In conclusion, sedation prior to euthanasia resulted in a shorter time to asystole and is therefore recommended for the euthanasia of horses. Importantly, the results show that the clinical definition of death occurred significantly earlier than cardiac death (defined as asystole), which indicates that the clinical declaration of death in horses could be premature compared to that used in humans. Copyright © 2012 Elsevier Ltd. All rights reserved.

C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest.

PubMed

Hernandez, Caleb; Shuler, Klaus; Hannan, Hashibul; Sonyika, Chionesu; Likourezos, Antonios; Marshall, John

2008-02-01

Cardiac arrest is a condition frequently encountered by physicians in the hospital setting including the Emergency Department, Intensive Care Unit and medical/surgical wards. This paper reviews the current literature involving the use of ultrasound in resuscitation and proposes an algorithmic approach for the use of ultrasound during cardiac arrest. At present there is the need for a means of differentiating between various causes of cardiac arrest, which are not a direct result of a primary ventricular arrhythmia. Identifying the cause of pulseless electrical activity or asystole is important as the underlying cause is what guides management in such cases. This approach, incorporating ultrasound to manage cardiac arrest aids in the diagnosis of the most common and easily reversible causes of cardiac arrest not caused by primary ventricular arrhythmia, namely; severe hypovolemia, tension pneumothorax, cardiac tamponade, and massive pulmonary embolus. These four conditions are addressed in this paper using four accepted emergency ultrasound applications to be performed during resuscitation of a cardiac arrest patient with the aim of determining the underlying cause of a cardiac arrest. Identifying the underlying cause of cardiac arrest represents the one of the greatest challenges of managing patients with asystole or PEA and accurate determination has the potential to improve management by guiding therapeutic decisions. We include several clinical images demonstrating examples of cardiac tamponade, massive pulmonary embolus, and severe hypovolemia secondary to abdominal aortic aneurysm. In conclusion, this protocol has the potential to reduce the time required to determine the etiology of a cardiac arrest and thus decrease the time between arrest and appropriate therapy.

Cardiopulmonary complications during pediatric seizures: A prelude to understanding SUDEP

PubMed Central

Singh, Kanwaljit; Katz, Eliot S.; Zarowski, Marcin; Loddenkemper, Tobias; Llewellyn, Nichelle; Manganaro, Sheryl; Gregas, Matt; Pavlova, Milena; Kothare, Sanjeev V.

2017-01-01

Summary Purpose Sudden unexpected death in epilepsy (SUDEP) is an important, unexplained cause of death in epilepsy. Role of cardiopulmonary abnormalities in the pathophysiology of SUDEP is unclear in the pediatric population. Our objective was to assess cardiopulmonary abnormalities during epileptic seizures in children, with the long-term goal of identifying potential mechanisms of SUDEP. Methods We prospectively recorded cardiopulmonary functions using pulse-oximetry, electrocardiography (ECG), and respiratory inductance plethysmography (RIP). Logistic regression was used to evaluate association of cardiorespiratory findings with seizure characteristics and demographics. Key Findings We recorded 101 seizures in 26 children (average age 3.9 years). RIP provided analyzable data in 78% and pulse-oximetry in 63% seizures. Ictal central apnea was more prevalent in patients with younger age (p = 0.01), temporal lobe (p < 0.001), left-sided (p < 0.01), symptomatic generalized (p = 0.01), longer duration seizures (p < 0.0002), desaturation (p < 0.0001), ictal bradycardia (p < 0.05), and more antiepileptic drugs (AEDs; p < 0.01), and was less prevalent in frontal lobe seizures (p < 0.01). Ictal bradypnea was more prevalent in left-sided (p < 0.05), symptomatic generalized seizures (p < 0.01), and in brain magnetic resonance imaging (MRI) lesions (p < 0.1). Ictal tachypnea was more prevalent in older-age (p = 0.01), female gender (p = 0.05), frontal lobe (p < 0.05), right-sided seizures (p < 0.001), fewer AEDs (p < 0.01), and less prevalent in lesional (p < 0.05) and symptomatic generalized seizures (p < 0.05). Ictal bradycardia was more prevalent in male patients (p < 0.05) longer duration seizures (p < 0.05), desaturation (p = 0.001), and more AEDs (p < 0.05), and was less prevalent in frontal lobe seizures (p = 0.01). Ictal and postictal bradycardia were directly associated (p < 0.05). Desaturation was more prevalent in longer-duration seizures (p < 0.0001), ictal

The effect of epileptic seizures on proton MRS visible neurochemical concentrations.

PubMed

Simister, Robert J; McLean, Mary A; Salmenpera, Tuuli M; Barker, Gareth J; Duncan, John S

2008-09-01

To investigate post-ictal changes in cerebral metabolites. We performed a longitudinal quantitative proton magnetic resonance spectroscopy (MRS) study in 10 patients with epilepsy and 10 control subjects. The patients were studied on two occasions: immediately following a seizure, and on a second occasion at least 7h after the most recent seizure. Each study measured N-acetyl aspartate plus N-acetyl aspartyl glutamate (NAAt), Creatine plus phosphocreatine (Cr), Choline containing compounds (Cho) and glutamate plus glutamine (GLX) concentrations using a short-echo time sequence (TE=30ms), and NAAt, Cr and lactate using a second sequence with longer echo time (TE=144ms). The control group was studied on two occasions using the same sequences. No inter-scan differences were observed for the control group. NAAt and NAAt/Cr levels were lower in the patient group at both measured TEs but did not change significantly between studies. The ratio of Cr at TE 144ms to TE 30ms (Cr(144)/Cr(30)) and GLX/Cr were higher and Cho lower in the post-ictal scan compared to the inter-ictal study. Change in Cr(144)/Cr(30) and NAAt(144)/Cr(144) correlated with the post-ictal interval. Lactate measurement at longer TE was not informative. Proton MRS is sensitive to metabolite changes following epileptic seizures within the immediate post-ictal period. The ratio Cr(144)/Cr(30) is the most sensitive measure of metabolic disturbance and is highest in the post-ictal period but appears to normalise within 2h of the most recent seizure.

Regional cerebral blood flow changes associated with focal electrically administered seizure therapy (FEAST).

PubMed

Chahine, George; Short, Baron; Spicer, Ken; Schmidt, Matthew; Burns, Carol; Atoui, Mia; George, Mark S; Sackeim, Harold A; Nahas, Ziad

2014-01-01

Use of electroconvulsive therapy (ECT) is limited by cognitive disturbance. Focal electrically-administered seizure therapy (FEAST) is designed to initiate focal seizures in the prefrontal cortex. To date, no studies have documented the effects of FEAST on regional cerebral blood flow (rCBF). A 72 year old depressed man underwent three single photon emission computed tomography (SPECT) scans to capture the onset and resolution of seizures triggered with right unilateral FEAST. We used Bioimage Suite for within-subject statistical analyses of perfusion differences ictally and post-ictally compared with the baseline scan. Early ictal increases in regional cerebral blood flow (rCBF) were limited to the right prefrontal cortex. Post-ictally, perfusion was reduced in bilateral frontal and occipital cortices and increased in left motor and precuneus cortex. FEAST appears to triggers focal onsets of seizure activity in the right prefrontal cortex with subsequent generalization. Future studies are needed on a larger sample. Copyright © 2014 Elsevier Inc. All rights reserved.

Automated Non-invasive Video-Microscopy of Oyster Spat Heart Rate during Acute Temperature Change: Impact of Acclimation Temperature

PubMed Central

Domnik, Nicolle J.; Polymeropoulos, Elias T.; Elliott, Nicholas G.; Frappell, Peter B.; Fisher, John T.

2016-01-01

We developed an automated, non-invasive method to detect real-time cardiac contraction in post-larval (1.1–1.7 mm length), juvenile oysters (i.e., oyster spat) via a fiber-optic trans-illumination system. The system is housed within a temperature-controlled chamber and video microscopy imaging of the heart was coupled with video edge-detection to measure cardiac contraction, inter-beat interval, and heart rate (HR). We used the method to address the hypothesis that cool acclimation (10°C vs. 22°C—Ta10 or Ta22, respectively; each n = 8) would preserve cardiac phenotype (assessed via HR variability, HRV analysis and maintained cardiac activity) during acute temperature changes. The temperature ramp (TR) protocol comprised 2°C steps (10 min/experimental temperature, Texp) from 22°C to 10°C to 22°C. HR was related to Texp in both acclimation groups. Spat became asystolic at low temperatures, particularly Ta22 spat (Ta22: 8/8 vs. Ta10: 3/8 asystolic at Texp = 10°C). The rate of HR decrease during cooling was less in Ta10 vs. Ta22 spat when asystole was included in analysis (P = 0.026). Time-domain HRV was inversely related to temperature and elevated in Ta10 vs. Ta22 spat (P < 0.001), whereas a lack of defined peaks in spectral density precluded frequency-domain analysis. Application of the method during an acute cooling challenge revealed that cool temperature acclimation preserved active cardiac contraction in oyster spat and increased time-domain HRV responses, whereas warm acclimation enhanced asystole. These physiologic changes highlight the need for studies of mechanisms, and have translational potential for oyster aquaculture practices. PMID:27445833

Tilt testing results are influenced by tilt protocol.

PubMed

Zyśko, Dorota; Fedorowski, Artur; Nilsson, David; Rudnicki, Jerzy; Gajek, Jacek; Melander, Olle; Sutton, Richard

2016-07-01

It is unknown how the return to supine position influences duration of loss of consciousness (LOC) and cardioinhibition during tilt test. Retrospective analysis of two datasets containing records of patients who underwent tilt testing for unexplained syncope in two centres was performed. Patients, totalling 1232, were included in the study: 262 in a Swedish centre and 970 patients in a Polish centre. In Sweden, tilt table with tilt-down time (TDT) of 18 s was used (Group II). In Poland, two different tilt tables were used, one of them with TDT of 10 s (Group I, n = 325), and the other with TDT of 47 s (Group III, n = 645). Cardioinhibitory reflex occurred most frequently in Group III, whereas number of pauses >3 s, frequency of very long asystole ≥30 s, and the total duration of pauses >3 s demonstrated a trend to increase from Group I to III. Duration of LOC in Groups II and III was significantly longer compared with Group I (32.0 and 33.7 s vs. 16.4 s). In the multivariate-adjusted regression model, cardioinhibitory reflex was predicted by tilt-table model (odds ratio per model with increasing TDT: 1.40; 95% confidence interval, 1.19-1.64; P < 0.0001), whereas LOC duration was longer with increasing TDT (P < 0.0001) and age (P < 0.0001). Longer TDT during induced vasovagal syncope increases the prevalence of cardioinhibitory reflex and prolongs the duration of LOC. Tilt-down time does not affect asystolic pause duration but delay may lead to occurrence of multiple pauses, higher frequency of very long asystole, and longer total asystole duration. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Pulseless electrical activity: a misdiagnosed entity during asphyxia in newborn infants?

PubMed

Patel, Sparsh; Cheung, Po-Yin; Solevåg, Anne Lee; Barrington, Keith J; Kamlin, C Omar Farouk; Davis, Peter G; Schmölzer, Georg M

2018-06-12

The 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant's heart rate (HR) when determining the need for resuscitation at birth. However, a recent case report raised concerns about this technique in the delivery room. To compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets. Neonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope. Overall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation. Clinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Association of initial rhythm with neurologically favorable survival in non-shockable out-of-hospital cardiac arrest without a bystander witness or bystander cardiopulmonary resuscitation.

PubMed

Fukuda, Tatsuma; Ohashi-Fukuda, Naoko; Matsubara, Takehiro; Doi, Kent; Kitsuta, Yoichi; Nakajima, Susumu; Yahagi, Naoki

2016-05-01

Out-of-hospital cardiac arrest (OHCA) has a predominantly non-shockable rhythm. Non-shockable rhythm, and the absence of a bystander witness or bystander cardiopulmonary resuscitation (CPR) are associated with poor outcomes. However, the association between the type of non-shockable rhythm and outcomes is not well known. To examine the association between the initial rhythm and neurologically favorable outcomes after non-shockable OHCA without a bystander witness or bystander CPR. In a nationwide, population-based, cohort study, we analyzed 213,984 adult OHCA patients with a non-shockable rhythm who had neither a bystander witness nor bystander CPR. They were identified through the Japanese national OHCA registry data from January 1, 2005 to December 31, 2010. The primary outcome was neurologically favorable survival. Among 213,984 patients, the initial rhythm was Pulseless Electrical Activity (PEA) in 31,179 patients (14.6%) and Asystole in 182,805 patients (85.4%). The neurological outcome was more favorable in PEA than in Asystole (1.4% vs. 0.2%, p<0.0001). After adjusting for age, sex, etiology of arrest, epinephrine administration, advanced airway management, time from call to contact with patient, and calendar year, PEA was associated with an increased neurologically favorable survival rate (odds ratio 7.86; 95% confidence interval 6.81-9.07). In subgroup analysis stratified by age group (18-64, 65-84, or ≥85years), the neurologically favorable survival rate was ≥1% in PEA, even for patients aged ≥85years, but <1% in Asystole among all age groups. PEA and Asystole should not be considered to be identical to non-shockable rhythm, but rather should be clearly distinguished from each other from the perspective of quantitative medical futility. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Vocational Cosmetology: An Integrated Secondary-Post Secondary Curriculum Guide (Tentative).

ERIC Educational Resources Information Center

Utah State Board for Vocational Education, Salt Lake City.

This guide for Cosmetology is part of a public school effort to articulate secondary and post-secondary vocational education programs. It is organized in a pattern of behavioral objectives so that students may enter and complete the program in high school, or in a post-secondary program, or may transfer and continue without loss of time. Of the…

Fast spiking interneuron control of seizure propagation in a cortical slice model of focal epilepsy

PubMed Central

Cammarota, Mario; Losi, Gabriele; Chiavegato, Angela; Zonta, Micaela; Carmignoto, Giorgio

2013-01-01

In different animal models of focal epilepsy, seizure-like ictal discharge propagation is transiently opposed by feedforward inhibition. The specific cellular source of this signal and the mechanism by which inhibition ultimately becomes ineffective are, however, undefined. We used a brain slice model to study how focal ictal discharges that were repetitively evoked from the same site, and at precise times, propagate across the cortex. We used Ca2+ imaging and simultaneous single/dual cell recordings from pyramidal neurons (PyNs) and different classes of interneurons in rodents, including G42 and GIN transgenic mice expressing the green fluorescence protein in parvalbumin (Pv)-fast spiking (FS) and somatostatin (Som) interneurons, respectively. We found that these two classes of interneurons fired intensively shortly after ictal discharge generation at the focus. The inhibitory barrages that were recorded in PyNs occurred in coincidence with Pv-FS, but not with Som interneuron burst discharges. Furthermore, the strength of inhibitory barrages increased or decreased in parallel with increased or decreased firing in Pv-FS interneurons but not in Som interneurons. A firing impairment of Pv-FS interneurons caused by a membrane depolarization was found to precede ictal discharge onset in neighbouring pyramidal neurons. This event may account for the collapse of local inhibition that allows spatially defined clusters of PyNs to be recruited into propagating ictal discharges. Our study demonstrates that Pv-FS interneurons are a major source of the inhibitory barrages that oppose ictal discharge propagation and raises the possibility that targeting Pv-FS interneurons represents a new therapeutic strategy to prevent the generalization of human focal seizures. PMID:23207591

Seizure threshold increases can be predicted by EEG quality in right unilateral ultrabrief ECT.

PubMed

Gálvez, Verònica; Hadzi-Pavlovic, Dusan; Waite, Susan; Loo, Colleen K

2017-12-01

Increases in seizure threshold (ST) over a course of brief pulse ECT can be predicted by decreases in EEG quality, informing ECT dose adjustment to maintain adequate supra-threshold dosing. ST increases also occur over a course of right unilateral ultrabrief (RUL UB) ECT, but no data exist on the relationship between ST increases and EEG indices. This study (n = 35) investigated if increases in ST over RUL UB ECT treatments could be predicted by a decline in seizure quality. ST titration was performed at ECT session one and seven, with treatment dosing maintained stable (at 6-8 times ST) in intervening sessions. Seizure quality indices (slow-wave onset, mid-ictal amplitude, regularity, stereotypy, and post-ictal suppression) were manually rated at the first supra-threshold treatment, and last supra-threshold treatment before re-titration, using a structured rating scale, by a single trained rater blinded to the ECT session being rated. Twenty-one subjects (60%) had a ST increase. The association between ST changes and EEG quality indices was analysed by logistic regression, yielding a significant model (p < 0.001). Initial ST (p < 0.05) and percentage change in mid-ictal amplitude (p < 0.05) were significant predictors of change in ST. Percentage change in post-ictal suppression reached trend level significance (p = 0.065). Increases in ST over a RUL UB ECT course may be predicted by decreases in seizure quality, specifically decline in mid-ictal amplitude and potentially in post-ictal suppression. Such EEG indices may be able to inform when dose adjustments are necessary to maintain adequate supra-threshold dosing in RUL UB ECT.

Secondary Craters

NASA Image and Video Library

2016-12-21

This image of a southern mid-latitude crater was intended to investigate the lineated material on the crater floor. At the higher resolution of HiRISE, the image reveals a landscape peppered by small impact craters. These craters range from about 30 meters in diameter down to the resolution limit (about 2 meter diameter in this image acquired by averaging 2x2 picture elements). Such dense clusters of small craters are frequently formed by secondary craters, caused by the impact of material that was excavated and ejected from the surface of Mars during the creation of a larger nearby crater by the impact of a comet or an asteroid. Secondary impact craters are both interesting and vexing. They are interesting because they show the trajectories of the material that was ejected from the primary impact with the greatest speeds, typically material from near the surface of the blast zone. Secondary craters are often found along the traces of crater rays, linear features that extend radially from fresh impact craters and can reach many crater diameters in length. Secondary craters can be useful when crater rays are visible and the small craters can be associated with a particular primary impact crater. They can be used to constrain the age of the surface where they fell, since the surface must be older than the impact event. The age of the crater can be approximately estimated from the probability of an impact that produced a crater of such a size within a given area of Mars over a given time period. But these secondary craters can also be perplexing when no crater rays are preserved and a source crater is not easily identifiable, as is the case here. The impact that formed these secondary craters took place long enough ago that their association with a particular crater has been erased. They do not appear along the trace of a crater ray that is still apparent in visible or thermal infrared observations. These secondary craters complicate the task of estimating the age of

Predicting seizures in untreated temporal lobe epilepsy using point-process nonlinear models of heartbeat dynamics.

PubMed

Valenza, G; Romigi, A; Citi, L; Placidi, F; Izzi, F; Albanese, M; Scilingo, E P; Marciani, M G; Duggento, A; Guerrisi, M; Toschi, N; Barbieri, R

2016-08-01

Symptoms of temporal lobe epilepsy (TLE) are frequently associated with autonomic dysregulation, whose underlying biological processes are thought to strongly contribute to sudden unexpected death in epilepsy (SUDEP). While abnormal cardiovascular patterns commonly occur during ictal events, putative patterns of autonomic cardiac effects during pre-ictal (PRE) periods (i.e. periods preceding seizures) are still unknown. In this study, we investigated TLE-related heart rate variability (HRV) through instantaneous, nonlinear estimates of cardiovascular oscillations during inter-ictal (INT) and PRE periods. ECG recordings from 12 patients with TLE were processed to extract standard HRV indices, as well as indices of instantaneous HRV complexity (dominant Lyapunov exponent and entropy) and higher-order statistics (bispectra) obtained through definition of inhomogeneous point-process nonlinear models, employing Volterra-Laguerre expansions of linear, quadratic, and cubic kernels. Experimental results demonstrate that the best INT vs. PRE classification performance (balanced accuracy: 73.91%) was achieved only when retaining the time-varying, nonlinear, and non-stationary structure of heartbeat dynamical features. The proposed approach opens novel important avenues in predicting ictal events using information gathered from cardiovascular signals exclusively.

Seizure outcomes of temporal lobe epilepsy surgery in patients with normal MRI and without specific histopathology.

PubMed

Ivanovic, Jugoslav; Larsson, Pål G; Østby, Ylva; Hald, John; Krossnes, Bård K; Fjeld, Jan G; Pripp, Are H; Alfstad, Kristin Å; Egge, Arild; Stanisic, Milo

2017-05-01

Seizure outcome following surgery in pharmacoresistant temporal lobe epilepsy patients with normal magnetic resonance imaging and normal or non-specific histopathology is not sufficiently presented in the literature. In a retrospective design, we reviewed data of 263 patients who had undergone temporal lobe epilepsy surgery and identified 26 (9.9%) who met the inclusion criteria. Seizure outcomes were determined at 2-year follow-up. Potential predictors of Engel class I (satisfactory outcome) were identified by logistic regression analyses. Engel class I outcome was achieved in 61.5% of patients, 50% being completely seizure free (Engel class IA outcome). The strongest predictors of satisfactory outcome were typical ictal seizure semiology (p = 0.048) and localised ictal discharges on scalp EEG (p = 0.036). Surgery might be an effective treatment choice for the majority of these patients, although outcomes are less favourable than in patients with magnetic resonance imaging-defined lesional temporal lobe epilepsy. Typical ictal seizure semiology and localised ictal discharges on scalp EEG were predictors of Engel class I outcome.

Outcomes of patients with altered level of consciousness and abnormal electroencephalogram: A retrospective cohort study

PubMed Central

Ferrari-Marinho, Taissa; Naves, Pedro Vicente Ferreira; Ladeia-Frota, Carol; Caboclo, Luís Otávio

2017-01-01

Introduction Nonconvulsive seizures (NCS) are frequent in hospitalized patients and may further aggravate injury in the already damaged brain, potentially worsening outcomes in encephalopathic patients. Therefore, both early seizure recognition and treatment have been advocated to prevent further neurological damage. Objective Evaluate the main EEG patterns seen in patients with impaired consciousness and address the effect of treatment with antiepileptic drugs (AEDs), continuous intravenous anesthetic drugs (IVADs), or the combination of both, on outcomes. Methods This was a single center retrospective cohort study conducted in a private, tertiary care hospital. Consecutive adult patients with altered consciousness submitted to a routine EEG between January 2008 and February 2011 were included in this study. Based on EEG pattern, patients were assigned to one of three groups: Group Interictal Patterns (IP; EEG showing only interictal epileptiform discharges or triphasic waves), Group Rhythmic and Periodic Patterns (RPP; at least one EEG with rhythmic or periodic patterns), and Group Ictal (Ictal; at least one EEG showing ictal pattern). Groups were compared in terms of administered antiepileptic treatment and frequency of unfavorable outcomes (modified Rankin scale ≥3 and in-hospital mortality). Results Two hundred and six patients (475 EEGs) were included in this analysis. Interictal pattern was observed in 35.4% (73/206) of patients, RPP in 53.4% (110/206) and ictal in 11.2% (23/206) of patients. Treatment with AEDs, IVADs or a combination of both was administered in half of the patients. While all Ictal group patients received treatment (AEDs or IVADs), only 24/73 (32.9%) IP group patients and 55/108 (50.9%) RPP group patients were treated (p<0.001). Hospital length of stay (LOS) and frequency of unfavorable outcomes did not differ among the groups. In-hospital mortality was higher in IVADs treated RPP patients compared to AEDs treated RPP patients [11/19 (57

Outcomes of patients with altered level of consciousness and abnormal electroencephalogram: A retrospective cohort study.

PubMed

Sanches, Paula Rodrigues; Corrêa, Thiago Domingos; Ferrari-Marinho, Taissa; Naves, Pedro Vicente Ferreira; Ladeia-Frota, Carol; Caboclo, Luís Otávio

2017-01-01

Nonconvulsive seizures (NCS) are frequent in hospitalized patients and may further aggravate injury in the already damaged brain, potentially worsening outcomes in encephalopathic patients. Therefore, both early seizure recognition and treatment have been advocated to prevent further neurological damage. Evaluate the main EEG patterns seen in patients with impaired consciousness and address the effect of treatment with antiepileptic drugs (AEDs), continuous intravenous anesthetic drugs (IVADs), or the combination of both, on outcomes. This was a single center retrospective cohort study conducted in a private, tertiary care hospital. Consecutive adult patients with altered consciousness submitted to a routine EEG between January 2008 and February 2011 were included in this study. Based on EEG pattern, patients were assigned to one of three groups: Group Interictal Patterns (IP; EEG showing only interictal epileptiform discharges or triphasic waves), Group Rhythmic and Periodic Patterns (RPP; at least one EEG with rhythmic or periodic patterns), and Group Ictal (Ictal; at least one EEG showing ictal pattern). Groups were compared in terms of administered antiepileptic treatment and frequency of unfavorable outcomes (modified Rankin scale ≥3 and in-hospital mortality). Two hundred and six patients (475 EEGs) were included in this analysis. Interictal pattern was observed in 35.4% (73/206) of patients, RPP in 53.4% (110/206) and ictal in 11.2% (23/206) of patients. Treatment with AEDs, IVADs or a combination of both was administered in half of the patients. While all Ictal group patients received treatment (AEDs or IVADs), only 24/73 (32.9%) IP group patients and 55/108 (50.9%) RPP group patients were treated (p<0.001). Hospital length of stay (LOS) and frequency of unfavorable outcomes did not differ among the groups. In-hospital mortality was higher in IVADs treated RPP patients compared to AEDs treated RPP patients [11/19 (57.9%) vs. 11/36 (30.6%) patients

Secondary Evaluations.

ERIC Educational Resources Information Center

Cook, Thomas D.

Secondary evaluations, in which an investigator takes a body of evaluation data collected by a primary evaluation researcher and examines the data to see if the original conclusions about the program correspond with his own, are discussed. The different kinds of secondary evaluations and the advantages and disadvantages of each are pointed out,…

Training Secondary Reading Specialists.

ERIC Educational Resources Information Center

Burmeister, Lou E.

In an effort to clarify and elaborate on the International Reading Association's recommendations for professional preparation of secondary reading teachers and secondary reading consultants, competency objectives are presented in performance-based behavioral terms for secondary reading teachers and consultants. The objectives are stated in an…

Teaching with Secondary Data.

ERIC Educational Resources Information Center

Sobol, Jeff

1981-01-01

Presents a general overview of the use of secondary data in teaching sociology on the college level. Topics discussed include potential for additional applications, sources which constitute secondary data, reasons for using secondary data in the classroom, information about computing, and potential problems. (Author/DB)

Team-based model for non-operating room airway management: validation using a simulation-based study.

PubMed

DeMaria, S; Berman, D J; Goldberg, A; Lin, H-M; Khelemsky, Y; Levine, A I

2016-07-01

Non-operating room (non-OR) airway management has previously been identified as an area of concern because it carries a significant risk for complications. One reason for this could be attributed to the independent practice of residents in these situations. The aim of the present study was to ascertain whether differences in performance exist between residents working alone vs with a resident partner when encountering simulated non-OR airway management scenarios. Thirty-six anaesthesia residents were randomized into two groups. Each group experienced three separate scenarios (two scenarios initially and then a third 6 weeks later). The scenarios consisted of one control scenario and two critical event scenarios [i.e. asystole during laryngoscopy and pulseless electrical activity (PEA) upon post-intubation institution of positive pressure ventilation]. One group experienced the simulated non-OR scenarios alone (Solo group). The other group consisted of resident pairs, participating in the same three scenarios (Team group). Although the time to intubation did not differ between the Solo and Team groups, there were several differences in performance. The Team group received better overall performance ratings for the asystole (8.5 vs 5.5 out of 10; P<0.001) and PEA (8.5 vs 5.8 out of 10; P<0.001) scenarios. The Team group was also able to recognize asystole and PEA conditions faster than the Solo group [10.1 vs 23.5 s (P<0.001) and 13.3 vs 36.0 s (P<0.001), respectively]. Residents who performed a simulated intubation with a second trained provider had better overall performance than those who practised independently. The residents who practised in a group were also faster to diagnose serious complications, including peri-intubation asystole and PEA. Given these data, it is reasonable that training programmes consider performing all non-OR airway management with a team-based method. © The Author 2016. Published by Oxford University Press on behalf of the British

Pulmonary hypertension and predominant right heart failure in thyrotoxicosis.

PubMed

Paran, Yael; Nimrod, Adi; Goldin, Yelena; Justo, Dan

2006-05-01

In this report we discuss a patient with predominant right heart failure and pulmonary hypertension, caused by thyrotoxicosis due to Graves disease, which deteriorated to asystole, due to amiodarone administration for rapid atrial fibrillation.

Quantitative secondary electron detection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Agrawal, Jyoti; Joy, David C.; Nayak, Subuhadarshi

Quantitative Secondary Electron Detection (QSED) using the array of solid state devices (SSD) based electron-counters enable critical dimension metrology measurements in materials such as semiconductors, nanomaterials, and biological samples (FIG. 3). Methods and devices effect a quantitative detection of secondary electrons with the array of solid state detectors comprising a number of solid state detectors. An array senses the number of secondary electrons with a plurality of solid state detectors, counting the number of secondary electrons with a time to digital converter circuit in counter mode.

The quantitative measurement of consciousness during epileptic seizures.

PubMed

Nani, Andrea; Cavanna, Andrea E

2014-01-01

The assessment of consciousness is a fundamental element in the classification of epileptic seizures. It is, therefore, of great importance for clinical practice to develop instruments that enable an accurate and reliable measurement of the alteration of consciousness during seizures. Over the last few years, three psychometric scales have been specifically proposed to measure ictal consciousness: the Ictal Consciousness Inventory (ICI), the Consciousness Seizure Scale (CSS), and the Responsiveness in Epilepsy Scale--versions I and II (RES-I and RES-II). The ICI is a self-report psychometric instrument which retrospectively assesses ictal consciousness along the dimensions of the level/arousal and contents/awareness. The CSS has been used by clinicians to quantify the impairment of consciousness in order to establish correlations with the brain mechanisms underlying alterations of consciousness during temporal lobe seizures. The most recently developed observer-rated instrument is the RES-I, which has been used to assess responsiveness during epileptic seizures in patients undergoing video-EEG. The implementation of standardized psychometric tools for the assessment of ictal consciousness can complement clinical observations and contribute to improve accuracy in seizure classification. © 2013.

Muscle and eye movement artifact removal prior to EEG source localization.

PubMed

Hallez, Hans; Vergult, Anneleen; Phlypo, Ronald; Van Hese, Peter; De Clercq, Wim; D'Asseler, Yves; Van de Walle, Rik; Vanrumste, Bart; Van Paesschen, Wim; Van Huffel, Sabine; Lemahieu, Ignace

2006-01-01

Muscle and eye movement artifacts are very prominent in the ictal EEG of patients suffering from epilepsy, thus making the dipole localization of ictal activity very unreliable. Recently, two techniques (BSS-CCA and pSVD) were developed to remove those artifacts. The purpose of this study is to assess whether the removal of muscle and eye movement artifacts improves the EEG dipole source localization. We used a total of 8 EEG fragments, each from another patient, first unfiltered, then filtered by the BSS-CCA and pSVD. In both the filtered and unfiltered EEG fragments we estimated multiple dipoles using RAP-MUSIC. The resulting dipoles were subjected to a K-means clustering algorithm, to extract the most prominent cluster. We found that the removal of muscle and eye artifact results to tighter and more clear dipole clusters. Furthermore, we found that localization of the filtered EEG corresponded with the localization derived from the ictal SPECT in 7 of the 8 patients. Therefore, we can conclude that the BSS-CCA and pSVD improve localization of ictal activity, thus making the localization more reliable for the presurgical evaluation of the patient.

Frontal lobe epileptic seizures are accompanied by elevated pitch during verbal communication.

PubMed

Speck, Iva; Echternach, Matthias; Sammler, Daniela; Schulze-Bonhage, Andreas

2018-03-01

The objective of our study was to assess alterations in speech as a possible localizing sign in frontal lobe epilepsy. Ictal speech was analyzed in 18 patients with frontal lobe epilepsy (FLE) during seizures and in the interictal period. Matched identical words were analyzed regarding alterations in fundamental frequency (ƒo) as an approximation of pitch. In patients with FLE, ƒo of ictal utterances was significantly higher than ƒo in interictal recordings (p = 0.016). Ictal ƒo increases occurred in both FLE of right and left seizure origin. In contrast, a matched temporal lobe epilepsy (TLE) group showed less pronounced increases in ƒo, and only in patients with right-sided seizure foci. This study for the first time shows significant voice alterations in ictal speech in a cohort of patients with FLE. This may contribute to the localization of the epileptic focus. Increases in ƒo were interestingly found in frontal lobe seizures with origin in either hemisphere, suggesting a bilateral involvement to the planning of speech production, in contrast to a more right-sided lateralization of pitch perception in prosodic processing. Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.

K-Partite RNA Secondary Structures

NASA Astrophysics Data System (ADS)

Jiang, Minghui; Tejada, Pedro J.; Lasisi, Ramoni O.; Cheng, Shanhong; Fechser, D. Scott

RNA secondary structure prediction is a fundamental problem in structural bioinformatics. The prediction problem is difficult because RNA secondary structures may contain pseudoknots formed by crossing base pairs. We introduce k-partite secondary structures as a simple classification of RNA secondary structures with pseudoknots. An RNA secondary structure is k-partite if it is the union of k pseudoknot-free sub-structures. Most known RNA secondary structures are either bipartite or tripartite. We show that there exists a constant number k such that any secondary structure can be modified into a k-partite secondary structure with approximately the same free energy. This offers a partial explanation of the prevalence of k-partite secondary structures with small k. We give a complete characterization of the computational complexities of recognizing k-partite secondary structures for all k ≥ 2, and show that this recognition problem is essentially the same as the k-colorability problem on circle graphs. We present two simple heuristics, iterated peeling and first-fit packing, for finding k-partite RNA secondary structures. For maximizing the number of base pair stackings, our iterated peeling heuristic achieves a constant approximation ratio of at most k for 2 ≤ k ≤ 5, and at most frac6{1-(1-6/k)^k} le frac6{1-e^{-6}} < 6.01491 for k ≥ 6. Experiment on sequences from PseudoBase shows that our first-fit packing heuristic outperforms the leading method HotKnots in predicting RNA secondary structures with pseudoknots. Source code, data set, and experimental results are available at http://www.cs.usu.edu/ mjiang/rna/kpartite/.

Secondary psychoses: an update

PubMed Central

Keshavan, Matcheri S; Kaneko, Yoshio

2013-01-01

Psychotic disorders due to a known medical illness or substance use are collectively termed secondary psychoses. In this paper, we first review the historic evolution of the concept of secondary versus primary psychosis and how this distinction supplanted the earlier misleading classification of psychoses into organic and functional. We then outline the clinical features and approach to the diagnosis of secondary psychotic disorders. Features such as atypical presentation, temporal relation to detectable medical cause, evidence of direct physiological causal relationship to the etiological agent, and the absence of evidence of a primary psychotic illness that may better explain the presentation suggest consideration of a secondary psychosis. Finally, we discuss how careful studies of secondary psychotic disorders can help elucidate the pathophysiology of primary, or idiopathic, psychotic disorders such as schizophrenia. We illustrate this issue through a discussion of three secondary psychotic disorders — psychoses associated with temporal lobe epilepsy, velocardiofacial syndrome, and N-methyl D-aspartate (NMDA) receptor encephalitis — that can, respectively, provide neuroanatomical, genetic, and neurochemical models of schizophrenia pathogenesis. PMID:23471787

Microencephaloceles: another dual pathology of intractable temporal lobe epilepsy in childhood.

PubMed

Aquilina, Kristian; Clarke, Dave F; Wheless, James W; Boop, Frederick A

2010-04-01

Temporal lobe encephaloceles can be associated with temporal lobe epilepsy. The authors report on the case of an adolescent with multiple microencephaloceles, in the anterolateral middle fossa floor, identified at surgery (temporal lobectomy) for intractable partial-onset seizures of temporal origin. Magnetic resonance imaging revealed only hippocampal atrophy. Subdural electrodes demonstrated ictal activity arising primarily from the anterior and lateral temporal lobe, close to the microencephaloceles, spreading to the anterior and posterior mesial structures. Pathological examination revealed diffuse temporal gliosis involving the hippocampus, together with microdysgenesis of the amygdala. The literature on epilepsy secondary to encephaloceles is reviewed and the contribution of the microencephaloceles to the seizure disorder in this patient is discussed.

Postictal apnea as an important mechanism for SUDEP: A near-SUDEP with continuous EEG-ECG-EMG recording.

PubMed

Jin, Lang; Zhang, Ying; Wang, Xiao-Li; Zhang, Wen-Juan; Liu, Yong-Hong; Jiang, Zhao

2017-09-01

Sudden unexpected death in epilepsy (SUDEP) is one of the most frequent causes of death among patients with epilepsy. Most SUDEP or near-SUDEP are unwitnessed and not observed or recorded during video-EEG recording in epilepsy monitoring units. This report describes a young woman with post ictal apnea and generalized EEG suppression (PGES) after a secondary generalized tonic-clonic seizure (sGTCS). This was accompanied by bradycardia and then ventricular tachycardia (VT). But at the end of VT, the patient's breath recovered without any intervention, such as cardio-respiratory resuscitation. This case report with continuous EEG, EKG, EMG during near SUDEP may provide insights into the mechanism of action. Copyright © 2017 Elsevier Ltd. All rights reserved.

Secondary School Dropouts.

ERIC Educational Resources Information Center

Minnesota State Dept. of Education, St. Paul.

This report on secondary school dropouts consists of an analysis of the scope and nature of the dropout problem, a discussion of successful programs and activities for dropouts, a description of a pilot study involving Minnesota public secondary schools and Comprehensive Employment and Training Act (CETA) agencies, and presentation of…

Secondary fuel delivery system

DOEpatents

Parker, David M.; Cai, Weidong; Garan, Daniel W.; Harris, Arthur J.

2010-02-23

A secondary fuel delivery system for delivering a secondary stream of fuel and/or diluent to a secondary combustion zone located in the transition piece of a combustion engine, downstream of the engine primary combustion region is disclosed. The system includes a manifold formed integral to, and surrounding a portion of, the transition piece, a manifold inlet port, and a collection of injection nozzles. A flowsleeve augments fuel/diluent flow velocity and improves the system cooling effectiveness. Passive cooling elements, including effusion cooling holes located within the transition boundary and thermal-stress-dissipating gaps that resist thermal stress accumulation, provide supplemental heat dissipation in key areas. The system delivers a secondary fuel/diluent mixture to a secondary combustion zone located along the length of the transition piece, while reducing the impact of elevated vibration levels found within the transition piece and avoiding the heat dissipation difficulties often associated with traditional vibration reduction methods.

Recurrent epileptic Wernicke aphasia.

PubMed

Sahaya, Kinshuk; Dhand, Upinder K; Goyal, Munish K; Soni, Chetan R; Sahota, Pradeep K

2010-04-15

We report a patient with recurrent epileptic Wernicke aphasia who prior to this presentation, had been misdiagnosed as transient ischemic attacks for several years. This case report emphasizes the consideration of epileptic nature of aphasia when a clear alternate etiology is unavailable, even when EEG fails to show a clear ictal pattern. We also present a brief discussion of previously reported ictal aphasias. Copyright 2010 Elsevier B.V. All rights reserved.

Financial Literacy of Secondary Students, and Its Place within Secondary Schools

ERIC Educational Resources Information Center

Neill, Alex; Berg, Melanie; Stevens, Liesje

2014-01-01

This report investigates the behaviour, attitudes and experiences of New Zealand secondary students with money and financial products. It also looks at financial literacy programmes in New Zealand secondary schools and explores barriers to the implementation of financial literacy teaching. The research was commissioned by the Commission for…

Is There a Relation between EEG-Slow Waves and Memory Dysfunction in Epilepsy? A Critical Appraisal

PubMed Central

Höller, Yvonne; Trinka, Eugen

2015-01-01

Is there a relationship between peri-ictal slow waves, loss of consciousness, memory, and slow-wave sleep, in patients with different forms of epilepsy? We hypothesize that mechanisms, which result in peri-ictal slow-wave activity as detected by the electroencephalogram, could negatively affect memory processes. Slow waves (≤4 Hz) can be found in seizures with impairment of consciousness and also occur in focal seizures without impairment of consciousness but with inhibited access to memory functions. Peri-ictal slow waves are regarded as dysfunctional and are probably caused by mechanisms, which are essential to disturb the consolidation of memory entries in these patients. This is in strong contrast to physiological slow-wave activity during deep sleep, which is thought to group memory-consolidating fast oscillatory activity. In patients with epilepsy, slow waves may not only correlate with the peri-ictal clouding of consciousness, but could be the epiphenomenon of mechanisms, which interfere with normal brain function in a wider range. These mechanisms may have transient impacts on memory, such as temporary inhibition of memory systems, altered patterns of hippocampal–neocortical interactions during slow-wave sleep, or disturbed cross-frequency coupling of slow and fast oscillations. In addition, repeated tonic–clonic seizures over the years in uncontrolled chronic epilepsy may cause a progressive cognitive decline. This hypothesis can only be assessed in long-term prospective studies. These studies could disentangle the reversible short-term impacts of seizures, and the impacts of chronic uncontrolled seizures. Chronic uncontrolled seizures lead to irreversible memory impairment. By contrast, short-term impacts do not necessarily lead to a progressive cognitive decline but result in significantly impaired peri-ictal memory performance. PMID:26124717

Neural Connectivity in Epilepsy as Measured by Granger Causality.

PubMed

Coben, Robert; Mohammad-Rezazadeh, Iman

2015-01-01

Epilepsy is a chronic neurological disorder characterized by repeated seizures or excessive electrical discharges in a group of brain cells. Prevalence rates include about 50 million people worldwide and 10% of all people have at least one seizure at one time in their lives. Connectivity models of epilepsy serve to provide a deeper understanding of the processes that control and regulate seizure activity. These models have received initial support and have included measures of EEG, MEG, and MRI connectivity. Preliminary findings have shown regions of increased connectivity in the immediate regions surrounding the seizure foci and associated low connectivity in nearby regions and pathways. There is also early evidence to suggest that these patterns change during ictal events and that these changes may even by related to the occurrence or triggering of seizure events. We present data showing how Granger causality can be used with EEG data to measure connectivity across brain regions involved in ictal events and their resolution. We have provided two case examples as a demonstration of how to obtain and interpret such data. EEG data of ictal events are processed, converted to independent components and their dipole localizations, and these are used to measure causality and connectivity between these locations. Both examples have shown hypercoupling near the seizure foci and low causality across nearby and associated neuronal pathways. This technique also allows us to track how these measures change over time and during the ictal and post-ictal periods. Areas for further research into this technique, its application to epilepsy, and the formation of more effective therapeutic interventions are recommended.

Acute and chronic efficacy of Bumetanide in an in vitro model of post-traumatic epileptogenesis

PubMed Central

Dzhala, Volodymyr; Staley, Kevin

2014-01-01

Background Seizures triggered by acute injuries to the developing brain respond poorly to first-line medications that target the inhibitory chloride-permeable GABAA-receptor. Neuronal injury is associated with profound increases in cytoplasmic chloride ([Cl−]i) resulting in depolarizing GABA signaling, higher seizure propensity and limited efficacy of GABAergic anticonvulsants. The Na+-K+-2Cl− (NKCC1) co-transporter blocker bumetanide reduces [Cl−]i and causes more negative GABA equilibrium potential in injured neurons. We therefore tested both the acute and chronic efficacy of bumetanide on early post-traumatic ictal-like epileptiform discharges and epileptogenesis. Methods Acute hippocampal slices were used as a model of severe traumatic brain injury and post-traumatic epileptogenesis. Hippocampal slices were then incubated for three weeks. After a one week latent period slice cultures developed chronic spontaneous ictal-like discharges. The anticonvulsant and antiepileptogenic efficacy of bumetanide, phenobarbital and the combination of these drugs was studied. Results Bumetanide reduced the frequency and power of early post-traumatic ictal-like discharges in vitro and enhanced the anticonvulsant efficacy of phenobarbital. Continuous two-three week administration of bumetanide as well as phenobarbital in combination with bumetanide failed to prevent post-traumatic ictal-like discharges and epileptogenesis. Conclusions Our data demonstrate a persistent contribution of NKCC1 co-transport in post-traumatic ictal-like activity, presumably as a consequence of chronic alterations in neuronal chloride homeostasis and GABA-mediated inhibition. New strategies for more effective reduction in post-traumatic and seizure-induced [Cl−]i accumulation could provide the basis for effective treatments for post-traumatic epileptogenesis and the resultant seizures. PMID:25495911

Periictal activity in cooled asphyxiated neonates with seizures.

PubMed

Major, Philippe; Lortie, Anne; Dehaes, Mathieu; Lodygensky, Gregory Anton; Gallagher, Anne; Carmant, Lionel; Birca, Ala

2017-04-01

Seizures are common in critically ill neonates. Both seizures and antiepileptic treatments may lead to short term complications and worsen the outcomes. Predicting the risks of seizure reoccurrence could enable individual treatment regimens and better outcomes. We aimed to identify EEG signatures of seizure reoccurrence by investigating periictal electrographic features and spectral power characteristics in hypothermic neonates with hypoxic-ischemic encephalopathy (HIE) with or without reoccurrence of seizures on rewarming. We recruited five consecutive HIE neonates, submitted to continuous EEG monitoring, with high seizure burden (>20% per hour) while undergoing therapeutic hypothermia. Two of them had reoccurrence of seizures on rewarming. We performed quantitative analysis of fifteen artifact-free consecutive seizures to appreciate spectral power changes between the interictal, preictal and ictal periods, separately for each patient. Visual analysis allowed description of electrographic features associated with ictal events. Every patient demonstrated a significant increase in overall spectral power from the interictal to preictal and ictal periods (p<0.01). Alpha power increase was more pronounced in the two patients with reoccurrence of seizures on rewarming and significant when comparing both interictal-to-preictal and interictal-to-ictal periods. This alpha activity increase could be also appreciated using visual analysis and distinguished neonates with and without seizure reoccurrence. This distinct alpha activity preceding ictal onset could represent a biomarker of propensity for seizure reoccurrence in neonates. Future studies should be performed to confirm whether quantitative periictal characteristics and electrographic features allow predicting the risks of seizure reoccurrence in HIE neonates and other critically ill patients. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Dual Credit: Secondary to Post-Secondary Transitions--Dual Credit Policy and Practice in BC and Elsewhere

ERIC Educational Resources Information Center

FitzGibbon, John

2015-01-01

There has been considerable interest in British Columbia in improving secondary to post-secondary transitions, and the provincial government and secondary and post-secondary institutions have adopted a number of strategies intended to aid in successful student transition from one system to the other. This paper looks specifically at the policy and…

Hush sign: a new clinical sign in temporal lobe epilepsy.

PubMed

Kutlu, Gulnihal; Bilir, Erhan; Erdem, Atilla; Gomceli, Yasemin B; Kurt, G Semiha; Serdaroglu, Ayse

2005-05-01

Neurologists have been analyzing the clinical behaviors that occur during seizures for many years. Several ictal behaviors have been defined in temporal lobe epilepsy (TLE). Ictal behaviors are especially important in the evaluation of epilepsy surgery candidates. We propose a new lateralizing sign in TLE originating from the nondominant hemisphere-the "hush" sign. Our patients were 30- and 21-year old women (Cases 1 and 2, respectively). Their epileptogenic foci were localized to the right mesial temporal region after noninvasive presurgical investigations. Case 1 had no cranial MRI abnormality, whereas cranial MRI revealed right hippocampal atrophy in Case 2. These women repeatedly moved their right index fingers to their mouth while puckering their lips during complex partial seizures. We have named this ictal behavior the "hush" sign. Anterior temporal lobectomy with amygdalohippocampectomy was performed in both patients, and pathological examinations revealed hippocampal sclerosis. The "hush" sign no longer occurred after seizures were controlled. They were seizure free as of 30 and 31 months of follow-up, respectively. We believe that the "hush" sign may be supportive of a diagnosis of TLE originating from the nondominant hemisphere. This sign may occur as a result of ictal activation of a specific brain region in this hemisphere.

Prescience as an aura of temporal lobe epilepsy.

PubMed

Sadler, R Mark; Rahey, Susan

2004-08-01

A patient with a distinct aura of prescience as a manifestation of temporal lobe epilepsy was encountered. The experience prompted a review of this ictal phenomenon among patients attending a tertiary care epilepsy outpatient clinic. A computer epilepsy database was searched for patients with simple partial sensory seizures and complex partial seizures with auras. Identified patients had charts reviewed for details of the auras; patients were contacted and asked to provide written descriptions of their experiences. Literature searches (PubMed) were done by using the terms "precognition" or "prescience" and "seizures" or "epilepsy." Standard comprehensive epilepsy textbooks were reviewed. The charts of 218 patients were reviewed from 927 in the database; three had prescience as an ictal feature. The patients' descriptions were very similar in all cases (a profound sense of "knowing" what was going to happen in their environment in the immediate future). The experience was distinct from déjà vu and other psychic experiences. All patients probably have temporal lobe epilepsy. Only one other description of prescience as an ictal feature was found in the literature. Prescience can occur as an ictal feature of temporal lobe epilepsy and represents a previously underreported psychic phenomenon. The potential lateralizing value of this symptom is yet to be determined.

Belongingness in Early Secondary School: Key Factors that Primary and Secondary Schools Need to Consider

PubMed Central

Vaz, Sharmila; Falkmer, Marita; Ciccarelli, Marina; Passmore, Anne; Parsons, Richard; Black, Melissa; Cuomo, Belinda; Tan, Tele; Falkmer, Torbjörn

2015-01-01

It is unknown if, and how, students redefine their sense of school belongingness after negotiating the transition to secondary school. The current study used longitudinal data from 266 students with, and without, disabilities who negotiated the transition from 52 primary schools to 152 secondary schools. The study presents the 13 most significant personal student and contextual factors associated with belongingness in the first year of secondary school. Student perception of school belongingness was found to be stable across the transition. No variability in school belongingness due to gender, disability or household-socio-economic status (SES) was noted. Primary school belongingness accounted for 22% of the variability in secondary school belongingness. Several personal student factors (competence, coping skills) and school factors (low-level classroom task-goal orientation), which influenced belongingness in primary school, continued to influence belongingness in secondary school. In secondary school, effort-goal orientation of the student and perception of their school’s tolerance to disability were each associated with perception of school belongingness. Family factors did not influence belongingness in secondary school. Findings of the current study highlight the need for primary schools to foster belongingness among their students at an early age, and transfer students’ belongingness profiles as part of the hand-over documentation. Most of the factors that influenced school belongingness before and after the transition to secondary are amenable to change. PMID:26372554

Belongingness in Early Secondary School: Key Factors that Primary and Secondary Schools Need to Consider.

PubMed

Vaz, Sharmila; Falkmer, Marita; Ciccarelli, Marina; Passmore, Anne; Parsons, Richard; Black, Melissa; Cuomo, Belinda; Tan, Tele; Falkmer, Torbjörn

2015-01-01

It is unknown if, and how, students redefine their sense of school belongingness after negotiating the transition to secondary school. The current study used longitudinal data from 266 students with, and without, disabilities who negotiated the transition from 52 primary schools to 152 secondary schools. The study presents the 13 most significant personal student and contextual factors associated with belongingness in the first year of secondary school. Student perception of school belongingness was found to be stable across the transition. No variability in school belongingness due to gender, disability or household-socio-economic status (SES) was noted. Primary school belongingness accounted for 22% of the variability in secondary school belongingness. Several personal student factors (competence, coping skills) and school factors (low-level classroom task-goal orientation), which influenced belongingness in primary school, continued to influence belongingness in secondary school. In secondary school, effort-goal orientation of the student and perception of their school's tolerance to disability were each associated with perception of school belongingness. Family factors did not influence belongingness in secondary school. Findings of the current study highlight the need for primary schools to foster belongingness among their students at an early age, and transfer students' belongingness profiles as part of the hand-over documentation. Most of the factors that influenced school belongingness before and after the transition to secondary are amenable to change.

Connecting Advanced and Secondary Mathematics

ERIC Educational Resources Information Center

Murray, Eileen; Baldinger, Erin; Wasserman, Nicholas; Broderick, Shawn; White, Diana

2017-01-01

There is an ongoing debate among scholars in understanding what mathematical knowledge secondary teachers should have in order to provide effective instruction. We explore connections between advanced and secondary mathematics as an entry point into this debate. In many cases, advanced mathematics is considered relevant for secondary teachers…

Neuropathy secondary to drugs

MedlinePlus

... drugs URL of this page: //medlineplus.gov/ency/article/000700.htm Neuropathy secondary to drugs To use the sharing features on this page, please enable JavaScript. Neuropathy secondary to drugs is a loss of ...

34 CFR 300.36 - Secondary school.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Secondary school. 300.36 Section 300.36 Education... DISABILITIES General Definitions Used in This Part § 300.36 Secondary school. Secondary school means a nonprofit institutional day or residential school, including a public secondary charter school that provides...

Secondary Syphilitic Lesions

PubMed Central

Baughn, Robert E.; Musher, Daniel M.

2005-01-01

An important theme that emerges from all early historical accounts is that in addition to the decreased virulence of Treponema pallidum, the incidence of secondary syphilis has decreased drastically over the past three centuries. Even in the early 20th century, most syphilologists were of the opinion that the disease had undergone changes in its manifestations and that they were dealing with an attenuated form of the spirochete. Such opinions were based primarily on the observations that violent cutaneous reactions and fatalities associated with the secondary stage had become extremely rare. The rate of primary and secondary syphilis in the United States increased in 2002 for the second consecutive year. After a decade-long decline that led to an all-time low in 2000, the recent trend is attributable, to a large extent, by a increase in reported syphilis cases among men, particularly homosexual and bisexual men having sex with men. The present review addresses the clinical and diagnostic criteria for the recognition of secondary syphilis, the clinical course and manifestations of the disease if allowed to proceed past the primary stage of disease in untreated individuals, and the treatment for this stage of the disease. PMID:15653827

Secondary pool boiling effects

NASA Astrophysics Data System (ADS)

Kruse, C.; Tsubaki, A.; Zuhlke, C.; Anderson, T.; Alexander, D.; Gogos, G.; Ndao, S.

2016-02-01

A pool boiling phenomenon referred to as secondary boiling effects is discussed. Based on the experimental trends, a mechanism is proposed that identifies the parameters that lead to this phenomenon. Secondary boiling effects refer to a distinct decrease in the wall superheat temperature near the critical heat flux due to a significant increase in the heat transfer coefficient. Recent pool boiling heat transfer experiments using femtosecond laser processed Inconel, stainless steel, and copper multiscale surfaces consistently displayed secondary boiling effects, which were found to be a result of both temperature drop along the microstructures and nucleation characteristic length scales. The temperature drop is a function of microstructure height and thermal conductivity. An increased microstructure height and a decreased thermal conductivity result in a significant temperature drop along the microstructures. This temperature drop becomes more pronounced at higher heat fluxes and along with the right nucleation characteristic length scales results in a change of the boiling dynamics. Nucleation spreads from the bottom of the microstructure valleys to the top of the microstructures, resulting in a decreased surface superheat with an increasing heat flux. This decrease in the wall superheat at higher heat fluxes is reflected by a "hook back" of the traditional boiling curve and is thus referred to as secondary boiling effects. In addition, a boiling hysteresis during increasing and decreasing heat flux develops due to the secondary boiling effects. This hysteresis further validates the existence of secondary boiling effects.

[Preventive dentistry 5. Secondary caries].

PubMed

Hollanders, A C C; Kuper, N K; Opdam, N J M; Huysmans, M C D N J M

2017-05-01

Secondary caries is reported as one of the most important reasons for replacing restorations. The patient's general caries risk plays an important role in the development of secondary caries. The connection, at the patient level, between various factors, the risk of caries and restoration factors, such as the presence of a gap and the kind of restoration material, deserves additional investigation. The minimum gap width in which secondary caries can develop is most likely less than 100 µm and could depend on the patient's caries risk. Composite restorations seem more susceptible to secondary caries than amalgam restorations in patients with high caries risk. So far, there is no unambiguous explanation for this difference. The prevention of secondary caries is comparable to that of primary caries and stresses the importance of fluoride, diet and oral hygiene.

Reconstitution of a secondary cell wall in a secondary cell wall-deficient Arabidopsis mutant.

PubMed

Sakamoto, Shingo; Mitsuda, Nobutaka

2015-02-01

The secondary cell wall constitutes a rigid frame of cells in plant tissues where rigidity is required. Deposition of the secondary cell wall in fiber cells contributes to the production of wood in woody plants. The secondary cell wall is assembled through co-operative activities of many enzymes, and their gene expression is precisely regulated by a pyramidal cascade of transcription factors. Deposition of a transmuted secondary cell wall in empty fiber cells by expressing selected gene(s) in this cascade has not been attempted previously. In this proof-of-concept study, we expressed chimeric activators of 24 transcription factors that are preferentially expressed in the stem, in empty fiber cells of the Arabidopsis nst1-1 nst3-1 double mutant, which lacks a secondary cell wall in fiber cells, under the control of the NST3 promoter. The chimeric activators of MYB46, SND2 and ANAC075, as well as NST3, reconstituted a secondary cell wall with different characteristics from those of the wild type in terms of its composition. The transgenic lines expressing the SND2 or ANAC075 chimeric activator showed increased glucose and xylose, and lower lignin content, whereas the transgenic line expressing the MYB46 chimeric activator showed increased mannose content. The expression profile of downstream genes in each transgenic line was also different from that of the wild type. This study proposed a new screening strategy to identify factors of secondary wall formation and also suggested the potential of the artificially reconstituted secondary cell walls as a novel raw material for production of bioethanol and other chemicals. © The Author 2014. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists.

Focal Electrically Administered Seizure Therapy (FEAST): A novel form of ECT illustrates the roles of current directionality, polarity, and electrode configuration in seizure induction

PubMed Central

Spellman, Timothy; Peterchev, Angel V.; Lisanby, Sarah H.

2009-01-01

Electroconvulsive therapy (ECT) is a mainstay in the treatment of severe, medication resistant depression. The antidepressant efficacy and cognitive side effects of ECT are influenced by the position of the electrodes on the head and by the degree to which the electrical stimulus exceeds the threshold for seizure induction. However, surprisingly little is known about the effects of other key electrical parameters such as current directionality, polarity, and electrode configuration. Understanding these relationships may inform the optimization of therapeutic interventions to improve their risk/benefit ratio. To elucidate these relationships, we evaluated a novel form of ECT (focal electrically administered seizure therapy, FEAST) that combines unidirectional stimulation, control of polarity, and an asymmetrical electrode configuration, and contrasted it with conventional ECT in a nonhuman primate model. Rhesus monkeys had their seizure thresholds determined on separate days with ECT conditions that crossed the factors of current directionality (unidirectional or bidirectional), electrode configuration (standard bilateral or FEAST (small anterior and large posterior electrode)), and polarity (assignment of anode and cathode in unidirectional stimulation). Ictal expression and post-ictal suppression were quantified via scalp EEG. Findings were replicated and extended in a second experiment with the same subjects. Seizures were induced in each of 75 trials, including 42 FEAST procedures. Seizure thresholds were lower with unidirectional than with bidirectional stimulation (p<0.0001), and lower in FEAST than in bilateral ECS (p=0.0294). Ictal power was greatest in posterior-anode unidirectional FEAST, and post-ictal suppression was strongest in anterior-anode FEAST (p=0.0008 and p=0.0024, respectively). EEG power was higher in the stimulated hemisphere in posterior-anode FEAST (p=0.0246), consistent with the anode being the site of strongest activation. These findings

Focal electrically administered seizure therapy: a novel form of ECT illustrates the roles of current directionality, polarity, and electrode configuration in seizure induction.

PubMed

Spellman, Timothy; Peterchev, Angel V; Lisanby, Sarah H

2009-07-01

Electroconvulsive therapy (ECT) is a mainstay in the treatment of severe, medication-resistant depression. The antidepressant efficacy and cognitive side effects of ECT are influenced by the position of the electrodes on the head and by the degree to which the electrical stimulus exceeds the threshold for seizure induction. However, surprisingly little is known about the effects of other key electrical parameters such as current directionality, polarity, and electrode configuration. Understanding these relationships may inform the optimization of therapeutic interventions to improve their risk/benefit ratio. To elucidate these relationships, we evaluated a novel form of ECT (focal electrically administered seizure therapy, FEAST) that combines unidirectional stimulation, control of polarity, and an asymmetrical electrode configuration, and contrasted it with conventional ECT in a nonhuman primate model. Rhesus monkeys had their seizure thresholds determined on separate days with ECT conditions that crossed the factors of current directionality (unidirectional or bidirectional), electrode configuration (standard bilateral or FEAST (small anterior and large posterior electrode)), and polarity (assignment of anode and cathode in unidirectional stimulation). Ictal expression and post-ictal suppression were quantified through scalp EEG. Findings were replicated and extended in a second experiment with the same subjects. Seizures were induced in each of the 75 trials, including 42 FEAST procedures. Seizure thresholds were lower with unidirectional than with bidirectional stimulation (p<0.0001), and lower in FEAST than in bilateral ECS (p=0.0294). Ictal power was greatest in posterior-anode unidirectional FEAST, and post-ictal suppression was strongest in anterior-anode FEAST (p=0.0008 and p=0.0024, respectively). EEG power was higher in the stimulated hemisphere in posterior-anode FEAST (p=0.0246), consistent with the anode being the site of strongest activation. These

Surgical Treatment of Pediatric Epileptic Encephalopathies

PubMed Central

Fridley, J.; Reddy, G.; Curry, D.; Agadi, S.

2013-01-01

Pediatric epileptiform encephalopathies are a group of neurologically devastating disorders related to uncontrolled ictal and interictal epileptic activity, with a poor prognosis. Despite the number of pharmacological options for treatment of epilepsy, many of these patients are drug resistant. For these patients with uncontrolled epilepsy, motor and/or neuropsychological deterioration is common. To prevent these secondary consequences, surgery is often considered as either a curative or a palliative option. Magnetic resonance imaging to look for epileptic lesions that may be surgically treated is an essential part of the workup for these patients. Many surgical procedures for the treatment of epileptiform encephalopathies have been reported in the literature. In this paper the evidence for these procedures for the treatment of pediatric epileptiform encephalopathies is reviewed. PMID:24288601

[Epilepsy and psychic seizures].

PubMed

Fukao, Kenjiro

2006-01-01

Various psychic symptoms as ictal manifestation have been found in epileptic patients. They are classified as psychic seizures within simple partial seizures, and subclassified into affective, cognitive, dysmnesic seizures and so on, although the subclassification is not yet satisfactory and almost nothing is known about their relationships with normal brain functions. In this presentation, the speaker picked ictal fear, déjà vu and out-of-body experience (OBE) from them and suggested that studies on these symptoms could uniquely contribute to the progress of cognitive neuroscience, presenting some results from the research and case study that he had been engaged in. Psychic seizures are prone to be missed or misdiagnosed unless psychiatrists with sufficient knowledge and experience on epilepsy care would not treat them, because they are subjective symptoms that are diverse and subtle, while they have some characteristics as ictal symptoms.

Consciousness, epilepsy, and emotional qualia.

PubMed

Monaco, Francesco; Mula, Marco; Cavanna, Andrea E

2005-09-01

The last decade has seen a renaissance of consciousness studies, witnessed by the growing number of scientific investigations on this topic. The concept of consciousness is central in epileptology, despite the methodological difficulties concerning its application to the multifaced ictal phenomenology. The authors provide an up-to-date review of the neurological literature on the relationship between epilepsy and consciousness and propose a bidimensional model (level vs contents of consciousness) for the description of seizure-induced alterations of conscious states, according to the findings of recent neuroimaging studies. The neurophysiological correlates of ictal loss and impairment of consciousness are also reviewed. Special attention is paid to the subjective experiential states associated with medial temporal lobe epilepsy. Such ictal phenomenal experiences are suggested as a paradigm for a neuroscientific approach to the apparently elusive philosophical concept of qualia. Epilepsy is confirmed to represent a privileged window over basic neurobiological mechanisms of consciousness.

Information theoretic measures of network coordination in high-frequency scalp EEG reveal dynamic patterns associated with seizure termination

PubMed Central

Stamoulis, Catherine; Schomer, Donald L.; Chang, Bernard S.

2013-01-01

How a seizure terminates is still under-studied and, despite its clinical importance, remains an obscure phase of seizure evolution. Recent studies of seizure-related scalp EEGs at frequencies >100 Hz suggest that neural activity, in the form of oscillations and/or neuronal network interactions, may play an important role in preictal/ictal seizure evolution [2, 31]. However, the role of high-frequency activity in seizure termination, is unknown, if it exists at all. Using information theoretic measures of network coordination, this study investigated ictal and immediate postictal neurodynamic interactions encoded in scalp EEGs from a relatively small sample of 8 patients with focal epilepsy and multiple seizures originating in temporal and/or frontal brain regions, at frequencies ≤100 Hz and >100 Hz, respectively. Despite some heterogeneity in the dynamics of these interactions, consistent patterns were also estimated. Specifically, in several seizures, linear or non-linear increase in high-frequency neuronal coordination during ictal intervals, coincided with a corresponding decrease in coordination at frequencies <100 Hz, suggesting a potential interference role of high-frequency activity, to disrupt abnormal ictal synchrony at lower frequencies. These changes in network synchrony started at least 20–30 sec prior to seizure offset, depending on the seizure duration. Opposite patterns were estimated at frequencies ≤100 Hz in several seizures. These results raise the possibility that high-frequency interference may occur in the form of progressive network coordination during the ictal interval, which continues during the postictal interval. This may be one of several possible mechanisms that facilitate seizure termination. In fact, inhibition of pairwise interactions between EEGs by other signals in their spatial neighborhood, quantified by negative interaction information, was estimated at frequencies ≤100 Hz, at least in some seizures. PMID:23608198

Information theoretic measures of network coordination in high-frequency scalp EEG reveal dynamic patterns associated with seizure termination.

PubMed

Stamoulis, Catherine; Schomer, Donald L; Chang, Bernard S

2013-08-01

How a seizure terminates is still under-studied and, despite its clinical importance, remains an obscure phase of seizure evolution. Recent studies of seizure-related scalp EEGs at frequencies >100 Hz suggest that neural activity, in the form of oscillations and/or neuronal network interactions, may play an important role in preictal/ictal seizure evolution (Andrade-Valenca et al., 2011; Stamoulis et al., 2012). However, the role of high-frequency activity in seizure termination, is unknown, if it exists at all. Using information theoretic measures of network coordination, this study investigated ictal and immediate postictal neurodynamic interactions encoded in scalp EEGs from a relatively small sample of 8 patients with focal epilepsy and multiple seizures originating in temporal and/or frontal brain regions, at frequencies ≤ 100 Hz and >100 Hz, respectively. Despite some heterogeneity in the dynamics of these interactions, consistent patterns were also estimated. Specifically, in several seizures, linear or non-linear increase in high-frequency neuronal coordination during ictal intervals, coincided with a corresponding decrease in coordination at frequencies <100 Hz, suggesting a potential interference role of high-frequency activity, to disrupt abnormal ictal synchrony at lower frequencies. These changes in network synchrony started at least 20-30s prior to seizure offset, depending on the seizure duration. Opposite patterns were estimated at frequencies ≤ 100 Hz in several seizures. These results raise the possibility that high-frequency interference may occur in the form of progressive network coordination during the ictal interval, which continues during the postictal interval. This may be one of several possible mechanisms that facilitate seizure termination. In fact, inhibition of pairwise interactions between EEGs by other signals in their spatial neighborhood, quantified by negative interaction information, was estimated at frequencies ≤ 100 Hz

Gifted Secondary School Students

ERIC Educational Resources Information Center

Brigandi, Carla B.; Siegle, Del; Weiner, Jennie M.; Gubbins, E. Jean; Little, Catherine A.

2016-01-01

Grounded in the Enrichment Triad and Achievement Orientation Models, this qualitative case study builds understanding of the relationship between participation in Type III Enrichment and the achievement orientation attitude of goal valuation in gifted secondary school students. Participants included 10 gifted secondary school students, their…

Secondary metabolites from Ganoderma.

PubMed

Baby, Sabulal; Johnson, Anil John; Govindan, Balaji

2015-06-01

Ganoderma is a genus of medicinal mushrooms. This review deals with secondary metabolites isolated from Ganoderma and their biological significance. Phytochemical studies over the last 40years led to the isolation of 431 secondary metabolites from various Ganoderma species. The major secondary compounds isolated are (a) C30 lanostanes (ganoderic acids), (b) C30 lanostanes (aldehydes, alcohols, esters, glycosides, lactones, ketones), (c) C27 lanostanes (lucidenic acids), (d) C27 lanostanes (alcohols, lactones, esters), (e) C24, C25 lanostanes (f) C30 pentacyclic triterpenes, (g) meroterpenoids, (h) farnesyl hydroquinones (meroterpenoids), (i) C15 sesquiterpenoids, (j) steroids, (k) alkaloids, (l) prenyl hydroquinone (m) benzofurans, (n) benzopyran-4-one derivatives and (o) benzenoid derivatives. Ganoderma lucidum is the species extensively studied for its secondary metabolites and biological activities. Ganoderma applanatum, Ganoderma colossum, Ganoderma sinense, Ganoderma cochlear, Ganoderma tsugae, Ganoderma amboinense, Ganoderma orbiforme, Ganoderma resinaceum, Ganoderma hainanense, Ganoderma concinna, Ganoderma pfeifferi, Ganoderma neo-japonicum, Ganoderma tropicum, Ganoderma australe, Ganoderma carnosum, Ganoderma fornicatum, Ganoderma lipsiense (synonym G. applanatum), Ganoderma mastoporum, Ganoderma theaecolum, Ganoderma boninense, Ganoderma capense and Ganoderma annulare are the other Ganoderma species subjected to phytochemical studies. Further phytochemical studies on Ganoderma could lead to the discovery of hitherto unknown biologically active secondary metabolites. Copyright © 2015 Elsevier Ltd. All rights reserved.

Secondary Fire Analysis.

DTIC Science & Technology

1981-09-01

of wood frame and brick veneer, slab on grade construction), killed 33, injured more than 1,000, derailed a train, destroyed 4,000 cars, uprooted most... of a nuclear detonation) in or near structures, with emphasis on critical facil- ities and industries. Assessment of the potential for secondary fires...and/or 517 East Dayshore, Redwood City, CA 94063 DistI pial (DETACHABLE SUMMARY) SECONDARY FIRE ANALYSIS This report presents the results of a

Adrenal Mass Causing Secondary Hypertension.

PubMed

Robinson, Darlene Y

2015-11-01

Most hypertensive patients have essential (primary) hypertension; only 5% to 10% have a secondary cause. Two clinical characteristics suggestive of secondary hypertension are early onset (< 30 years of age) and severe hypertension (>180/110 mm Hg). When faced with these findings, clinicians should consider a secondary cause of hypertension. A 22-year-old woman being evaluated for asthma exacerbation in the emergency department was noted to have severe persistent hypertension. Additional evaluation revealed severe hypokalemia, metabolic alkalosis, and hypernatremia. The patient was admitted to the hospital for blood pressure management, electrolyte replacement, and further evaluation of presumed hyperaldosteronism. Diagnostic imaging revealed a large adrenal mass. Surgical resection was performed, leading to a diagnosis of hyperaldosteronism caused by adrenal carcinoma. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Secondary hypertension is far less common than essential hypertension; however, considering the large volume of patients seen in emergency departments, it is likely that some will have secondary hypertension. Emergency physicians should be aware of the clinical characteristics that suggest secondary hypertension so that the appropriate diagnostic and treatment pathways can be pursued. Copyright © 2015 Elsevier Inc. All rights reserved.

Secondary osteoporosis.

PubMed

Gennari, C; Martini, G; Nuti, R

1998-06-01

Generalized osteoporosis currently represents a heterogeneous group of conditions with many different causes and pathogenetic mechanisms, that often are variably associated. The term "secondary" is applied to all patients with osteoporosis in whom the identifiable causal factors are other than menopause and aging. In this heterogeneous group of conditions, produced by many different pathogenetic mechanisms, a negative bone balance may be variably associated with low, normal or increased bone remodeling states. A consistent group of secondary osteoporosis is related to endocrinological or iatrogenic causes. Exogenous hypercortisolism may be considered an important risk factor for secondary osteoporosis in the community, and probably glucocorticoid-induced osteoporosis is the most common type of secondary osteoporosis. Supraphysiological doses of corticosteroids cause two abnormalities in bone metabolism: a relative increase in bone resorption, and a relative reduction in bone formation. Bone loss, mostly of trabecular bone, with its resultant fractures is the most incapacitating consequence of osteoporosis. The estimated incidence of fractures in patients prescribed corticosteroid is 30% to 50%. Osteoporosis is considered one of the potentially serious side effects of heparin therapy. The occurrence of heparin-induced osteoporosis appeared to be strictly related to the length of treatment (over 4-5 months), and the dosage (15,000 U or more daily), but the pathogenesis is poorly understood. It has been suggested that heparin could cause an increase in bone resorption by increasing the number of differentiated osteoclasts, and by enhancing the activity of individual osteoclasts. Hyperthyroidism is frequently associated with loss of trabecular and cortical bone; the enhanced bone turnover that develops in thyrotoxicosis is characterized by an increase in the number of osteoclasts and resorption sites, and an increase in the ratio of resorptive to formative bone

Rhythmic EEG patterns in extremely preterm infants: Classification and association with brain injury and outcome.

PubMed

Weeke, Lauren C; van Ooijen, Inge M; Groenendaal, Floris; van Huffelen, Alexander C; van Haastert, Ingrid C; van Stam, Carolien; Benders, Manon J; Toet, Mona C; Hellström-Westas, Lena; de Vries, Linda S

2017-12-01

Classify rhythmic EEG patterns in extremely preterm infants and relate these to brain injury and outcome. Retrospective analysis of 77 infants born <28 weeks gestational age (GA) who had a 2-channel EEG during the first 72 h after birth. Patterns detected by the BrainZ seizure detection algorithm were categorized: ictal discharges, periodic epileptiform discharges (PEDs) and other waveforms. Brain injury was assessed with sequential cranial ultrasound (cUS) and MRI at term-equivalent age. Neurodevelopmental outcome was assessed with the BSITD-III (2 years) and WPPSI-III-NL (5 years). Rhythmic patterns were observed in 62.3% (ictal 1.3%, PEDs 44%, other waveforms 86.3%) with multiple patterns in 36.4%. Ictal discharges were only observed in one and excluded from further analyses. The EEG location of the other waveforms (p<0.05), but not PEDs (p=0.238), was significantly associated with head position. No relation was found between the median total duration of each pattern and injury on cUS and MRI or cognition at 2 and 5 years. Clear ictal discharges are rare in extremely preterm infants. PEDs are common but their significance is unclear. Rhythmic waveforms related to head position are likely artefacts. Rhythmic EEG patterns may have a different significance in extremely preterm infants. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

The cortical focus in childhood absence epilepsy; evidence from nonlinear analysis of scalp EEG recordings.

PubMed

Sarrigiannis, Ptolemaios G; Zhao, Yifan; He, Fei; Billings, Stephen A; Baster, Kathleen; Rittey, Chris; Yianni, John; Zis, Panagiotis; Wei, Hualiang; Hadjivassiliou, Marios; Grünewald, Richard

2018-03-01

To determine the origin and dynamic characteristics of the generalised hyper-synchronous spike and wave (SW) discharges in childhood absence epilepsy (CAE). We applied nonlinear methods, the error reduction ratio (ERR) causality test and cross-frequency analysis, with a nonlinear autoregressive exogenous (NARX) model, to electroencephalograms (EEGs) from CAE, selected with stringent electro-clinical criteria (17 cases, 42 absences). We analysed the pre-ictal and ictal strength of association between homologous and heterologous EEG derivations and estimated the direction of synchronisation and corresponding time lags. A frontal/fronto-central onset of the absences is detected in 13 of the 17 cases with the highest ictal strength of association between homologous frontal followed by centro-temporal and fronto-central areas. Delays consistently in excess of 4 ms occur at the very onset between these regions, swiftly followed by the emergence of "isochronous" (0-2 ms) synchronisation but dynamic time lag changes occur during SW discharges. In absences an initial cortico-cortical spread leads to dynamic lag changes to include periods of isochronous interhemispheric synchronisation, which we hypothesize is mediated by the thalamus. Absences from CAE show ictal epileptic network dynamics remarkably similar to those observed in WAG/Rij rats which guided the formulation of the cortical focus theory. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Utility of stereoelectroencephalography in preoperative assessment of temporal lobe epilepsy.

PubMed Central

Binnie, C D; Elwes, R D; Polkey, C E; Volans, A

1994-01-01

Of 269 consecutive patients entered into a preoperative assessment programme for possible surgical treatment of epilepsy, 33 had intracranial recording (SEEG) with combined subdural and depth electrodes for the purpose of localising a suspected temporal site of seizure onset. The findings in these patients are analysed with particular reference to: 1) the criteria of selection for SEEG and their validity; 2) information on SEEG compared with that obtained by less invasive means, including foramen ovale telemetry; 3) information on the use of intracerebral electrodes compared with subdural placements; 4) possible predictors of failure of localisation by SEEG and of surgical outcome. It was concluded that SEEG had usefully contributed to the management of 69% of the patients in whom it was used, establishing a previously unidentified site of seizure onset in 33%, correcting an erroneous localisation in 15%, and establishing inoperability in 21% of patients. No predictors of failure of SEEG or of surgery emerged; thus there was no evidence of unnecessary use of this procedure. Five patients were found with incorrect lateralisation of seizure onset on foramen ovale recording (of a total of 192 foramen ovale telemetries). Localisation of the ictal onset zone either by the distribution of inter-ictal discharges or by the initial ictal changes at subdural electrodes was unreliable, confirming the need for ictal, depth recordings. PMID:8301306

Scalp EEG does not predict hemispherectomy outcome

PubMed Central

Greiner, Hansel M.; Park, Yong D.; Holland, Katherine; Horn, Paul S.; Byars, Anna W.; Mangano, Francesco T.; Smith, Joseph R.; Lee, Mark R.; Lee, Ki-Hyeong

2012-01-01

Background Functional hemispherectomy is effective in carefully selected patients, resulting in a reduction of seizure burden up to complete resolution, improvement of intellectual development, and developmental benefit despite possible additional neurological deficit. Despite apparent hemispheric pathology on brain magnetic resonance imaging (MRI) or other imaging tests, scalp electroencephalography (EEG) could be suggestive of bilateral ictal onset or even ictal onset contralateral to the dominant imaging abnormality. We aimed to investigate the role of scalp EEG lateralization pre-operatively in predicting outcome. Methods We retrospectively reviewed 54 patients who underwent hemispherectomy between 1991 and 2009 at Medical College of Georgia (1991–2006) and Cincinnati Children’s Hospital Medical Center (2006–2009) and had at least one year post-operative follow-up. All preoperative EEGs were reviewed, and classified as either lateralizing or nonlateralizing, for both ictal and interictal EEG recordings. Results Of 54 patients, 42 (78%) became seizure free. Twenty-four (44%) of 54 had a nonlateralizing ictal or interictal EEG. Further analysis was based on etiology of epilepsy, including malformation of cortical development (MCD), Rasmussen syndrome (RS), and stroke (CVA). EEG nonlateralization did not predict poor outcome in any of the etiology groups evaluated. Conclusion Scalp EEG abnormalities in contralateral or bilateral hemispheres do not, in isolation, predict a poor outcome from hemispherectomy. Results of other non-invasive and invasive evaluations should be used to determine candidacy. PMID:21813300

Secondary impact hazard assessment

NASA Technical Reports Server (NTRS)

1986-01-01

A series of light gas gun shots (4 to 7 km/sec) were performed with 5 mg nylon and aluminum projectiles to determine the size, mass, velocity, and spatial distribution of spall and ejecta from a number of graphite/epoxy targets. Similar determinations were also performed on a few aluminum targets. Target thickness and material were chosen to be representative of proposed Space Station structure. The data from these shots and other information were used to predict the hazard to Space Station elements from secondary particles resulting from impacts of micrometeoroids and orbital debris on the Space Station. This hazard was quantified as an additional flux over and above the primary micrometeoroid and orbital debris flux that must be considered in the design process. In order to simplify the calculations, eject and spall mass were assumed to scale directly with the energy of the projectile. Other scaling systems may be closer to reality. The secondary particles considered are only those particles that may impact other structure immediately after the primary impact. The addition to the orbital debris problem from these primary impacts was not addressed. Data from this study should be fed into the orbital debris model to see if Space Station secondaries make a significant contribution to orbital debris. The hazard to a Space Station element from secondary particles above and beyond the micrometeoroid and orbital debris hazard is categorized in terms of two factors: (1) the 'view factor' of the element to other Space Station structure or the geometry of placement of the element, and (2) the sensitivity to damage, stated in terms of energy. Several example cases were chosen, the Space Station module windows, windows of a Shuttle docked to the Space Station, the habitat module walls, and the photovoltaic solar cell arrays. For the examples chosen the secondary flux contributed no more than 10 percent to the total flux (primary and secondary) above a given calculated

Cellular compartmentalization of secondary metabolism

PubMed Central

Kistler, H. Corby; Broz, Karen

2015-01-01

Fungal secondary metabolism is often considered apart from the essential housekeeping functions of the cell. However, there are clear links between fundamental cellular metabolism and the biochemical pathways leading to secondary metabolite synthesis. Besides utilizing key biochemical precursors shared with the most essential processes of the cell (e.g., amino acids, acetyl CoA, NADPH), enzymes for secondary metabolite synthesis are compartmentalized at conserved subcellular sites that position pathway enzymes to use these common biochemical precursors. Co-compartmentalization of secondary metabolism pathway enzymes also may function to channel precursors, promote pathway efficiency and sequester pathway intermediates and products from the rest of the cell. In this review we discuss the compartmentalization of three well-studied fungal secondary metabolite biosynthetic pathways for penicillin G, aflatoxin and deoxynivalenol, and summarize evidence used to infer subcellular localization. We also discuss how these metabolites potentially are trafficked within the cell and may be exported. PMID:25709603

Ruling out secondary causes of hypertension.

PubMed

Ott, Christian; Schneider, Markus P; Schmieder, Roland E

2013-05-01

In the majority of hypertensive patients, no particular cause for abnormal blood pressure is evident (primary or essential hypertension). In contrast, in the minority of patients with secondary hypertension a specific underlying cause is responsible for the elevated blood pressure. The prevalence of secondary hypertension is higher in patients with resistant hypertension than in the general hypertensive population and increases with age. The list of secondary forms of hypertension is long and prevalence of the individual causes of secondary hypertension varies. Hence, this review divides them into two categories: common causes and rare causes. If appropriately diagnosed and treated, patients with a secondary form of hypertension might be cured, or at least show an improvement in their blood pressure control. Consequently, screening for secondary causes of hypertension plays an essential part in the care of patients with arterial hypertension. If the basal work-up raises the suspicion of a secondary cause of hypertension, specific diagnostic procedures become necessary, some of which can be performed by primary care physicians, while others require specialist input.

Secondary parkinsonism

MedlinePlus

... developing. Alternative Names Parkinsonism - secondary; Atypical Parkinson disease Images Central nervous system and peripheral nervous system References Jankovic J. Parkinson disease and other movement disorders. In: Daroff ...

Intramural Programming for Elementary, Junior Secondary, and Senior Secondary Schools. A Practical Approach.

ERIC Educational Resources Information Center

Watts, Gayle E.; Korchinsky, Nestor N.

A justification for the offering of intramural sports is offered, and an introduction to methods for establishing such programs at the elementary, junior secondary, and senior secondary school levels is presented. General information on intramural programing at each level includes discussion of questions on commitment, financing, liability,…

Automated Extraction of Secondary Flow Features

NASA Technical Reports Server (NTRS)

Dorney, Suzanne M.; Haimes, Robert

2005-01-01

The use of Computational Fluid Dynamics (CFD) has become standard practice in the design and development of the major components used for air and space propulsion. To aid in the post-processing and analysis phase of CFD many researchers now use automated feature extraction utilities. These tools can be used to detect the existence of such features as shocks, vortex cores and separation and re-attachment lines. The existence of secondary flow is another feature of significant importance to CFD engineers. Although the concept of secondary flow is relatively understood there is no commonly accepted mathematical definition for secondary flow. This paper will present a definition for secondary flow and one approach for automatically detecting and visualizing secondary flow.

40 CFR 133.102 - Secondary treatment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Secondary treatment. 133.102 Section 133.102 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS SECONDARY TREATMENT REGULATION § 133.102 Secondary treatment. The following paragraphs describe the minimum level of...

RNA-SSPT: RNA Secondary Structure Prediction Tools.

PubMed

Ahmad, Freed; Mahboob, Shahid; Gulzar, Tahsin; Din, Salah U; Hanif, Tanzeela; Ahmad, Hifza; Afzal, Muhammad

2013-01-01

The prediction of RNA structure is useful for understanding evolution for both in silico and in vitro studies. Physical methods like NMR studies to predict RNA secondary structure are expensive and difficult. Computational RNA secondary structure prediction is easier. Comparative sequence analysis provides the best solution. But secondary structure prediction of a single RNA sequence is challenging. RNA-SSPT is a tool that computationally predicts secondary structure of a single RNA sequence. Most of the RNA secondary structure prediction tools do not allow pseudoknots in the structure or are unable to locate them. Nussinov dynamic programming algorithm has been implemented in RNA-SSPT. The current studies shows only energetically most favorable secondary structure is required and the algorithm modification is also available that produces base pairs to lower the total free energy of the secondary structure. For visualization of RNA secondary structure, NAVIEW in C language is used and modified in C# for tool requirement. RNA-SSPT is built in C# using Dot Net 2.0 in Microsoft Visual Studio 2005 Professional edition. The accuracy of RNA-SSPT is tested in terms of Sensitivity and Positive Predicted Value. It is a tool which serves both secondary structure prediction and secondary structure visualization purposes.

RNA-SSPT: RNA Secondary Structure Prediction Tools

PubMed Central

Ahmad, Freed; Mahboob, Shahid; Gulzar, Tahsin; din, Salah U; Hanif, Tanzeela; Ahmad, Hifza; Afzal, Muhammad

2013-01-01

The prediction of RNA structure is useful for understanding evolution for both in silico and in vitro studies. Physical methods like NMR studies to predict RNA secondary structure are expensive and difficult. Computational RNA secondary structure prediction is easier. Comparative sequence analysis provides the best solution. But secondary structure prediction of a single RNA sequence is challenging. RNA-SSPT is a tool that computationally predicts secondary structure of a single RNA sequence. Most of the RNA secondary structure prediction tools do not allow pseudoknots in the structure or are unable to locate them. Nussinov dynamic programming algorithm has been implemented in RNA-SSPT. The current studies shows only energetically most favorable secondary structure is required and the algorithm modification is also available that produces base pairs to lower the total free energy of the secondary structure. For visualization of RNA secondary structure, NAVIEW in C language is used and modified in C# for tool requirement. RNA-SSPT is built in C# using Dot Net 2.0 in Microsoft Visual Studio 2005 Professional edition. The accuracy of RNA-SSPT is tested in terms of Sensitivity and Positive Predicted Value. It is a tool which serves both secondary structure prediction and secondary structure visualization purposes. PMID:24250115

Reviewing Canadian Post-Secondary Education: Post-Secondary Education Policy in Post-Industrial Canada

ERIC Educational Resources Information Center

Kirby, Dale

2007-01-01

Since 2004, a number of Canadian provinces have initiated comprehensive reviews of their respective public post-secondary education systems. This paper examines the ways in which these provincial post-secondary education reviews are consistent with the pervasive influence of economic globalization on higher education and a more market-driven and…

Clinical reasoning in feline epilepsy: Which combination of clinical information is useful?

PubMed

Stanciu, Gabriela-Dumitrita; Packer, Rowena Mary Anne; Pakozdy, Akos; Solcan, Gheorghe; Volk, Holger Andreas

2017-07-01

We sought to identify the association between clinical risk factors and the diagnosis of idiopathic epilepsy (IE) or structural epilepsy (SE) in cats, using statistical models to identify combinations of discrete parameters from the patient signalment, history and neurological examination findings that could suggest the most likely diagnosis. Data for 138 cats with recurrent seizures were reviewed, of which 110 were valid for inclusion. Seizure aetiology was classified as IE in 57% and SE in 43% of cats. Binomial logistic regression analyses demonstrated that pedigree status, older age at seizure onset (particularly >7years old), abnormal neurological examinations, and ictal vocalisation were associated with a diagnosis of SE compared to IE, and that ictal salivation was more likely to be associated with a diagnosis of IE than SE. These findings support the importance of considering inter-ictal neurological deficits and seizure history in clinical reasoning. Copyright © 2017 Elsevier Ltd. All rights reserved.

13 CFR 120.601 - SBA Secondary Market.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false SBA Secondary Market. 120.601 Section 120.601 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Fiscal and Transfer Agent (fta) § 120.601 SBA Secondary Market. The SBA secondary market...

Differential diagnosis and secondary causes of osteoporosis.

PubMed

Taxel, P; Kenny, A

2000-01-01

Secondary osteoporosis refers to osteoporosis in which an underlying cause or factor other than those attributable to the postmenopausal state or aging can be identified. Primary, or idiopathic, osteoporosis implies that a secondary cause cannot be found. Secondary osteoporosis occurs not only in postmenopausal women but also in men and premenopausal women. In series reported from specialized centers, as many as 30% of postmenopausal women and 50% to 80% of men have an identifiable secondary cause of osteoporosis, although the frequency of secondary osteoporosis is probably much lower in the general population. In assessing the patient with osteoporosis, it is important to look for secondary causes and aggravating factors that are reversible and amenable to therapy. In addition to secondary forms, 2 metabolic bone diseases, osteomalacia and primary hyperparathyroidism, can mimic or aggravate osteoporosis. This paper will summarize the differential diagnosis and management of osteoporosis, osteomalacia, and hyperparathyroidism and review the most common causes of secondary osteoporosis.

Oral Manifestations of Secondary Syphilis.

PubMed

de Paulo, Luiz Fernando Barbosa; Servato, João Paulo Silva; Oliveira, Maiolino Thomaz Fonseca; Durighetto, Antonio Francisco; Zanetta-Barbosa, Darceny

2015-06-01

Known as "the great imitator," secondary syphilis may clinically manifest itself in myriad ways, involving different organs including the oral mucosa, and mimicking, both clinically and histologically, several diseases, thereby making diagnosis a challenge for clinicians. We highlight the clinical aspects of oral manifestation in 7 patients with secondary syphilis. Clinicians should consider secondary syphilis in the differential diagnosis of ulcerative and/or white oral lesions. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

A Selected and Annotated Environmental Education Bibliography for Elementary, Secondary and Post-Secondary Schools.

ERIC Educational Resources Information Center

Howell, Jerry F., Jr.; Osborne, Jeanne S.

This is an environmental education bibliography for elementary, secondary, and post-secondary schools. Eighteen environmental categories are included. They consist of attitudes, bibliographies, careers, conservation, ecology, energy, environmental education, law and citizen action, organic farming, other resources, periodicals, pesticides,…

The Policy of Universal Secondary Education: Its Influence on Secondary Schooling in Grenada

ERIC Educational Resources Information Center

Knight, Verna

2014-01-01

In an era of increasing access to secondary education in the Caribbean, it becomes critical that we understand the effect that Universal Secondary Education (USE) has had on our education systems in order to inform current educational reform efforts and future educational planning. This study explores the experience of the country of Grenada with…

Suicide Prevention for Counselors Working with Youth in Secondary and Post-Secondary School

ERIC Educational Resources Information Center

Wiley, Cindy

2012-01-01

According to the latest statistics, suicide is the 3rd leading cause of death in those aged 15-24 (CDC, 2010), when many are enrolled in secondary and post-secondary institutions. Because of such alarming statistics, the need for prevention education is great. However, many counselors and educators feel ill- equipped in prevention and intervention…

CSI 3.0: a web server for identifying secondary and super-secondary structure in proteins using NMR chemical shifts

PubMed Central

Hafsa, Noor E.; Arndt, David; Wishart, David S.

2015-01-01

The Chemical Shift Index or CSI 3.0 (http://csi3.wishartlab.com) is a web server designed to accurately identify the location of secondary and super-secondary structures in protein chains using only nuclear magnetic resonance (NMR) backbone chemical shifts and their corresponding protein sequence data. Unlike earlier versions of CSI, which only identified three types of secondary structure (helix, β-strand and coil), CSI 3.0 now identifies total of 11 types of secondary and super-secondary structures, including helices, β-strands, coil regions, five common β-turns (type I, II, I′, II′ and VIII), β hairpins as well as interior and edge β-strands. CSI 3.0 accepts experimental NMR chemical shift data in multiple formats (NMR Star 2.1, NMR Star 3.1 and SHIFTY) and generates colorful CSI plots (bar graphs) and secondary/super-secondary structure assignments. The output can be readily used as constraints for structure determination and refinement or the images may be used for presentations and publications. CSI 3.0 uses a pipeline of several well-tested, previously published programs to identify the secondary and super-secondary structures in protein chains. Comparisons with secondary and super-secondary structure assignments made via standard coordinate analysis programs such as DSSP, STRIDE and VADAR on high-resolution protein structures solved by X-ray and NMR show >90% agreement between those made with CSI 3.0. PMID:25979265

CSI 3.0: a web server for identifying secondary and super-secondary structure in proteins using NMR chemical shifts.

PubMed

Hafsa, Noor E; Arndt, David; Wishart, David S

2015-07-01

The Chemical Shift Index or CSI 3.0 (http://csi3.wishartlab.com) is a web server designed to accurately identify the location of secondary and super-secondary structures in protein chains using only nuclear magnetic resonance (NMR) backbone chemical shifts and their corresponding protein sequence data. Unlike earlier versions of CSI, which only identified three types of secondary structure (helix, β-strand and coil), CSI 3.0 now identifies total of 11 types of secondary and super-secondary structures, including helices, β-strands, coil regions, five common β-turns (type I, II, I', II' and VIII), β hairpins as well as interior and edge β-strands. CSI 3.0 accepts experimental NMR chemical shift data in multiple formats (NMR Star 2.1, NMR Star 3.1 and SHIFTY) and generates colorful CSI plots (bar graphs) and secondary/super-secondary structure assignments. The output can be readily used as constraints for structure determination and refinement or the images may be used for presentations and publications. CSI 3.0 uses a pipeline of several well-tested, previously published programs to identify the secondary and super-secondary structures in protein chains. Comparisons with secondary and super-secondary structure assignments made via standard coordinate analysis programs such as DSSP, STRIDE and VADAR on high-resolution protein structures solved by X-ray and NMR show >90% agreement between those made with CSI 3.0. © The Author(s) 2015. Published by Oxford University Press on behalf of Nucleic Acids Research.

Educational Options for Migrant Secondary Students.

ERIC Educational Resources Information Center

Morales, Jeanette A.; And Others

Designed to address the need for secondary migrant educators to have access to model secondary programs, the guide highlights some 20 state and national programs that seem to be effective in serving the migrant secondary student. The programs are representative of three types of approaches which have proven to be effective in reducing the migrant…

Secondary emission electron gun using external primaries

DOEpatents

Srinivasan-Rao, Triveni [Shoreham, NY; Ben-Zvi, Ilan [Setauket, NY

2009-10-13

An electron gun for generating an electron beam is provided, which includes a secondary emitter. The secondary emitter includes a non-contaminating negative-electron-affinity (NEA) material and emitting surface. The gun includes an accelerating region which accelerates the secondaries from the emitting surface. The secondaries are emitted in response to a primary beam generated external to the accelerating region. The accelerating region may include a superconducting radio frequency (RF) cavity, and the gun may be operated in a continuous wave (CW) mode. The secondary emitter includes hydrogenated diamond. A uniform electrically conductive layer is superposed on the emitter to replenish the extracted current, preventing charging of the emitter. An encapsulated secondary emission enhanced cathode device, useful in a superconducting RF cavity, includes a housing for maintaining vacuum, a cathode, e.g., a photocathode, and the non-contaminating NEA secondary emitter with the uniform electrically conductive layer superposed thereon.

Secondary emission electron gun using external primaries

DOEpatents

Srinivasan-Rao, Triveni [Shoreham, NY; Ben-Zvi, Ilan [Setauket, NY; Kewisch, Jorg [Wading River, NY; Chang, Xiangyun [Middle Island, NY

2007-06-05

An electron gun for generating an electron beam is provided, which includes a secondary emitter. The secondary emitter includes a non-contaminating negative-electron-affinity (NEA) material and emitting surface. The gun includes an accelerating region which accelerates the secondaries from the emitting surface. The secondaries are emitted in response to a primary beam generated external to the accelerating region. The accelerating region may include a superconducting radio frequency (RF) cavity, and the gun may be operated in a continuous wave (CW) mode. The secondary emitter includes hydrogenated diamond. A uniform electrically conductive layer is superposed on the emitter to replenish the extracted current, preventing charging of the emitter. An encapsulated secondary emission enhanced cathode device, useful in a superconducting RF cavity, includes a housing for maintaining vacuum, a cathode, e.g., a photocathode, and the non-contaminating NEA secondary emitter with the uniform electrically conductive layer superposed thereon.

Survival after severe envenomation by the blue-ringed octopus (Hapalochlaena maculosa).

PubMed

Walker, D G

I report two cases of life-endangering respiratory failure after envenomation by a blue-ringed octopus (Hapalochlaena maculosa). Early and efficient support of respiratory function is vital in such cases. Cardiac asystole occurred in one patient. Both patients recovered completely after the vigorous application of routine resuscitation techniques.

Highly charged ion secondary ion mass spectroscopy

DOEpatents

Hamza, Alex V.; Schenkel, Thomas; Barnes, Alan V.; Schneider, Dieter H.

2001-01-01

A secondary ion mass spectrometer using slow, highly charged ions produced in an electron beam ion trap permits ultra-sensitive surface analysis and high spatial resolution simultaneously. The spectrometer comprises an ion source producing a primary ion beam of highly charged ions that are directed at a target surface, a mass analyzer, and a microchannel plate detector of secondary ions that are sputtered from the target surface after interaction with the primary beam. The unusually high secondary ion yield permits the use of coincidence counting, in which the secondary ion stops are detected in coincidence with a particular secondary ion. The association of specific molecular species can be correlated. The unique multiple secondary nature of the highly charged ion interaction enables this new analytical technique.

Cellular compartmentalization of secondary metabolism

USDA-ARS?s Scientific Manuscript database

Fungal secondary metabolism is often considered apart from the essential housekeeping functions of the cell. However, there are clear links between fundamental cellular metabolism and the biochemical pathways leading to secondary metabolite synthesis. Besides utilizing key biochemical precursors sh...

Phenobarbital and neonatal seizures affect cerebral oxygen metabolism: a near-infrared spectroscopy study

PubMed Central

Sokoloff, Max D.; Plegue, Melissa A.; Chervin, Ronald D.; Barks, John D.E.; Shellhaas, Renée A.

2014-01-01

Background Near-infrared spectroscopy (NIRS) measures oxygen metabolism and is increasingly used for monitoring critically-ill neonates. The implications of NIRS-recorded data in this population are poorly understood. We evaluated NIRS monitoring for neonates with seizures. Methods In neonates monitored with video-EEG, NIRS-measured cerebral regional oxygen saturation (rSO2) and systemic O2 saturation were recorded every 5 seconds. Mean rSO2 was extracted for 1-hour blocks before, during, and after phenobarbital doses. For each electrographic seizure, mean rSO2 was extracted for a period of 3-times the duration of the seizure before and after the ictal pattern, and during the seizure. Linear mixed models were developed to assess the impact of phenobarbital administration and of seizures on rSO2 and fractional tissue oxygen extraction (FTOE). Results For 20 neonates (EGA 39.6±1.5 weeks), 61 phenobarbital doses and 40 seizures were analyzed. Cerebral rSO2 rose (p=0.005), and FTOE declined (p=0.018) with increasing phenobarbital doses. rSO2 declined during seizures, compared with baseline and post-ictal phases (baseline 81.2 vs. ictal 77.7 vs. post-ictal 79.4; p=0.004). FTOE was highest during seizures (p=0.002). Conclusions Cerebral oxygen metabolism decreases after phenobarbital administration and increases during seizures. These small, but clear, changes in cerebral oxygen metabolism merit assessment for potential clinical impact. PMID:25812123

On the prediction of turbulent secondary flows

NASA Technical Reports Server (NTRS)

Speziale, C. G.; So, R. M. C.; Younis, B. A.

1992-01-01

The prediction of turbulent secondary flows, with Reynolds stress models, in circular pipes and non-circular ducts is reviewed. Turbulence-driven secondary flows in straight non-circular ducts are considered along with turbulent secondary flows in pipes and ducts that arise from curvature or a system rotation. The physical mechanisms that generate these different kinds of secondary flows are outlined and the level of turbulence closure required to properly compute each type is discussed in detail. Illustrative computations of a variety of different secondary flows obtained from two-equation turbulence models and second-order closures are provided to amplify these points.

Secondary Crater-Initiated Debris Flow on the Moon

NASA Technical Reports Server (NTRS)

Martin-Wells, K. S.; Campbell, D. B.; Campbell, B. A.; Carter, L. M.; Fox, Q.

2016-01-01

In recent work, radar circular polarization echo properties have been used to identify "secondary" craters without distinctive secondary morphologies. Because of the potential for this method to improve our knowledge of secondary crater population-in particular the effect of secondary populations on crater- derived ages based on small craters-it is important to understand the origin of radar polarization signatures associated with secondary impacts. In this paper, we utilize Lunar Reconnaissance Orbiter Camera photographs to examine the geomorphology of secondary craters with radar circular polarization ratio enhancements. Our investigation reveals evidence of dry debris flow with an impact melt component at such secondary craters. We hypothesize that these debris flows were initiated by the secondary impacts themselves, and that they have entrained blocky material ejected from the secondaries. By transporting this blocky material downrange, we propose that these debris flows (rather than solely ballistic emplacement) are responsible for the tail-like geometries of enhanced radar circular polarization ratio associated with the secondary craters investigated in this work. Evidence of debris flow was observed at both clustered and isolated secondary craters, suggesting that such flow may be a widespread occurrence, with important implications for the mixing of primary and local material in crater rays.

[Secondary Arterial Hypertension: Uncertainties in Diagnosis].

PubMed

Dinis, Paulo Gomes; Cachulo, Maria Carmo; Fernandes, Andreia; Paiva, Luis; Gonçalves, Lino

2017-06-30

Arterial hypertension is regarded today as a global public health problem, and the prevalence rate in Portugal is 26.9%. According to the etiology, is classified into primary or secondary arterial hypertension. In about 90% of cases it is not possible to establish a cause, so is called primary arterial hypertension. In the remaining 5 to 10%, it can be identified secondary causes, which are potentially treatable. For secondary arterial hypertension study to be cost-effective, it is essential to understand which patients investigate, and evaluate the best strategy to adopt. The main causes identified as responsible for secondary arterial hypertension are: kidney disease; endocrine and vascular diseases and obstructive sleep apnea. Among these some are consensual, and others more controversial in the literature. In this regard we present two cases of arterial hypertension, which are potentially secondary in etiology, but still focus of debate.

Secondary reconstruction of maxillofacial trauma.

PubMed

Castro-Núñez, Jaime; Van Sickels, Joseph E

2017-08-01

Craniomaxillofacial trauma is one of the most complex clinical conditions in contemporary maxillofacial surgery. Vital structures and possible functional and esthetic sequelae are important considerations following this type of trauma and intervention. Despite the best efforts of the primary surgery, there are a group of patients that will have poor outcomes requiring secondary reconstruction to restore form and function. The purpose of this study is to review current concepts on secondary reconstruction to the maxillofacial complex. The evaluation of a posttraumatic patient for a secondary reconstruction must include an assessment of the different subunits of the upper face, middle face, and lower face. Virtual surgical planning and surgical guides represent the most important innovations in secondary reconstruction over the past few years. Intraoperative navigational surgery/computed-assisted navigation is used in complex cases. Facial asymmetry can be corrected or significantly improved by segmentation of the computerized tomography dataset and mirroring of the unaffected side by means of virtual surgical planning. Navigational surgery/computed-assisted navigation allows for a more precise surgical correction when secondary reconstruction involves the replacement of extensive anatomical areas. The use of technology can result in custom-made replacements and prebent plates, which are more stable and resistant to fracture because of metal fatigue. Careful perioperative evaluation is the key to positive outcomes of secondary reconstruction after trauma. The advent of technological tools has played a capital role in helping the surgical team perform a given treatment plan in a more precise and predictable manner.

Qualitative Secondary Analysis: A Case Exemplar.

PubMed

Tate, Judith Ann; Happ, Mary Beth

Qualitative secondary analysis (QSA) is the use of qualitative data that was collected by someone else or was collected to answer a different research question. Secondary analysis of qualitative data provides an opportunity to maximize data utility, particularly with difficult-to-reach patient populations. However, qualitative secondary analysis methods require careful consideration and explicit description to best understand, contextualize, and evaluate the research results. In this article, we describe methodologic considerations using a case exemplar to illustrate challenges specific to qualitative secondary analysis and strategies to overcome them. Copyright © 2017 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Photogenic partial seizures.

PubMed

Hennessy, M J; Binnie, C D

2000-01-01

To establish the incidence and symptoms of partial seizures in a cohort of patients investigated on account of known sensitivity to intermittent photic stimulation and/or precipitation of seizures by environmental visual stimuli such as television (TV) screens or computer monitors. We report 43 consecutive patients with epilepsy, who had exhibited a significant EEG photoparoxysmal response or who had seizures precipitated by environmental visual stimuli and underwent detailed assessment of their photosensitivity in the EEG laboratory, during which all were questioned concerning their ictal symptoms. All patients were considered on clinical grounds to have an idiopathic epilepsy syndrome. Twenty-eight (65%) patients reported visually precipitated attacks occurring initially with maintained consciousness, in some instances evolving to a period of confusion or to a secondarily generalized seizure. Visual symptoms were most commonly reported and included positive symptoms such as coloured circles or spots, but also blindness and subjective symptoms such as "eyes going funny." Other symptoms described included nonspecific cephalic sensations, deja-vu, auditory hallucinations, nausea, and vomiting. No patient reported any clear spontaneous partial seizures, and there were no grounds for supposing that any had partial epilepsy excepting the ictal phenomenology of some or all of the visually induced attacks. These findings provide clinical support for the physiological studies that indicate that the trigger mechanism for human photosensitivity involves binocularly innervated cells located in the visual cortex. Thus the visual cortex is the seat of the primary epileptogenic process, and the photically triggered discharges and seizures may be regarded as partial with secondary generalization.

Millersville University Secondary Education PDS

ERIC Educational Resources Information Center

Marcum-Dietrich, Nanette I.; Mahoney, Tim

2015-01-01

Millersville University of Pennsylvania (MU) has over 150 years of proud heritage in the preparation of teachers. This article describes how the Secondary Education Professional Development School (PDS) Program model has transformed Millersville University's secondary teacher education from a traditional teacher preparation program into a dynamic…

Secondary lead production in Malaysia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lim, J.S.S.; Lim, C.L.

1988-04-01

In the absence of a lead producers' association in Malaysia and the continued presence of illegal operators whose activities are confined to remelting of cable scraps and/or smelting of battery scraps using a shaft furnace, this paper relies heavily on the information obtained from Metal Reclamation Industries, Sdn. Bhd. -the only modern integrated lead smelter in the country. Consequently, the authors can only present a semiquantitative and general paper on secondary lead production in Malaysia covering the following areas: history; secondary lead smelting; raw material; products; quality control; pollution controls; and future of secondary lead production in Malaysia. They concludemore » that if Malaysia is to become a major secondary lead producer in the Asian region, the industry must: (1) import raw materials in the form of scrapped batteries; (2) develop or acquire new technology; (3) cope with changing pollution regulations, and (4) develop technical skills and efficient quality controls to meet new challenges. 2 figures, 3 tables.« less

[Rescue helicopters in secondary missions].

PubMed

Gorgass, B; Frey, G

1977-11-03

During the last five years, we have had to fly 560 primary and 1150 secondary missions with the rescue helicopter of the Ulm Rescue Centre. This relationship of approximately 1 : 2 is distinctly different from the numbers obtained in other helicopter bases. The geographical location and structure of the hospitals within range of the Ulm rescue helicopter account for the large proportion of urgent secondary missions. The evaluation of these secondary missions concurs with the ADAC statistics and shows that the quick transport of the emergency doctor to the scene of the emergency, is only one component in the functions of the rescue helicopter. During primary and secondary missions, the ability to transport emergency patients to the nearest qualified hospital by helicopter, which is a mobile intensive care unit, is of equal importance. In the future, rescue helicopters will have to take these requirements into account by providing the necessary equipment and more especially, by providing sufficient space to carry out emergency diagnostic and therapeutic treatment.

[A review on fundamental studies of secondary forest management].

PubMed

Zhu, Jiaojun

2002-12-01

Secondary forest is also called as natural secondary forest, which regenerates on native forest that has been disturbed by severe natural or anthropogenic disturbances. The structural and dynamic organizations, growth, productivity and stand environment of secondary forests are significantly different from those of natural and artificial forests. Such significant differences make secondary forests have their own special characteristics in forestry. Secondary forests are the main body of forests in China. Therefore, their management plays a very important role in the projects of natural forest conservation and the construction of ecological environment in China or in the world. Based on a wide range of literature collection on secondary forest research, the fundamental studies of secondary forest management were discussed. The major topics are as follows: 1) basic characteristics of secondary forest, 2) principles of secondary forest management, 3) types of secondary forest, 4) community structure and succession dynamics of secondary forest, including niches, biodiversity, succession and so on, 5) main ecological processes of secondary forest, including regeneration, forest soil and forest environment. Additionally, the research needs and tendency related to secondary forest in the future were also given, based on the analyses of the main results and the problems in current management of secondary forest. The review may be helpful to the research of secondary forest management, and to the projects of natural forest conservation in China.

Secondary metabolites in fungus-plant interactions

PubMed Central

Pusztahelyi, Tünde; Holb, Imre J.; Pócsi, István

2015-01-01

Fungi and plants are rich sources of thousands of secondary metabolites. The genetically coded possibilities for secondary metabolite production, the stimuli of the production, and the special phytotoxins basically determine the microscopic fungi-host plant interactions and the pathogenic lifestyle of fungi. The review introduces plant secondary metabolites usually with antifungal effect as well as the importance of signaling molecules in induced systemic resistance and systemic acquired resistance processes. The review also concerns the mimicking of plant effector molecules like auxins, gibberellins and abscisic acid by fungal secondary metabolites that modulate plant growth or even can subvert the plant defense responses such as programmed cell death to gain nutrients for fungal growth and colonization. It also looks through the special secondary metabolite production and host selective toxins of some significant fungal pathogens and the plant response in form of phytoalexin production. New results coming from genome and transcriptional analyses in context of selected fungal pathogens and their hosts are also discussed. PMID:26300892

Potassium Secondary Batteries.

PubMed

Eftekhari, Ali; Jian, Zelang; Ji, Xiulei

2017-02-08

Potassium may exhibit advantages over lithium or sodium as a charge carrier in rechargeable batteries. Analogues of Prussian blue can provide millions of cyclic voltammetric cycles in aqueous electrolyte. Potassium intercalation chemistry has recently been demonstrated compatible with both graphite and nongraphitic carbons. In addition to potassium-ion batteries, potassium-O 2 (or -air) and potassium-sulfur batteries are emerging. Additionally, aqueous potassium-ion batteries also exhibit high reversibility and long cycling life. Because of potentially low cost, availability of basic materials, and intriguing electrochemical behaviors, this new class of secondary batteries is attracting much attention. This mini-review summarizes the current status, opportunities, and future challenges of potassium secondary batteries.

Technical Subjects in Secondary Schools

ERIC Educational Resources Information Center

Howard, A. E.

2008-01-01

Purpose: This paper aims to examine technical education in various types of secondary schools, and suggests three levels of technical courses to be taught in secondary schools. Design/methodology/approach: The paper discusses the differences between technical schools and colleges, and vocational technical courses taught in "academic"…

Secondary osteoporosis.

PubMed

Boyle, I T

1993-10-01

Osteoporosis with attendant increased fracture risk is a common complication of many other diseases. Indeed, almost all chronic diseases make some impact on life-style, usually by restricting physical activity and hence reducing the anabolic effect of exercise and gravitational strains on the skeleton. Restricted appetite and modified gastrointestinal tract function is another commonplace finding that has an impact on bone nutrition and synthesis, as on other systems. Sex hormone status is of particular importance for the maintenance of the normal skeleton, and the postmenopausal woman is at particular risk for most causes of secondary osteoporosis. In dealing with secondary osteoporosis in the hypo-oestrogenic woman, the question of giving hormone replacement therapy in addition to other disease-specific therapy should always be considered, as, for example, in a young amenorrhoeic woman with Crohn's disease. Similarly, in hypogonadal men the administration of testosterone is useful for bone conservation. The wider availability of bone densitometry ought to make us more aware of the presence of osteoporosis in the many disease states discussed above. This is particularly important as the life span of such patients is now increased by improved management of the underlying disease process in many instances. Even in steroid-induced osteoporosis--one of the commonest and most severe forms of osteoporosis--we now have some effective therapy in the form of the bisphosphonates and other anti-bone-resorbing drug classes. The possibility of prophylaxis against secondary osteoporosis has therefore become a possibility, although the very long-term effects of such drug regimens are still unknown. In some situations, such as thyrotoxicosis, Cushing's syndrome and immobilization, spontaneous resolution of at least part of the osteoporosis is possible after cure of the underlying problem. The shorter the existence of the basic problem, the more successful the restoration of the

[Diagnostic of secondary hypertension in clinical practice].

PubMed

Somlóová, Z; Rosa, J; Petrák, O; Strauch, B; Zelinka, T; Holaj, R; Widimský, J

2011-09-01

Arterial hypertension is a common worldwide disease with a prevalence of approximately 26%. Secondary cause is known in 5-10% of patients with hypertension. We should think of secondary hypertension in all patients with resistant hypertension, in patients with sudden deterioration in the control of hypertension and in patients with laboratory and clinical signs of diseases associated with secondary hypertension. It is important to distinguish between secondary hypertension and pseudo-resistance (noncompliance to treatment, white coat syndrome). Secondary causes of hypertension can be divided into endocrine (primary aldosteronism, pheochromocytoma, hypercortisolism, hyperparathyreoidism), renal - renovascular and renal parenchymal hypertension, and other causes as sleep apnoe syndrome, hypertension in pregnancy, coarctation of the aorta and intracranial tumors.

Secondary abdominal appendicular ectopic pregnancy.

PubMed

Nama, Vivek; Gyampoh, Bright; Karoshi, Mahantesh; McRae, Reynold; Opemuyi, Isaac

2007-01-01

Although the case fatality rate for ectopic pregnancies has decreased to 0.08% in industrialized countries, it still represents 3.8% of maternal mortality in the United States alone. In developing countries, the case fatality rate varies from 3% to 27%. Laparoscopic management of tubal pregnancies is now the standard form of treatment where this technology is available. Abdominal pregnancies are rare, and secondary implantation of tubal ectopic pregnancies is the most common cause of abdominal gestations. We present an interesting case of secondary implantation of a tubal ectopic pregnancy to highlight the appendix as a possible secondary implantation site after a tubal ectopic pregnancy.

Metabolomics for secondary metabolite research.

PubMed

Breitling, Rainer; Ceniceros, Ana; Jankevics, Andris; Takano, Eriko

2013-11-11

Metabolomics, the global characterization of metabolite profiles, is becoming an increasingly powerful tool for research on secondary metabolite discovery and production. In this review we discuss examples of recent technological advances and biological applications of metabolomics in the search for chemical novelty and the engineered production of bioactive secondary metabolites.

Reading in the Secondary School.

ERIC Educational Resources Information Center

Teaching English, 1976

1976-01-01

The topic of discussion of this issue of the journal "Teaching English" is reading instruction in the secondary school. Articles include "Reading in the Primary School" (Alastair Hendry), "Patterns of Progress" (Fergus McBride), "Teaching Reading--Whose Business?" (James Maxwell), "A Reading Policy for the Secondary School" (Iain McGillivray),…

Importance of secondary damage in downer cows.

PubMed

Poulton, P J; Vizard, A L; Anderson, G A; Pyman, M F

2016-05-01

To investigate the relative importance in downer cows of the primary cause of recumbency in comparison with secondary complications. Downer dairy cows were monitored during their recumbency under field conditions in South Gippsland, Victoria, Australia. The cause of the original recumbency of the 218 cows was determined and secondary damage, status on day 7 and final outcome were recorded. Some type of secondary damage was found in 183/218 (84%) cows, of which 173/218 (79%) had damage deemed to be clinically important. By day 7, 52 (24%) had recovered and 69 (32%) eventually recovered. Of the 149 (68%) cows that were euthanased or died, 23 (15%) were deemed to have been lost solely from the primary cause, 107 (72%) from secondary damage and 19 (13%) from a combination of both. There was no difference in recovery among the five broad groups of causes of primary recumbency. Secondary damage was very common and presented in a large variety of ways, with many cows having multiple types of secondary damage concurrently. For most cows the secondary damage was more important than the initial primary damage in determining their fate. © 2016 Australian Veterinary Association.

The changes of HRV in refractory epilepsy: The potential index to predict the onset of epilepsy in children.

PubMed

Gong, Xuehao; Mao, Xuhua; Chen, Yan; Huang, Leidan; Liu, Weizong; Huang, Xian; Tan, Zheng; Wang, Xianming; Wu, Wanqing; Chen, Qian; Li, Rong

2016-01-01

In this study, we examine the potential of heart rate variability (HRV) as an efficient tool for predicting the onset of epilepsy in children. We totally collected 53 seizures EEG and ECG data using Video - EEG - ECG monitoring system. We then separated the ECG data into three segments: ten-minute before onset of each seizure, five-minute before onset of each seizure, and five-minute from the onset of each seizure. After the HRV parameters in all segments were calculated, we compared the differences between pre-ictal period and ictal period. We found that the values of meanHR, LF and LF/HF were greater in onset period. And the values of meanRR and the HF were less in ictal period. And it presented the similar changes when seizures occurred in the daytime and seizures occurred in the nighttime. In brief, we found that the sympathetic nervous system was under a more active status during onset period. We speculated that the HRV parameters such as the LF, HF or LF/HF could have potential to predict the seizures in children with epilepsy.

7 CFR 930.17 - Secondary inventory reserve.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Secondary inventory reserve. 930.17 Section 930.17... Handling Definitions § 930.17 Secondary inventory reserve. Secondary inventory reserve means any portion of handled cherries voluntarily placed into inventory by a handler under § 930.57. ...

Monomer-dependent secondary nucleation in amyloid formation.

PubMed

Linse, Sara

2017-08-01

Secondary nucleation of monomers on the surface of an already existing aggregate that is formed from the same kind of monomers may lead to autocatalytic amplification of a self-assembly process. Such monomer-dependent secondary nucleation occurs during the crystallization of small molecules or proteins and self-assembled materials, as well as in protein self-assembly into fibrous structures. Indications of secondary nucleation may come from analyses of kinetic experiments starting from pure monomers or monomers supplemented with a low concentration of pre-formed aggregates (seeds). More firm evidence requires additional experiments, for example those employing isotope labels to distinguish new aggregates arising from the monomer from those resulting from fragmentation of the seed. In cases of amyloid formation, secondary nucleation leads to the formation of toxic oligomers, and inhibitors of secondary nucleation may serve as starting points for therapeutic developments. Secondary nucleation displays a high degree of structural specificity and may be enhanced by mutations or screening of electrostatic repulsion.

Secondary School Counseling. Research Brief

ERIC Educational Resources Information Center

Walker, Karen

2005-01-01

"Secondary school counselors are professional educators with a mental health perspective who understand and respond to the challenges presented by today's diverse student population" ("Why secondary school counselors?"). As times have changed, so has the role of the school counselor. In the early part of the 20th century when the country was…

Fourier-based classification of protein secondary structures.

PubMed

Shu, Jian-Jun; Yong, Kian Yan

2017-04-15

The correct prediction of protein secondary structures is one of the key issues in predicting the correct protein folded shape, which is used for determining gene function. Existing methods make use of amino acids properties as indices to classify protein secondary structures, but are faced with a significant number of misclassifications. The paper presents a technique for the classification of protein secondary structures based on protein "signal-plotting" and the use of the Fourier technique for digital signal processing. New indices are proposed to classify protein secondary structures by analyzing hydrophobicity profiles. The approach is simple and straightforward. Results show that the more types of protein secondary structures can be classified by means of these newly-proposed indices. Copyright © 2017 Elsevier Inc. All rights reserved.

Who Makes It to Secondary School? Determinants of Transition to Secondary Schools in Rural India

ERIC Educational Resources Information Center

Siddhu, Gaurav

2011-01-01

Despite considerable progress made, a significant proportion of children continue to drop out before reaching secondary school in India. This study investigates factors influencing parental decision-making with regard to children's secondary schooling in the context of a rural area of Uttar Pradesh. The study finds that cost, distance to the…

Live imaging of mouse secondary palate fusion

PubMed Central

Kim, Seungil; Prochazka, Jan; Bush, Jeffrey O.

2017-01-01

LONG ABSTRACT The fusion of the secondary palatal shelves to form the intact secondary palate is a key process in mammalian development and its disruption can lead to cleft secondary palate, a common congenital anomaly in humans. Secondary palate fusion has been extensively studied leading to several proposed cellular mechanisms that may mediate this process. However, these studies have been mostly performed on fixed embryonic tissues at progressive timepoints during development or in fixed explant cultures analyzed at static timepoints. Static analysis is limited for the analysis of dynamic morphogenetic processes such a palate fusion and what types of dynamic cellular behaviors mediate palatal fusion is incompletely understood. Here we describe a protocol for live imaging of ex vivo secondary palate fusion in mouse embryos. To examine cellular behaviors of palate fusion, epithelial-specific Keratin14-cre was used to label palate epithelial cells in ROSA26-mTmGflox reporter embryos. To visualize filamentous actin, Lifeact-mRFPruby reporter mice were used. Live imaging of secondary palate fusion was performed by dissecting recently-adhered secondary palatal shelves of embryonic day (E) 14.5 stage embryos and culturing in agarose-containing media on a glass bottom dish to enable imaging with an inverted confocal microscope. Using this method, we have detected a variety of novel cellular behaviors during secondary palate fusion. An appreciation of how distinct cell behaviors are coordinated in space and time greatly contributes to our understanding of this dynamic morphogenetic process. This protocol can be applied to mutant mouse lines, or cultures treated with pharmacological inhibitors to further advance understanding of how secondary palate fusion is controlled. PMID:28784960

Implications of Secondary Aftershocks for Failure Processes

NASA Astrophysics Data System (ADS)

Gross, S. J.

2001-12-01

When a seismic sequence with more than one mainshock or an unusually large aftershock occurs, there is a compound aftershock sequence. The secondary aftershocks need not have exactly the same decay as the primary sequence, with the differences having implications for the failure process. When the stress step from the secondary mainshock is positive but not large enough to cause immediate failure of all the remaining primary aftershocks, failure processes which involve accelerating slip will produce secondary aftershocks that decay more rapidly than primary aftershocks. This is because the primary aftershocks are an accelerated version of the background seismicity, and secondary aftershocks are an accelerated version of the primary aftershocks. Real stress perturbations may be negative, and heterogeneities in mainshock stress fields mean that the real world situation is quite complicated. I will first describe and verify my picture of secondary aftershock decay with reference to a simple numerical model of slipping faults which obeys rate and state dependent friction and lacks stress heterogeneity. With such a model, it is possible to generate secondary aftershock sequences with perturbed decay patterns, quantify those patterns, and develop an analysis technique capable of correcting for the effect in real data. The secondary aftershocks are defined in terms of frequency linearized time s(T), which is equal to the number of primary aftershocks expected by a time T, $ s ≡ ∫ t=0T n(t) dt, where the start time t=0 is the time of the primary aftershock, and the primary aftershock decay function n(t) is extrapolated forward to the times of the secondary aftershocks. In the absence of secondary sequences the function s(T)$ re-scales the time so that approximately one event occurs per new time unit; the aftershock sequence is gone. If this rescaling is applied in the presence of a secondary sequence, the secondary sequence is shaped like a primary aftershock sequence

Under-Representation in Nationally Representative Secondary Data

ERIC Educational Resources Information Center

Frederick, Karen; Barnard-Brak, Lucy; Sulak, Tracey

2012-01-01

There has been a significant increase in the use of secondary data sets. Many such data sets purport to be nationally representative. Secondary data sets include research commissioned by the National Center for Education Statistics, the Centers for Disease Control, and other public entities. Research increasingly utilizes these secondary data in…

Antifungal activity of microbial secondary metabolites.

PubMed

Coleman, Jeffrey J; Ghosh, Suman; Okoli, Ikechukwu; Mylonakis, Eleftherios

2011-01-01

Secondary metabolites are well known for their ability to impede other microorganisms. Reanalysis of a screen of natural products using the Caenorhabditis elegans-Candida albicans infection model identified twelve microbial secondary metabolites capable of conferring an increase in survival to infected nematodes. In this screen, the two compound treatments conferring the highest survival rates were members of the epipolythiodioxopiperazine (ETP) family of fungal secondary metabolites, acetylgliotoxin and a derivative of hyalodendrin. The abundance of fungal secondary metabolites indentified in this screen prompted further studies investigating the interaction between opportunistic pathogenic fungi and Aspergillus fumigatus, because of the ability of the fungus to produce a plethora of secondary metabolites, including the well studied ETP gliotoxin. We found that cell-free supernatant of A. fumigatus was able to inhibit the growth of Candida albicans through the production of a secreted product. Comparative studies between a wild-type and an A. fumigatus ΔgliP strain unable to synthesize gliotoxin demonstrate that this secondary metabolite is the major factor responsible for the inhibition. Although toxic to organisms, gliotoxin conferred an increase in survival to C. albicans-infected C. elegans in a dose dependent manner. As A. fumigatus produces gliotoxin in vivo, we propose that in addition to being a virulence factor, gliotoxin may also provide an advantage to A. fumigatus when infecting a host that harbors other opportunistic fungi.

Antifungal Activity of Microbial Secondary Metabolites

PubMed Central

Okoli, Ikechukwu; Mylonakis, Eleftherios

2011-01-01

Secondary metabolites are well known for their ability to impede other microorganisms. Reanalysis of a screen of natural products using the Caenorhabditis elegans-Candida albicans infection model identified twelve microbial secondary metabolites capable of conferring an increase in survival to infected nematodes. In this screen, the two compound treatments conferring the highest survival rates were members of the epipolythiodioxopiperazine (ETP) family of fungal secondary metabolites, acetylgliotoxin and a derivative of hyalodendrin. The abundance of fungal secondary metabolites indentified in this screen prompted further studies investigating the interaction between opportunistic pathogenic fungi and Aspergillus fumigatus, because of the ability of the fungus to produce a plethora of secondary metabolites, including the well studied ETP gliotoxin. We found that cell-free supernatant of A. fumigatus was able to inhibit the growth of Candida albicans through the production of a secreted product. Comparative studies between a wild-type and an A. fumigatus ΔgliP strain unable to synthesize gliotoxin demonstrate that this secondary metabolite is the major factor responsible for the inhibition. Although toxic to organisms, gliotoxin conferred an increase in survival to C. albicans-infected C. elegans in a dose dependent manner. As A. fumigatus produces gliotoxin in vivo, we propose that in addition to being a virulence factor, gliotoxin may also provide an advantage to A. fumigatus when infecting a host that harbors other opportunistic fungi. PMID:21966496

Kenya's Constituency Development Fund, Free Secondary Education Policy, and Access to Secondary Education

ERIC Educational Resources Information Center

Nzuki, Charles Kyalo

2018-01-01

The effects of the Constituency Development Fund (CDF) and the Free Secondary Education Policy (FSEP) on access to secondary school education in Kenya's Yatta sub-county have not been adequately explored in available public policy literature. Hence, this qualitative multiple-case study was designed to understand the effects of the 2 policies on…

Secondary School Reform, Inclusion, and Authentic Assessment. Research Institute on Secondary Education Reform (RISER) for Youth with Disabilities Brief.

ERIC Educational Resources Information Center

Braden, Jeffery P.; Schroeder, Jennifer L.; Buckley, Jacquelyn A.

The Research Institute on Secondary Education Reform for Youth with Disabilities (RISER) has identified Schools of Authentic and Inclusive Learning (SAIL) to explore whether and how secondary students with disabilities are included in secondary education reform. In this brief, the literature describing the intersection of reform, inclusion, and…

Seizure Semiology: Its Value and Limitations in Localizing the Epileptogenic Zone

PubMed Central

Lüders, Hans O.

2012-01-01

Epilepsy surgery has become an important treatment option in patients with medically refractory epilepsy. The ability to precisely localize the epileptogenic zone is crucial for surgical success. The tools available for localization of the epileptogenic zone are limited. Seizure semiology is a simple and cost effective tool that allows localization of the symptomatogenic zone which either overlaps or is in close proximity of the epileptogenic zone. This becomes particularly important in cases of MRI negative focal epilepsy. The ability to video record seizures made it possible to discover new localizing signs and quantify the sensitivity and specificity of others. Ideally the signs used for localization should fulfill these criteria; 1) Easy to identify and have a high inter-rater reliability, 2) It has to be the first or one of the earlier components of the seizure in order to have localizing value. Later symptoms or signs are more likely to be due to ictal spread and may have only a lateralizing value. 3) The symptomatogenic zone corresponding to the recorded ictal symptom has to be clearly defined and well documented. Reproducibility of the initial ictal symptoms with cortical stimulation identifies the corresponding symptomatogenic zone. Unfortunately, however, not all ictal symptoms can be reproduced by focal cortical stimulation. Therefore, the problem the clinician faces is trying to deduce the epileptogenic zone from the seizure semiology. The semiological classification system is particularly useful in this regard. We present the known localizing and lateralizing signs based on this system. PMID:23323131

Functional Connectivity Evidence of Cortico-Cortico Inhibition in Temporal Lobe Epilepsy

PubMed Central

Tracy, Joseph I.; Osipowicz, Karol; Spechler, Philip; Sharan, Ashwini; Skidmore, Christopher; Doucet, Gaelle; Sperling, Michael R.

2012-01-01

Epileptic seizures can initiate a neural circuit and lead to aberrant neural communication with brain areas outside the epileptogenic region. We focus on interictal activity in focal temporal lobe epilepsy and evaluate functional connectivity differences that emerge as function of bilateral versus strictly unilateral epileptiform activity. We assess the strength of functional connectivity at rest between the ictal and non-ictal temporal lobes, in addition to whole brain connectivity with the ictal temporal lobe. Results revealed strong connectivity between the temporal lobes for both patient groups, but this did not vary as a function of unilateral versus bilateral interictal status. Both the left and right unilateral temporal lobe groups showed significant anti-correlated activity in regions outside the epileptogenic temporal lobe, primarily involving the contralateral (non-ictal/non-pathologic) hemisphere, with precuneus involvement prominent. The bilateral groups did not show this contralateral anti-correlated activity. This anti-correlated connectivity may represent a form of protective and adaptive inhibition, helping to constrain epileptiform activity to the pathologic temporal lobe. The absence of this activity in the bilateral groups may be indicative of flawed inhibitory mechanisms, helping to explain their more widespread epileptiform activity. Our data suggest that the location and build up of epilepsy networks in the brain are not truly random, and are not limited to the formation of strictly epileptogenic networks. Functional networks may develop to take advantage of the regulatory function of structures such as the precuneus to instantiate an anti-correlated network, generating protective cortico-cortico inhibition for the purpose of limiting seizure spread or epileptogenesis. PMID:22987774

Identification of the epileptogenic zone of temporal lobe epilepsy from stereo-electroencephalography signals: A phase transfer entropy and graph theory approach.

PubMed

Wang, Meng-Yang; Wang, Jing; Zhou, Jian; Guan, Yu-Guang; Zhai, Feng; Liu, Chang-Qing; Xu, Fei-Fei; Han, Yi-Xian; Yan, Zhao-Fen; Luan, Guo-Ming

2017-01-01

The aim of this research is to apply an approach based on phase transfer entropy (PTE) and graph theory to study the interactions between the stereo-electroencephalography (SEEG) activities recorded in multilobar origin, in order to evaluate their ability to detect the epileptogenic zone (EZ) of temporal lobe epilepsies (TLE). Forty-three patients were included in this retrospective study. Five to sixteen (median = 12) multilead electrodes were implanted per patient, and, for each patient, a sub-set of between 10 and 32 (median = 22) bipolar derivations was selected for analysis. The leads were classified into the onset leads (OLs), the early propagation leads (EPLs), and the rest of the leads (RLs). The results showed that a significantly different dynamic trend of the out/in ratio (more obvious in the gamma band) distinguishes the OLs from RLs in the 23 patients who were seizure-free not only during the ictal event (significant elevation), but also during the inter-,pre-, late-ictal periods, and especially in the post-ictal (sharp decline) state. However, in the 20 patients who were not-seizure-free, the differences between the OLs and RLs during the post-ictal period were not found in any frequency band. The dynamic trend was used to predict surgical outcome, and the results showed that the sensitivity was 91% and the specificity was 70%. In brief, this study indicates that our approach may add new and valuable information, providing efficient quantitative measures useful for localizing the EZ.

Secondary Trauma in Children and School Personnel

ERIC Educational Resources Information Center

Motta, Robert W.

2012-01-01

A review of childhood secondary trauma is presented. Secondary trauma involves the transfer and acquisition of negative affective and dysfunctional cognitive states due to prolonged and extended contact with others, such as family members, who have been traumatized. As such, secondary trauma refers to a spread of trauma reactions from the victim…

Report of the Committee on Secondary Education.

ERIC Educational Resources Information Center

Western Australia Education Dept., Perth.

This document is an English-language abstract (approximately 1,500 words) of a Western Australian report on secondary education. In Western Australia, secondary education is offered over a period of five years following seven years of primary education, the age of entry being over twelve years of age. Government secondary schools are…

[Molecular regulation of microbial secondary metabolites--a review].

PubMed

Wang, Linqi; Tan, Huarong

2009-04-01

Microbial secondary metabolites play an important role in the field of industry, agriculture, medicine and human health. The molecular regulation of secondary metabolites is gradually becoming noticeable and intriguing. In recent years, many researches have demonstrated that secondary metabolite biosynthesis is tightly linked to the physiological and developmental status in its producer. It is suggested that the biosynthesis of secondary metabolites involves in complex process concerning multi-level regulation. Here we reviewed the recent research progress on the molecular regulation of secondary metabolites in microorganisms. In known about ten thousand kinds of natural secondary metabolites, most of them (about 60%) were produced by Streptomycete. Therefore, the regulation of secondary metabolites in Streptomyces is chosen as the mainline in this review. Additionally, several well-studied antibiotics as the representative members were targeted. Finally, some suggestions, in response to the issues at present, have been presented in this paper.

Secondary electron emission from textured surfaces

NASA Astrophysics Data System (ADS)

Huerta, C. E.; Patino, M. I.; Wirz, R. E.

2018-04-01

In this work, a Monte Carlo model is used to investigate electron induced secondary electron emission for varying effects of complex surfaces by using simple geometric constructs. Geometries used in the model include: vertical fibers for velvet-like surfaces, tapered pillars for carpet-like surfaces, and a cage-like configuration of interlaced horizontal and vertical fibers for nano-structured fuzz. The model accurately captures the secondary electron emission yield dependence on incidence angle. The model shows that unlike other structured surfaces previously studied, tungsten fuzz exhibits secondary electron emission yield that is independent of primary electron incidence angle, due to the prevalence of horizontally-oriented fibers in the fuzz geometry. This is confirmed with new data presented herein of the secondary electron emission yield of tungsten fuzz at incidence angles from 0-60°.

Turkey: Secondary Education and Training. Secondary Education Series.

ERIC Educational Resources Information Center

Fretwell, David H.; Wheeler, Antony

The World Bank has been assisting the efforts of developing countries to reform secondary education systems for more than 35 years. During this period, the context and imperatives for education reform have changed considerably due to various factors such as globalization of the world economy and the impact of new technologies. This paper is one of…

Simplified Hybrid-Secondary Uncluttered Machine And Method

DOEpatents

Hsu, John S [Oak Ridge, TN

2005-05-10

An electric machine (40, 40') has a stator (43) and a rotor (46) and a primary air gap (48) has secondary coils (47c, 47d) separated from the rotor (46) by a secondary air gap (49) so as to induce a slip current in the secondary coils (47c, 47d). The rotor (46, 76) has magnetic brushes (A, B, C, D) or wires (80) which couple flux in through the rotor (46) to the secondary coils (47c, 47d) without inducing a current in the rotor (46) and without coupling a stator rotational energy component to the secondary coils (47c, 47d). The machine can be operated as a motor or a generator in multi-phase or single-phase embodiments. A method of providing a slip energy controller is also disclosed.

Clonal Architecture of Secondary Acute Myeloid Leukemia

PubMed Central

Walter, Matthew J.; Shen, Dong; Ding, Li; Shao, Jin; Koboldt, Daniel C.; Chen, Ken; Larson, David E.; McLellan, Michael D.; Dooling, David; Abbott, Rachel; Fulton, Robert; Magrini, Vincent; Schmidt, Heather; Kalicki-Veizer, Joelle; O’Laughlin, Michelle; Fan, Xian; Grillot, Marcus; Witowski, Sarah; Heath, Sharon; Frater, John L.; Eades, William; Tomasson, Michael; Westervelt, Peter; DiPersio, John F.; Link, Daniel C.; Mardis, Elaine R.; Ley, Timothy J.; Wilson, Richard K.; Graubert, Timothy A.

2012-01-01

BACKGROUND The myelodysplastic syndromes are a group of hematologic disorders that often evolve into secondary acute myeloid leukemia (AML). The genetic changes that underlie progression from the myelodysplastic syndromes to secondary AML are not well understood. METHODS We performed whole-genome sequencing of seven paired samples of skin and bone marrow in seven subjects with secondary AML to identify somatic mutations specific to secondary AML. We then genotyped a bone marrow sample obtained during the antecedent myelodysplastic-syndrome stage from each subject to determine the presence or absence of the specific somatic mutations. We identified recurrent mutations in coding genes and defined the clonal architecture of each pair of samples from the myelodysplastic-syndrome stage and the secondary-AML stage, using the allele burden of hundreds of mutations. RESULTS Approximately 85% of bone marrow cells were clonal in the myelodysplastic-syndrome and secondary-AML samples, regardless of the myeloblast count. The secondary-AML samples contained mutations in 11 recurrently mutated genes, including 4 genes that have not been previously implicated in the myelodysplastic syndromes or AML. In every case, progression to acute leukemia was defined by the persistence of an antecedent founding clone containing 182 to 660 somatic mutations and the outgrowth or emergence of at least one subclone, harboring dozens to hundreds of new mutations. All founding clones and subclones contained at least one mutation in a coding gene. CONCLUSIONS Nearly all the bone marrow cells in patients with myelodysplastic syndromes and secondary AML are clonally derived. Genetic evolution of secondary AML is a dynamic process shaped by multiple cycles of mutation acquisition and clonal selection. Recurrent gene mutations are found in both founding clones and daughter subclones. (Funded by the National Institutes of Health and others.) PMID:22417201

Zakon za srednoto obrazovanie (Secondary Education Act).

ERIC Educational Resources Information Center

1971

This document is an English-language abstract (approximately 1,500 words) of the Macedonian Secondary Education Act of 1970. Secondary Education is an integral part of the consolidated system of education and training. All citizens have an equal right to acquire the knowledge and skills they need in any type of secondary level institution.…

Secondary missile injury from lightning strike.

PubMed

Blumenthal, Ryan

2012-03-01

A 48-year-old-woman was struck dead by lightning on October 24, 2010, in Pretoria, South Africa. The cause of death was due to direct lightning strike. Examination showed secondary missile injury on her legs. This secondary missile (shrapnel) injury was caused by the lightning striking the concrete pavement next to her. Small pieces of concrete were located embedded within the shrapnel wounds. This case report represents the first documented case of secondary missile formation (shrapnel injury) due to lightning strike in the literature.

Intracranial investigation of a patient with nodular heterotopia and hippocampal sclerosis: dealing with a dual pathology.

PubMed

Ladino, Lady Diana; Dash, Chelsea; Wu, Adam; Tellez-Zenteno, Jose Francisco

2017-06-01

The pre-operative assessment and surgical management of patients with dual pathology is challenging. We describe a patient with drug-resistant focal epilepsy with hippocampal sclerosis and extensive periventricular nodular heterotopia in the same hemisphere. The semiology, scalp EEG, and imaging were divergent, but the presence of focal interictal and ictal epileptic discharges of the putative ictal onset zone resulted in successful localization of the epileptogenic zone. A less aggressive resection was performed based on intracranial EEG recording. The patient has been seizure-free for three years since resection. Electroclinical hypotheses and challenges in defining the epileptogenic network are discussed.

Prediction of primary vs secondary hypertension in children.

PubMed

Baracco, Rossana; Kapur, Gaurav; Mattoo, Tej; Jain, Amrish; Valentini, Rudolph; Ahmed, Maheen; Thomas, Ronald

2012-05-01

Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. © 2012 Wiley Periodicals, Inc.

Hybrid-secondary uncluttered induction machine

DOEpatents

Hsu, John S.

2001-01-01

An uncluttered secondary induction machine (100) includes an uncluttered rotating transformer (66) which is mounted on the same shaft as the rotor (73) of the induction machine. Current in the rotor (73) is electrically connected to current in the rotor winding (67) of the transformer, which is not electrically connected to, but is magnetically coupled to, a stator secondary winding (40). The stator secondary winding (40) is alternately connected to an effective resistance (41), an AC source inverter (42) or a magnetic switch (43) to provide a cost effective slip-energy-controlled, adjustable speed, induction motor that operates over a wide speed range from below synchronous speed to above synchronous speed based on the AC line frequency fed to the stator.

Cannabinoids and Symptomatic Bradycardia.

PubMed

Heckle, Mark R; Nayyar, Mannu; Sinclair, Scott E; Weber, Karl T

2018-01-01

Cannabinoids, the bioactive components of marijuana, have adverse cardiovascular consequences, including symptomatic sinus bradycardia, sinus arrest and ventricular asystole. Physicians should be aware of these deleterious consequences which can appear in otherwise healthy persons who are chronic marijuana users. Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Consequences of Secondary Calibrations on Divergence Time Estimates.

PubMed

Schenk, John J

2016-01-01

Secondary calibrations (calibrations based on the results of previous molecular dating studies) are commonly applied in divergence time analyses in groups that lack fossil data; however, the consequences of applying secondary calibrations in a relaxed-clock approach are not fully understood. I tested whether applying the posterior estimate from a primary study as a prior distribution in a secondary study results in consistent age and uncertainty estimates. I compared age estimates from simulations with 100 randomly replicated secondary trees. On average, the 95% credible intervals of node ages for secondary estimates were significantly younger and narrower than primary estimates. The primary and secondary age estimates were significantly different in 97% of the replicates after Bonferroni corrections. Greater error in magnitude was associated with deeper than shallower nodes, but the opposite was found when standardized by median node age, and a significant positive relationship was determined between the number of tips/age of secondary trees and the total amount of error. When two secondary calibrated nodes were analyzed, estimates remained significantly different, and although the minimum and median estimates were associated with less error, maximum age estimates and credible interval widths had greater error. The shape of the prior also influenced error, in which applying a normal, rather than uniform, prior distribution resulted in greater error. Secondary calibrations, in summary, lead to a false impression of precision and the distribution of age estimates shift away from those that would be inferred by the primary analysis. These results suggest that secondary calibrations should not be applied as the only source of calibration in divergence time analyses that test time-dependent hypotheses until the additional error associated with secondary calibrations is more properly modeled to take into account increased uncertainty in age estimates.

A Secondary Guy: Physically Disabled Teenagers in Secondary Schools.

ERIC Educational Resources Information Center

Doubt, Lorna; McColl, Mary Ann

2003-01-01

A phenomenological study of seven teenagers with physical disabilities attending a regular secondary school focused on social integration and the factors influencing it. Results showed extrinsic and intrinsic factors that facilitate or limit integration. Occupational therapists can ensure that schools are inclusive and that clients are capable of…

Secondary effects of glyphosate on plants

USDA-ARS?s Scientific Manuscript database

Glyphosate is a unique herbicide with interesting secondary effects. Unfortunately, some have assumed that the secondary effects that occur in glyphosate-susceptible plants treated with glyphosate, such as altered mineral nutrition, reduced phenolic compound production and pathogen resistance, also ...

Secondary Generation of Mountain Waves in the Stratosphere

NASA Astrophysics Data System (ADS)

Woods, Bryan K.

Secondary generation of mountain waves was documented using in situ aircraft data from the Terrain-Induced Rotor Experiment (T-REX). Mountain waves propagating from the Sierra Nevada generated secondary waves due to stratospheric wave breaking. The seminal Eliassen and Palm (1961) relation of mountain wave energy and momentum fluxes is observationally verified for the first time. One case of reversed wave fluxes in the stratosphere is shown to be the result of multiscale secondary waves propagating down from the stratosphere. The Tropopause Inversion Layer (TIL) is shown to be capable of serving as a wave duct trapping such secondary waves. Simple idealized 2D simulations are shown to reproduce secondary wave patterns that bare striking resemblance to those observed in T-REX. However, 3D simulations are shown to fail to reproduce realistic secondary waves.

"Loss of breath" as a cause of postoperative hypoxia and bradycardia in children submitted to tonsillectomy.

PubMed

Moro, Eduardo Toshiyuki; Goulart, Alexandre Palmeira

2015-01-01

the "shortness of breath" or "breathing interruption" crisis can be considered a cause of hypoxia in childhood. It is characterized by the presence of a triggering factor followed by weeping and apnea in expiration accompanied by cyanosis or pallor. The sequence of events may include bradycardia, loss of consciousness, abnormal postural tone and even asystole. A review of the literature revealed only two reports of postoperative apnea caused by "shortness of breath". this article describes the case of a child with a history of "shortness of breath" undiagnosed before the adenotonsillectomy, but that represented the cause of episodes of hypoxemia and bradycardia in the postoperative period. the "shortness of breath" crisis should be considered as a possible cause of perioperative hypoxia in children, especially when there is a history suggestive of this problem. As some events may be accompanied by bradycardia, loss of consciousness, abnormal postural tone and even asystole, observation in a hospital setting should be considered. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

["Loss of breath" as a cause of postoperative hypoxia and bradycardia in children submitted to tonsillectomy].

PubMed

Moro, Eduardo Toshiyuki; Goulart, Alexandre Palmeira

2015-01-01

The "shortness of breath" or "breathing interruption" crisis can be considered a cause of hypoxia in childhood. It is characterized by the presence of a triggering factor followed by weeping and apnea in expiration accompanied by cyanosis or pallor. The sequence of events may include bradycardia, loss of consciousness, abnormal postural toneand even asystole. A review of the literature revealed only two reports of postoperative apneacaused by "shortness of breath". This article describes the case of a child with a history of "shortness of breath" undiagnosed before the adenotonsillectomy, but that represented the cause of episodes of hypoxemia and bradycardia in the postoperative period. the "shortness of breath" crisis should be considered as a possible cause of perioperative hypoxia in children, especially when there is a history suggestive of this problem. As some events may be accompanied by bradycardia, loss of consciousness, abnormal postural tone and even asystole, observation in a hospital setting should be considered. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

A Case of Trigeminocardiac Reflex During Infrastructure Maxillectomy.

PubMed

Mohan, Suresh; Flis, Daniel W; O'Leary, Miriam A

2014-06-01

The trigeminocardiac reflex refers to the sudden development of bradycardia or even asystole with arterial hypotension from manipulation of any sensory branches of the trigeminal nerve. Although it has only rarely been associated with morbidity and tends to be self-limited with removal of the stimulus, it is an important phenomenon for head and neck surgeons to recognize and respond to. We present the case of a woman in her late 60s with maxillary alveolar ridge squamous cell carcinoma who developed episodes of asystole and bradycardia during posterior maxillary manipulation for an infrastructure maxillectomy at a tertiary academic medical center. Administration of atropine and removal of the inciting stimulus sufficed to extinguish the episodes and allow procedure completion. The trigeminocardiac reflex can be provoked by a number of head and neck and skull base procedures including parotidectomy and posterior maxillectomy. Surgeons and anesthesiologists should be wary of inciting the reflex during manipulation of trigeminal branches. Careful dissection for prevention and early intervention with stimulus removal and anticholinergic use as needed are paramount to ensure good outcomes.

Secondary motion in three-dimensional branching networks

PubMed Central

Guha, Abhijit; Pradhan, Kaustav

2017-01-01

A major aim of the present work is to understand and thoroughly document the generation, the three-dimensional distribution, and the evolution of the secondary motion as the fluid progresses downstream through a branched network. Six generations (G0-G5) of branches (involving 63 straight portions and 31 bifurcation modules) are computed in one go; such computational challenges are rarely taken in the literature. More than 30 × 106 computational elements are employed for high precision of computed results and fine quality of the flow visualization diagrams. The study of co-planar vis-à-vis non-planar space-filling configurations establishes a quantitative evaluation of the dependence of the fluid dynamics on the three-dimensional arrangement of the same individual branches. As compared to the secondary motion in a simple curved pipe, three distinctive features, viz., the change of shape and size of the flow-cross-section, the division of non-uniform primary flow in a bifurcation module, and repeated switchover from clockwise to anticlockwise curvature and vice versa in the flow path, make the present situation more complex. It is shown that the straight portions in the network, in general, attenuate the secondary motion, while the three-dimensionally complex bifurcation modules generate secondary motion and may alter the number, arrangement, and structure of vortices. A comprehensive picture of the evolution of quantitative flow visualizations of the secondary motion is achieved by constructing contours of secondary velocity v→S, streamwise vorticity ωS, and λ2 iso-surfaces. It is demonstrated, for example, that for in-plane configuration, the vortices on any plane appear in pair (i.e., for each clockwise rotating vortex, there is an otherwise identical anticlockwise vortex), whereas the vortices on a plane for the out-of-plane configuration may be dissimilar, and there may even be an odd number of vortices. We have formulated three new parameters (ES/P, �

Secondary motion in three-dimensional branching networks

NASA Astrophysics Data System (ADS)

Guha, Abhijit; Pradhan, Kaustav

2017-06-01

A major aim of the present work is to understand and thoroughly document the generation, the three-dimensional distribution, and the evolution of the secondary motion as the fluid progresses downstream through a branched network. Six generations (G0-G5) of branches (involving 63 straight portions and 31 bifurcation modules) are computed in one go; such computational challenges are rarely taken in the literature. More than 30 × 106 computational elements are employed for high precision of computed results and fine quality of the flow visualization diagrams. The study of co-planar vis-à-vis non-planar space-filling configurations establishes a quantitative evaluation of the dependence of the fluid dynamics on the three-dimensional arrangement of the same individual branches. As compared to the secondary motion in a simple curved pipe, three distinctive features, viz., the change of shape and size of the flow-cross-section, the division of non-uniform primary flow in a bifurcation module, and repeated switchover from clockwise to anticlockwise curvature and vice versa in the flow path, make the present situation more complex. It is shown that the straight portions in the network, in general, attenuate the secondary motion, while the three-dimensionally complex bifurcation modules generate secondary motion and may alter the number, arrangement, and structure of vortices. A comprehensive picture of the evolution of quantitative flow visualizations of the secondary motion is achieved by constructing contours of secondary velocity | v → S | , streamwise vorticity ω S , and λ 2 iso-surfaces. It is demonstrated, for example, that for in-plane configuration, the vortices on any plane appear in pair (i.e., for each clockwise rotating vortex, there is an otherwise identical anticlockwise vortex), whereas the vortices on a plane for the out-of-plane configuration may be dissimilar, and there may even be an odd number of vortices. We have formulated three new parameters

Secondary reinforcement and number of primary reinforcements1

PubMed Central

Fantino, Edmund; Herrnstein, R. J.

1968-01-01

Pigeons' pecks on either of two concurrently available response keys produced secondary reinforcers according to independent one-minute variable-interval schedules. Different secondary reinforcers, in the presence of which the rates of primary reinforcement were equal, were associated with each key. The rate of pecking maintained by each secondary reinforcer varied directly, but nonproportionally, with the number of primary reinforcements given in the presence of the secondary reinforcer. PMID:5636860

Moon-Mercury: Relative preservation states of secondary craters

USGS Publications Warehouse

Scott, D.H.

1977-01-01

Geologic mapping of the Kuiper quadrangle of Mercury and other geologic studies of the planet indicate that secondary craters are much better preserved than those on the moon around primary craters of similar size and morphology. Among the oldest recognized secondary craters on the moon associated with craters 100 km across or less are those of Posidonius, Atlas and Plato; these craters have been dated as middle to late Imbrian in age. Many craters on Mercury with dimensions, morphologies and superposed crater densities similar to these lunar craters have fields and clusters of fresher appearing secondary craters. The apparent differences between secondary-crater morphology and parent crater may be due in part to: (1) rapid isostatic adjustment of the parent crater; (2) different impact fluxes between the two planets; and (or) (3) to the greater concentration of Mercurian secondaries around impact areas, thereby accentuating crater forms. Another factor which may contribute to the better state of preservation of Mercurian secondaries relative to the moon is the difference in crater ejecta velocities on both bodies. These velocities have been calculated for fields of secondary craters at about equal ranges from lunar and Mercurian parent craters. Results show that ejection velocities of material producing most of the secondary craters are rather low (<1 km/s) but velocities on Mercury are about 50% greater than those on the moon for equivalent ranges. Higher velocities may produce morphologically enhanced secondary craters which may account for their better preservation with time. ?? 1977.

Diagnosis of secondary hypertension: an age-based approach.

PubMed

Viera, Anthony J; Neutze, Dana M

2010-12-15

Secondary hypertension is a type of hypertension with an underlying, potentially correctable cause. A secondary etiology may be suggested by symptoms (e.g., flushing and sweating suggestive of pheochromocytoma), examina- tion findings (e.g., a renal bruit suggestive of renal artery stenosis), or laboratory abnormalities (e.g., hypokalemia suggestive of aldosteronism). Secondary hypertension also should be considered in patients with resistant hyper- tension, and early or late onset of hypertension. The prevalence of secondary hypertension and the most common etiologies vary by age group. Approximately 5 to 10 percent of adults with hypertension have a secondary cause. In young adults, particu- larly women, renal artery stenosis caused by fibromuscular dyspla- sia is one of the most common secondary etiologies. Fibromuscular dysplasia can be detected by abdominal magnetic resonance imag- ing or computed tomography. These same imaging modalities can be used to detect atherosclerotic renal artery stenosis, a major cause of secondary hypertension in older adults. In middle-aged adults, aldosteronism is the most common secondary cause of hyperten- sion, and the recommended initial diagnostic test is an aldosterone/ renin ratio. Up to 85 percent of children with hypertension have an identifiable cause, most often renal parenchymal disease. Therefore, all children with confirmed hypertension should have an evaluation for an underlying etiology that includes renal ultrasonography.

Pairwise amino acid secondary structural propensities

NASA Astrophysics Data System (ADS)

Chemmama, Ilan E.; Chapagain, Prem P.; Gerstman, Bernard S.

2015-04-01

We investigate the propensities for amino acids to form a specific secondary structure when they are paired with other amino acids. Our investigations use molecular dynamics (MD) computer simulations, and we compare the results to those from the Protein Data Bank (PDB). Proper comparison requires weighting of the MD results in a manner consistent with the relative frequency of appearance in the PDB of each possible pair of amino acids. We find that the propensity for an amino acid to assume a secondary structure varies dramatically depending on the amino acid that is before or after it in the primary sequence. This cooperative effect means that when selecting amino acids to facilitate the formation of a secondary structure in peptide engineering experiments, the adjacent amino acids must be considered. We also examine the preference for a secondary structure in bacterial proteins and compare the results to those of human proteins.

Secondary cell walls: biosynthesis, patterned deposition and transcriptional regulation.

PubMed

Zhong, Ruiqin; Ye, Zheng-Hua

2015-02-01

Secondary walls are mainly composed of cellulose, hemicelluloses (xylan and glucomannan) and lignin, and are deposited in some specialized cells, such as tracheary elements, fibers and other sclerenchymatous cells. Secondary walls provide strength to these cells, which lend mechanical support and protection to the plant body and, in the case of tracheary elements, enable them to function as conduits for transporting water. Formation of secondary walls is a complex process that requires the co-ordinated expression of secondary wall biosynthetic genes, biosynthesis and targeted secretion of secondary wall components, and patterned deposition and assembly of secondary walls. Here, we provide a comprehensive review of genes involved in secondary wall biosynthesis and deposition. Most of the genes involved in the biosynthesis of secondary wall components, including cellulose, xylan, glucomannan and lignin, have been identified and their co-ordinated activation has been shown to be mediated by a transcriptional network encompassing the secondary wall NAC and MYB master switches and their downstream transcription factors. It has been demonstrated that cortical microtubules and microtubule-associated proteins play important roles in the targeted secretion of cellulose synthase complexes, the oriented deposition of cellulose microfibrils and the patterned deposition of secondary walls. Further investigation of many secondary wall-associated genes with unknown functions will provide new insights into the mechanisms controlling the formation of secondary walls that constitute the bulk of plant biomass. © The Author 2014. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved. For permissions, please email: journals.permissions@oup.com.

40 CFR 143.3 - Secondary maximum contaminant levels.

Code of Federal Regulations, 2013 CFR

2013-07-01

.... 143.3 Section 143.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL SECONDARY DRINKING WATER REGULATIONS § 143.3 Secondary maximum contaminant levels. The secondary maximum contaminant levels for public water systems are as follows: Contaminant...

40 CFR 143.3 - Secondary maximum contaminant levels.

Code of Federal Regulations, 2011 CFR

2011-07-01

.... 143.3 Section 143.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL SECONDARY DRINKING WATER REGULATIONS § 143.3 Secondary maximum contaminant levels. The secondary maximum contaminant levels for public water systems are as follows: Contaminant...

40 CFR 143.3 - Secondary maximum contaminant levels.

Code of Federal Regulations, 2014 CFR

2014-07-01

.... 143.3 Section 143.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL SECONDARY DRINKING WATER REGULATIONS § 143.3 Secondary maximum contaminant levels. The secondary maximum contaminant levels for public water systems are as follows: Contaminant...

40 CFR 143.3 - Secondary maximum contaminant levels.

Code of Federal Regulations, 2012 CFR

2012-07-01

.... 143.3 Section 143.3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL SECONDARY DRINKING WATER REGULATIONS § 143.3 Secondary maximum contaminant levels. The secondary maximum contaminant levels for public water systems are as follows: Contaminant...

Validity of Secondary Retail Food Outlet Data

PubMed Central

Fleischhacker, Sheila E.; Evenson, Kelly R.; Sharkey, Joseph; Pitts, Stephanie B.J.; Rodriguez, Daniel A.

2013-01-01

Context Improving access to healthy foods is a promising strategy to prevent nutrition-related chronic diseases. To characterize retail food environments and identify areas with limited retail access, researchers, government programs, and community advocates have primarily used secondary retail food outlet data sources (e.g., InfoUSA or government food registries). To advance the state of the science on measuring retail food environments, this systematic review examined the evidence for validity reported for secondary retail food outlet data sources for characterizing retail food environments. Evidence acquisition A literature search was conducted through December 31, 2012 to identify peer-reviewed published literature that compared secondary retail food outlet data sources to primary data sources (i.e., field observations) for accuracy of identifying the type and location of retail food outlets. Data were analyzed in 2013. Evidence synthesis Nineteen studies met the inclusion criteria. The evidence for validity reported varied by secondary data sources examined, primary data–gathering approaches, retail food outlets examined, and geographic and sociodemographic characteristics. More than half of the studies (53%) did not report evidence for validity by type of food outlet examined and by a particular secondary data source. Conclusions Researchers should strive to gather primary data but if relying on secondary data sources, InfoUSA and government food registries had higher levels of agreement than reported by other secondary data sources and may provide sufficient accuracy for exploring these associations in large study areas. PMID:24050423

The potential for species conservation in tropical secondary forests.

PubMed

Chazdon, Robin L; Peres, Carlos A; Dent, Daisy; Sheil, Douglas; Lugo, Ariel E; Lamb, David; Stork, Nigel E; Miller, Scott E

2009-12-01

In the wake of widespread loss of old-growth forests throughout the tropics, secondary forests will likely play a growing role in the conservation of forest biodiversity. We considered a complex hierarchy of factors that interact in space and time to determine the conservation potential of tropical secondary forests. Beyond the characteristics of local forest patches, spatial and temporal landscape dynamics influence the establishment, species composition, and persistence of secondary forests. Prospects for conservation of old-growth species in secondary forests are maximized in regions where the ratio of secondary to old-growth forest area is relatively low, older secondary forests have persisted, anthropogenic disturbance after abandonment is relatively low, seed-dispersing fauna are present, and old-growth forests are close to abandoned sites. The conservation value of a secondary forest is expected to increase over time, as species arriving from remaining old-growth forest patches accumulate. Many studies are poorly replicated, which limits robust assessments of the number and abundance of old-growth species present in secondary forests. Older secondary forests are not often studied and few long-term studies are conducted in secondary forests. Available data indicate that both old-growth and second-growth forests are important to the persistence of forest species in tropical, human-modified landscapes.

Secondary Writing Centers: Benefits of College and Secondary Collaboration.

ERIC Educational Resources Information Center

Brinkley, Ellen H.

Based on college writing center models, a number of high schools are deciding to establish writing centers, some of them in anticipation of competency tests in composition. Staffing can be the single most significant and expensive factor for secondary schools wanting to provide writing centers. Among the options for dealing with the staffing…

30 CFR 57.6312 - Secondary blasting.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Explosives Transportation-Surface and Underground § 57.6312 Secondary blasting. Secondary blasts fired at the same time in...

Binary asteroid population. 3. Secondary rotations and elongations

NASA Astrophysics Data System (ADS)

Pravec, P.; Scheirich, P.; Kušnirák, P.; Hornoch, K.; Galád, A.; Naidu, S. P.; Pray, D. P.; Világi, J.; Gajdoš, Š.; Kornoš, L.; Krugly, Yu. N.; Cooney, W. R.; Gross, J.; Terrell, D.; Gaftonyuk, N.; Pollock, J.; Husárik, M.; Chiorny, V.; Stephens, R. D.; Durkee, R.; Reddy, V.; Dyvig, R.; Vraštil, J.; Žižka, J.; Mottola, S.; Hellmich, S.; Oey, J.; Benishek, V.; Kryszczyńska, A.; Higgins, D.; Ries, J.; Marchis, F.; Baek, M.; Macomber, B.; Inasaridze, R.; Kvaratskhelia, O.; Ayvazian, V.; Rumyantsev, V.; Masi, G.; Colas, F.; Lecacheux, J.; Montaigut, R.; Leroy, A.; Brown, P.; Krzeminski, Z.; Molotov, I.; Reichart, D.; Haislip, J.; LaCluyze, A.

2016-03-01

We collected data on rotations and elongations of 46 secondaries of binary and triple systems among near-Earth, Mars-crossing and small main belt asteroids. 24 were found or are strongly suspected to be synchronous (in 1:1 spin-orbit resonance), and the other 22, generally on more distant and/or eccentric orbits, were found or are suggested to have asynchronous rotations. For 18 of the synchronous secondaries, we constrained their librational angles, finding that their long axes pointed to within 20° of the primary on most epochs. The observed anti-correlation of secondary synchroneity with orbital eccentricity and the limited librational angles agree with the theories by Ćuk and Nesvorný (Ćuk, M., Nesvorný, D. [2010]. Icarus 207, 732-743) and Naidu and Margot (Naidu, S.P., Margot, J.-L. [2015]. Astron. J. 149, 80). A reason for the asynchronous secondaries being on wider orbits than synchronous ones may be longer tidal circularization time scales at larger semi-major axes. The asynchronous secondaries show relatively fast spins; their rotation periods are typically < 10 h. An intriguing observation is a paucity of chaotic secondary rotations; with an exception of (35107) 1991 VH, the secondary rotations are single-periodic with no signs of chaotic rotation and their periods are constant on timescales from weeks to years. The secondary equatorial elongations show an upper limit of a2 /b2 ∼ 1.5 . The lack of synchronous secondaries with greater elongations appears consistent, considering uncertainties of the axis ratio estimates, with the theory by Ćuk and Nesvorný that predicts large regions of chaotic rotation in the phase space for a2 /b2 ≳√{ 2 } . Alternatively, secondaries may not form or stay very elongated in gravitational (tidal) field of the primary. It could be due to the secondary fission mechanism suggested by Jacobson and Scheeres (Jacobson, S.A., Scheeres, D.J. [2011]. Icarus 214, 161-178), as its efficiency is correlated with the

Characteristics of the Secondary Divertor on DIII-D

NASA Astrophysics Data System (ADS)

Watkins, J. G.; Lasnier, C. J.; Leonard, A. W.; Evans, T. E.; Pitts, R.; Stangeby, P. C.; Boedo, J. A.; Moyer, R. A.; Rudakov, D. L.

2009-11-01

In order to address a concern that the ITER secondary divertor strike plates may be insufficiently robust to handle the incident pulses of particles and energy from ELMs, we performed dedicated studies of the secondary divertor plasma and scrape-off layer (SOL). Detailed measurements of the ELM energy and particle deposition footprint on the secondary divertor target plates were made with a fast IR camera and Langmuir probes and SOL profile and transport measurements were made with reciprocating probes. The secondary divertor and SOL conditions depended on changes in the magnetic balance and the core plasma density. Larger density resulted in smaller ELMs and the magnetic balance affected how many ELM particles coupled to the secondary SOL and divertor. Particularly striking are the images from a new fast IR camera that resolve ELM heat pulses and show spiral patterns with multiple peaks during ELMs in the secondary divertor.

Biologically Active Secondary Metabolites from the Fungi.

PubMed

Bills, Gerald F; Gloer, James B

2016-11-01

Many Fungi have a well-developed secondary metabolism. The diversity of fungal species and the diversification of biosynthetic gene clusters underscores a nearly limitless potential for metabolic variation and an untapped resource for drug discovery and synthetic biology. Much of the ecological success of the filamentous fungi in colonizing the planet is owed to their ability to deploy their secondary metabolites in concert with their penetrative and absorptive mode of life. Fungal secondary metabolites exhibit biological activities that have been developed into life-saving medicines and agrochemicals. Toxic metabolites, known as mycotoxins, contaminate human and livestock food and indoor environments. Secondary metabolites are determinants of fungal diseases of humans, animals, and plants. Secondary metabolites exhibit a staggering variation in chemical structures and biological activities, yet their biosynthetic pathways share a number of key characteristics. The genes encoding cooperative steps of a biosynthetic pathway tend to be located contiguously on the chromosome in coregulated gene clusters. Advances in genome sequencing, computational tools, and analytical chemistry are enabling the rapid connection of gene clusters with their metabolic products. At least three fungal drug precursors, penicillin K and V, mycophenolic acid, and pleuromutilin, have been produced by synthetic reconstruction and expression of respective gene clusters in heterologous hosts. This review summarizes general aspects of fungal secondary metabolism and recent developments in our understanding of how and why fungi make secondary metabolites, how these molecules are produced, and how their biosynthetic genes are distributed across the Fungi. The breadth of fungal secondary metabolite diversity is highlighted by recent information on the biosynthesis of important fungus-derived metabolites that have contributed to human health and agriculture and that have negatively impacted crops

Athletic Trainer Services in US Private Secondary Schools.

PubMed

Pike, Alicia; Pryor, Riana R; Mazerolle, Stephanie M; Stearns, Rebecca L; Casa, Douglas J

2016-09-01

Availability of athletic trainer (AT) services in US secondary schools has recently been reported to be as high as 70%, but this only describes the public sector. The extent of AT coverage in private secondary school settings has yet to be investigated and may differ from the public secondary school setting for several reasons, including differences in funding sources. To determine the level of AT services in US private secondary schools and identify the reasons why some schools did not employ ATs. Concurrent mixed-methods study. Private secondary schools in the United States. Of 5414 private secondary schools, 2044 (38%) responded to the survey. School administrators responded to the survey via telephone or e-mail. This instrument was previously used in a study examining AT services among public secondary schools. Descriptive statistics provided national data. Open-ended questions were evaluated through content analysis. Of the 2044 schools that responded, 58% (1176/2044) offered AT services, including 28% (574/2040) full time, 25% (501/2042) part time, 4% (78/1918) per diem, and 20% (409/2042) from a hospital or clinic. A total of 84% (281 285/336 165) of athletes had access to AT services. Larger private secondary schools were more likely to have AT services available. Barriers to providing AT services in the private sector were budgetary constraints, school size and sports, and lack of awareness of the role of an AT. More than half of the surveyed private secondary schools in the United States had AT services available; however, only 28% had a full-time AT. This demonstrates the need for increased medical coverage to provide athletes in this setting the appropriate level of care. Budgetary concerns, size of the school and sport offerings, and lack of awareness of the role of the AT continued to be barriers in the secondary school setting.

Modeling secondary accidents identified by traffic shock waves.

PubMed

Junhua, Wang; Boya, Liu; Lanfang, Zhang; Ragland, David R

2016-02-01

The high potential for occurrence and the negative consequences of secondary accidents make them an issue of great concern affecting freeway safety. Using accident records from a three-year period together with California interstate freeway loop data, a dynamic method for more accurate classification based on the traffic shock wave detecting method was used to identify secondary accidents. Spatio-temporal gaps between the primary and secondary accident were proven be fit via a mixture of Weibull and normal distribution. A logistic regression model was developed to investigate major factors contributing to secondary accident occurrence. Traffic shock wave speed and volume at the occurrence of a primary accident were explicitly considered in the model, as a secondary accident is defined as an accident that occurs within the spatio-temporal impact scope of the primary accident. Results show that the shock waves originating in the wake of a primary accident have a more significant impact on the likelihood of a secondary accident occurrence than the effects of traffic volume. Primary accidents with long durations can significantly increase the possibility of secondary accidents. Unsafe speed and weather are other factors contributing to secondary crash occurrence. It is strongly suggested that when police or rescue personnel arrive at the scene of an accident, they should not suddenly block, decrease, or unblock the traffic flow, but instead endeavor to control traffic in a smooth and controlled manner. Also it is important to reduce accident processing time to reduce the risk of secondary accident. Copyright © 2015 Elsevier Ltd. All rights reserved.

13 CFR 120.613 - Secondary Participation Guarantee Agreement.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Secondary Participation Guarantee Agreement. 120.613 Section 120.613 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Certificates § 120.613 Secondary Participation Guarantee Agreement. When a Lender...

13 CFR 120.613 - Secondary Participation Guarantee Agreement.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Secondary Participation Guarantee Agreement. 120.613 Section 120.613 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Certificates § 120.613 Secondary Participation Guarantee Agreement. When a Lender...

Secondary Craters in Bas Relief

NASA Image and Video Library

2017-04-17

NASA's Mars Reconnaissance Orbiter (MRO) captured this region of Mars, sprayed with secondary craters from 10-kilometer Zunil Crater to the northwest. Secondary craters form from rocks ejected at high speed from the primary crater, which then impact the ground at sufficiently high speed to make huge numbers of much smaller craters over a large region. In this scene, however, the secondary crater ejecta has an unusual raised-relief appearance like bas-relief sculpture. How did that happen? One idea is that the region was covered with a layer of fine-grained materials like dust or pyroclastics about 1 to 2 meters thick when the Zunil impact occurred (about a million years ago), and the ejecta served to harden or otherwise protect the fine-grained layer from later erosion by the wind. https://photojournal.jpl.nasa.gov/catalog/PIA21591

Factors Affecting Subsidized Free Day Secondary Education in Enhancing Learners Retention in Secondary Schools in Kenya

ERIC Educational Resources Information Center

James, Asena Muganda; Simiyu, Aggrey Mukasa; Riechi, Andrew

2016-01-01

Learners are the key stakeholders of a school for it to be registered by the Department of Education. However the retention of these learners in Kenya's Secondary Level Education is a great challenge in Kenya. Every secondary school dropout signifies unfulfilled objective, goal and aim for the individual as well as the community at large. The…

On the nature of seizure dynamics

PubMed Central

Stacey, William C.; Quilichini, Pascale P.; Ivanov, Anton I.

2014-01-01

Seizures can occur spontaneously and in a recurrent manner, which defines epilepsy; or they can be induced in a normal brain under a variety of conditions in most neuronal networks and species from flies to humans. Such universality raises the possibility that invariant properties exist that characterize seizures under different physiological and pathological conditions. Here, we analysed seizure dynamics mathematically and established a taxonomy of seizures based on first principles. For the predominant seizure class we developed a generic model called Epileptor. As an experimental model system, we used ictal-like discharges induced in vitro in mouse hippocampi. We show that only five state variables linked by integral-differential equations are sufficient to describe the onset, time course and offset of ictal-like discharges as well as their recurrence. Two state variables are responsible for generating rapid discharges (fast time scale), two for spike and wave events (intermediate time scale) and one for the control of time course, including the alternation between ‘normal’ and ictal periods (slow time scale). We propose that normal and ictal activities coexist: a separatrix acts as a barrier (or seizure threshold) between these states. Seizure onset is reached upon the collision of normal brain trajectories with the separatrix. We show theoretically and experimentally how a system can be pushed toward seizure under a wide variety of conditions. Within our experimental model, the onset and offset of ictal-like discharges are well-defined mathematical events: a saddle-node and homoclinic bifurcation, respectively. These bifurcations necessitate a baseline shift at onset and a logarithmic scaling of interspike intervals at offset. These predictions were not only confirmed in our in vitro experiments, but also for focal seizures recorded in different syndromes, brain regions and species (humans and zebrafish). Finally, we identified several possible biophysical

Heart rate changes in partial seizures: analysis of influencing factors among refractory patients

PubMed Central

2014-01-01

Background We analyzed the frequency of heart rate (HR) changes related to seizures, and we sought to identify the influencing factors of these changes during partial seizures, to summarize the regularity of the HR changes and gain some insight into the mechanisms involved in the neuronal regulation of cardiovascular function. To date, detailed information on influencing factors of HR changes related to seizures by multiple linear regression analysis remains scarce. Methods Using video-electroencephalograph (EEG)-electrocardiograph (ECG) recordings, we retrospectively assessed the changes in the HR of 81 patients during a total of 181 seizures, including 27 simple partial seizures (SPS), 110 complex partial seizures (CPS) and 44 complex partial seizures secondarily generalized (CPS-G). The epileptogenic focus and the seizure type, age, gender, and sleep/wakefulness state of each patient were evaluated during and after the seizure onset. The HR changes were evaluated in the stage of epilepsy as time varies. Results Of the 181 seizures from 81 patients with ictal ECGs, 152 seizures (83.98%) from 74 patients were accompanied by ictal tachycardia (IT). And only 1 patient was accompanied by ictal bradycardia (IB). A patient has both IT and IB. We observed that HR difference was independently correlated with side, type and sleep/wakefulness state. In this analysis, the HR changes were related to the side, gender, seizure type, and sleep/wakefulness state. Right focus, male, sleep, and CPS-G showed more significant increases than that were observed in left, female, wakefulness, SPS and CPS. HR increases rapidly within 10 seconds before seizure onset and ictus, and typically slows to normal with seizure offset. Conclusion CPS-G, sleep and right focus led to higher ictal HR. The HR in the stage of epilepsy has regularly been observed to change to become time-varying. The risk factors of ictal HR need to be controlled along with sleep, CPS-G and right focus. Our study first

Role of subdural electrocorticography in prediction of long-term seizure outcome in epilepsy surgery

PubMed Central

Juhász, Csaba; Shah, Aashit; Sood, Sandeep; Chugani, Harry T.

2009-01-01

Since prediction of long-term seizure outcome using preoperative diagnostic modalities remains suboptimal in epilepsy surgery, we evaluated whether interictal spike frequency measures obtained from extraoperative subdural electrocorticography (ECoG) recording could predict long-term seizure outcome. This study included 61 young patients (age 0.4–23.0 years), who underwent extraoperative ECoG recording prior to cortical resection for alleviation of uncontrolled focal seizures. Patient age, frequency of preoperative seizures, neuroimaging findings, ictal and interictal ECoG measures were preoperatively obtained. The seizure outcome was prospectively measured [follow-up period: 2.5–6.4 years (mean 4.6 years)]. Univariate and multivariate logistic regression analyses determined how well preoperative demographic and diagnostic measures predicted long-term seizure outcome. Following the initial cortical resection, Engel Class I, II, III and IV outcomes were noted in 35, 6, 12 and 7 patients, respectively. One child died due to disseminated intravascular coagulation associated with pseudomonas sepsis 2 days after surgery. Univariate regression analyses revealed that incomplete removal of seizure onset zone, higher interictal spike-frequency in the preserved cortex and incomplete removal of cortical abnormalities on neuroimaging were associated with a greater risk of failing to obtain Class I outcome. Multivariate logistic regression analysis revealed that incomplete removal of seizure onset zone was the only independent predictor of failure to obtain Class I outcome. The goodness of regression model fit and the predictive ability of regression model were greatest in the full regression model incorporating both ictal and interictal measures [R2 0.44; Area under the receiver operating characteristic (ROC) curve: 0.81], slightly smaller in the reduced model incorporating ictal but not interictal measures (R2 0.40; Area under the ROC curve: 0.79) and slightly smaller

Pre--Post Secondary Curriculum Guide: Health.

ERIC Educational Resources Information Center

Michael J. Owens Technical Coll., Perrysburg, OH.

A pre--Post secondary curriculum for preparing eleventh and twelfth grade students contemplating postsecondary education in the health occupations is presented in the document. The curriculum would assist high school students in their choice of health careers and in entering postsecondary education smoothly. The pre--post secondary curriculum…

Idea Generating among Secondary School Teachers.

ERIC Educational Resources Information Center

Tomic, Welko; Brouwers, Andre

This study investigated where and how secondary school teachers generated ideas linked to their work environment. A group of 146 teachers from 20 secondary schools in the Netherlands completed an adapted version of Geschka's questionnaire, which focused on (1) teachers' preferred conditions, environments, media, people, and activities before the…

30 CFR 56.6312 - Secondary blasting.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Explosives Use § 56.6312 Secondary blasting. Secondary blasts fired at the same time in the same work area shall be initiated from...

Secondary School Students: Prevention Resource Guide.

ERIC Educational Resources Information Center

Alcohol, Drug Abuse, and Mental Health Administration (DHHS/PHS), Rockville, MD. Office for Substance Abuse Prevention.

This prevention resource guide (compiled from a variety of publications and data bases and representing the most currently available information) focuses on secondary school students, and is divided into four sections. The first section contains facts from current research about substance abuse prevention for secondary school students. For…

Analysis of secondary motions in square duct flow

NASA Astrophysics Data System (ADS)

Modesti, Davide; Pirozzoli, Sergio; Orlandi, Paolo; Grasso, Francesco

2018-04-01

We carry out direct numerical simulations (DNS) of square duct flow spanning the friction Reynolds number range {Re}τ * =150-1055, to study the nature and the role of secondary motions. We preliminarily find that secondary motions are not the mere result of the time averaging procedure, but rather they are present in the instantaneous flow realizations, corresponding to large eddies persistent in both space and time. Numerical experiments have also been carried out whereby the secondary motions are suppressed, hence allowing to quantifying their effect on the mean flow field. At sufficiently high Reynolds number, secondary motions are found to increase the friction coefficient by about 3%, hence proportionally to their relative strength with respect to the bulk flow. Simulations without secondary motions are found to yield larger deviations on the mean velocity profiles from the standard law-of-the-wall, revealing that secondary motions act as a self-regulating mechanism of turbulence whereby the effect of the corners is mitigated.

A comparative study of primary and secondary stereotypies.

PubMed

Ghosh, Debabrata; Rajan, Prashant V; Erenberg, Gerald

2013-12-01

This study compares primary stereotypies (repetitive, self-stimulating, and seemingly nonsensical movements that can occur within typically developing children) and secondary stereotypies (those occurring within autistic or mentally retarded children). Utilizing a retrospective chart review from 1995 to 2010, the current study compares primary and secondary stereotypies by the application of a classification system that organizes the movement by its type (motor only, phonic only, mixed) and complexity. In addition, it investigates other parameters associated with the movements such as duration, frequency, age, functional impairment, and progression. The sample group consisted of 28 primary and 28 secondary cases. Primary stereotypies were predominantly motor, simple, of shorter duration, and of less frequency, whereas secondary stereotypies had more vocalization, complexity, longer durations, and higher frequencies. Moreover, functional impairment due to stereotypies was noted in 3 primary and 7 secondary cases, and worsening of stereotypies was noted in 70% of primary versus 44% of secondary cases.

Coprolalia as a manifestation of epileptic seizures.

PubMed

Massot-Tarrús, Andreu; Mousavi, Seyed Reza; Dove, Carin; Hayman-Abello S, Susan; Hayman-Abello, Brent; Derry, Paul A; Diosy, David C; McLachlan, Richard S; Burneo, Jorge G; Steven, David A; Mirsattari, Seyed M

2016-07-01

The aim of this study was to investigate the lateralizing and localizing value of ictal coprolalia and brain areas involved in its production. A retrospective search for patients manifesting ictal coprolalia was conducted in our EMU database. Continuous video-EEG recordings were reviewed, and EEG activity before and during coprolalia was analyzed using independent component analysis (ICA) technique and was compared to the seizures without coprolalia among the same patients. Nine patients were evaluated (five women), eight with intracranial video-EEG recordings (icVEEG). Four had frontal or temporal lesions, and five had normal MRIs. Six patients showed impairment in the language functions and five in the frontal executive tasks. Two hundred six seizures were reviewed (60.7% from icVEEG). Ictal coprolalia occurred in 46.6% of them, always associated with limbic auras or automatisms. They arose from the nondominant hemisphere in five patients, dominant hemisphere in three, and independently from the right and left hippocampus-parahippocampus in one. Electroencephalographic activity always involved orbitofrontal and/or mesial temporal regions of the nondominant hemisphere when coprolalia occurred. Independent component analysis of 31 seizures in seven patients showed a higher number of independent components in the nondominant hippocampus-parahippocampus before and during coprolalia and in the dominant lateral temporal region in those seizures without coprolalia (p=0.009). Five patients underwent surgery, and all five had an ILAE class 1 outcome. Ictal coprolalia occurs in both males and females with temporal or orbitofrontal epilepsy and has a limited lateralizing value to the nondominant hemisphere but can be triggered by seizures from either hemisphere. It involves activation of the paralimbic temporal-orbitofrontal network. Copyright © 2016 Elsevier Inc. All rights reserved.

[The role of ambulatory electroencephalogram monitoring: experience and results in 264 records].

PubMed

González de la Aleja, J; Saiz Díaz, R A; Martín García, H; Juntas, R; Pérez-Martínez, D; de la Peña, P

2008-11-01

Ambulatory electroencephalogram (EEG) monitoring allows for long-term, mobile electroencephalographic recordings of patients. This study aims to describe and analyze the results obtained with ambulatory EEG in our clinical practice. We have analyzed the results of 264 ambulatory EEG records, grouped according to the reason for the request: a) group 1: diagnostic evaluation of episodes of epileptic nature; b) group 2: diagnostic evaluation of paroxysmal episodes, and c) group 3: evaluation of the risk of relapse during anti-seizure treatment withdrawal in certain epileptic patients. a) Group 1 (n=137): normal results were found in 54 records (39.4%). There was generalized epileptic activity in 20 (14.6%) of them (5 with ictal activity) and focal epileptic activity was detected in 57 cases (42%) (8 with ictal activity). No EEG diagnosis could be reached in 6 (4%) recordings due to the presence of artefacts; b) group 2 (n=99): in 47 records (47.5 %), there were no episodes and the Holter-EEG was normal. There was a clinically documented episode without anomalies during Holter-EEG registration in 14 cases (14.2%). In 29 records (29.3%), focal epileptic activity was recorded (ictal 4) and generalized epileptic activity (ictal in 1) was recorded in 4 patients (4%). No EEG diagnosis could be reached in 5 cases (5%), and c) group 3 (n=28): the study was normal in 15 cases (53.6%) and showed focal interictal epileptic activity in 8 (28.6 %) and generalized interictal epileptic activity in 5 of them (17.8%). We believe that the ambulatory EEG recordings in correctly selected cases can provide important additional information regarding global assessment of patients with epilepsy.

Functional connectivity evidence of cortico-cortico inhibition in temporal lobe epilepsy.

PubMed

Tracy, Joseph I; Osipowicz, Karol; Spechler, Philip; Sharan, Ashwini; Skidmore, Christopher; Doucet, Gaelle; Sperling, Michael R

2014-01-01

Epileptic seizures can initiate a neural circuit and lead to aberrant neural communication with brain areas outside the epileptogenic region. We focus on interictal activity in focal temporal lobe epilepsy and evaluate functional connectivity (FC) differences that emerge as function of bilateral versus strictly unilateral epileptiform activity. We assess the strength of FC at rest between the ictal and non-ictal temporal lobes, in addition to whole brain connectivity with the ictal temporal lobe. Results revealed strong connectivity between the temporal lobes for both patient groups, but this did not vary as a function of unilateral versus bilateral interictal status. Both the left and right unilateral temporal lobe groups showed significant anti-correlated activity in regions outside the epileptogenic temporal lobe, primarily involving the contralateral (non-ictal/non-pathologic) hemisphere, with precuneus involvement prominent. The bilateral groups did not show this contralateral anti-correlated activity. This anti-correlated connectivity may represent a form of protective and adaptive inhibition, helping to constrain epileptiform activity to the pathologic temporal lobe. The absence of this activity in the bilateral groups may be indicative of flawed inhibitory mechanisms, helping to explain their more widespread epileptiform activity. Our data suggest that the location and build up of epilepsy networks in the brain are not truly random, and are not limited to the formation of strictly epileptogenic networks. Functional networks may develop to take advantage of the regulatory function of structures such as the precuneus to instantiate an anti-correlated network, generating protective cortico-cortico inhibition for the purpose of limiting seizure spread or epileptogenesis. Copyright © 2012 Wiley Periodicals, Inc.

An Excitatory Loop with Astrocytes Contributes to Drive Neurons to Seizure Threshold

PubMed Central

Chiavegato, Angela; Zonta, Micaela; Cammarota, Mario; Brondi, Marco; Vetri, Francesco; Uva, Laura; Pozzan, Tullio; de Curtis, Marco; Ratto, Gian Michele; Carmignoto, Giorgio

2010-01-01

Seizures in focal epilepsies are sustained by a highly synchronous neuronal discharge that arises at restricted brain sites and subsequently spreads to large portions of the brain. Despite intense experimental research in this field, the earlier cellular events that initiate and sustain a focal seizure are still not well defined. Their identification is central to understand the pathophysiology of focal epilepsies and to develop new pharmacological therapies for drug-resistant forms of epilepsy. The prominent involvement of astrocytes in ictogenesis was recently proposed. We test here whether a cooperation between astrocytes and neurons is a prerequisite to support ictal (seizure-like) and interictal epileptiform events. Simultaneous patch-clamp recording and Ca2+ imaging techniques were performed in a new in vitro model of focal seizures induced by local applications of N-methyl-D-aspartic acid (NMDA) in rat entorhinal cortex slices. We found that a Ca2+ elevation in astrocytes correlates with both the initial development and the maintenance of a focal, seizure-like discharge. A delayed astrocyte activation during ictal discharges was also observed in other models (including the whole in vitro isolated guinea pig brain) in which the site of generation of seizure activity cannot be precisely monitored. In contrast, interictal discharges were not associated with Ca2+ changes in astrocytes. Selective inhibition or stimulation of astrocyte Ca2+ signalling blocked or enhanced, respectively, ictal discharges, but did not affect interictal discharge generation. Our data reveal that neurons engage astrocytes in a recurrent excitatory loop (possibly involving gliotransmission) that promotes seizure ignition and sustains the ictal discharge. This neuron–astrocyte interaction may represent a novel target to develop effective therapeutic strategies to control seizures. PMID:20405049

Randomized trials are frequently fragmented in multiple secondary publications.

PubMed

Ebrahim, Shanil; Montoya, Luis; Kamal El Din, Mostafa; Sohani, Zahra N; Agarwal, Arnav; Bance, Sheena; Saquib, Juliann; Saquib, Nazmus; Ioannidis, John P A

2016-11-01

To assess the frequency and features of secondary publications of randomized controlled trials (RCTs). For 191 RCTs published in high-impact journals in 2009, we searched for secondary publications coauthored by at least one same author of the primary trial publication. We evaluated the probability of having secondary publications, characteristics of the primary trial publication that predict having secondary publications, types of secondary analyses conducted, and statistical significance of those analyses. Of 191 primary trials, 88 (46%) had a total of 475 secondary publications by 2/2014. Eight trials had >10 (up to 51) secondary publications each. In multivariable modeling, the risk of having subsequent secondary publications increased 1.32-fold (95% CI 1.05-1.68) per 10-fold increase in sample size, and 1.71-fold (95% CI 1.19-2.45) in the presence of a design article. In a sample of 197 secondary publications examined in depth, 193 tested different hypotheses than the primary publication. Of the 193, 43 tested differences between subgroups, 85 assessed predictive factors associated with an outcome of interest, 118 evaluated different outcomes than the original article, 71 had differences in eligibility criteria, and 21 assessed different durations of follow-up; 176 (91%) presented at least one analysis with statistically significant results. Approximately half of randomized trials in high-impact journals have secondary publications published with a few trials followed by numerous secondary publications. Almost all of these publications report some statistically significant results. Copyright © 2016 Elsevier Inc. All rights reserved.

Cortico-cortical evoked potentials for sites of early versus late seizure spread in stereoelectroencephalography.

PubMed

Lega, Bradley; Dionisio, Sasha; Flanigan, Patrick; Bingaman, William; Najm, Imad; Nair, Dileep; Gonzalez-Martinez, Jorge

2015-09-01

Cortico-cortical evoked potentials offer the possibility of understanding connectivity within seizure networks to improve diagnosis and more accurately identify candidates for seizure surgery. We sought to determine if cortico-cortical evoked potentials and post-stimulation oscillatory changes differ for sites of EARLY versus LATE ictal spread. 37 patients undergoing stereoelectroencephalography were tested using a cortico-cortical evoked potential paradigm. All electrodes were classified according to the speed of ictal spread. EARLY spread sites were matched to a LATE spread site equidistant from the onset zone. Root-mean-square was used to quantify evoked responses and post-stimulation gamma band power and coherence were extracted and compared. Sites of EARLY spread exhibited significantly greater evoked responses after stimulation across all patients (t(36)=2.973, p=0.004). Stimulation elicited enhanced gamma band activity at EARLY spread sites (t(36)=2.61, p=0.03, FDR corrected); this gamma band oscillation was highly coherent with the onset zone. Cortico-cortical evoked potentials and post-stimulation changes in gamma band activity differ between sites of EARLY versus LATE ictal spread. The oscillatory changes can help visualize connectivity within the seizure network. Copyright © 2015 Elsevier B.V. All rights reserved.

Phase synchronization of neuronal noise in mouse hippocampal epileptiform dynamics.

PubMed

Serletis, Demitre; Carlen, Peter L; Valiante, Taufik A; Bardakjian, Berj L

2013-02-01

Organized brain activity is the result of dynamical, segregated neuronal signals that may be used to investigate synchronization effects using sophisticated neuroengineering techniques. Phase synchrony analysis, in particular, has emerged as a promising methodology to study transient and frequency-specific coupling effects across multi-site signals. In this study, we investigated phase synchronization in intracellular recordings of interictal and ictal epileptiform events recorded from pairs of cells in the whole (intact) mouse hippocampus. In particular, we focused our analysis on the background noise-like activity (NLA), previously reported to exhibit complex neurodynamical properties. Our results show evidence for increased linear and nonlinear phase coupling in NLA across three frequency bands [theta (4-10 Hz), beta (12-30 Hz) and gamma (30-80 Hz)] in the ictal compared to interictal state dynamics. We also present qualitative and statistical evidence for increased phase synchronization in the theta, beta and gamma frequency bands from paired recordings of ictal NLA. Overall, our results validate the use of background NLA in the neurodynamical study of epileptiform transitions and suggest that what is considered "neuronal noise" is amenable to synchronization effects in the spatiotemporal domain.

Affective Strategies at the Secondary Level.

ERIC Educational Resources Information Center

Williamson, Ann Pollard

Affective teaching is particularly important at the secondary level when the student is facing the problems of adolescence (physical change, sex, social development, identity, values, and alienation). One of the most commonly accepted strategies at the secondary level is that of improving self-concept through the study of literature. Since an…

Secondary Teachers' Perceptions of Online Learning

ERIC Educational Resources Information Center

Brown, Chris L.

2016-01-01

The purpose of this qualitative study was to describe secondary teachers' perceptions of online learning in Washington. This was done by distributing a survey to three districts in the State of Washington to identify the advantages and challenges of online learning according to participating secondary teachers. In addition, the teachers provided…

Developing Vocational Competences during Secondary School?

ERIC Educational Resources Information Center

Behle, Heike

2017-01-01

Purpose: Using the example of an amalgamated secondary school qualification (International Baccalaureate Career-related Programme--IBCP), in which both vocational education and training (VET) and academic subjects are taught, the paper aims to discuss the use of skills and knowledge gained during the IBCP for post-secondary school activities.…

Secondary Schools Included: A Literature Review

ERIC Educational Resources Information Center

De Vroey, Annet; Struyf, Elke; Petry, Katja

2016-01-01

For over a decade, inclusive discourse comprises the development of a school for all, both in primary and in secondary education. Facing long-standing barriers for effective comprehensive education, secondary schools show specific interests, strengths and needs in a school-wide movement towards inclusion. Reviewing literature of recent research in…

Association between oxidative stress index and post-CPR early mortality in cardiac arrest patients: A prospective observational study.

PubMed

Yücel, Hasan; Türkdoğan, Kenan Ahmet; Zorlu, Ali; Aydın, Hüseyin; Kurt, Recep; Yılmaz, Mehmet Birhan

2015-09-01

Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest (CA). Many clinical and laboratory parameters, such as the presence of asystole, out-of-hospital CPR, and duration of cardiac arrest, are associated with failed CPR in patients with CA. Asystole is a state of no cardiac electrical activity, along with the absence of contractions of the myocardium and absence of cardiac output. Oxidative stress index (OSI), which is the ratio of total oxidative status to total antioxidant status, increases by ischemia-reperfusion injury. We investigated whether OSI levels in patients with CA could predict early mortality after CPR. This study has a prospective observational cohort design. Five patients with a history of cancer, four patients who developed hemolysis in their blood, six patients who were transferred to our hospital from other hospitals, and six patients in whom blood samples for OSI could not be stored properly were excluded. Finally, a total of 90 in-hospital or out-of-hospital CA patients and 40 age- and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n=46) and a failed group (n=44). Comparisons between groups were performed using one-way ANOVA with post hoc analysis by Tukey's HSD or independent samples t-test and the Kruskal-Wallis tests or Mann- Whitney U test for normally and abnormally distributed data, respectively. Also, we used chi-square test, Spearman's correlation test, univariate and multible logistic regression analyses, and receiver operator characteristic curve analysis. OSI was 3.0±4.0, 5.6±4.3, and 8.7±3.8 in the control group, the successful CPR group, and the failed CPR group, respectively (p<0.001 for the 2 comparisons). OSI on admission, ischemia-modified albumin, presence of asystole, mean duration of cardiac arrest, out-of-hospital CPR, pH, and

Secondary hypertension: the ways of management.

PubMed

Rossi, Gian P; Seccia, Teresa M; Pessina, Achille C

2010-11-01

The prevalence of secondary hypertension is lower than that of primary (essential) hypertension, but it is likely that it has been underestimated because appropriate tests were not generally performed. Hence, before embarking on a search for secondary hypertension physicians are generally advised to select populations of patients with a high pre-test probability of secondary forms of hypertension in order to maximize the positive predictive value and the gain in "ruling in" of the diagnostic tests. Based on updated information on prevalence and pathophysiology we herein critically review the general diagnostic strategy and the management of the main forms of secondary hypertension. In particular, strategies for identifying primary aldosteronism, the most frequent form of endocrine secondary hypertension, and for determining its unilateral or bilateral causes are discussed in details, because of the differences of treatment that requires adrenalectomy in the unilateral forms and mineralocorticoid receptor blockade in the bilateral forms. The tests available for the diagnosing pheochromocytoma (pheo), which is much rarer but extremely important to identify, as it can be fatal if unrecognized are also discussed, with emphasis on the recent developments in genetic testing. Renovascular hypertension is also a common curable form of hypertension, which should be identified as early as possible to avoid the onset of cardiovascular target organ damage and events, is also discussed.

The Two Faces of Secondary Headship: Women Deputy Head Teachers' Perceptions of the Secondary Head Teacher Role

ERIC Educational Resources Information Center

Guihen, Laura

2017-01-01

Men continue to outnumber women at the secondary head teacher level. This article reports on some of the preliminary findings of a larger study exploring the ways in which women deputy head teachers, as potential aspirants to headship, perceive the secondary head teacher role. Using an Interpretative Phenomenological Analysis methodology,…

Athletic Trainer Services in US Private Secondary Schools

PubMed Central

Pike, Alicia; Pryor, Riana R.; Mazerolle, Stephanie M.; Stearns, Rebecca L.; Casa, Douglas J.

2016-01-01

Context: Availability of athletic trainer (AT) services in US secondary schools has recently been reported to be as high as 70%, but this only describes the public sector. The extent of AT coverage in private secondary school settings has yet to be investigated and may differ from the public secondary school setting for several reasons, including differences in funding sources. Objective: To determine the level of AT services in US private secondary schools and identify the reasons why some schools did not employ ATs. Design: Concurrent mixed-methods study. Setting: Private secondary schools in the United States. Patients or Other Participants: Of 5414 private secondary schools, 2044 (38%) responded to the survey. Main Outcome Measure(s): School administrators responded to the survey via telephone or e-mail. This instrument was previously used in a study examining AT services among public secondary schools. Descriptive statistics provided national data. Open-ended questions were evaluated through content analysis. Results: Of the 2044 schools that responded, 58% (1176/2044) offered AT services, including 28% (574/2040) full time, 25% (501/2042) part time, 4% (78/1918) per diem, and 20% (409/2042) from a hospital or clinic. A total of 84% (281 285/336 165) of athletes had access to AT services. Larger private secondary schools were more likely to have AT services available. Barriers to providing AT services in the private sector were budgetary constraints, school size and sports, and lack of awareness of the role of an AT. Conclusions: More than half of the surveyed private secondary schools in the United States had AT services available; however, only 28% had a full-time AT. This demonstrates the need for increased medical coverage to provide athletes in this setting the appropriate level of care. Budgetary concerns, size of the school and sport offerings, and lack of awareness of the role of the AT continued to be barriers in the secondary school setting. PMID

Jasmonate-responsive transcription factors regulating plant secondary metabolism.

PubMed

Zhou, Meiliang; Memelink, Johan

2016-01-01

Plants produce a large variety of secondary metabolites including alkaloids, glucosinolates, terpenoids and phenylpropanoids. These compounds play key roles in plant-environment interactions and many of them have pharmacological activity in humans. Jasmonates (JAs) are plant hormones which induce biosynthesis of many secondary metabolites. JAs-responsive transcription factors (TFs) that regulate the JAs-induced accumulation of secondary metabolites belong to different families including AP2/ERF, bHLH, MYB and WRKY. Here, we give an overview of the types and functions of TFs that have been identified in JAs-induced secondary metabolite biosynthesis, and highlight their similarities and differences in regulating various biosynthetic pathways. We review major recent developments regarding JAs-responsive TFs mediating secondary metabolite biosynthesis, and provide suggestions for further studies. Copyright © 2016 Elsevier Inc. All rights reserved.

Secondary concentrators for parabolic dish solar thermal power systems

NASA Technical Reports Server (NTRS)

Jaffe, L. D.; Poon, P. T.

1981-01-01

A variety of different concepts are currently being studied with the objective to lower the cost of parabolic mirrors and to provide alternatives. One of the considered approaches involves the use of compound concentrators. A compound solar concentrator is a concentrator in which the sunlight is reflected or refracted more than once. It consists of a primary mirror or lens, whose aperture determines the amount of sunlight gathered, and a smaller secondary mirror or lens. Additional small optical elements may also be incorporated. The possibilities and problems regarding a use of compound concentrators in parabolic dish systems are discussed. Attention is given to concentrating secondary lenses, secondary imaging and concentrating mirrors, conical secondary mirrors, compound elliptic secondary concentrating mirrors, and hyperbolic trumpet secondary concentrating mirrors.

A semi-supervised learning approach for RNA secondary structure prediction.

PubMed

Yonemoto, Haruka; Asai, Kiyoshi; Hamada, Michiaki

2015-08-01

RNA secondary structure prediction is a key technology in RNA bioinformatics. Most algorithms for RNA secondary structure prediction use probabilistic models, in which the model parameters are trained with reliable RNA secondary structures. Because of the difficulty of determining RNA secondary structures by experimental procedures, such as NMR or X-ray crystal structural analyses, there are still many RNA sequences that could be useful for training whose secondary structures have not been experimentally determined. In this paper, we introduce a novel semi-supervised learning approach for training parameters in a probabilistic model of RNA secondary structures in which we employ not only RNA sequences with annotated secondary structures but also ones with unknown secondary structures. Our model is based on a hybrid of generative (stochastic context-free grammars) and discriminative models (conditional random fields) that has been successfully applied to natural language processing. Computational experiments indicate that the accuracy of secondary structure prediction is improved by incorporating RNA sequences with unknown secondary structures into training. To our knowledge, this is the first study of a semi-supervised learning approach for RNA secondary structure prediction. This technique will be useful when the number of reliable structures is limited. Copyright © 2015 Elsevier Ltd. All rights reserved.

Ergonomics and safety in secondary wood processing

Treesearch

Rado Gazo; James D. McGlothlin; Yuehwern, Wiedenbeck, Jan Yih; Yuehwern Yih

2002-01-01

The main goal of the project was to initiate a pilot program in ergonomics for the secondary wood products industry. Case studies were conducted at three Midwest secondary wood product companies in 2000 and 2001.

Secondary Breast Augmentation.

PubMed

Brown, Mitchell H; Somogyi, Ron B; Aggarwal, Shagun

2016-07-01

After studying this article, the participant should be able to: 1. Assess common clinical problems in the secondary breast augmentation patient. 2. Describe a treatment plan to correct the most common complications of breast augmentation. 3. Provide surgical and nonsurgical options for managing complications of breast augmentation. 4. Decrease the incidence of future complications through accurate assessment, preoperative planning, and precise surgical technique. Breast augmentation has been increasing steadily in popularity over the past three decades. Many of these patients present with secondary problems or complications following their primary breast augmentation. Two of the most common complications are capsular contracture and implant malposition. Familiarity and comfort with the assessment and management of these complications is necessary for all plastic surgeons. An up-to-date understanding of current devices and techniques may decrease the need to manage future complications from the current cohort of breast augmentation patients.

[Secondary Metabolites from Marine Microorganisms. I. Secondary Metabolites from Marine Actinomycetes].

PubMed

Orlova, T I; Bulgakova, V G; Polin, A N

2015-01-01

Review represents data on new active metabolites isolated from marine actinomycetes published in 2007 to 2014. Marine actinomycetes are an unlimited source of novel secondary metabolites with various biological activities. Among them there are antibiotics, anticancer compounds, inhibitors of biochemical processes.

Secondary STEM Educational Reform. Secondary Education in a Changing World

ERIC Educational Resources Information Center

Johnson, Carla C., Ed.

2011-01-01

Federal and state funding agencies have invested billions of dollars into secondary STEM (Science, Technology, Education, Mathematics) educational reform over the past decade. This volume addresses the interplay of external and internal variables associated with school reform and how this dynamic has impacted many efforts. The goal of this book is…

Secondary Education in Romania. Guide to Secondary Education in Europe.

ERIC Educational Resources Information Center

Georgescu, Dakmara-Ana

Secondary education in Romania is characterized by innovations introduced by the communist system and by recent efforts to restructure the system. This book presents a systematic and coherent exposition of the Romanian educational system, and outlines the essential problems the system faces. The book opens with the historical, social, and…

Design of the GOES Telescope secondary mirror mounting

NASA Technical Reports Server (NTRS)

Hookman, Robert A.

1989-01-01

The GOES Telescope utilizes a flexure mounting system for the secondary mirror to minimize thermally induced distortions of the secondary mirror. The detailed design is presented along with a discussion of the microradian pointing requirements and how they were achieved. The methodology used to dynamically tune the flexure/secondary mirror assembly to minimize structural interactions will also be discussed.

Secondary Schools: A Reference Handbook. Contemporary Education Issues.

ERIC Educational Resources Information Center

Villaverde, Leila E.

This book attempts to serve as a compendium and a chronology of secondary education in the United States, taking a broad rather than a narrow approach and touching on a great many topics and issues. Chapters 1 and 2 present a history of secondary schools and a discussion of adolescence. Chapter 3 discusses curriculum in secondary schools,…

Senior Secondary School Children's Understanding of Plant Nutrition

ERIC Educational Resources Information Center

Mosothwane, Modise

2011-01-01

The purpose of this study was to assess children's understanding of plant nutrition. The research was done on a sample of secondary school pupils in the age range of 16 to 19 years in two senior secondary schools in Botswana. The sample contained 137 senior secondary pupils all in their final year of study. These children were above average…

Influence of Stationary Crossflow Modulation on Secondary Instability

NASA Technical Reports Server (NTRS)

Choudhari, Meelan M.; Li, Fei; Paredes, Pedro

2016-01-01

A likely scenario for swept wing transition on subsonic aircraft with natural laminar flow involves the breakdown of stationary crossflow vortices via high frequency secondary instability. A majority of the prior research on this secondary instability has focused on crossflow vortices with a single dominant spanwise wavelength. This paper investigates the effects of the spanwise modulation of stationary crossflow vortices at a specified wavelength by a subharmonic stationary mode. Secondary instability of the modulated crossflow pattern is studied using planar, partial-differential-equation based eigenvalue analysis. Computations reveal that weak modulation by the first subharmonic of the input stationary mode leads to mode splitting that is particularly obvious for Y-type secondary modes that are driven by the wall-normal shear of the basic state. Thus, for each Y mode corresponding to the fundamental wavelength of results in unmodulated train of crossflow vortices, the modulated flow supports a pair of secondary modes with somewhat different amplification rates. The mode splitting phenomenon suggests that a more complex stationary modulation such as that induced by natural surface roughness would yield a considerably richer spectrum of secondary instability modes. Even modest levels of subharmonic modulation are shown to have a strong effect on the overall amplification of secondary disturbances, particularly the Z-modes driven by the spanwise shear of the basic state. Preliminary computations related to the nonlinear breakdown of these secondary disturbances provide interesting insights into the process of crossflow transition in the presence of the first subharmonic of the dominant stationary vortex.

Primary versus secondary achalasia: New signs on barium esophagogram

PubMed Central

Gupta, Pankaj; Debi, Uma; Sinha, Saroj Kant; Prasad, Kaushal Kishor

2015-01-01

Aim: To investigate new signs on barium swallow that can differentiate primary from secondary achalasia. Materials and Methods: Records of 30 patients with primary achalasia and 17 patients with secondary achalasia were reviewed. Clinical, endoscopic, and manometric data was recorded. Barium esophagograms were evaluated for peristalsis and morphology of distal esophageal segment (length, symmetry, nodularity, shouldering, filling defects, and “tram-track sign”). Results: Mean age at presentation was 39 years in primary achalasia and 49 years in secondary achalasia. The mean duration of symptoms was 3.5 years in primary achalasia and 3 months in secondary achalasia. False-negative endoscopic results were noted in the first instance in five patients. In the secondary achalasia group, five patients had distal esophageal segment morphology indistinguishable from that of primary achalasia. None of the patients with primary achalasia and 35% patients with secondary achalasia had a length of the distal segment approaching combined height of two vertebral bodies. None of the patients with secondary achalasia and 34% patients with primary achalasia had maximum caliber of esophagus approaching combined height of two vertebral bodies. Tertiary contractions were noted in 90% patients with primary achalasia and 24% patients with secondary achalasia. Tram-track sign was found in 55% patients with primary achalasia. Filling defects in the distal esophageal segment were noted in 94% patients with secondary achalasia. Conclusion: Length of distal esophageal segment, tertiary contractions, tram-track sign, and filling defects in distal esophageal segment are useful esophagographic features distinguishing primary from secondary achalasia. PMID:26288525

Nuffield Secondary Science, Theme 6, Movement.

ERIC Educational Resources Information Center

Richardson, W.; Tollyfield, J. K.

Nuffield Secondary Science is a set of tested materials from which teachers can prepare courses for students in grades 9-11 (approximately) who do not intend to major in science. The materials are designed for British secondary schools but are adaptable for other countries. The Teachers' Guide to the entire set of materials is described in SE 015…

Perception on mathematics teachers' quality of teaching between all boys secondary schools and all girls secondary schools

NASA Astrophysics Data System (ADS)

Arbin, Norazman; Kamarudin, Norsyazana; Abu, Mohd Syafarudy; Hamzah, Firdaus Mohamad; Ghani, Sazelli Abdul

2015-05-01

This survey research was designed to identify the secondary mathematics teachers' quality of teaching. Specifically, this study focused on students' perception, based on genders on the quality of teaching of their secondary mathematics teachers and, its relationship with the former's mathematics achievement. This research was carried in four different schools: two all boys' secondary schools and two all girls' secondary schools. Thus, a comparison between these two types of schools was made. The sample of the study involved 100 form four students from those schools. The result showed that the students from those schools had positive perception on their teachers' quality of teaching. Statistically, there was no difference between the boys' and girls' perceptions. There was a significant relationship between the boys' perception on the quality of their teachers' teaching and the boys' achievement. However, there was no significant relationship between the girls' perceptions on the quality of their teachers' teaching and the girls' achievement. The findings of this research could be used as a useful guideline for mathematics teachers and future mathematics teachers in enhancing the quality of their teaching and learning.

Secondary Containers and Service Containers for Pesticides

EPA Pesticide Factsheets

Secondary containers and service containers are used by pesticide applicators in the process of applying a pesticide. EPA does not require secondary containers or service containers to be labeled or to meet particular construction standards. Learn more.

Initiation and slow propagation of epileptiform activity from ventral to dorsal medial entorhinal cortex is constrained by an inhibitory gradient.

PubMed

Ridler, Thomas; Matthews, Peter; Phillips, Keith G; Randall, Andrew D; Brown, Jonathan T

2018-06-01

The medial entorhinal cortex (mEC) has an important role in initiation and propagation of seizure activity. Several anatomical relationships exist in neurophysiological properties of mEC neurons; however, in the context of hyperexcitability, previous studies often considered it as a homogeneous structure. Using multi-site extracellular recording techniques, ictal-like activity was observed along the dorso-ventral axis of the mEC in vitro in response to various ictogenic stimuli. This originated predominantly from ventral areas, spreading to dorsal mEC with a surprisingly slow velocity. Modulation of inhibitory tone was capable of changing the slope of ictal initiation, suggesting seizure propagation behaviours are highly dependent on levels of GABAergic function in this region. A distinct disinhibition model also showed, in the absence of inhibition, a prevalence for interictal-like initiation in ventral mEC, reflecting the intrinsic differences in mEC neurons. These findings suggest the ventral mEC is more prone to hyperexcitable discharge than the dorsal mEC, which may be relevant under pathological conditions. The medial entorhinal cortex (mEC) has an important role in the generation and propagation of seizure activity. The organization of the mEC is such that a number of dorso-ventral relationships exist in neurophysiological properties of neurons. These range from intrinsic and synaptic properties to density of inhibitory connectivity. We examined the influence of these gradients on generation and propagation of epileptiform activity in the mEC. Using a 16-shank silicon probe array to record along the dorso-ventral axis of the mEC in vitro, we found 4-aminopyridine application produces ictal-like activity originating predominantly in ventral areas. This activity spreads to dorsal mEC at a surprisingly slow velocity (138 μm s -1 ), while cross-site interictal-like activity appeared relatively synchronous. We propose that ictal propagation is constrained by

Regulation and Role of Fungal Secondary Metabolites.

PubMed

Macheleidt, Juliane; Mattern, Derek J; Fischer, Juliane; Netzker, Tina; Weber, Jakob; Schroeckh, Volker; Valiante, Vito; Brakhage, Axel A

2016-11-23

Fungi have the capability to produce a tremendous number of so-called secondary metabolites, which possess a multitude of functions, e.g., communication signals during coexistence with other microorganisms, virulence factors during pathogenic interactions with plants and animals, and in medical applications. Therefore, research on this topic has intensified significantly during the past 10 years and thus knowledge of regulatory mechanisms and the understanding of the role of secondary metabolites have drastically increased. This review aims to depict the complexity of all the regulatory elements involved in controlling the expression of secondary metabolite gene clusters, ranging from epigenetic control and signal transduction pathways to global and specific transcriptional regulators. Furthermore, we give a short overview on the role of secondary metabolites, focusing on the interaction with other microorganisms in the environment as well as on pathogenic relationships.

Secondary Forests from Agricultural Abandonment in Amazonia 2000-2009

NASA Technical Reports Server (NTRS)

Morton, Douglas

2010-01-01

Ongoing negotiations to include reducing emissions from tropical deforestation and forest degradation (REDD+) in a post-Kyoto climate agreement highlight the critical role of satellite data for accurate and transparent accounting of forest cover changes. In addition to deforestation and degradation, knowledge of secondary forest dynamics is essential for full carbon accounting under REDD+. Land abandonment to secondary forests also frames one of the key tradeoffs for agricultural production in tropical forest countries-whether to incentivize secondary forest growth (for carbon sequestration and biodiversity conservation) or low-carbon expansion of agriculture or biofuels production in areas of secondary forests. We examined patterns of land abandonment to secondary forest across the arc of deforestation in Brazil and Bolivia using time series of annual Landsat and MODIS data from 2000-2009. Rates of land abandonment to secondary forest during 2002-2006 were less than 5% of deforestation rates in these years. Small areas of new secondary forest were scattered across the entire arc of deforestation, rather than concentrated in any specific region of the basin. Taken together, our analysis of the satellite data record emphasizes the difficulties of addressing the pool of new secondary forests in the context of REDD+ in Amazonia. Due to the small total area of secondary forests, land sparing through agricultural intensification will be an important element of efforts to reduce deforestation rates under REDD+ while improving agricultural productivity in Amazonia.

Evaluation of selected recurrence measures in discriminating pre-ictal and inter-ictal periods from epileptic EEG data

NASA Astrophysics Data System (ADS)

Ngamga, Eulalie Joelle; Bialonski, Stephan; Marwan, Norbert; Kurths, Jürgen; Geier, Christian; Lehnertz, Klaus

2016-04-01

We investigate the suitability of selected measures of complexity based on recurrence quantification analysis and recurrence networks for an identification of pre-seizure states in multi-day, multi-channel, invasive electroencephalographic recordings from five epilepsy patients. We employ several statistical techniques to avoid spurious findings due to various influencing factors and due to multiple comparisons and observe precursory structures in three patients. Our findings indicate a high congruence among measures in identifying seizure precursors and emphasize the current notion of seizure generation in large-scale epileptic networks. A final judgment of the suitability for field studies, however, requires evaluation on a larger database.

Association of fungal secondary metabolism and sclerotial biology

PubMed Central

Calvo, Ana M.; Cary, Jeffrey W.

2015-01-01

Fungal secondary metabolism and morphological development have been shown to be intimately associated at the genetic level. Much of the literature has focused on the co-regulation of secondary metabolite production (e.g., sterigmatocystin and aflatoxin in Aspergillus nidulans and Aspergillus flavus, respectively) with conidiation or formation of sexual fruiting bodies. However, many of these genetic links also control sclerotial production. Sclerotia are resistant structures produced by a number of fungal genera. They also represent the principal source of primary inoculum for some phytopathogenic fungi. In nature, higher plants often concentrate secondary metabolites in reproductive structures as a means of defense against herbivores and insects. By analogy, fungi also sequester a number of secondary metabolites in sclerotia that act as a chemical defense system against fungivorous predators. These include antiinsectant compounds such as tetramic acids, indole diterpenoids, pyridones, and diketopiperazines. This chapter will focus on the molecular mechanisms governing production of secondary metabolites and the role they play in sclerotial development and fungal ecology, with particular emphasis on Aspergillus species. The global regulatory proteins VeA and LaeA, components of the velvet nuclear protein complex, serve as virulence factors and control both development and secondary metabolite production in many Aspergillus species. We will discuss a number of VeA- and LaeA-regulated secondary metabolic gene clusters in A. flavus that are postulated to be involved in sclerotial morphogenesis and chemical defense. The presence of multiple regulatory factors that control secondary metabolism and sclerotial formation suggests that fungi have evolved these complex regulatory mechanisms as a means to rapidly adapt chemical responses to protect sclerotia from predators, competitors and other environmental stressors. PMID:25762985

Secondary aerosol production from agricultural gas precursors

USDA-ARS?s Scientific Manuscript database

Studies of air quality indicate that agricultural emissions may impact particulate mass concentrations through both primary and secondary processes. Increasing evidence from both laboratory and field work suggests that not only does ammonia produce secondary particulate matter, but some volatile org...

Characterising RNA secondary structure space using information entropy

PubMed Central

2013-01-01

Comparative methods for RNA secondary structure prediction use evolutionary information from RNA alignments to increase prediction accuracy. The model is often described in terms of stochastic context-free grammars (SCFGs), which generate a probability distribution over secondary structures. It is, however, unclear how this probability distribution changes as a function of the input alignment. As prediction programs typically only return a single secondary structure, better characterisation of the underlying probability space of RNA secondary structures is of great interest. In this work, we show how to efficiently compute the information entropy of the probability distribution over RNA secondary structures produced for RNA alignments by a phylo-SCFG, and implement it for the PPfold model. We also discuss interpretations and applications of this quantity, including how it can clarify reasons for low prediction reliability scores. PPfold and its source code are available from http://birc.au.dk/software/ppfold/. PMID:23368905

Moon-Mercury - Relative preservation states of secondary craters

NASA Technical Reports Server (NTRS)

Scott, D. H.

1977-01-01

Geologic studies including mapping of the Kuiper quadrangle of Mercury suggest that secondary craters are much better preserved than those on the moon. Factors which may account for the apparent differences between lunar and Mercurian secondary crater morphology include: (1) the rapid isostatic adjustment of the parent crater, (2) different impact fluxes of the two planets, (3) the greater concentration of Mercurian secondaries around impact areas, and (4) differences in crater ejection velocities. It has been shown that the ejection velocities on Mercury are about 50% greater than those on the moon at equivalent ranges. This may account for morphologically enhanced secondary craters, and may explain their better preservation with time.

An Approach to a One-School-Year Technical/Occupational Program Articulation between the Secondary and Post-Secondary Levels.

ERIC Educational Resources Information Center

Emerson, Nancy H.

An articulation effort between secondary and postsecondary occupational education is described in this report as conducted by the Dallas County Community College District. After an introduction to the articulation project emphasizes the original goal of developing material necessary to award postsecondary credit for mastery at the secondary level,…

Problems Encountered by Religious Vocational Secondary School and Other Secondary School Students in Physical Education and Sports Activities

ERIC Educational Resources Information Center

Bar, Mustafa; Yaman, Menzure Sibel; Hergüner, Gülten

2016-01-01

The study aimed to determine problems encountered by Religious Vocational Secondary School and other Secondary School students in physical education and sports activities and to compare these problems according to school type and gender. A questionnaire named "Problems encountered in attending to physical education and sports activities"…

40 CFR 133.105 - Treatment equivalent to secondary treatment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Treatment equivalent to secondary treatment. 133.105 Section 133.105 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS SECONDARY TREATMENT REGULATION § 133.105 Treatment equivalent to secondary treatment...

Secondary optics for Fresnel lens solar concentrators

NASA Astrophysics Data System (ADS)

Fu, Ling; Leutz, Ralf; Annen, Hans Philipp

2010-08-01

Secondary optics are used in concentrating photovoltaic (CPV) systems with Fresnel lens primaries to increase the optical system efficiency by catching refracted light that otherwise would miss the receiver, better the tracking tolerance (acceptance half-angle) and enhance the flux uniformity on the cell. Several refractive secondary optics under the same Fresnel lens primary are designed, analyzed and compared based on their optical performances, materials, manufacturability, manufacturing tolerancing and cost. The goal of this work is to show the basic two different design approaches statistical mixing as opposed to deterministic mixing. Caustics are elementary in the deterministic tailoring approach. We find that statistical mixing offers higher flexibility for the solar application. It is also shown that there are conventional, i.e. designs based on conic section ("half-egg") that work well as solar secondaries. It is also made clear that primary and secondary must be designed as optical train.

Athletic Trainer Services in Public and Private Secondary Schools.

PubMed

Pike, Alicia M; Pryor, Riana R; Vandermark, Lesley W; Mazerolle, Stephanie M; Casa, Douglas J

2017-01-01

 The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored.  To compare the level of AT services in public and private secondary schools.  Concurrent mixed-methods study.  Public and private secondary schools in the United States.  A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private).  School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis.  A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators.  Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector.

Athletic Trainer Services in Public and Private Secondary Schools

PubMed Central

Pike, Alicia M.; Pryor, Riana R.; Vandermark, Lesley W.; Mazerolle, Stephanie M.; Casa, Douglas J.

2017-01-01

Context: The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored. Objective: To compare the level of AT services in public and private secondary schools. Design: Concurrent mixed-methods study. Setting: Public and private secondary schools in the United States. Patients or Other Participants: A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private). Main Outcome Measure(s): School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis. Results: A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators. Conclusions: Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector. PMID:28157403

Double-Shift Secondary Schools: Possibilities and Issues. Secondary Education Series.

ERIC Educational Resources Information Center

Linden, Toby

The World Bank has been assisting the efforts of developing countries to reform secondary education systems for more than 35 years. During this period, the context and imperatives for education reform have changed considerably due to various factors such as globalization of the world economy and the impact of new technologies. This paper is one of…

Auditory processing assessment suggests that Wistar audiogenic rat neural networks are prone to entrainment.

PubMed

Pinto, Hyorrana Priscila Pereira; Carvalho, Vinícius Rezende; Medeiros, Daniel de Castro; Almeida, Ana Flávia Santos; Mendes, Eduardo Mazoni Andrade Marçal; Moraes, Márcio Flávio Dutra

2017-04-07

Epilepsy is a neurological disease related to the occurrence of pathological oscillatory activity, but the basic physiological mechanisms of seizure remain to be understood. Our working hypothesis is that specific sensory processing circuits may present abnormally enhanced predisposition for coordinated firing in the dysfunctional brain. Such facilitated entrainment could share a similar mechanistic process as those expediting the propagation of epileptiform activity throughout the brain. To test this hypothesis, we employed the Wistar audiogenic rat (WAR) reflex animal model, which is characterized by having seizures triggered reliably by sound. Sound stimulation was modulated in amplitude to produce an auditory steady-state-evoked response (ASSR; -53.71Hz) that covers bottom-up and top-down processing in a time scale compatible with the dynamics of the epileptic condition. Data from inferior colliculus (IC) c-Fos immunohistochemistry and electrographic recordings were gathered for both the control Wistar group and WARs. Under 85-dB SLP auditory stimulation, compared to controls, the WARs presented higher number of Fos-positive cells (at IC and auditory temporal lobe) and a significant increase in ASSR-normalized energy. Similarly, the 110-dB SLP sound stimulation also statistically increased ASSR-normalized energy during ictal and post-ictal periods. However, at the transition from the physiological to pathological state (pre-ictal period), the WAR ASSR analysis demonstrated a decline in normalized energy and a significant increase in circular variance values compared to that of controls. These results indicate an enhanced coordinated firing state for WARs, except immediately before seizure onset (suggesting pre-ictal neuronal desynchronization with external sensory drive). These results suggest a competing myriad of interferences among different networks that after seizure onset converge to a massive oscillatory circuit. Copyright © 2017 IBRO. Published by

Intravenous Levetiracetam in the Rat Pilocarpine-Induced Status Epilepticus Model: Behavioral, Physiological and Histological Studies

PubMed Central

Zheng, Yi; Moussally, Jon; Cash, Sydney S.; Karnam, Havisha B.; Cole, Andrew J.

2010-01-01

Purpose Status epilepticus is a neurological emergency associated with neuronal injury, lasting behavioral disturbance, and a high rate of mortality. Intravenous levetiracetam (LEV), an antiepileptic drug approved to treat partial seizures, has recently been introduced. We sought to determine the effect of LEV administered intravenously in a chemoconvulsant model of status epilepticus. Methods We examined the effect of intravenous LEV in the rat lithium-pilocarpine model of status epilepticus. Ten or 30 minutes after the onset of behavioral status epilepticus, animals were treated with LEV (200–1200 mg/kg i.v.) administered in a single bolus. Behavioral responses were recorded. Selected animals had continuous EEG recording before, during and after the administration of LEV. Some animals were sacrificed 24 h after the experiment and processed for histochemical assessment of neuronal injury. Results When administered 30 minutes after the onset of behavioral epileptic seizures, transient attenuation of ictal behavior was observed in animals treated with 800 mg/kg or more of LEV. The duration of behavioral attenuation increased sharply as the dose rose to 1000 mg/kg or higher, from a mean of 4 minutes to 23.6 minutes. When administered 10 minutes after seizure onset, 400 mg/kg of LEV resulted in transient ictal behavioral attenuation, and higher doses caused relatively longer periods of attenuation. Pretreatment with LEV prior to pilocarpine also delayed the onset of seizures. EEG recordings, however, showed no significant attenuation of ictal discharge. By contrast, TUNEL staining demonstrated less neuronal injury in hippocampii and other limbic structures in animals that responded behaviorally to LEV. Conclusions Intravenous administration of LEV in a chemoconvulsant model of status epilepticus results in attenuation of behavioral manifestations of seizure discharge and in reduction of neuronal injury but does not significantly alter ictal discharge recorded by EEG

Independent Epileptiform Discharge Patterns in the Olfactory and Limbic Areas of the In Vitro Isolated Guinea Pig Brain During 4-Aminopyridine Treatment

PubMed Central

Carriero, Giovanni; Uva, Laura; Gnatkovsky, Vadym; Avoli, Massimo; de Curtis, Marco

2016-01-01

In vitro studies performed on brain slices demonstrate that the potassium channel blocker 4-aminopyridine (4AP, 50 μM) discloses electrographic seizure activity and interictal discharges. These epileptiform patterns have been further analyzed here in a isolated whole guinea pig brain in vitro by using field potential recordings in olfactory and limbic structures. In 8 of 13 experiments runs of fast oscillatory activity (fast runs, FRs) in the piriform cortex (PC) propagated to the lateral entorhinal cortex (EC), hippocampus and occasionally to the medial EC. Early and late FRs were asynchronous in the hemispheres showed different duration [1.78 ± 0.51 and 27.95 ± 4.55 (SD) s, respectively], frequency of occurrence (1.82 ± 0.49 and 34.16 ± 6.03 s) and frequency content (20–40 vs. 40–60 Hz). Preictal spikes independent from the FRs appeared in the hippocampus/EC and developed into ictal-like discharges that did not propagate to the PC. Ictal-like activity consisted of fast activity with onset either in the hippocampus (n = 6) or in the mEC (n = 2), followed by irregular spiking and sequences of diffusely synchronous bursts. Perfusion of the N-methyl-D-aspartate receptor antagonist 2-amino-5-phosphonopentanoic acid (100 μM) did not prevent FRs, increased the duration of limbic ictal-like discharges and favored their propagation to olfactory structures. The AMPA receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (50 μM) blocked ictal-like events and reduced FRs. In conclusion, 4AP-induced epileptiform activities are asynchronous and independent in olfactory and hippocampal-entorhinal regions. Epileptiform discharges in the isolated guinea pig brain show different pharmacological properties compared with rodent in vitro slices. PMID:20220076

Intravenous levetiracetam in the rat pilocarpine-induced status epilepticus model: behavioral, physiological and histological studies.

PubMed

Zheng, Yi; Moussally, Jon; Cash, Sydney S; Karnam, Havisha B; Cole, Andrew J

2010-01-01

Status epilepticus is a neurological emergency associated with neuronal injury, lasting behavioral disturbance, and a high rate of mortality. Intravenous levetiracetam (LEV), an anti-epileptic drug approved to treat partial seizures, has recently been introduced. We sought to determine the effect of LEV administered intravenously in a chemoconvulsant model of status epilepticus. We examined the effect of intravenous LEV in the rat lithium-pilocarpine model of status epilepticus. Ten or 30 min after the onset of behavioral status epilepticus, animals were treated with LEV (200-1200 mg/kg i.v.) administered in a single bolus. Behavioral responses were recorded. Selected animals had continuous EEG recording before, during and after the administration of LEV. Some animals were sacrificed 24 h after the experiment and processed for histochemical assessment of neuronal injury. When administered 30 min after the onset of behavioral epileptic seizures, transient attenuation of ictal behavior was observed in animals treated with 800 mg/kg or more of LEV. The duration of behavioral attenuation increased sharply as the dose rose to 1000 mg/kg or higher, from a mean of 4-23.6 min. When administered 10 min after seizure onset, 400 mg/kg of LEV resulted in transient ictal behavioral attenuation, and higher doses caused relatively longer periods of attenuation. Pretreatment with LEV prior to pilocarpine also delayed the onset of seizures. EEG recordings, however, showed no significant attenuation of ictal discharge. By contrast, TUNEL staining demonstrated less neuronal injury in hippocampii and other limbic structures in animals that responded behaviorally to LEV. Intravenous administration of LEV in a chemoconvulsant model of status epilepticus results in attenuation of behavioral manifestations of seizure discharge and in reduction of neuronal injury but does not significantly alter ictal discharge recorded by EEG. Copyright 2009 Elsevier Ltd. All rights reserved.

Application of high-frequency Granger causality to analysis of epileptic seizures and surgical decision making.

PubMed

Epstein, Charles M; Adhikari, Bhim M; Gross, Robert; Willie, Jon; Dhamala, Mukesh

2014-12-01

In recent decades intracranial EEG (iEEG) recordings using increasing numbers of electrodes, higher sampling rates, and a variety of visual and quantitative analyses have indicated the presence of widespread, high frequency ictal and preictal oscillations (HFOs) associated with regions of seizure onset. Seizure freedom has been correlated with removal of brain regions generating pathologic HFOs. However, quantitative analysis of preictal HFOs has seldom been applied to the clinical problem of planning the surgical resection. We performed Granger causality (GC) analysis of iEEG recordings to analyze features of preictal seizure networks and to aid in surgical decision making. Ten retrospective and two prospective patients were chosen on the basis of individually stereotyped seizure patterns by visual criteria. Prospective patients were selected, additionally, for failure of those criteria to resolve apparent multilobar ictal onsets. iEEG was recorded at 500 or 1,000 Hz, using up to 128 surface and depth electrodes. Preictal and early ictal GC from individual electrodes was characterized by the strength of causal outflow, spatial distribution, and hierarchical causal relationships. In all patients we found significant, widespread preictal GC network activity at peak frequencies from 80 to 250 Hz, beginning 2-42 s before visible electrographic onset. In the two prospective patients, GC source/sink comparisons supported the exclusion of early ictal regions that were not the dominant causal sources, and contributed to planning of more limited surgical resections. Both patients have a class 1 outcome at 1 year. GC analysis of iEEG has the potential to increase understanding of preictal network activity, and to help improve surgical outcomes in cases of otherwise ambiguous iEEG onset. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

Long-term monitoring of cardiorespiratory patterns in drug-resistant epilepsy.

PubMed

Goldenholz, Daniel M; Kuhn, Amanda; Austermuehle, Alison; Bachler, Martin; Mayer, Christopher; Wassertheurer, Siegfried; Inati, Sara K; Theodore, William H

2017-01-01

Sudden unexplained death in epilepsy (SUDEP) during inpatient electroencephalography (EEG) monitoring has been a rare but potentially preventable event, with associated cardiopulmonary markers. To date, no systematic evaluation of alarm settings for a continuous pulse oximeter (SpO 2 ) has been performed. In addition, evaluation of the interrelationship between the ictal and interictal states for cardiopulmonary measures has not been reported. Patients with epilepsy were monitored using video-EEG, SpO 2 , and electrocardiography (ECG). Alarm thresholds were tested systematically, balancing the number of false alarms with true seizure detections. Additional cardiopulmonary patterns were explored using automated ECG analysis software. One hundred ninety-three seizures (32 generalized) were evaluated from 45 patients (7,104 h recorded). Alarm thresholds of 80-86% SpO 2 detected 63-73% of all generalized convulsions and 20-28% of all focal seizures (81-94% of generalized and 25-36% of focal seizures when considering only evaluable data). These same thresholds resulted in 25-146 min between false alarms. The sequential probability of ictal SpO 2 revealed a potential common seizure termination pathway of desaturation. A statistical model of corrected QT intervals (QTc), heart rate (HR), and SpO 2 revealed close cardiopulmonary coupling ictally. Joint probability maps of QTc and SpO 2 demonstrated that many patients had baseline dysfunction in either cardiac, pulmonary, or both domains, and that ictally there was dissociation-some patients exhibited further dysfunction in one or both domains. Optimal selection of continuous pulse oximetry thresholds involves a tradeoff between seizure detection accuracy and false alarm frequency. Alarming at 86% for patients that tend to have fewer false alarms and at 80% for those who have more, would likely result in a reasonable tradeoff. The cardiopulmonary findings may lead to SUDEP biomarkers and early seizure termination therapies

On the Secondary Eyewall Formation of Hurricane Edouard (2014)

NASA Technical Reports Server (NTRS)

Abarca, Sergio F.; Montgomery, Michael T.; Braun, Scott A.; Dunion, Jason

2016-01-01

A first observationally-based estimation of departures from gradient wind balance during secondary eyewall formation is presented. The study is based on the Atlantic Hurricane Edouard (2014). This storm was observed during the National Aeronautics and Space Administrations (NASA) Hurricane and Severe Storm Sentinel (HS3) experiment, a field campaign conducted in collaboration with the National Oceanic and Atmospheric Administration (NOAA). A total of 135 dropsondes are analyzed in two separate time periods: one named the secondary eyewall formation period and the other one referred to as the decaying-double eyewalled storm period. During the secondary eyewall formation period, a time when the storm was observed to have only one eyewall, the diagnosed agradient force has a secondary maxima that coincides with the radial location of the secondary eyewall observed in the second period of study. The maximum spin up tendency of the radial influx of absolute vertical vorticity is within the boundary layer in the region of the eyewall of the storm and the spin up tendency structure elongates radially outward into the secondary region of supergradient wind, where the secondary wind maxima is observed in the second period of study. An analysis of the boundary layer averaged vertical structure of equivalent potential temperature reveals a conditionally unstable environment in the secondary eyewall formation region. These findings support the hypothesis that deep convective activity in this region contributed to spin up of the boundary layer tangential winds and the formation of a secondary eyewall that is observed during the decaying-double eyewalled storm period.

On the secondary eyewall formation of Hurricane Edouard (2014)

PubMed Central

Abarca, Sergio F.; Montgomery, Michael T.; Braun, Scott A.; Dunion, Jason

2018-01-01

A first observationally-based estimation of departures from gradient wind balance during secondary eyewall formation is presented. The study is based on the Atlantic Hurricane Edouard (2014). This storm was observed during the National Aeronautics and Space Administration’s (NASA) Hurricane and Severe Storm Sentinel (HS3) experiment, a field campaign conducted in collaboration with the National Oceanic and Atmospheric Administration (NOAA). A total of 135 dropsondes are analyzed in two separate time periods: one named the secondary eyewall formation period and the other one referred to as the decaying-double eyewalled storm period. During the secondary eyewall formation period, a time when the storm was observed to have only one eyewall, the diagnosed agradient force has a secondary maxima that coincides with the radial location of the secondary eyewall observed in the second period of study. The maximum spin up tendency of the radial influx of absolute vertical vorticity is within the boundary layer in the region of the eyewall of the storm and the spin up tendency structure elongates radially outward into the secondary region of supergradient wind, where the secondary wind maxima is observed in the second period of study. An analysis of the boundary-layer averaged vertical structure of equivalent potential temperature reveals a conditionally unstable environment in the secondary eyewall formation region. These findings support the hypothesis that deep convective activity in this region contributed to spin up of the boundary layer tangential winds and the formation of a secondary eyewall that is observed during the decaying-double eyewalled storm period. PMID:29651170

On the secondary eyewall formation of Hurricane Edouard (2014).

PubMed

Abarca, Sergio F; Montgomery, Michael T; Braun, Scott A; Dunion, Jason

2016-09-01

A first observationally-based estimation of departures from gradient wind balance during secondary eyewall formation is presented. The study is based on the Atlantic Hurricane Edouard (2014). This storm was observed during the National Aeronautics and Space Administration's (NASA) Hurricane and Severe Storm Sentinel (HS3) experiment, a field campaign conducted in collaboration with the National Oceanic and Atmospheric Administration (NOAA). A total of 135 dropsondes are analyzed in two separate time periods: one named the secondary eyewall formation period and the other one referred to as the decaying-double eyewalled storm period. During the secondary eyewall formation period, a time when the storm was observed to have only one eyewall, the diagnosed agradient force has a secondary maxima that coincides with the radial location of the secondary eyewall observed in the second period of study. The maximum spin up tendency of the radial influx of absolute vertical vorticity is within the boundary layer in the region of the eyewall of the storm and the spin up tendency structure elongates radially outward into the secondary region of supergradient wind, where the secondary wind maxima is observed in the second period of study. An analysis of the boundary-layer averaged vertical structure of equivalent potential temperature reveals a conditionally unstable environment in the secondary eyewall formation region. These findings support the hypothesis that deep convective activity in this region contributed to spin up of the boundary layer tangential winds and the formation of a secondary eyewall that is observed during the decaying-double eyewalled storm period.

Secondary Metabolites from Higher Fungi: Discovery, Bioactivity, and Bioproduction

NASA Astrophysics Data System (ADS)

Zhong, Jian-Jiang; Xiao, Jian-Hui

Medicinal higher fungi such as Cordyceps sinensis and Ganoderma lucidum have been used as an alternative medicine remedy to promote health and longevity for people in China and other regions of the world since ancient times. Nowadays there is an increasing public interest in the secondary metabolites of those higher fungi for discovering new drugs or lead compounds. Current research in drug discovery from medicinal higher fungi involves a multifaceted approach combining mycological, biochemical, pharmacological, metabolic, biosynthetic and molecular techniques. In recent years, many new secondary metabolites from higher fungi have been isolated and are more likely to provide lead compounds for new drug discovery, which may include chemopreventive agents possessing the bioactivity of immunomodulatory, anticancer, etc. However, numerous challenges of secondary metabolites from higher fungi are encountered including bioseparation, identification, biosynthetic metabolism, and screening model issues, etc. Commercial production of secondary metabolites from medicinal mushrooms is still limited mainly due to less information about secondary metabolism and its regulation. Strategies for enhancing secondary metabolite production by medicinal mushroom fermentation include two-stage cultivation combining liquid fermentation and static culture, two-stage dissolved oxygen control, etc. Purification of bioactive secondary metabolites, such as ganoderic acids from G. lucidum, is also very important to pharmacological study and future pharmaceutical application. This review outlines typical examples of the discovery, bioactivity, and bioproduction of secondary metabolites of higher fungi origin.

Recommendation on transition from primary/secondary radar to secondary-only radar capability

DOT National Transportation Integrated Search

1994-10-01

This recommendation has been prepared to support the FAA decision to deactivate primary Long-range radars and presents a : transition strategy and implementation plan for the transformation of the existing primary/secondary en route radar : system to...

Event-related potentials and secondary task performance during simulated driving.

PubMed

Wester, A E; Böcker, K B E; Volkerts, E R; Verster, J C; Kenemans, J L

2008-01-01

Inattention and distraction account for a substantial number of traffic accidents. Therefore, we examined the impact of secondary task performance (an auditory oddball task) on a primary driving task (lane keeping). Twenty healthy participants performed two 20-min tests in the Divided Attention Steering Simulator (DASS). The visual secondary task of the DASS was replaced by an auditory oddball task to allow recording of brain activity. The driving task and the secondary (distracting) oddball task were presented in isolation and simultaneously, to assess their mutual interference. In addition to performance measures (lane keeping in the primary driving task and reaction speed in the secondary oddball task), brain activity, i.e. event-related potentials (ERPs), was recorded. Performance parameters on the driving test and the secondary oddball task did not differ between performance in isolation and simultaneous performance. However, when both tasks were performed simultaneously, reaction time variability increased in the secondary oddball task. Analysis of brain activity indicated that ERP amplitude (P3a amplitude) related to the secondary task, was significantly reduced when the task was performed simultaneously with the driving test. This study shows that when performing a simple secondary task during driving, performance of the driving task and this secondary task are both unaffected. However, analysis of brain activity shows reduced cortical processing of irrelevant, potentially distracting stimuli from the secondary task during driving.

Resection for secondary malignancy of the pancreas.

PubMed

Hung, Jui-Hsia; Wang, Shin-E; Shyr, Yi-Ming; Su, Cheng-Hsi; Chen, Tien-Hua; Wu, Chew-Wun

2012-01-01

This study tried to clarify the role of pancreatic resection in the treatment of secondary malignancy with metastasis or local invasion to the pancreas in terms of surgical risk and survival benefit. Data of secondary malignancy of the pancreas from our 19 patients and cases reported in the English literature were pooled together for analysis. There were 329 cases of resected secondary malignancy of the pancreas, including 241 cases of metastasis and 88 cases of local invasion. The most common primary tumor metastatic to the pancreas and amenable to resection was renal cell carcinoma (RCC) (73.9%). More than half (52.3%) of the primary cancers with local invasion to the pancreas were colon cancer, and nearly half (40.9%) were stomach cancer. The median metastatic interval was 84 months (7 years) for overall primary tumors and 108 months (9 years) for RCC. The 5-year survival for secondary malignancy of the pancreas after resection was 61.1% for metastasis and 58.9% for local invasion, with 72.8% for RCC metastasis, 69.0% for colon cancer, and 43.8% for stomach cancer with local invasion to the pancreas. Pancreatic resection should not be precluded for secondary malignancy of the pancreas because long-term survival could be achieved with acceptable surgical risk in selected patients.

[Synthetic biology toward microbial secondary metabolites and pharmaceuticals].

PubMed

Wu, Lin-Zhuan; Hong, Bin

2013-02-01

Microbial secondary metabolites are one of the major sources of anti-bacterial, anti-fungal, antitumor, anti-virus and immunosuppressive agents for clinical use. Present challenges in microbial pharmaceutical development are the discovery of novel secondary metabolites with significant biological activities, improving the fermentation titers of industrial microbial strains, and production of natural product drugs by re-establishing their biosynthetic pathways in suitable microbial hosts. Synthetic biology, which is developed from systematic biology and metabolic engineering, provides a significant driving force for microbial pharmaceutical development. The review describes the major applications of synthetic biology in novel microbial secondary metabolite discovery, improved production of known secondary metabolites and the production of some natural drugs in genetically modified or reconstructed model microorganisms.

38 CFR 21.5136 - Benefit payments-secondary school program.

Code of Federal Regulations, 2011 CFR

2011-07-01

...-secondary school program. 21.5136 Section 21.5136 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...—secondary school program. (a) Restrictions on payments. (1) The Department of Veterans Affairs may authorize... secondary school diploma or an equivalency certificate without charge to entitlement. Payments may be made...

38 CFR 21.5136 - Benefit payments-secondary school program.

Code of Federal Regulations, 2010 CFR

2010-07-01

...-secondary school program. 21.5136 Section 21.5136 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...—secondary school program. (a) Restrictions on payments. (1) The Department of Veterans Affairs may authorize... secondary school diploma or an equivalency certificate without charge to entitlement. Payments may be made...

Secondary School Science Department Chairs Leading Change

ERIC Educational Resources Information Center

Gaubatz, Julie A.

2012-01-01

Secondary school department chairs are content area specialists in their schools and are responsible for providing students with the most appropriate curricula. However, most secondary school department chairs have limited authority to institute change unilaterally (Gmelch, 1993; Hannay & Erb, 1999). To explore how these educational leaders…

SPECT measurements with /sup 99m/Tc-HM-PAO in focal epilepsy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ryding, E.; Rosen, I.; Elmqvist, D.

1988-12-01

The ability of SPECT measurements with (/sup 99m/Tc)-HM-PAO (Ceretec) to find the location of the epileptic focus was studied in patients under consideration for neurosurgical treatment for therapy-resistant focal epilepsy. The location of low (/sup 99m/Tc)-HM-PAO uptake regions found at interictal measurements, and of high (/sup 99m/Tc)-HM-PAO uptake regions found at ictal measurements, was compared to the findings of extensive ictal and interictal EEG examinations, and to the results of CT and MRT. While EEG revealed focal epileptic activity in all of the 14 patients, SPECT showed regional abnormalities in 13 (93%). CT and MRT showed abnormal findings in 30%.

Promoting Science in Secondary School Education.

PubMed

Chiovitti, Anthony; Duncan, Jacinta C; Jabbar, Abdul

2017-06-01

Engaging secondary school students with science education is crucial for a society that demands a high level of scientific literacy in order to deal with the economic and social challenges of the 21st century. Here we present how parasitology could be used to engage and promote science in secondary school students under the auspice of a 'Specialist Centre' model for science education. Copyright © 2017 Elsevier Ltd. All rights reserved.

Secondary malignancy following radiotherapy for thyroid eye disease.

PubMed

Gillis, Christopher C; Chang, Eun Hae; Al-Kharazi, Khalid; Pickles, Tom

2016-01-01

To describe the first case of a secondary meningioma in a patient after radiation treatment for thyroid eye disease (TED). Secondarily to identify any additional cases of secondary malignancy resulting from radiotherapy for thyroid eye disease from our institutional experience. Thyroid eye disease (TED) is a self-limiting auto-immune disorder causing expansion of orbital soft tissue from deposition of glycosaminoglycans and collagen, leading to significant cosmetic and functional morbidity. Established management options for TED include: glucocorticosteroids, orbital radiotherapy, and surgical orbital decompression. Two large series on radiotherapy for TED have been reported without any cases of secondary malignancy. The case of a patient with visual failure, found to have a sphenoid wing meningioma after previous TED radiotherapy is described. We then reviewed 575 patients with at least 3-year follow-up receiving radiotherapy for TED at British Columbia Cancer Agency to identify other possible secondary malignancies. The patient had postoperative improvement in her vision without any identified complications. Three additional cases of hematologic malignancy were identified. The calculated risk in our population of developing a radiation-induced meningioma after TED with at least 3 years of follow-up of is 0.17% (1/575); with hematopoetic malignancies the risk for secondary malignancy is 0.7% (4/575). Our calculated risk for secondary malignancy (0.17%, 0.7%) is similar to the reported theoretical risk published in the literature (0.3-1.2%). There is real risk for the development of a secondary malignancy after radiotherapy treatment of TED and treatment options should include consideration for this potential.

Modeling when and where a secondary accident occurs.

PubMed

Wang, Junhua; Liu, Boya; Fu, Ting; Liu, Shuo; Stipancic, Joshua

2018-01-31

The occurrence of secondary accidents leads to traffic congestion and road safety issues. Secondary accident prevention has become a major consideration in traffic incident management. This paper investigates the location and time of a potential secondary accident after the occurrence of an initial traffic accident. With accident data and traffic loop data collected over three years from California interstate freeways, a shock wave-based method was introduced to identify secondary accidents. A linear regression model and two machine learning algorithms, including a back-propagation neural network (BPNN) and a least squares support vector machine (LSSVM), were implemented to explore the distance and time gap between the initial and secondary accidents using inputs of crash severity, violation category, weather condition, tow away, road surface condition, lighting, parties involved, traffic volume, duration, and shock wave speed generated by the primary accident. From the results, the linear regression model was inadequate in describing the effect of most variables and its goodness-of-fit and accuracy in prediction was relatively poor. In the training programs, the BPNN and LSSVM demonstrated adequate goodness-of-fit, though the BPNN was superior with a higher CORR and lower MSE. The BPNN model also outperformed the LSSVM in time prediction, while both failed to provide adequate distance prediction. Therefore, the BPNN model could be used to forecast the time gap between initial and secondary accidents, which could be used by decision makers and incident management agencies to prevent or reduce secondary collisions. Copyright © 2018 Elsevier Ltd. All rights reserved.

Trends in nitrogen and phosphorus cycling are consistent and constrained during tropical secondary forest succession: is secondary forest young primary forest from a nutrient perspective?

NASA Astrophysics Data System (ADS)

Sullivan, B. W.; Nasto, M.; Alvarez-Clare, S.; Cole, R. J.; Reed, S.; Chazdon, R.; Davidson, E. A.; Cleveland, C. C.

2015-12-01

Extensive deforestation of tropical rainforest often leads to agricultural abandonment and secondary forest regeneration. The land area of secondary rainforest is soon likely to exceed that of primary forest, highlighting the importance of secondary tropical rainforest in the global carbon (C) cycle. Secondary forests often grow rapidly, but the role soil nutrients play in regulating secondary forest productivity remains unsettled. Consistent with biogeochemical theory, a landmark study from a set of sites in the Amazon Basin showed that secondary forests had low nitrogen (N) availability and relatively higher phosphorus (P) availability immediately after abandonment, but that as succession proceeded, N availability "recuperated" and there was relatively less P available. To address whether such changes in N and P availability during secondary forest growth are common, we reviewed 38 studies in lowland tropical rainforest that reported changes in 23 different metrics of N and P cycling during secondary succession. We calculated slopes (rates of change) during secondary succession for each metric in each study, and analyzed patterns in these rates of change. Significant trends during secondary succession were more evident in soils than in plants, but in most cases, the variability among studies was surprisingly low. Both soil N and P availability increased through succession, at least in surface soil. Such consistent changes imply substantial biogeochemical resilience of tropical forest soils in spite of differing land use histories and species compositions among studies. In most cases, slopes were similar whether primary forest was included in, or excluded from, our analysis, suggesting that secondary succession eventually leads to similar biogeochemical conditions as those found in primary forest. Our results suggesting consistent changes in N and P availability during succession provide a biogeochemical rationale for the conservation and restoration value of

Mathematical Modeling in the Secondary School Curriculum.

ERIC Educational Resources Information Center

Swetz, Frank, Ed.; Hartzler, J. S., Ed.

Over the past 10 years, national conferences and committees investigating the state of American mathematics education have advocated an increased emphasis on problem solving and mathematical modeling situations in the secondary school curriculum. However, little effort has been made to prepare secondary school teachers to use mathematical modeling…

Secondary Hypertension: Discovering the Underlying Cause.

PubMed

Charles, Lesley; Triscott, Jean; Dobbs, Bonnie

2017-10-01

Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of secondary hypertension vary by age. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; severe hypertension and a unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.

Epileptic seizure detection from EEG signals with phase-amplitude cross-frequency coupling and support vector machine

NASA Astrophysics Data System (ADS)

Liu, Yang; Wang, Jiang; Cai, Lihui; Chen, Yingyuan; Qin, Yingmei

2018-03-01

As a pattern of cross-frequency coupling (CFC), phase-amplitude coupling (PAC) depicts the interaction between the phase and amplitude of distinct frequency bands from the same signal, and has been proved to be closely related to the brain’s cognitive and memory activities. This work utilized PAC and support vector machine (SVM) classifier to identify the epileptic seizures from electroencephalogram (EEG) data. The entropy-based modulation index (MI) matrixes are used to express the strength of PAC, from which we extracted features as the input for classifier. Based on the Bonn database, which contains five datasets of EEG segments obtained from healthy volunteers and epileptic subjects, a 100% classification accuracy is achieved for identifying seizure ictal from healthy data, and an accuracy of 97.67% is reached in the classification of ictal EEG signals from inter-ictal EEGs. Based on the CHB-MIT database which is a group of continuously recorded epileptic EEGs by scalp electrodes, a 97.50% classification accuracy is obtained and a raising sign of MI value is found at 6s before seizure onset. The classification performance in this work is effective, and PAC can be considered as a useful tool for detecting and predicting the epileptic seizures and providing reference for clinical diagnosis.

A Novel Signal Modeling Approach for Classification of Seizure and Seizure-Free EEG Signals.

PubMed

Gupta, Anubha; Singh, Pushpendra; Karlekar, Mandar

2018-05-01

This paper presents a signal modeling-based new methodology of automatic seizure detection in EEG signals. The proposed method consists of three stages. First, a multirate filterbank structure is proposed that is constructed using the basis vectors of discrete cosine transform. The proposed filterbank decomposes EEG signals into its respective brain rhythms: delta, theta, alpha, beta, and gamma. Second, these brain rhythms are statistically modeled with the class of self-similar Gaussian random processes, namely, fractional Brownian motion and fractional Gaussian noises. The statistics of these processes are modeled using a single parameter called the Hurst exponent. In the last stage, the value of Hurst exponent and autoregressive moving average parameters are used as features to design a binary support vector machine classifier to classify pre-ictal, inter-ictal (epileptic with seizure free interval), and ictal (seizure) EEG segments. The performance of the classifier is assessed via extensive analysis on two widely used data set and is observed to provide good accuracy on both the data set. Thus, this paper proposes a novel signal model for EEG data that best captures the attributes of these signals and hence, allows to boost the classification accuracy of seizure and seizure-free epochs.

40 CFR 421.320 - Applicability: Description of the secondary uranium subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... secondary uranium subcategory. 421.320 Section 421.320 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Uranium Subcategory § 421.320 Applicability: Description of the secondary uranium... uranium (including depleted uranium) by secondary uranium facilities. ...

40 CFR 421.320 - Applicability: Description of the secondary uranium subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... secondary uranium subcategory. 421.320 Section 421.320 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Uranium Subcategory § 421.320 Applicability: Description of the secondary uranium... uranium (including depleted uranium) by secondary uranium facilities. ...

40 CFR 421.320 - Applicability: Description of the secondary uranium subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... secondary uranium subcategory. 421.320 Section 421.320 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Uranium Subcategory § 421.320 Applicability: Description of the secondary uranium... uranium (including depleted uranium) by secondary uranium facilities. ...

40 CFR 421.320 - Applicability: Description of the secondary uranium subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... secondary uranium subcategory. 421.320 Section 421.320 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Uranium Subcategory § 421.320 Applicability: Description of the secondary uranium... uranium (including depleted uranium) by secondary uranium facilities. ...

40 CFR 421.320 - Applicability: Description of the secondary uranium subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... secondary uranium subcategory. 421.320 Section 421.320 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Uranium Subcategory § 421.320 Applicability: Description of the secondary uranium... uranium (including depleted uranium) by secondary uranium facilities. ...

Skin bridging secondary to ingrown toenail

PubMed Central

Dadaci, Mehmet; Ince, Bilsev; Altuntas, Zeynep; Kamburoglu, Haldun Onuralp; Bitik, Ozan

2014-01-01

Ingrown toenails are painful conditions that especially affect young people and may become chronic if not treated. We describe a case of chronically inflamed ingrown toenail left untreated for three years. In the physical examination, skin bridging and epithelialization was observed in midline secondary to soft tissue hypertrophy of the lateral nail matrixes. Epithelized fibrous tissue was cut across the lateral nail matrix and left for secondary healing. Partial matrixectomy was applied and the remnants were cauterized in compliance with the Winograd procedure after removal of the nail. Our case is an advanced condition which is the second report in the literature. Skin bridging secondary to excess soft tissue hypertrophy can be observed in untreated bilateral Heinfert or Frost stage 3 ingrown nails. This rare case can be classified as advanced stage 3 disease or stage 4. PMID:25674152

Safe Schools Survey: Post-Secondary Survey Results.

ERIC Educational Resources Information Center

Mowery, Andrea

This report provides the results of a survey of safety and security at colleges and universities in Minnesota, along with policy recommendations to improve safety and security at Minnesota post-secondary institutions. It is based on campus security reports voluntarily submitted by 60 of the 110 Minnesota post-secondary institutions, personal…

Record Management in Nigerian Secondary School Administration

ERIC Educational Resources Information Center

Nakpodia, E. D.

2009-01-01

This paper examined the usefulness of record management in Nigerian Secondary Schools. Record keeping is one of the administrative principles in secondary school administration and it cannot be overemphasized in any organisation. The continuity of any school organisation depends on availability of useful records of past activities. In a complex…

Response-Centered Teaching and Secondary Film Education.

ERIC Educational Resources Information Center

Niemi, Richard Eugene

This study explores the question: Is the response-centered approach to teaching literature suitable for secondary film education? The personal growth rationale and response-approach pedagogy, particularly as articulated in the past decade, are presented in detail. Following a survey of the history of American secondary film education, the film…

Clinics in diagnostic imaging (153). Severe hypoxic ischaemic brain injury.

PubMed Central

Chua, Wynne; Lim, Boon Keat; Lim, Tchoyoson Choie Cheio

2014-01-01

A 58-year-old Indian woman presented with asystole after an episode of haemetemesis, with a patient downtime of 20 mins. After initial resuscitation efforts, computed tomography of the brain, obtained to evaluate neurological injury, demonstrated evidence of severe hypoxic ischaemic brain injury. The imaging features of hypoxic ischaemic brain injury and the potential pitfalls with regard to image interpretation are herein discussed. PMID:25091891

Secondary Dystonia-Clinical Clues and Syndromic Associations

PubMed Central

Schneider, Susanne A; Bhatia, Kailash P

2009-01-01

Background: Dystonia is a hyperkinetic movement disorder defined by involuntary sustained muscle spasms and unusual postures. Etiologically, dystonic syndromes can be broadly divided into primary and secondary forms, dystonia-plus syndromes and heredodegenerative forms. In particular, diagnosis of secondary dystonic syndromes can be challenging in view of the variety of causes. Purpose: The purpose of this article is to highlight some clinical clues and syndromic associations as well as investigational findings which may be helpful in the approach to a patient with suspected secondary dystonia. Methods: We outline characteristic clinical and neuroimaging findings which may be directive in the diagnostic process of dystonia patients and facilitate making the correct diagnosis, thus allowing initiating the best treatment. Results: Secondary causes of dystonia include, among others, strategic brain lesions of various origins, metabolic disease, neurodegenerative conditions, and previous exposure to drugs or toxins. Presence of clinical signs including prominent oromandibular involvement, eye movement disorders, retinitis pigmentosa, deafness, peripheral neuropathy, parkinsonism or progressive dementia should alert the clinician to consider a secondary cause. Strategic lesions within the basal ganglia, but also within the brainstem, cerebellum or cortical areas may underlie dystonia and should thus be excluded. Conclusions: When thorough clinical examination reveals features atypical of primary dystonia, syndromic associations may help the clinician to narrow down the list of differential diagnosis. Directive investigations like neuroimaging may confirm the clinical suspicion. PMID:24868358

Pharmaceutically active secondary metabolites of marine actinobacteria.

PubMed

Manivasagan, Panchanathan; Venkatesan, Jayachandran; Sivakumar, Kannan; Kim, Se-Kwon

2014-04-01

Marine actinobacteria are one of the most efficient groups of secondary metabolite producers and are very important from an industrial point of view. Many representatives of the order Actinomycetales are prolific producers of thousands of biologically active secondary metabolites. Actinobacteria from terrestrial sources have been studied and screened since the 1950s, for many important antibiotics, anticancer, antitumor and immunosuppressive agents. However, frequent rediscovery of the same compounds from the terrestrial actinobacteria has made them less attractive for screening programs in the recent years. At the same time, actinobacteria isolated from the marine environment have currently received considerable attention due to the structural diversity and unique biological activities of their secondary metabolites. They are efficient producers of new secondary metabolites that show a range of biological activities including antibacterial, antifungal, anticancer, antitumor, cytotoxic, cytostatic, anti-inflammatory, anti-parasitic, anti-malaria, antiviral, antioxidant, anti-angiogenesis, etc. In this review, an evaluation is made on the current status of research on marine actinobacteria yielding pharmaceutically active secondary metabolites. Bioactive compounds from marine actinobacteria possess distinct chemical structures that may form the basis for synthesis of new drugs that could be used to combat resistant pathogens. With the increasing advancement in science and technology, there would be a greater demand for new bioactive compounds synthesized by actinobacteria from various marine sources in future. Copyright © 2013 Elsevier GmbH. All rights reserved.

[STandardized Reporting Of Secondary data Analyses (STROSA)—a recommendation].

PubMed

Swart, Enno; Schmitt, Jochen

2014-01-01

Secondary data analyses will play an increasingly important role in health services research. But to date, there is no guideline for the systematic, transparent and complete reporting of secondary data. We investigated whether the STROBE statement, i.e., the recommendations for reporting observational studies, satisfies the specific characteristics of secondary data analyses and whether any specifications/modifications and extensions are necessary. For the majority of the 22 STROBE criteria, specifications and extensions are needed to meet the requirements of systematic, transparent and complete reporting of secondary data analysis. Seven aspects of secondary data analysis not covered by STROBE (legal aspects, data flow, protocol, unit of analysis, internal validations/definitions, advantages of secondary data utilisation, role of data owners) should be considered as a specific complement to STROBE. The so called STROSA (STandardized Reporting Of Secondary data Analyses) checklist therefore includes 29 items that relate to the title/abstract, introduction, methods, results and discussion sections of articles. The STROSA checklist is intended to support authors and readers in the critical appraisal of secondary data analyses. This proposal will now be subject to continued scientific discussions. Copyright © 2014. Published by Elsevier GmbH.

Cooperative Learning in Science: Intervention in the Secondary School

ERIC Educational Resources Information Center

Topping, K. J.; Thurston, A.; Tolmie, A.; Christie, D.; Murray, P.; Karagiannidou, E.

2011-01-01

The use of cooperative learning in secondary school is reported--an area of considerable concern given attempts to make secondary schools more interactive and gain higher recruitment to university science courses. In this study the intervention group was 259 pupils aged 12-14 years in nine secondary schools, taught by 12 self-selected teachers.…

Nanoparticles Alter Secondary Metabolism in Plants via ROS Burst

PubMed Central

Marslin, Gregory; Sheeba, Caroline J.; Franklin, Gregory

2017-01-01

The particles within the size range of 1 and 100 nm are known as nanoparticles (NPs). NP-containing wastes released from household, industrial and medical products are emerging as a new threat to the environment. Plants, being fixed to the two major environmental sinks where NPs accumulate — namely water and soil, cannot escape the impact of nanopollution. Recent studies have shown that plant growth, development and physiology are significantly affected by NPs. But, the effect of NPs on plant secondary metabolism is still obscure. The induction of reactive oxygen species (ROS) following interactions with NPs has been observed consistently across plant species. Taking into account the existing link between ROS and secondary signaling messengers that lead to transcriptional regulation of secondary metabolism, in this perspective we put forward the argument that ROS induced in plants upon their interaction with NPs will likely interfere with plant secondary metabolism. As plant secondary metabolites play vital roles in plant performance, communication, and adaptation, a comprehensive understanding of plant secondary metabolism in response to NPs is an utmost priority. PMID:28580002

Religious Identity Choices in English Secondary Schools

ERIC Educational Resources Information Center

Moulin, Daniel

2015-01-01

This paper explores religious adolescents' reported experiences of secondary schools. Fifty-four qualitative interviews were conducted in places of worship in three cities in England with Christians (n = 46), Jews (n = 38) and Muslims (n = 15). Secondary schools of a religious and non-religious character were reported as not providing a suitable…

22 CFR 62.25 - Secondary school students.

Code of Federal Regulations, 2014 CFR

2014-04-01

... same native languages in a single home. (2) Prior to the student's departure from his or her home... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Secondary school students. 62.25 Section 62.25... Program Provisions § 62.25 Secondary school students. (a) Purpose. This section governs Department of...

22 CFR 62.25 - Secondary school students.

Code of Federal Regulations, 2012 CFR

2012-04-01

... same native languages in a single home. (2) Prior to the student's departure from his or her home... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Secondary school students. 62.25 Section 62.25... Program Provisions § 62.25 Secondary school students. (a) Purpose. This section governs Department of...

22 CFR 62.25 - Secondary school students.

Code of Federal Regulations, 2011 CFR

2011-04-01

... same native languages in a single home. (2) Prior to the student's departure from his or her home... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Secondary school students. 62.25 Section 62.25... Program Provisions § 62.25 Secondary school students. (a) Purpose. This section governs Department of...

22 CFR 62.25 - Secondary school students.

Code of Federal Regulations, 2013 CFR

2013-04-01

... same native languages in a single home. (2) Prior to the student's departure from his or her home... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Secondary school students. 62.25 Section 62.25... Program Provisions § 62.25 Secondary school students. (a) Purpose. This section governs Department of...

Designing Knowledge Building Communities in Secondary Schools

ERIC Educational Resources Information Center

Lai, Kwok-Wing

2014-01-01

In 2012-2013, sixteen senior secondary classes participated in this study, with eight of them being distance classes. Approximately 220 Year 11-13 students and 8 teachers took part in this study. This project aimed at designing and evaluating a computer-supported knowledge building community in senior secondary classes. Researchers sought to…

Collaborative Tools in Upper Secondary School--Why?

ERIC Educational Resources Information Center

Mathiasen, Helle; Degn, Hans-Peter; Dalsgaard, Christian; Bech, Christian W.; Gregersen, Claus

2013-01-01

The paper will discuss potentials of digital media to support student engagement and student production in Danish upper secondary education with a specific focus on group work and collaboration. With the latest school reform, upper secondary education in Denmark has experienced an increased focus on problem-based and self-governed work of…

Secondary Products (Markets, Competition, and Technological Improvements)

Treesearch

Philip A. Araman

1988-01-01

Competitiveness, imports, exports, and technological improvements--these are issues facing secondary wood-product manufacturers. The major problems focus on increasing foreign imports and the inability of U.S. industries to repell the imports. How and where should we, as researchers, allocate our efforts to enhance the competitiveness of secondary forest industries in...

Characteristics of tuberculosis patients who generate secondary cases.

PubMed

Rodrigo, T; Caylà, J A; García de Olalla, P; Galdós-Tangüis, H; Jansà, J M; Miranda, P; Brugal, T

1997-08-01

To determine the characteristics of smear positive tuberculosis (TB) patients who generate secondary TB cases. Those smear positive TB patients detected by the Barcelona Tuberculosis Program between 1990-1993, and for whom contact studies had been performed, were studied. We analyzed the predictive role of the variables: age, sex, intravenous drug use (IVDU), the presence of the acquired immune deficiency syndrome (AIDS), human immunodeficiency virus (HIV) infection, radiology pattern, district of residence, history of imprisonment, alcoholism, smoking, history of TB, treatment compliance and the number of secondary cases generated. Statistical analysis was based on the logistic regression model, calculating the odds ratios (OR) with 95% confidence intervals (CI). Of the 1079 patients studied, 78 (7.2%) had generated only one secondary case, and 30 (2.8%) two or more. The variables associated with generating two or more secondary cases were: IVDU (P < 0.001; OR = 4.06; CI: 1.80-9.15), cavitary radiology pattern (P = 0.002; OR = 3.69; CI: 1.62-8.43), and age (P = 0.016; OR = 0.98; CI: 0.96-0.99). When we examined those who had generated one or more secondary cases, the following variables were significant: IVDU (P = 0.043; OR = 1.75; CI: 1.02-3.02), cavitary radiology pattern (P < 0.001; OR = 3.07; CI: 1.98-4.77) and age (P < 0.001; OR = 0.98; CI: 0.97-0.99). The study of the contacts of smear positive TB patients allows us to detect an important number of secondary cases. Young adults, those with cavitary radiology pattern, and IVDU are more likely to generate secondary cases.

Study Habits and Academic Performance of Secondary School Students in Mathematic: A Case Study of Selected Secondary Schools in Uyo Local Education Council

ERIC Educational Resources Information Center

Sakirudeen, Abisola Oladeni; Sanni, Kudirat Bimbo

2017-01-01

The study examined study habits and academic performance of secondary school students in Mathematics. A case study of selected secondary schools in Uyo Local Education Council. The main purpose of the study was to investigate the relationship between study habits and academic performance of secondary school students in Mathematics. To carry out…

40 CFR 421.200 - Applicability: Description of the secondary mercury subcategory.

Code of Federal Regulations, 2010 CFR

2010-07-01

... secondary mercury subcategory. 421.200 Section 421.200 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Mercury Subcategory § 421.200 Applicability: Description of the secondary mercury... mercury from secondary mercury facilities processing recycled mercuric oxide batteries and other mercury...

40 CFR 421.200 - Applicability: Description of the secondary mercury subcategory.

Code of Federal Regulations, 2013 CFR

2013-07-01

... secondary mercury subcategory. 421.200 Section 421.200 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Mercury Subcategory § 421.200 Applicability: Description of the secondary mercury... mercury from secondary mercury facilities processing recycled mercuric oxide batteries and other mercury...

40 CFR 421.200 - Applicability: Description of the secondary mercury subcategory.

Code of Federal Regulations, 2011 CFR

2011-07-01

... secondary mercury subcategory. 421.200 Section 421.200 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Mercury Subcategory § 421.200 Applicability: Description of the secondary mercury... mercury from secondary mercury facilities processing recycled mercuric oxide batteries and other mercury...

40 CFR 421.200 - Applicability: Description of the secondary mercury subcategory.

Code of Federal Regulations, 2014 CFR

2014-07-01

... secondary mercury subcategory. 421.200 Section 421.200 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Mercury Subcategory § 421.200 Applicability: Description of the secondary mercury... mercury from secondary mercury facilities processing recycled mercuric oxide batteries and other mercury...

40 CFR 421.200 - Applicability: Description of the secondary mercury subcategory.

Code of Federal Regulations, 2012 CFR

2012-07-01

... secondary mercury subcategory. 421.200 Section 421.200 Protection of Environment ENVIRONMENTAL PROTECTION... CATEGORY Secondary Mercury Subcategory § 421.200 Applicability: Description of the secondary mercury... mercury from secondary mercury facilities processing recycled mercuric oxide batteries and other mercury...

The Global Contribution of Secondary Craters on the Icy Satellites

NASA Astrophysics Data System (ADS)

Hoogenboom, T.; Johnson, K. E.; Schenk, P.

2014-12-01

At present, surface ages of bodies in the Outer Solar System are determined only from crater size-frequency distributions (a method dependent on an understanding of the projectile populations responsible for impact craters in these planetary systems). To derive accurate ages using impact craters, the impactor population must be understood. Impact craters in the Outer Solar System can be primary, secondary or sesquinary. The contribution of secondary craters to the overall population has recently become a "topic of interest." Our objective is to better understand the contribution of dispersed secondary craters to the small crater populations, and ultimately that of small comets to the projectile flux on icy satellites in general. We measure the diameters of obvious secondary craters (determined by e.g. irregular crater shape, small size, clustering) formed by all primary craters on Ganymede for which we have sufficiently high resolution data to map secondary craters. Primary craters mapped range from approximately 40 km to 210 km. Image resolution ranges from 45 to 440 m/pixel. Bright terrain on Ganymede is our primary focus. These resurfaced terrains have relatively low crater densities and serve as a basis for characterizing secondary populations as a function of primary size on an icy body for the first time. Although focusing on Ganymede, we also investigate secondary crater size, frequency, distribution, and formation, as well as secondary crater chain formation on icy satellites throughout the Saturnian and Jovian systems principally Rhea. We compare our results to similar studies of secondary cratering on the Moon and Mercury. Using Galileo and Voyager data, we have identified approximately 3,400 secondary craters on Ganymede. In some cases, we measured crater density as a function of distance from a primary crater. Because of the limitations of the Galileo data, it is necessary to extrapolate from small data sets to the global population of secondary craters

The Development of a Secondary School Health Assessment Model

ERIC Educational Resources Information Center

Sriring, Srinual; Erawan, Prawit; Sriwarom, Monoon

2015-01-01

The objective of this research was to: 1) involved a survey of information relating to secondary school health, 2) involved the construction of a model of health assessment and a handbook for using the model in secondary school, 3) develop an assessment model for secondary school. The research included 3 phases. (1) involved a survey of…

Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage.

PubMed

Zumofen, Daniel W; Roethlisberger, Michel; Achermann, Rita; Bawarjan, Schatlo; Stienen, Martin N; Fung, Christian; D'Alonzo, Donato; Maldaner, Nicolai; Ferrari, Andrea; Corniola, Marco V; Schoeni, Daniel; Goldberg, Johannes; Valsecchi, Daniele; Robert, Thomas; Maduri, Rodolfo; Seule, Martin; Burkhardt, Jan-Karl; Marbacher, Serge; Bijlenga, Philippe; Blackham, Kristine A; Bucher, Heiner C; Mariani, Luigi; Guzman, Raphael

2018-02-10

Grading scales yield objective measure of the severity of aneurysmal subarachnoid hemorrhage and serve as to guide treatment decisions and for prognostication. The purpose of this cohort study was to determine what factors govern a patient's disease-specific admission scores in a representative Central European cohort. The Swiss Study of Subarachnoid Hemorrhage includes anonymized data from all tertiary referral centers serving subarachnoid hemorrhage patients in Switzerland. The 2009-2014 dataset was used to evaluate the impact of patient and aneurysm characteristics on the patients' status at admission using descriptive and multivariate regression analysis. The primary/co-primary endpoints were the GCS and the WFNS grade. The secondary endpoints were the Fisher grade, the presence of a thick cisternal or ventricular clot, the presence of a new focal neurological deficit or cranial nerve palsy, and the patient's intubation status. In our cohort of 1787 consecutive patients, increasing patient age by 10 years and low pre-ictal functional status (mRS 3-5) were inversely correlated with "high" GCS score (GCS ≥ 13) (OR 0.91, 95% CI 0.84-0.97 and OR 0.67, 95% CI 0.31-1.46), "low" WFNS grade (grade VI-V) (OR 1.21, 95% CI 1.04-1.20 and OR 1.47, 95% CI 0.66-3.27), and high Fisher grade (grade III-IV) (OR 1.08, 95% CI 1.00-1.17 and OR 1.54, 95% CI 0.55-4.32). Other independent predictors for the patients' clinical and radiological condition at admission were the ruptured aneurysms' location and its size. In sum, chronological age and pre-ictal functional status, as well as the ruptured aneurysm's location and size, determine the patients' clinical and radiological condition at admission to the tertiary referral hospital.

Characteristic phasic evolution of convulsive seizure in PCDH19-related epilepsy.

PubMed

Ikeda, Hiroko; Imai, Katsumi; Ikeda, Hitoshi; Shigematsu, Hideo; Takahashi, Yukitoshi; Inoue, Yushi; Higurashi, Norimichi; Hirose, Shinichi

2016-03-01

PCDH19-related epilepsy is a genetic disorder that was first described in 1971, then referred to as "epilepsy and mental retardation limited to females". PCDH19 has recently been identified as the responsible gene, but a detailed characterization of the seizure manifestation based on video-EEG recording is still limited. The purpose of this study was to elucidate features of the seizure semiology in children with PCDH19-related epilepsy. To do this, ictal video-EEG recordings of 26 convulsive seizures in three girls with PCDH19-related epilepsy were analysed. All seizures occurred in clusters, mainly during sleep accompanied by fever. The motor manifestations consisted of six sequential phases: "jerk", "reactive", "mild tonic", "fluttering", "mild clonic", and "postictal". Some phases were brief or lacking in some seizures, whereas others were long or pronounced. In the reactive phase, the patients looked fearful or startled with sudden jerks and turned over reactively. The tonic and clonic components were less intense compared with those of typical tonic-clonic seizures in other types of epilepsy. The fluttering phase was characterised initially by asymmetric, less rhythmic, and less synchronous tremulous movement and was then followed by the subtle clonic phase. Subtle oral automatism was observed in the postictal phase. The reactive, mild tonic, fluttering and mild clonic phases were most characteristic of seizures of PCDH19-related epilepsy. Ictal EEG started bilaterally and was symmetric in some patients but asymmetric in others. It showed asymmetric rhythmic discharges in some seizures at later phases. The electroclinical pattern of the phasic evolution of convulsive seizure suggests a focal onset seizure with secondary generalisation. Based on our findings, we propose that the six unique sequential phases in convulsive seizures suggest the diagnosis of PCDH19-related epilepsy when occurring in clusters with or without high fever in girls. [Published with

Evaluation Considerations for Secondary Uses of Clinical Data: Principles for an Evidence-based Approach to Policy and Implementation of Secondary Analysis.

PubMed

Scott, P J; Rigby, M; Ammenwerth, E; McNair, J Brender; Georgiou, A; Hyppönen, H; de Keizer, N; Magrabi, F; Nykänen, P; Gude, W T; Hackl, W

2017-08-01

Objectives: To set the scientific context and then suggest principles for an evidence-based approach to secondary uses of clinical data, covering both evaluation of the secondary uses of data and evaluation of health systems and services based upon secondary uses of data. Method: Working Group review of selected literature and policy approaches. Results: We present important considerations in the evaluation of secondary uses of clinical data from the angles of governance and trust, theory, semantics, and policy. We make the case for a multi-level and multi-factorial approach to the evaluation of secondary uses of clinical data and describe a methodological framework for best practice. We emphasise the importance of evaluating the governance of secondary uses of health data in maintaining trust, which is essential for such uses. We also offer examples of the re-use of routine health data to demonstrate how it can support evaluation of clinical performance and optimize health IT system design. Conclusions: Great expectations are resting upon "Big Data" and innovative analytics. However, to build and maintain public trust, improve data reliability, and assure the validity of analytic inferences, there must be independent and transparent evaluation. A mature and evidence-based approach needs not merely data science, but must be guided by the broader concerns of applied health informatics. Georg Thieme Verlag KG Stuttgart.

Examining Practice in Secondary Visual Arts Education

ERIC Educational Resources Information Center

Mitchell, Donna Mathewson

2015-01-01

Teaching in secondary visual arts classrooms is complex and challenging work. While it is implicated in much research, the complexity of the lived experience of secondary visual arts teaching has rarely been the subject of sustained and synthesized research. In this paper, the potential of practice as a concept to examine and represent secondary…

Secondary and tertiary preventions of thyroid disease.

PubMed

Azizi, Fereidoun; Mehran, Ladan; Hosseinpanah, Farhad; Delshad, Hossein; Amouzegar, Atieh

2018-05-01

Secondary and tertiary preventions are concerned with the recognition of the disease process in a very early stage and delay in progression to complete disease and minimization of complications and the impact of illness. All articles related to secondary and tertiary prevention of thyroid diseases were reviewed. Using related key words, articles published between 2001 and 2015 were evaluated, categorized, and analyzed. In secondary prevention, congenital hypothyroidism and subclinical hypo and hyperthyroidism are equally important. Routine screening of patients with multinodular goiter by either ultrasonography or calcitonin is a controversial issue, while calcitonin assessments in medullary cancer and RET in family members are recommended. Screening of thyroid disease in pregnancy is limited to those with risk factors. Views regarding the importance of thyroid autoimmunity in secondary prevention are also presented. In tertiary prevention, prescribing excessive doses of levothyroxine, in the elderly in particular and appropriate care of all patients to avoid progression and complications are the key issues. Optimization of management of thyroid diseases requires timely screening, prevention of progression to more sever disease, optimal medical care, and avoidance of iatrogenic conditions.

Simulation of secondary emission calorimeter for future colliders

NASA Astrophysics Data System (ADS)

Yetkin, E. A.; Yetkin, T.; Ozok, F.; Iren, E.; Erduran, M. N.

2018-03-01

We present updated results from a simulation study of a conceptual sampling electromagnetic calorimeter based on secondary electron emission process. We implemented the secondary electron emission process in Geant4 as a user physics list and produced the energy spectrum and yield of secondary electrons. The energy resolution of the SEE calorimeter was σ/E = (41%) GeV1/2/√E and the response linearity to electromagnetic showers was to within 1.5%. The simulation results were also compared with a traditional scintillator calorimeter.

Nuffield Secondary Science, Theme 7, Using Materials.

ERIC Educational Resources Information Center

Blackledge, J.; And Others

Nuffield Secondary Science is a set of tested materials from which teachers can prepare courses for students in grades 9-11 (approximately) who do not intend to major in science. The materials are designed for British secondary schools but are adaptable for other countries. The Teachers' Guide to the entire set of materials is described in SE 015…

Secondary School Students' Predictors of Science Attitudes

ERIC Educational Resources Information Center

Tosun, Cemal; Genç, Murat

2016-01-01

The purpose of this study is to identify the factors that affect the secondary school students' attitudes in science. This study was conducted using survey method. The sample of the study was 503 students from four different secondary schools in Bartin and Düzce. Data were obtained using the Survey of Factors Affecting Students' Science Attitudes…

General Well-Being of Higher Secondary Students

ERIC Educational Resources Information Center

Lawrence, A. S. Arul

2017-01-01

General well-being is the quality of life of a person/individual in terms of health, happiness and prosperity rather than wealth. The present study aims to probe the General Well-being of Higher Secondary Students. In this normative survey study, the investigator has selected a sample of 200 higher secondary school students who were studying 11th…

Ensemble-based prediction of RNA secondary structures.

PubMed

Aghaeepour, Nima; Hoos, Holger H

2013-04-24

Accurate structure prediction methods play an important role for the understanding of RNA function. Energy-based, pseudoknot-free secondary structure prediction is one of the most widely used and versatile approaches, and improved methods for this task have received much attention over the past five years. Despite the impressive progress that as been achieved in this area, existing evaluations of the prediction accuracy achieved by various algorithms do not provide a comprehensive, statistically sound assessment. Furthermore, while there is increasing evidence that no prediction algorithm consistently outperforms all others, no work has been done to exploit the complementary strengths of multiple approaches. In this work, we present two contributions to the area of RNA secondary structure prediction. Firstly, we use state-of-the-art, resampling-based statistical methods together with a previously published and increasingly widely used dataset of high-quality RNA structures to conduct a comprehensive evaluation of existing RNA secondary structure prediction procedures. The results from this evaluation clarify the performance relationship between ten well-known existing energy-based pseudoknot-free RNA secondary structure prediction methods and clearly demonstrate the progress that has been achieved in recent years. Secondly, we introduce AveRNA, a generic and powerful method for combining a set of existing secondary structure prediction procedures into an ensemble-based method that achieves significantly higher prediction accuracies than obtained from any of its component procedures. Our new, ensemble-based method, AveRNA, improves the state of the art for energy-based, pseudoknot-free RNA secondary structure prediction by exploiting the complementary strengths of multiple existing prediction procedures, as demonstrated using a state-of-the-art statistical resampling approach. In addition, AveRNA allows an intuitive and effective control of the trade-off between

The Articulation of Secondary and Post-Secondary Vocational Education Programs. Workshop Products.

ERIC Educational Resources Information Center

Keene State Coll., NH.

As a result of the cooperative efforts in articulation by secondary/postsecondary instructor teams, six packages representing the occupational areas of child care, culinary arts, electronics, health occupations, power mechanics, and industrial welding were developed. Each package contains the following three components: a series of job titles…

Initiation of secondary ice production in clouds

NASA Astrophysics Data System (ADS)

Sullivan, Sylvia C.; Hoose, Corinna; Kiselev, Alexei; Leisner, Thomas; Nenes, Athanasios

2018-02-01

Disparities between the measured concentrations of ice-nucleating particles (INPs) and in-cloud ice crystal number concentrations (ICNCs) have led to the hypothesis that mechanisms other than primary nucleation form ice in the atmosphere. Here, we model three of these secondary production mechanisms - rime splintering, frozen droplet shattering, and ice-ice collisional breakup - with a six-hydrometeor-class parcel model. We perform three sets of simulations to understand temporal evolution of ice hydrometeor number (Nice), thermodynamic limitations, and the impact of parametric uncertainty when secondary production is active. Output is assessed in terms of the number of primarily nucleated ice crystals that must exist before secondary production initiates (NINP(lim)) as well as the ICNC enhancement from secondary production and the timing of a 100-fold enhancement. Nice evolution can be understood in terms of collision-based nonlinearity and the phasedness of the process, i.e., whether it involves ice hydrometeors, liquid ones, or both. Ice-ice collisional breakup is the only process for which a meaningful NINP(lim) exists (0.002 up to 0.15 L-1). For droplet shattering and rime splintering, a warm enough cloud base temperature and modest updraft are the more important criteria for initiation. The low values of NINP(lim) here suggest that, under appropriate thermodynamic conditions for secondary ice production, perturbations in cloud concentration nuclei concentrations are more influential in mixed-phase partitioning than those in INP concentrations.

Secondary currents in a curved, stratified, estuarine channel

USGS Publications Warehouse

Lacy, J.R.; Monismith, Stephen G.

2001-01-01

This paper presents a study of secondary circulation in a curved stratified channel in northern San Francisco Bay over a 12.5-hour tidal cycle. Secondary currents were strong at times (varying by up to 35 cm/s from top to bottom) but relatively transient, as the balance between centrifugal and lateral baroclinic forcing changed over time. The short travel time around the bend did not allow a steady state balance to develop between centrifugal and lateral baroclinic forcing. During the flood tide the confluence of two streams with different velocities produced a strong lateral gradient in streamwise velocity. As a result, lateral advection was a significant term in the streamwise momentum balance, having the same order of magnitude as the barotropic and baroclinic pressure gradients, and the frictional terms. During the first part of the ebb, secondary currents were induced by lateral baroclinic forcing. The direction of the secondary circulation reversed later in the ebb, as the baroclinic forcing became weaker than the centrifugal acceleration. The gradient Richardson number showed that stratification was stable over most of the tidal cycle, decreasing the importance of friction and allowing secondary currents to persist. Copyright 2001 by the American Geophysical Union.

Current approaches toward production of secondary plant metabolites

PubMed Central

Hussain, Md. Sarfaraj; Fareed, Sheeba; Ansari, Saba; Rahman, Md. Akhlaquer; Ahmad, Iffat Zareen; Saeed, Mohd.

2012-01-01

Plants are the tremendous source for the discovery of new products with medicinal importance in drug development. Today several distinct chemicals derived from plants are important drugs, which are currently used in one or more countries in the world. Secondary metabolites are economically important as drugs, flavor and fragrances, dye and pigments, pesticides, and food additives. Many of the drugs sold today are simple synthetic modifications or copies of the naturally obtained substances. The evolving commercial importance of secondary metabolites has in recent years resulted in a great interest in secondary metabolism, particularly in the possibility of altering the production of bioactive plant metabolites by means of tissue culture technology. Plant cell and tissue culture technologies can be established routinely under sterile conditions from explants, such as plant leaves, stems, roots, and meristems for both the ways for multiplication and extraction of secondary metabolites. In vitro production of secondary metabolite in plant cell suspension cultures has been reported from various medicinal plants, and bioreactors are the key step for their commercial production. Based on this lime light, the present review is aimed to cover phytotherapeutic application and recent advancement for the production of some important plant pharmaceuticals. PMID:22368394

Delayed fungal endophthalmitis secondary to Curvularia.

PubMed

Xu, Kunyong; Almeida, David R P; Chin, Eric K; Mahajan, Vinit B

2016-10-01

To describe a case of fungal endophthalmitis secondary to Curvularia after cataract surgery. This case showed delayed and recalcitrant fungal endophthalmitis secondary to Curvularia despite treatment with pars plana vitrectomy, intravitreal antifungal therapy, and systemic antifungals. Curvularia -associated endophthalmitis should be considered in the differential diagnosis of delayed post-cataract endophthalmitis, especially in tropical or subtropical geographical areas. Awareness and early identification, timely removal of the nidi of sequestration, and prolonged antifungal treatments are important for the eradication of Curvularia -associated endophthalmitis.

Hybrid-secondary uncluttered permanent magnet machine and method

DOEpatents

Hsu, John S.

2005-12-20

An electric machine (40) has a stator (43), a permanent magnet rotor (38) with permanent magnets (39) and a magnetic coupling uncluttered rotor (46) for inducing a slip energy current in secondary coils (47). A dc flux can be produced in the uncluttered rotor when the secondary coils are fed with dc currents. The magnetic coupling uncluttered rotor (46) has magnetic brushes (A, B, C, D) which couple flux in through the rotor (46) to the secondary coils (47c, 47d) without inducing a current in the rotor (46) and without coupling a stator rotational energy component to the secondary coils (47c, 47d). The machine can be operated as a motor or a generator in multi-phase or single-phase embodiments and is applicable to the hybrid electric vehicle. A method of providing a slip energy controller is also disclosed.

[Secondary osteoporosis].

PubMed

Lafita, J; Pineda, J; Fuentes, C; Martínez, J P

2003-01-01

Secondary osteoporosis is caused by pathologies or medications, differing from the bone loss explainable by the post-menopausal stage or by ageing. The possible pathologies that can condition the loss of bone mass are very varied: endocrinological, digestive, genetic, haematological, rheumatic, post-transplant, pharmacological and a wide miscellaneous group. This article essentially reviews the endocrinological causes, with special emphasis on the more controversial aspects, followed by a clinical approach for the systematic diagnosis of these pathologies, which are frequent in cases initially labelled as primary osteoporosis

Laboratory Course on "Streptomyces" Genetics and Secondary Metabolism

ERIC Educational Resources Information Center

Siitonen, Vilja; Räty, Kaj; Metsä-Ketelä, Mikko

2016-01-01

The "'Streptomyces' genetics and secondary metabolism" laboratory course gives an introduction to the versatile soil dwelling Gram-positive bacteria "Streptomyces" and their secondary metabolism. The course combines genetic modification of "Streptomyces"; growing of the strain and protoplast preparation, plasmid…

Observations of Effective Teacher-Student Interactions in Secondary School Classrooms: Predicting Student Achievement with the Classroom Assessment Scoring System--Secondary

ERIC Educational Resources Information Center

Allen, Joseph; Gregory, Anne; Mikami, Amori; Lun, Janetta; Hamre, Bridget; Pianta, Robert

2013-01-01

Multilevel modeling techniques were used with a sample of 643 students enrolled in 37 secondary school classrooms to predict future student achievement (controlling for baseline achievement) from observed teacher interactions with students in the classroom, coded using the Classroom Assessment Scoring System--Secondary. After accounting for prior…

Applied evolutionary theories for engineering of secondary metabolic pathways.

PubMed

Bachmann, Brian O

2016-12-01

An expanded definition of 'secondary metabolism' is emerging. Once the exclusive provenance of naturally occurring organisms, evolved over geological time scales, secondary metabolism increasingly encompasses molecules generated via human engineered biocatalysts and biosynthetic pathways. Many of the tools and strategies for enzyme and pathway engineering can find origins in evolutionary theories. This perspective presents an overview of selected proposed evolutionary strategies in the context of engineering secondary metabolism. In addition to the wealth of biocatalysts provided via secondary metabolic pathways, improving the understanding of biosynthetic pathway evolution will provide rich resources for methods to adapt to applied laboratory evolution. Copyright © 2016 Elsevier Ltd. All rights reserved.

Secondary instability in boundary-layer flows

NASA Technical Reports Server (NTRS)

Nayfeh, A. H.; Bozatli, A. N.

1979-01-01

The stability of a secondary Tollmien-Schlichting wave, whose wavenumber and frequency are nearly one half those of a fundamental Tollmien-Schlichting instability wave is analyzed using the method of multiple scales. Under these conditions, the fundamental wave acts as a parametric exciter for the secondary wave. The results show that the amplitude of the fundamental wave must exceed a critical value to trigger this parametric instability. This value is proportional to a detuning parameter which is the real part of k - 2K, where k and K are the wavenumbers of the fundamental and its subharmonic, respectively. For Blasius flow, the critical amplitude is approximately 29% of the mean flow, and hence many other secondary instabilities take place before this parametric instability becomes significant. For other flows where the detuning parameter is small, such as free-shear layer flows, the critical amplitude can be small, thus the parametric instability might play a greater role.

Nitrogen oxides/sulfur oxides (NOx/SOx) Secondary NAAQS ...

EPA Pesticide Factsheets

This document assesses the policy basis for setting the secondary NOx/SOx NAAQS. To provide the policy assessment information for the Administrator to make a more informed decision about the basis for retaining or revising the secondary NOx/SOx NAAQS.

Social inclusion and career development--transition from upper secondary school to work or post-secondary education among hard of hearing students.

PubMed

Danermark, B; Antonson, S; Lundström, I

2001-01-01

The aim of this study was to investigate the decision process and to analyse the mechanisms involved in the transition from upper secondary education to post-secondary education or the labour market. Sixteen students with sensorioneural hearing loss were selected. Among these eight of the students continued to university and eight did not. Twenty-five per cent of the students were women and the average age was 28 years. The investigation was conducted about 5 years after graduation from the upper secondary school. Both quantitative and qualitative methods were used. The results showed that none of the students came from a family where any or both of the parents had a university or comparable education. The differences in choice between the two groups cannot be explained in terms of social inheritance. Our study indicates that given normal intellectual capacity the level of the hearing loss seems to have no predictive value regarding future educational performance and academic career. The conclusion is that it is of great importance that a hearing impaired pupil with normal intellectual capacity is encouraged and guided to choose an upper secondary educational programme which is orientated towards post-secondary education (instead of a narrow vocational programme). Additional to their hearing impairment and related educational problems, hard of hearing students have much more difficulty than normal hearing peers in coping with changes in intentions and goals regarding their educational career during their upper secondary education.

Nuffield Secondary Science, Theme 4, Harnessing Energy.

ERIC Educational Resources Information Center

Howard, Edgar

Nuffield Secondary Science is a set of tested materials from which teachers can prepare courses for students in grades 9-11 (approximately) who do not intend to major in science. The materials are designed for British secondary schools but are adaptable to other countries. The Teachers' Guide to the entire set of Themes is described in SE 015 440…

Interictal 18FDG PET findings in temporal lobe epilepsy with déjà vu.

PubMed

Adachi, N; Koutroumanidis, M; Elwes, R D; Polkey, C E; Binnie, C D; Reynolds, E H; Barrington, S F; Maisey, M N; Panayiotopoulos, C P

1999-01-01

The authors studied the functional anatomy of the déjà vu (DV) experience in nonlesional temporal lobe epilepsy (TLE), using interictal fluorine-18 fluorodeoxyglucose PET in 14 patients with and 17 patients without DV. Several clinical conditions, such as age at PET study, side of ictal onset zone, and dominance for language, were no different between the two groups. The patients with DV showed significant relative reductions in glucose metabolism in the mesial temporal structures and the parietal cortex. The findings demonstrate that ictal DV is of no lateralizing value. They further suggest that temporal lobe dysfunction is necessary but not sufficient for the generation of DV. Extensive association cortical areas may be involved as part of the network that integrates this distinct experience.

A case study on Discrete Wavelet Transform based Hurst exponent for epilepsy detection.

PubMed

Madan, Saiby; Srivastava, Kajri; Sharmila, A; Mahalakshmi, P

2018-01-01

Epileptic seizures are manifestations of epilepsy. Careful analysis of EEG records can provide valuable insight and improved understanding of the mechanism causing epileptic disorders. The detection of epileptic form discharges in EEG is an important component in the diagnosis of epilepsy. As EEG signals are non-stationary, the conventional frequency and time domain analysis does not provide better accuracy. So, in this work an attempt has been made to provide an overview of the determination of epilepsy by implementation of Hurst exponent (HE)-based discrete wavelet transform techniques for feature extraction from EEG data sets obtained during ictal and pre ictal stages of affected person and finally classifying EEG signals using SVM and KNN Classifiers. The The highest accuracy of 99% is obtained using SVM.

Secondary hypertension in adults

PubMed Central

Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

2016-01-01

Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. PMID:27211205

Influence of abiotic stress signals on secondary metabolites in plants

PubMed Central

Ramakrishna, Akula; Ravishankar, Gokare Aswathanarayana

2011-01-01

Plant secondary metabolites are unique sources for pharmaceuticals, food additives, flavors, and industrially important biochemicals. Accumulation of such metabolites often occurs in plants subjected to stresses including various elicitors or signal molecules. Secondary metabolites play a major role in the adaptation of plants to the environment and in overcoming stress conditions. Environmental factors viz. temperature, humidity, light intensity, the supply of water, minerals, and CO2 influence the growth of a plant and secondary metabolite production. Drought, high salinity, and freezing temperatures are environmental conditions that cause adverse effects on the growth of plants and the productivity of crops. Plant cell culture technologies have been effective tools for both studying and producing plant secondary metabolites under in vitro conditions and for plant improvement. This brief review summarizes the influence of different abiotic factors include salt, drought, light, heavy metals, frost etc. on secondary metabolites in plants. The focus of the present review is the influence of abiotic factors on secondary metabolite production and some of important plant pharmaceuticals. Also, we describe the results of in vitro cultures and production of some important secondary metabolites obtained in our laboratory. PMID:22041989

Prevalence of Venous Thromboembolism in Patients With Secondary Polycythemia

PubMed Central

Nadeem, Omar; Gui, Jiang; Ornstein, Deborah L.

2013-01-01

To investigate an association between secondary polycythemia and venous thromboembolism (VTE) risk, we performed a case–control study to compare the prevalence of VTE in participants with secondary polycythemia due to chronic obstructive pulmonary disease (COPD; N = 86) to that in age- and sex-matched controls with COPD without secondary polycythemia (N = 86). Although there was a significant difference in mean hematocrit between cases and controls (53.5% vs 43.6%, respectively; P < .005), we identified no difference in the number of total or idiopathic VTE events in the 2 groups. Patients with VTE, however, had a significantly higher body mass index than patients without VTE. Our findings suggest that secondary polycythemia alone may not be a significant risk factor for VTE but that VTE risk in this population may be related to known risk factors such as obesity. The role of phlebotomy for VTE risk reduction secondary polycythemia is therefore questionable. PMID:23007895

Experimental study on secondary electron emission characteristics of Cu

NASA Astrophysics Data System (ADS)

Liu, Shenghua; Liu, Yudong; Wang, Pengcheng; Liu, Weibin; Pei, Guoxi; Zeng, Lei; Sun, Xiaoyang

2018-02-01

Secondary electron emission (SEE) of a surface is the origin of the multipacting effect which could seriously deteriorate beam quality and even perturb the normal operation of particle accelerators. Experimental measurements on secondary electron yield (SEY) for different materials and coatings have been developed in many accelerator laboratories. In fact, the SEY is just one parameter of secondary electron emission characteristics which include spatial and energy distribution of emitted electrons. A novel experimental apparatus was set up in China Spallation Neutron Source, and an innovative method was applied to obtain the whole characteristics of SEE. Taking Cu as the sample, secondary electron yield, its dependence on beam injection angle, and the spatial and energy distribution of secondary electrons were achieved with this measurement device. The method for spatial distribution measurement was first proposed and verified experimentally. This contribution also tries to give all the experimental results a reasonable theoretical analysis and explanation.

Prevalence of venous thromboembolism in patients with secondary polycythemia.

PubMed

Nadeem, Omar; Gui, Jiang; Ornstein, Deborah L

2013-01-01

To investigate an association between secondary polycythemia and venous thromboembolism (VTE) risk, we performed a case-control study to compare the prevalence of VTE in participants with secondary polycythemia due to chronic obstructive pulmonary disease (COPD; N = 86) to that in age- and sex-matched controls with COPD without secondary polycythemia (N = 86). Although there was a significant difference in mean hematocrit between cases and controls (53.5% vs 43.6%, respectively; P < .005), we identified no difference in the number of total or idiopathic VTE events in the 2 groups. Patients with VTE, however, had a significantly higher body mass index than patients without VTE. Our findings suggest that secondary polycythemia alone may not be a significant risk factor for VTE but that VTE risk in this population may be related to known risk factors such as obesity. The role of phlebotomy for VTE risk reduction secondary polycythemia is therefore questionable.

[Secondary amyloidosis of the bladder and massive hematuria].

PubMed

García-Escudero López, A; Arruza Echevarría, A; Leunda Saizar, J; Infante Riaño, R; Padilla Nieva, J; Ortiz Barredo, E

2010-01-01

To report four additional cases of secondary amyloidosis of the bladder, an extremely rare condition, as shown by the cases reported in the literature. Four clinical cases are reported, all of them occurring as hematuria, which was massive and fulminant and resulted in death in three patients. Secondary amyloidosis of the bladder is of the AA type, which is more common in females and mainly secondary to rheumatoid arthritis, but also to ankylosing spondylitis and long-standing chronic inflammatory conditions. Hematuria is the main and virtually only symptom. A pathological and immunohistochemical study confirmed diagnosis. All three patients who experienced massive, fatal hematuria had an intercurrent condition requiring urethral catheterization, which was the triggering factor. Despite its rarity, as shown by the few cases reported, secondary amyloidosis of the bladder should be considered in patients already diagnosed with systemic amyloidosis and/or the conditions reported who require simple urethral catheterization.

Job Satisfaction among Secondary-School-Heads: A Gender Based-Comparative Study

ERIC Educational Resources Information Center

Suleman, Qaiser; Hussain, Ishtiaq

2018-01-01

The purpose of the study was to examine and compare the job satisfaction of male and female secondary-school heads in Khyber Pakhtunkhwa, Pakistan. All the male and female secondary-school heads working in pubic secondary schools of Khyber Pakhtunkhwa constituted the population of the study. A total sample of 402 secondary-school heads was…

Selecting a measure for assessing secondary trauma in nurses.

PubMed

Watts, Jenny; Robertson, Noelle

2015-11-01

To summarise the usefulness of available psychometric tools in assessing secondary trauma in nursing staff and examine their limitations, as well as their strengths, to enable researchers to select the most suitable measures. Secondary trauma is an extreme persistent reaction that can be experienced by nursing staff following exposure to a potentially life-threatening situation. This relatively new concept is increasingly used to explore staff distress, but is complicated by various definitions. In this growing and popular field, few rigorously tested measures are used. Therefore, it is timely to examine the measures available and their robustness. In March 2014 the following databases were used: BNI, CINAHL, EMBASE, PILOTS, Medline, PsycINFO and the Cochrane Library. A systematic search of nurse and health research databases was conducted from 1980 to 2014 using the terms nurs* AND PTSD OR Posttraumatic Stress Disorder OR secondary trauma OR secondary traumatic stress OR STS OR compassion fatigue. To strengthen confidence in research findings and make the most useful contribution to practice, researchers should use the most rigorous measures available. Of the assessment tools used, the only one subject to robust peer review is the Secondary Traumatic Stress Scale (STSS). The scale most frequently used to assess secondary traumatic stress is the Professional Quality of Life Scale (ProQOL); its lack of psychometric evaluation is a potential weakness. CONCLUSION The STSS is the only validated tool reported in the peer-reviewed, published literature and the authors suggest greater application when secondary trauma is a suspected consequence of nursing work. Validated tools such as the HADS and GHQ-28 are more useful in assessing broader-based psychological morbidity. The authors suggest greater application of the STSS when secondary trauma is a suspected consequence of nursing work. Researchers interested in assessing more than trauma responses are advised to use HADS

Secondary prevention of stroke in Saskatchewan, Canada: hypertension control.

PubMed

Bartsch, Janelle Ann; Teare, Gary F; Neufeld, Anne; Hudema, Nedeene; Muhajarine, Nazeem

2013-10-01

In the province of Saskatchewan, Canada, stroke is the third leading cause of death as well as the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary stroke. Hypertension (elevated blood pressure) is the single most important modifiable risk factor for both first and recurrent stroke, and is thus an important risk factor to be controlled. According to the Canadian Stroke Strategy (CSS) Best Practice Recommendations, blood pressure lowering treatment should be initiated before discharge from hospital for all stroke/TIA patients. The purpose of this study was to examine the quality of medically driven secondary stroke prevention care in Saskatchewan as applied to hypertension control. The objectives of the study were to: (1) develop methodology and calculate a secondary stroke process of care measure using available data in Saskatchewan, based on an appropriate hypertension therapy indicator recommendation from the CSS Performance Measurement Manual; (2) examine variation in secondary stroke prevention hypertensive care among the Saskatchewan Regional Health Authorities; and (3) investigate factors associated with receiving evidence-based hypertensive secondary stroke prevention. This multi-year cross-sectional study was an analysis of deidentified health data derived from linkage of administrative health data. A select indicator from the CSS Performance Measurement Manual that measures adherence to a CSS Best Practice Guidelines concerning use of antihypertensive medications for secondary stroke prevention was calculated. Logistic regression was used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended hypertensive secondary stroke prevention. The target population was all Saskatchewan residents who were hospitalized in Saskatchewan for a stroke or TIA between April 1, 2001

The conservation and function of RNA secondary structure in plants

PubMed Central

Vandivier, Lee E.; Anderson, Stephen J.; Foley, Shawn W.; Gregory, Brian D.

2016-01-01

RNA transcripts fold into secondary structures via intricate patterns of base pairing. These secondary structures impart catalytic, ligand binding, and scaffolding functions to a wide array of RNAs, forming a critical node of biological regulation. Among their many functions, RNA structural elements modulate epigenetic marks, alter mRNA stability and translation, regulate alternative splicing, transduce signals, and scaffold large macromolecular complexes. Thus, the study of RNA secondary structure is critical to understanding the function and regulation of RNA transcripts. Here, we review the origins, form, and function of RNA secondary structure, focusing on plants. We then provide an overview of methods for probing secondary structure, from physical methods such as X-ray crystallography and nuclear magnetic resonance imaging (NMR) to chemical and nuclease probing methods. Marriage with high-throughput sequencing has enabled these latter methods to scale across whole transcriptomes, yielding tremendous new insights into the form and function of RNA secondary structure. PMID:26865341

EELV Secondary Payload Adapter (ESPA)

NASA Astrophysics Data System (ADS)

Haskett, Scott A.; Weis, Steven C.; Doggrell, Leslie J.; Sciulli, Dino; Meink, Troy E.; Ganley, Jeff T.; Maly, Joseph R.; Jurisson, Karl

2000-11-01

Despite growing international interest in small satellites, high dedicated expendable launch vehicle costs and the lack of secondary launch opportunities continue to hinder the full exploitation of small satellite technology. In the United States, the Department of Defense (DoD), NASA, other government agencies, commercial companies, and many universities use small satellites to perform space experiments, demonstrate new technology, and test operational prototype hardware. In addition, the DoD continues to study the role of small satellites in fulfilling operational mission requirements. However, the US lacks sufficient small satellite launch capacity. Furthermore, US government agencies are restricted to the use of US launch vehicles, which eliminates many affordable launch opportunities. In an effort to increase the number of space experiments that can be flown with a small, fixed budget, the DoD Space Test Program (STP) has teamed with the Air Force Research Laboratory Space Vehicles Directorate (AFRL/VS) to develop a low-cost solution for the small satellite launch program. Our solution, which can be implemented on both Boeing and Lockheed-Martin Evolved Expendable Launch Vehicle-Medium (EELV-M) boosters, is called the EELV Secondary Payload Adaptor (ESPA). ESPA will increase the number of launch opportunities for 180kg-class (or smaller) satellites at prices highly competitive with other secondary launch services worldwide.

Nanotechnology and Secondary Science Teacher's Self-Efficacy

NASA Astrophysics Data System (ADS)

Cox, Elena K.

The recommendations of the United States President's Council of Advisors on Science and Technology and the multi-agency National Nanotechnology Initiative (NNI) identified the need to prepare the workforce and specialists in the field of nanotechnology in order for the United States to continue to compete in the global marketplace. There is a lack of research reported in recent literature on the readiness of secondary science teachers to introduce higher level sciences---specifically nanotechnology---in their classes. The central research question of this study examined secondary science teachers' beliefs about teaching nanotechnology comfortably, effectively, and successfully. Bandura's self-efficacy theory provided the conceptual framework for this phenomenological study. A data analysis rubric was used to identify themes and patterns that emerged from detailed descriptions during in-depth interviews with 15 secondary science teachers. The analysis revealed the shared, lived experiences of teachers and their beliefs about their effectiveness and comfort in teaching higher-level sciences, specifically nanotechnology. The results of the study indicated that, with rare exceptions, secondary science teachers do not feel comfortable or effective, nor do they believe they have adequate training to teach nanotechnology concepts to their students. These teachers believed they were not prepared or trained in incorporating these higher level science concepts in the curriculum. Secondary science teachers' self-efficacy and personal beliefs of effectiveness in teaching nanotechnology can be an important component in achieving a positive social change by helping to familiarize high school students with nanotechnology and how it can benefit society and the future of science.

Aspergillus flavus secondary metabolites: more than just aflatoxins

USDA-ARS?s Scientific Manuscript database

Aspergillus flavus is best known for producing the family of potent carcinogenic secondary metabolites known as aflatoxins. However, this opportunistic plant and animal pathogen also produces numerous other secondary metabolites, many of which have also been shown to be toxic. While about forty of t...

Structurally coloured secondary particles composed of black and white colloidal particles.

PubMed

Takeoka, Yukikazu; Yoshioka, Shinya; Teshima, Midori; Takano, Atsushi; Harun-Ur-Rashid, Mohammad; Seki, Takahiro

2013-01-01

This study investigated the colourful secondary particles formed by controlling the aggregation states of colloidal silica particles and the enhancement of the structural colouration of the secondary particles caused by adding black particles. We obtained glossy, partially structurally coloured secondary particles in the absence of NaCl, but matte, whitish secondary particles were obtained in the presence of NaCl. When a small amount of carbon black was incorporated into both types of secondary particles, the incoherent multiple scattering of light from the amorphous region was considerably reduced. However, the peak intensities in the reflection spectra, caused by Bragg reflection and by coherent single wavelength scattering, were only slightly decreased. Consequently, a brighter structural colour of these secondary particles was observed with the naked eye. Furthermore, when magnetite was added as a black particle, the coloured secondary particles could be moved and collected by applying an external magnetic field.

Structurally Coloured Secondary Particles Composed of Black and White Colloidal Particles

PubMed Central

Takeoka, Yukikazu; Yoshioka, Shinya; Teshima, Midori; Takano, Atsushi; Harun-Ur-Rashid, Mohammad; Seki, Takahiro

2013-01-01

This study investigated the colourful secondary particles formed by controlling the aggregation states of colloidal silica particles and the enhancement of the structural colouration of the secondary particles caused by adding black particles. We obtained glossy, partially structurally coloured secondary particles in the absence of NaCl, but matte, whitish secondary particles were obtained in the presence of NaCl. When a small amount of carbon black was incorporated into both types of secondary particles, the incoherent multiple scattering of light from the amorphous region was considerably reduced. However, the peak intensities in the reflection spectra, caused by Bragg reflection and by coherent single wavelength scattering, were only slightly decreased. Consequently, a brighter structural colour of these secondary particles was observed with the naked eye. Furthermore, when magnetite was added as a black particle, the coloured secondary particles could be moved and collected by applying an external magnetic field. PMID:23917891

Nonlinear Development and Secondary Instability of Traveling Crossflow Vortices

NASA Technical Reports Server (NTRS)

Li, Fei; Choudhari, Meelan M.; Duan, Lian; Chang, Chau-Lyan

2014-01-01

Transition research under NASA's Aeronautical Sciences Project seeks to develop a validated set of variable fidelity prediction tools with known strengths and limitations, so as to enable "sufficiently" accurate transition prediction and practical transition control for future vehicle concepts. This paper builds upon prior effort targeting the laminar breakdown mechanisms associated with stationary crossflow instability over a swept-wing configuration relevant to subsonic aircraft with laminar flow technology. Specifically, transition via secondary instability of traveling crossflow modes is investigated as an alternate scenario for transition. Results show that, for the parameter range investigated herein, secondary instability of traveling crossflow modes becomes insignificant in relation to the secondary instability of the stationary modes when the relative initial amplitudes of the traveling crossflow instability are lower than those of the stationary modes by approximately two orders of magnitudes or more. Linear growth predictions based on the secondary instability theory are found to agree well with those based on PSE and DNS, with the most significant discrepancies being limited to spatial regions of relatively weak secondary growth, i.e., regions where the primary disturbance amplitudes are smaller in comparison to its peak amplitude. Nonlinear effects on secondary instability evolution is also investigated and found to be initially stabilizing, prior to breakdown.

Colonialism and Secondary Technical Education in Hong Kong: 1945-1997

ERIC Educational Resources Information Center

Lau, Wai Wah; Kan, Flora

2011-01-01

This study examines the influence of the colonial experience (1945-1997) on the planning of secondary technical education in Hong Kong. Specifically, the origins of secondary technical institutions and their positioning in secondary education are examined. Primary source materials are used as the basis of investigation and analysis, supplemented…

The Development Effectiveness Management Model for Sub-District Secondary School

ERIC Educational Resources Information Center

Butsankom, Akachai; Sirishuthi, Chaiyuth; Lammana, Preeda

2016-01-01

The purposes of this research were to study the factors of effectiveness management model for subdistrict secondary school, to investigate current situations and desirable situations of effectiveness management model for sub-district secondary school, to develop the effectiveness management model for sub-district secondary school and to study the…

Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

PubMed

Algarra, Nelson N; Lele, Abhijit V; Prathep, Sumidtra; Souter, Michael J; Vavilala, Monica S; Qiu, Qian; Sharma, Deepak

2017-07-01

Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score <13 who underwent single orthopedic surgery within 2 weeks of TBI. Secondary insults examined were: systemic hypotension (systolic blood pressure<90 mm Hg), intracranial hypertension (ICP>20 mm Hg), cerebral hypotension (cerebral perfusion pressure<50 mm Hg), hypercarbia (end-tidal CO2>40 mm Hg), hypocarbia (end-tidal CO2<30 mm Hg in absence of intracranial hypertension), hyperglycemia (glucose>200 mg/dL), hypoglycemia (glucose<60 mg/dL), and hyperthermia (temperature >38°C). A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (P<0.001). Intraoperative secondary insults were common during orthopedic surgery in patients with TBI and were associated with postoperative escalation of care. Strategies to minimize intraoperative secondary insults are needed.

Secondary lift for magnetically levitated vehicles

DOEpatents

Cooper, Richard K.

1976-01-01

A high-speed terrestrial vehicle that is magnetically levitated by means of magnets which are used to induce eddy currents in a continuous electrically conductive nonferromagnetic track to produce magnetic images that repel the inducing magnet to provide primary lift for the vehicle. The magnets are arranged so that adjacent ones have their fields in opposite directions and the magnets are spaced apart a distance that provides a secondary lift between each magnet and the adjacent magnet's image, the secondary lift being maximized by optimal spacing of the magnets.

Secondary eyewall formation as a progressive boundary layer response

NASA Astrophysics Data System (ADS)

Abarca, S. F.; Montgomery, M. T.; Bell, M. M.

2012-12-01

The robust observational (satellite based) evidence that secondary eyewalls are common features in major hurricanes contrasts with the scarce in situ observations of the phenomena and its life cycle. This lack of observations has resulted in an incomplete understanding of the dynamics of secondary eyewall formation (SEF). A wide variety of physical processes have been invoked to explain SEF, but only the recently proposed theory of a progressive boundary layer control in SEF has been supported by a variety of full physics mesoscale numerical integrations. The RAINEX field project provided unique observations of the secondary eyewall of Hurricane Rita (2005) both before and during the time Rita exhibited a clear secondary eyewall structure. These observations have contributed to the advancement of the understanding of the secondary eyewall phenomenon. However, in the RAINEX experiment, there was limited data sampling during the development of the secondary wind maxima, thereby precluding a complete observational investigation of the dynamics of SEF. In this presentation we adopt an azimuthally-averaged perspective of the flow dynamics and we test the newly proposed theory of a progressive boundary layer control on SEF. Specifically, we use both RAINEX data as well as data from high resolution, full physics mesoscale numerical simulations to initialize and force an axisymmetric slab boundary layer model with radial diffusion included. The objective is to investigate whether such a reduced boundary layer model can generate secondary wind maxima as a response to environments like those that result in SEF in nature and in full physics simulations.

Secondary Instability of Second Modes in Hypersonic Boundary Layers

NASA Technical Reports Server (NTRS)

Li, Fei; Choudhari, Meelan M.; Chang, Chau-Lyan; White, Jeffery A.

2012-01-01

Second mode disturbances dominate the primary instability stage of transition in a number of hypersonic flow configurations. The highest amplification rates of second mode disturbances are usually associated with 2D (or axisymmetric) perturbations and, therefore, a likely scenario for the onset of the three-dimensionality required for laminar-turbulent transition corresponds to the parametric amplification of 3D secondary instabilities in the presence of 2D, finite amplitude second mode disturbances. The secondary instability of second mode disturbances is studied for selected canonical flow configurations. The basic state for the secondary instability analysis is obtained by tracking the linear and nonlinear evolution of 2D, second mode disturbances using nonlinear parabolized stability equations. Unlike in previous studies, the selection of primary disturbances used for the secondary instability analysis was based on their potential relevance to transition in a low disturbance environment and the effects of nonlinearity on the evolution of primary disturbances was accounted for. Strongly nonlinear effects related to the self-interaction of second mode disturbances lead to an upstream shift in the upper branch neutral location. Secondary instability computations confirm the previously known dominance of subharmonic modes at relatively small primary amplitudes. However, for the Purdue Mach 6 compression cone configuration, it was shown that a strong fundamental secondary instability can exist for a range of initial amplitudes of the most amplified second mode disturbance, indicating that the exclusive focus on subharmonic modes in the previous applications of secondary instability theory to second mode primary instability may not have been fully justified.

Secondary arterial hypertension: when, who, and how to screen?

PubMed

Rimoldi, Stefano F; Scherrer, Urs; Messerli, Franz H

2014-05-14

Secondary hypertension refers to arterial hypertension due to an identifiable cause and affects ∼5-10% of the general hypertensive population. Because secondary forms are rare and work up is time-consuming and expensive, only patients with clinical suspicion should be screened. In recent years, some new aspects gained importance regarding this screening. In particular, increasing evidence suggests that 24 h ambulatory blood pressure (BP) monitoring plays a central role in the work up of patients with suspected secondary hypertension. Moreover, obstructive sleep apnoea has been identified as one of the most frequent causes. Finally, the introduction of catheter-based renal denervation for the treatment of patients with resistant hypertension has dramatically increased the interest and the number of patients evaluated for renal artery stenosis. We review the clinical clues of the most common causes of secondary hypertension. Specific recommendations are given as to evaluation and treatment of various forms of secondary hypertension. Despite appropriate therapy or even removal of the secondary cause, BP rarely ever returns to normal with long-term follow-up. Such residue hypertension indicates either that some patients with secondary hypertension also have concomitant essential hypertension or that irreversible vascular remodelling has taken place. Thus, in patients with potentially reversible causes of hypertension, early detection and treatment are important to minimize/prevent irreversible changes in the vasculature and target organs. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.

Parental education, children's performance and the transition to higher secondary education: trends in primary and secondary effects over five Dutch school cohorts (1965-99).

PubMed

Kloosterman, Rianne; Ruiter, Stijn; de Graaf, Paul M; Kraaykamp, Gerbert

2009-06-01

According to Boudon, social background affects educational transitions as a result of differences in children's academic performance (primary effects) and differences in transition probabilities given children's level of academic performance (secondary effects). This study addresses historical changes in both primary and secondary effects on the educational transition from primary school to higher secondary education in The Netherlands. In addition, it considers changes over time in the relative importance of these effects. The study compares five cohorts of Dutch pupils, specifically those enrolling in secondary education in 1965, 1977, 1989, 1993 and 1999, and it employs counterfactual analyses. The main findings are that secondary effects have been stable and primary effects have fluctuated to some extent. As a result, the proportion of the total effect of social background accounted for by primary effects has increased somewhat, from 53 per cent to 58 per cent.

48 CFR 252.225-7031 - Secondary Arab boycott of Israel.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Secondary Arab boycott of... of Provisions And Clauses 252.225-7031 Secondary Arab boycott of Israel. As prescribed in 225.7605, use the following provision: Secondary Arab Boycott of Israel (JUN 2005) (a) Definitions. As used in...

48 CFR 252.225-7031 - Secondary Arab boycott of Israel.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Secondary Arab boycott of... of Provisions And Clauses 252.225-7031 Secondary Arab boycott of Israel. As prescribed in 225.7605, use the following provision: Secondary Arab Boycott of Israel (JUN 2005) (a) Definitions. As used in...

48 CFR 252.225-7031 - Secondary Arab boycott of Israel.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Secondary Arab boycott of... of Provisions And Clauses 252.225-7031 Secondary Arab boycott of Israel. As prescribed in 225.7605, use the following provision: Secondary Arab Boycott of Israel (JUN 2005) (a) Definitions. As used in...

48 CFR 252.225-7031 - Secondary Arab boycott of Israel.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Secondary Arab boycott of... of Provisions And Clauses 252.225-7031 Secondary Arab boycott of Israel. As prescribed in 225.7605, use the following provision: Secondary Arab Boycott of Israel (JUN 2005) (a) Definitions. As used in...

Transnational Secondary Schooling and Im/mobile International Students

ERIC Educational Resources Information Center

Rahimi, Mark; Halse, Christine; Blackmore, Jill

2017-01-01

Schools and school education systems within nations are vying to increase international student enrolments in secondary schools. This analysis of the change over a decade in the enrolment of international secondary students in Victoria, Australia, indicates how the processes of internationalisation and commercialisation of education have affected…

Identifying the Comparative Academic Performance of Secondary Schools

ERIC Educational Resources Information Center

Bendikson, Linda; Hattie, John; Robinson, Viviane

2011-01-01

Purpose: One of the features of the New Zealand secondary schools system is that achievement closely reflects the taught curriculum. The National Certificate of Educational Achievement (NCEA) directly assesses student achievement on the secondary school curriculum through a combination of criterion-based internal and external assessments. The…

Effective Schools: Do Elementary Prescriptions Fit Secondary Schools?

ERIC Educational Resources Information Center

Firestone, William A.; Herriott, Robert E.

Most of the recent research identifying organizational characteristics that seem to make schools unusually effective has been conducted at the elementary level and may not be applicable to secondary schools. Research currently underway suggests that the basic organizational structures of elementary and secondary schools dictate two different…

Millennial Instructional Preferences in Post-Secondary Business Programs

ERIC Educational Resources Information Center

West, Cynthia Elaine

2017-01-01

The purpose of this mixed method study was to examine the instructional preferences of millennial learners and how their instructional preferences affect their choice in post-secondary business programs. The instructional preferences of millennial learners are an important question for post-secondary business programs enrolling learners from…

Comprehensive Support for Peer Relationships at Secondary Transition

ERIC Educational Resources Information Center

Keay, Andy; Lang, Jane; Frederickson, Norah

2015-01-01

Peer relationships represent a major source of concern to children transitioning to secondary school. They also offer a potentially important source of support to adjustment and academic progress. However, strategies to support peer relationships at secondary transition have received little attention in previous research. This semi-structured…

USE OF STROKE SECONDARY PREVENTION SERVICES

PubMed Central

Ross, Joseph S.; Halm, Ethan A.; Bravata, Dawn M.

2009-01-01

Objective To examine whether there are disparities in use of stroke secondary prevention services because disparities in stroke outcomes have been found among older adults, women, racial minorities, and within Stroke Belt states. Methods Using the nationally-representative 2005 Behavior Risk Factor Surveillance System, we examined self-reported use of 11 stroke secondary prevention services queried in the survey. We used multivariable logistic regression to examine the association between service use and age, sex, race, and Stroke Belt state residence, controlling for other socio-demographic and health care access characteristics. Results Among 11,862 adults with a history of stroke, 16% were 80 or older, 54% were women, 13% were non-Hispanic black, and 23% lived within a Stroke Belt state. Overall service use varied: 31% reported post-stroke outpatient rehabilitation, 57% regular exercise, 66% smoking cessation counseling, and 91% current use of anti-hypertensive medications. Age 80 or older was not associated with lower use of any of the 11 services. Women were less likely to report post-stroke outpatient rehabilitation and regular exercise when compared with men (P values ≤ 0.005); there were no sex-based differences in use of the 9 other services. Blacks were less likely to report pneumococcal vaccination when compared with whites, but were more likely to report post-stroke outpatient rehabilitation (P values ≤ 0.005); there were no race-based differences in use of the 9 other services. Stroke Belt state residence was not associated with lower use of any of the 11 services. Conclusions Use of many stroke secondary prevention services was suboptimal. We did not find consistent age, sex, racial, or Stroke Belt state residence disparities in care. CONDENSED ABSTRACT We examined the association between stroke secondary prevention service use and age, sex, race, and Stroke Belt state residence using nationally-representative data. Although use of many stroke

Discovering the secondary metabolite potential encoded within Entomopathogenic Fungi

USDA-ARS?s Scientific Manuscript database

This article discusses the secondary metabolite potential of the insect pathogens Metarhizium and Beauveria, including a bioinformatics analysis of secondary metabolite genes for which no products are yet identified....

Detection of the secondary star in HT Cassiopeiae

NASA Technical Reports Server (NTRS)

Marsh, T. R.

1990-01-01

Low-resolution spectra of the eclipsing dwarf nova HT Cas, taken over the range 5000-9800 A show TiO bands and Na I absorption lines from the secondary star. From the TiO band ratio at mid-eclipse it is estimated that the secondary star contributes about 37 percent of the light at 7500 A during the eclipse, and that it has a Boeshaar spectral type M5.4 + or - 0.3. The mass, radius, and luminosity of the secondary star are all consistent with main-sequence values. The TiO band strength diminishes greatly near phase 0.5, but an eclipse by the disk is not sufficient to explain this. The radial velocity is measured from the Na line near 8200 A for most of the spectra and (after a correction for the asymmetric distribution of absorption over the secondary star) its radial velocity semiamplitude K2 = 430 + or - 25 km/sec.

[Secondary Splenic Rupture after Initially Inconspicuous CAT Scan].

PubMed

Prokop, A; Koll, S; Chmielnicki, M

2016-04-01

Splenic injuries occur in 1-5 % of blunt abdominal trauma cases. After initial haemorrhagic compression, secondary delayed spleen rupture can occur with a latency of one day to a month or longer. Mortality is then up to 15 %. The spleen injury is almost always recognisable on CT or ultrasound. In one case from our clinic, secondary splenic rupture occurred in a patient after discharge from hospitalisation, even though the initial CT and ultrasound were unremarkable. The patient survived, and underwent emergent splenectomy 8 days after the trauma. An expert review of the case identified no errors in treatment. No case of secondary splenic rupture after initially unremarkable diagnostic studies and clinical course has previously been published. Secondary splenic rupture has a high mortality rate. Patients should be advised of potential complications after hospital discharge, and should return to the hospital immediately in case of symptoms. Georg Thieme Verlag KG Stuttgart · New York.

Surface determination through atomically resolved secondary-electron imaging

PubMed Central

Ciston, J.; Brown, H. G.; D'Alfonso, A. J.; Koirala, P.; Ophus, C.; Lin, Y.; Suzuki, Y.; Inada, H.; Zhu, Y.; Allen, L. J.; Marks, L. D.

2015-01-01

Unique determination of the atomic structure of technologically relevant surfaces is often limited by both a need for homogeneous crystals and ambiguity of registration between the surface and bulk. Atomically resolved secondary-electron imaging is extremely sensitive to this registration and is compatible with faceted nanomaterials, but has not been previously utilized for surface structure determination. Here we report a detailed experimental atomic-resolution secondary-electron microscopy analysis of the c(6 × 2) reconstruction on strontium titanate (001) coupled with careful simulation of secondary-electron images, density functional theory calculations and surface monolayer-sensitive aberration-corrected plan-view high-resolution transmission electron microscopy. Our work reveals several unexpected findings, including an amended registry of the surface on the bulk and strontium atoms with unusual seven-fold coordination within a typically high surface coverage of square pyramidal TiO5 units. Dielectric screening is found to play a critical role in attenuating secondary-electron generation processes from valence orbitals. PMID:26082275

Evolutionary diversification of secondary mechanoreceptor cells in tunicata.

PubMed

Rigon, Francesca; Stach, Thomas; Caicci, Federico; Gasparini, Fabio; Burighel, Paolo; Manni, Lucia

2013-06-04

Hair cells are vertebrate secondary sensory cells located in the ear and in the lateral line organ. Until recently, these cells were considered to be mechanoreceptors exclusively found in vertebrates that evolved within this group. Evidence of secondary mechanoreceptors in some tunicates, the proposed sister group of vertebrates, has recently led to the hypothesis that vertebrate and tunicate secondary sensory cells share a common origin. Secondary sensory cells were described in detail in two tunicate groups, ascidians and thaliaceans, in which they constitute an oral sensory structure called the coronal organ. Among thaliaceans, the organ is absent in salps and it has been hypothesised that this condition is due to a different feeding system adopted by this group of animals. No information is available as to whether a comparable structure exists in the third group of tunicates, the appendicularians, although different sensory structures are known to be present in these animals. We studied the detailed morphology of appendicularian oral mechanoreceptors. Using light and electron microscopy we could demonstrate that the mechanosensory organ called the circumoral ring is composed of secondary sensory cells. We described the ultrastructure of the circumoral organ in two appendicularian species, Oikopleura dioica and Oikopleura albicans, and thus taxonomically completed the data collection of tunicate secondary sensory cells. To understand the evolution of secondary sensory cells in tunicates, we performed a cladistic analysis using morphological data. We constructed a matrix consisting of 19 characters derived from detailed ultrastructural studies in 16 tunicate species and used a cephalochordate and three vertebrate species as outgroups. Our study clearly shows that the circumoral ring is the appendicularian homologue of the coronal organ of other tunicate taxa. The cladistic analysis enabled us to reconstruct the features of the putative ancestral hair cell in

Secondary combined suicide pact.

PubMed

Jayanth, S H; Girish Chandra, Y P; Hugar, Basappa S; Kainoor, Sunilkumar

2014-03-01

This article reports a combined suicide pact, where in a young couple; a 26 year old male and a 20 year old female committed suicide by using two methods. The couple had resorted to hanging and self-immolation to prevent failure of single method alone. In secondary combined suicides, several other methods of suicide are tried after the first method chosen has failed. It is primary combined suicide only when two or more methods are used simultaneously. Both types of combined suicide by one individual is well reported in the literature whereas the same by two persons together is rare. In this report, the deceased were disappointed lovers, poor and the family members were against their marriage. The investigation of scene, methods employed to commit suicide, autopsy findings and the interview with their relatives altogether suggested that it was a secondary combined suicide pact. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Secondary hypertension in adults.

PubMed

Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong

2016-05-01

Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. Copyright: © Singapore Medical Association.

The evolution of development of vascular cambia and secondary growth