Technical Tips: Keeping It Clean during COVID-19.

Since 1995, ASET has periodically published updates to recommendations for best practices in infection prevention for Neurodiagnostic technologists. The latest installment was accepted in December 2019 for publication in Volume 60, Issue 1, before we had much knowledge or understanding about the SARS-CoV-2, the virus that causes COVID-19. This Technical Tips article is presented as an addendum to the 2020 update and includes important information about infection prevention measures specific to procedure protocols when working with patients positive or under investigation for a highly infectious disease, and when working with patients in general during the current pandemic. All Neurodiagnostic technologists who have direct patient care are responsible for ensuring the use of best practices to prevent the spread of infection.

Infection Prevention: 2020 Review and Update for Neurodiagnostic Technologists.

Since 1995, ASET has published recommendations for infection prevention. With the aim of keeping our readers current with updates in infection prevention initiatives, this article reviews ASET's past publications by Altman 1995, Altman 2000, Scott 2013, and Sullivan & Altman 2008, and incorporates new information from published scientific literature, online resources, print publications, national and international guidelines, OSHA and other regulatory agencies. Knowledge of current infection control practices and recommendations is essential for every Neurodiagnostic technologist, whether working in a hospital, an ambulatory setting, intensive care unit or in the operating room. All technologists who have direct patient contact are responsible for ensuring use of best practices to prevent the spread of infection.

The Revised Definition and Classification of Epilepsy for Neurodiagnostic Technologists.

The definition of who has epilepsy, classification of seizure types, and types of epilepsy have all recently been revised. The classical definition of epilepsy as a person having two or more unprovoked seizures more than 24 hours apart has been expanded also to include those with one seizure and a high likelihood (more than 60%) of having another. In the new definition, epilepsy is considered to be resolved when a person is seizure-free for 10 years, the terminal 5 being off seizure medicines, or when an age-dependent syndrome has been outgrown. The new seizure type classification revises the 1981 system but maintains the primary distinction of focal- versus generalized-onset seizures. Seizures also can be of unknown onset. Focal seizures may demonstrate retention or impairment of awareness, resulting in focal-aware or focal-impaired awareness seizures. Several new focal and generalized seizure types are introduced. Classification of the epilepsies is now by grouping of seizure types, etiologies, comorbidities, and epilepsy syndromes. The goal of the new terminology is greater clarity of communication and more accurate grouping of seizure types for research. Neurodiagnostic technologists can be of great help in observing clinical and electrographic features that will define the type of seizure.

The use of neurodiagnostic technologies in the 21st century neuroscientific revolution.

Neuroscience is fascinating, mysterious, and truly medicine's "final frontier" but deciphering its marvels has historically been inhibited by its sheer complexity. The recent escalation of global neuroscientific endeavors and vast financial backing from governments, foundations, and industries, however are changing this perspective. The sequencing of the human genome, development of innovative tools for mapping neuronal connectivities, and enhanced resolution capabilities of imaging techniques have made landmark contributions toward advancing neurotechnologies. Nations all around the world have initiated and launched brain mapping projects on such a profound and financially immense scale that research in 2015 and beyond are highly anticipated to revolutionize medicine and our interaction with the technological world. Although neurodiagnostic technology is not the vanguard of research interest in the scientific community, it will certainly ride the coattails of these new neuroscientific endeavors. And, in turn, these advancements will greatly impact how we diagnose, treat, and care for our patients in the future. Therefore, the purpose of this article is not only to introduce current neuroscientific enterprises, but to also explore some of the most interesting and instrumental findings using neurodiagnostic technology over the past year.

Basal gene expression in male and female Sprague-Dawley rat nasal respiratory and olfactory epithelium.

The nasal epithelium is an important target site for chemically induced toxicity and carcinogenicity. Experimental studies show that site-specific lesions can arise within the nasal respiratory or olfactory epithelium following the inhalation of certain chemicals. Moreover, gender differences in epithelial response are also reported. To better understand and predict gender differences in response of the nasal epithelium to inhaled xenobiotics, gene expression profiles from naive male and female Sprague-Dawley rats were constructed. Epithelial cells were manually collected from the nasal septum, naso- and maxillo-turbinates, and ethmoid turbinates of nine male and nine female rats. Gene expression analysis was performed using the Affymetrix Rat Genome 430 2.0 microarray. Surprisingly, there were few gender differences in gene expression. Gene ontology enrichment analysis identified several functional categories, including xenobiotic metabolism, cell cycle, apoptosis, and ion channel/transport, with significantly different expression between tissue types. These baseline data will contribute to our understanding of the normal physiology and selectivity of the nasal epithelial cells' response to inhaled environmental toxicants.

Incorporation of tissue reaction kinetics in a computational fluid dynamics model for nasal extraction of inhaled hydrogen sulfide in rats.

Rodents exposed to hydrogen sulfide (H2S) develop olfactory neuronal loss. This lesion has been used by the risk assessment community to develop occupational and environmental exposure standards. A correlation between lesion locations and areas of high H2S flux to airway walls has been previously demonstrated, but a quantitative dose assessment is needed to extrapolate dose at lesion sites to humans. In this study, nasal extraction (NE) of 10, 80, and 200 ppm H2S was measured in the isolated upper respiratory tract of anesthetized rats under constant unidirectional inspiratory flow rates of 75, 150, and 300 ml/min. NE was dependent on inspired H2S concentration and air flow rate: increased NE was observed when H2S exposure concentrations or inspiratory air flow rates were low. An anatomically accurate, three-dimensional computational fluid dynamics (CFD) model of rat nasal passages was used to predict NE of inhaled H2S. To account for the observed dependence of NE on H2S exposure concentration, the boundary condition used at airway walls incorporated first-order and saturable kinetics in nasal tissue to govern mass flux at the air:tissue interface. Since the kinetic parameters cannot be obtained using the CFD model, they were estimated independently by fitting a well-mixed, two-compartment pharmacokinetic (PK) model to the NE data. Predicted extraction values using this PK-motivated CFD approach were in good agreement with the experimental measurements. The CFD model provides estimates of localized H2S flux to airway walls and can be used to calibrate lesion sites by dose.