"Counting sheep PSG": EEGLAB-compatible open-source matlab software for signal processing, visualization, event marking and staging of polysomnographic data.

BACKGROUND: Progress in advancing sleep research employing polysomnography (PSG) has been negatively impacted by the limited availability of widely available, open-source sleep-specific analysis tools. NEW METHOD: Here, we introduce Counting Sheep PSG, an EEGLAB-compatible software for signal processing, visualization, event marking and manual sleep stage scoring of PSG data for MATLAB. RESULTS: Key features include: (1) signal processing tools including bad channel interpolation, down-sampling, re-referencing, filtering, independent component analysis, artifact subspace reconstruction, and power spectral analysis, (2) customizable display of polysomnographic data and hypnogram, (3) event marking mode including manual sleep stage scoring, (4) automatic event detections including movement artifact, sleep spindles, slow waves and eye movements, and (5) export of main descriptive sleep architecture statistics, event statistics and publication-ready hypnogram. COMPARISON WITH EXISTING METHODS: Counting Sheep PSG was built on the foundation created by sleepSMG (https://sleepsmg.sourceforge.net/). The scope and functionalities of the current software have made significant advancements in terms of EEGLAB integration/compatibility, preprocessing, artifact correction, event detection, functionality and ease of use. By comparison, commercial software can be costly and utilize proprietary data formats and algorithms, thereby restricting the ability to distribute and share data and analysis results. CONCLUSIONS: The field of sleep research remains shackled by an industry that resists standardization, prevents interoperability, builds-in planned obsolescence, maintains proprietary black-box data formats and analysis approaches. This presents a major challenge for the field of sleep research. The need for free, open-source software that can read open-format data is essential for scientific advancement to be made in the field.

The EEG correlates and dangerous behavioral consequences of drowsy driving after a single night of mild sleep deprivation.

OBJECTIVE: Here, we investigated the behavioral, cognitive, and electrophysiological impact of mild, acute sleep loss via simultaneously recorded behavioral and electrophysiological measures of vigilance during a "real-world", simulated driving task. METHODS: Participants (N = 34) visited the lab for two testing days where their brain activity and vigilance were simultaneously recorded during a driving simulator task. The driving task lasted approximately 70 mins and consisted of tailgating the lead car at high speed, which braked randomly, requiring participants to react quickly to avoid crashing. The night before testing, participants either slept from 12am-9am (Normally Rested), or 1am-6am (Sleep Restriction). RESULTS: After a single night of mild sleep restriction, sleepiness was increased, participants took longer to brake, missed more braking events, and crashed more often. Brain activity showed more intense alpha burst activity and significant changes in EEG spectral power frequencies related to arousal (e.g., delta, theta, alpha). Importantly, increases in amplitude and number of alpha bursts predicted delays in reaction time when braking. CONCLUSIONS: The findings of this study suggest that a single night of mild sleep loss has significant, negative consequences on driving performance and vigilance, and a clear impact on the physiology of the brain in ways that reflect reduced arousal. SIGNIFICANCE: Understanding neural and cognitive changes associated with sleep loss may lead to important advancements in identifying and preventing potentially dangerous sleep-related lapses in vigilance.

Sleep Enhances Consolidation of Memory Traces for Complex Problem-Solving Skills.

Sleep consolidates memory for procedural motor skills, reflected by sleep-dependent changes in the hippocampal-striatal-cortical network. Other forms of procedural skills require the acquisition of a novel strategy to solve a problem, which recruit overlapping brain regions and specialized areas including the caudate and prefrontal cortex. Sleep preferentially benefits strategy and problem-solving skills over the accompanying motor execution movements. However, it is unclear how acquiring new strategies benefit from sleep. Here, participants performed a task requiring the execution of a sequence of movements to learn a novel cognitive strategy. Participants performed this task while undergoing fMRI before and after an interval of either a full night sleep, a daytime nap, or wakefulness. Participants also performed a motor control task, which precluded the opportunity to learn the strategy. In this way, we subtracted motor execution-related brain activations from activations specific to the strategy. The sleep and nap groups experienced greater behavioral performance improvements compared to the wake group on the strategy-based task. Following sleep, we observed enhanced activation of the caudate in addition to other regions in the hippocampal-striatal-cortical network, compared to wakefulness. This study demonstrates that sleep is a privileged time to enhance newly acquired cognitive strategies needed to solve problems.

EEG and behavioural correlates of mild sleep deprivation and vigilance.

OBJECTIVE: The current study investigated the behavioral, cognitive, and electrophysiological impact of mild (only a few hours) and acute (one night) sleep loss via simultaneously recorded behavioural and physiological measures of vigilance. METHODS: Participants (N = 23) came into the lab for two testing days where their brain activity and vigilance were recorded and assessed. The night before the testing session, participants either slept from 12am to 9am (Normally Rested), or from 1am to 6am (Sleep Restriction). RESULTS: Vigilance was reduced and sleepiness was increased in the Sleep Restricted vs. Normally Rested condition, and this was exacerbated over the course of performing the vigilance task. As well, sleep restriction resulted in more intense alpha bursts. Lastly, EEG spectral power differed in Sleep Restricted vs. Normally Rested conditions as sleep onset progressed, particularly for frequencies reflecting arousal (e.g., delta, alpha, beta). CONCLUSIONS: The findings of this study suggest that only one night of mild sleep loss significantly increases sleepiness and, importantly, reduces vigilance. In addition, this sleep loss has a clear impact on the physiology of the brain in ways that reflect reduced arousal. SIGNIFICANCE: Understanding the neural correlates and cognitive processes associated with loss of sleep may lead to important advancements in identifying and preventing deleterious or potentially dangerous, sleep-related lapses in vigilance.

Sleep preferentially enhances memory for a cognitive strategy but not the implicit motor skills used to acquire it.

Sleep is known to be beneficial to the strengthening of two distinct forms of procedural memory: memory for novel, cognitively simple series of motor movements, and memory for novel, cognitively complex strategies required to solve problems. However, these two types of memory are intertwined, since learning a new cognitive procedural strategy occurs through practice, and thereby also requires the execution of a series of simple motor movements. As a result, it is unclear whether the benefit of sleep results from the enhancement of the cognitive strategy, or the motor skills required to execute the solution. To disentangle the role of sleep in these aspects of procedural memory, we employed two tasks: (1) the Tower of Hanoi (ToH), and, (2) a modified version of the ToH, akin to an implicit Motor Sequence Learning (MSL) task. The MSL task involved the identical series of motor movements as the ToH, but without access to the information necessary to execute the task according to the underlying cognitive procedural strategy. Participants (n = 28) were trained on the 3-disk ToH, then retested on 5-disk versions of both ToH and MSL tasks. Half (n = 15) were trained and immediately tested at 8 PM and retested at 8 AM after a night of sleep. They were retested again at 8 PM after a day of wake (PM-AM-PM condition). The other half (n = 13) were trained and immediately tested at 8 AM, retested at 8 PM after a day of wake, and retested again at 8 AM after a night of sleep (AM-PM-AM condition). ToH performance only improved following a period of sleep. There was no benefit of sleep to implicit MSL. Our results show that sleep, but not wake, allowed individuals to extrapolate what was learned on a simpler 3-disk version of the task to the larger 5-disk problem, which included new elements to which they had not yet been exposed. Here, we isolate the specific role sleep plays for cognitive procedural memory: sleep benefits the cognitive strategy, rather than strengthening implicitly acquired motor sequences required to learn and execute the underlying strategy itself.

[Accidental amphetamine poisoning in an 11-month-old boy]. / Intoxication involontaire aux amphétamines chez un nourrisson de 11 mois.

INTRODUCTION: In France, the use of illicit drugs is increasing and therefore accidental poisoning may occur in infants and children. We report on a case of ecstasy poisoning in an infant who presented with atypical neurological symptoms. CASE REPORT: An 11-month-old infant suddenly developed agitation with eye rolling and unreactive bilateral mydriasis. All neurologic causes were excluded. The search for toxicants revealed an intoxication with an amphetamine and MDMA. Progression was favorable in 24h. CONCLUSION: Although rare, pediatric intoxications by ecstasy have become more common in recent years, due to its consumption within households, exposing young children and infants to accidental ingestion of a tablet of ecstasy.

Increased GABAergic activity in the region of the pedunculopontine and deep mesencephalic reticular nuclei reduces REM sleep and impairs learning in rats.

Newly formed memories are initially fragile and require consolidation to be transformed into an enduring state. Memory consolidation may occur during increased postlearning REM sleep. REM deprivation during these periods (termed REM sleep windows [RSWs]) impairs subsequent performance. The pedunculopontine nucleus (PPT) and adjacent deep mesencephalic reticular nuclei (DpMe) have been implicated in the generation of REM sleep. Following 24-hr baseline recording, rats were trained on the 2-way avoidance task for 50 trials/day over 2 days and retested on Day 3. EEG was recorded 22 hr after training on training Days 1 and 2. Rats were injected with the GABAB agonist baclofen or saline into the PPT/DpMe region at 0300 to coincide with the start of a known RSW. Based on shuttle performance, saline rats were assigned post hoc to a learning group (LG) that avoided the footshock at least 60% at retest or nonlearning group (NLG) that performed below this criterion. Baclofen-injected rats were not assigned post hoc into separate groups as all rats performed below the learning criterion. PPN/DpMe infusions of the inhibitory GABAB agonist baclofen decreased REM and impaired subsequent memory performance. Normal GABAergic transmission in the PPN/DpMe may be necessary for REM to occur and for the consolidation of incentive learning.

Too much of a good thing? Elevated baseline sleep spindles predict poor avoidance performance in rats.

Sleep spindles may be involved in synaptic plasticity. Learning-dependent increases in spindles have been observed in both humans and rats. In humans, the innate (i.e., baseline) number of spindles correlate with measures of academic potential such as Intelligence Quotient (IQ) tests. The present study investigated if spindles predict whether rats are able to learn to make avoidance responses in the two-way shuttle task. Baseline recordings were taken continuously for 24h prior to training on the two-way shuttle task for 50trials/day for two days followed by a 25 trial re-test on the third day. At re-test, rats were categorized into learners (n=16) or non-learners (n=21). Groups did not differ in baseline duration of rapid eye movement sleep, slow wave sleep, wake or spindle density. For combined groups, spindle density in the 21 to 24-hour period but not at any other period during baseline was negatively correlated with shuttle task performance at re-test. Conversely, the learning-related change in spindle density in the 21 to 24-hour period, but not at any other time after the first training session was positively correlated with shuttle task performance. Rats in the non-learning condition have a higher number of spindles at baseline, which is unaffected by training. On the other hand, learning rats have fewer spindles at baseline, but have a learning-related increase in spindles. Extreme spindle activity and high spindle density have been observed in humans with learning disabilities. Results suggest that while spindles may be involved in memory consolidation, in some cases, high levels of spindles prior to training may be maladaptive.

Sleep spindles and learning potential.

The number of sleep spindles remains relatively stable within individuals from night to night. However, there is little explanation for the large interindividual differences in spindles. The authors investigated the relationship between spindles and intelligence quotient (IQ) in 3 separate studies. The number of spindles and sigma power were positively correlated with performance IQ (PIQ), but not verbal IQ (VIQ). The perceptual/analytical skills measured by the PIQ Picture Completion subscale accounted for most of the interindividual differences in spindles. Furthermore, there was a relationship between the rapid eye movements (REMs) of REM sleep and VIQ in individuals with higher IQ scores. A similar pattern was observed between spindles and PIQ. It was hypothesized that high-IQ individuals have more spindles that can support more complex cortical networks underlying perceptual/analytical abilities.

New techniques for the reconstruction of complex vascular anatomies from MRI images.

The accurate representation of two-dimensional images in three dimensions has become important for many medical imaging applications and for cardiac magnetic resonance imaging (MRI) in particular. Reconstruction methods applied after data acquisition can produce three-dimensional information from two-dimensional data and make applications such as surgical planning more effective. Current reconstruction techniques usually demand contrast agents, and can suffer due to poor segmentation and sampling constraints that cause surface irregularities and distort dimensions. The novel technique presented here for anatomical modeling uses adaptive control grid interpolation (ACGI) to approximate data not captured by scanning, and a progressive shape-element segmentation technique to complete reconstruction. Quantitative validations conducted on models of pediatric cardiac malformations have confirmed the theoretical advantages of this technique, and that higher quality is achieved than with competing methods based on geometric parameters. Vascular diameters from reconstructions showed errors of less than 1% for a known geometry as compared to over 9% for competing methods. Qualitatively, models produced with the new methodology displayed substantial improvement over alternatives. Approximately 50 rare cardiac structures, including surgically altered Fontan and atypical aortic anatomies, have been reconstructed. All data used to create these reconstructions were acquired using standard pulse sequences and without contrast agents. Benefits of the new technique are particularly evident when complex vascular configurations complicate reconstruction. The proposed methodology enables a powerful tool allowing physicians to analyze and manipulate highly accurate and clearly presented vascular structures in an interactive medium.

[Biometric study of acute-angle-closure glaucoma using Orbscan and echography]. / Analyse biométrique par Orbscan et échographie du glaucome aigu par fermeture de l'angle.

PURPOSE: To study acute-angle-closure glaucoma (AACG) biometry using Orbscan and echography. MATERIAL AND METHODS: We prospectively studied 200 normal eyes of 100 patients (including eyes with ametropia), 50 eyes of 25 patients before peripherial YAG laser iridotomy, 25 phakic eyes of 25 patients with a history of acute-angle-closure glaucoma (AACG) in the fellow eye. Both plane and polynomial modes of reconstruction of the iridocorneal angle measurement were analyzed. Biometric measurements of the three groups were compared. Biometric measurements (i.e., iridocorneal angle, anterior chamber depth, axial length, and lens thickness) and subjective spherical equivalent were correlated with the etiological classification. RESULTS: Age, sex, iridocorneal angle, anterior chamber depth, lens thickness, axial length and subjective spherical equivalent were significantly different in the three groups (p<0.002). The polynomial iridocorneal angle measurement was 43.4 degrees in the normal group, 36.5 degrees in the iridotomy group, and 28.4 degrees in the AACG group (p<0.001). Iridocorneal angle measurement correlated with the other biometric measurements (rs>0.51; p<0.001) and with the etiological classification (rs< or =0.68; p<0.001). The anterior chamber depth measurement obtained by Orbscan or echography was the best parameter for predicting ACCG (rs=0.77; p<0.001). CONCLUSION: The anterior chamber depth and polynimial iridocorneal angle obtained using the Orbscan device appears to be useful in predicting acute-angle-closure glaucoma.

Combined spinal-epidural versus epidural labor analgesia.

BACKGROUND: Despite the growing popularity of combined spinal-epidural analgesia in laboring women, the exact role of intrathecal opioids and the needle-through-needle technique remains to be determined. The authors hypothesized that anesthetic technique would have little effect on obstetric outcome or anesthetic complications. METHODS: Data were prospectively collected from 2,183 laboring women randomly assigned to have labor analgesia induced with either 10 microg intrathecal sufentanil with or without 2.0 mg bupivacaine (n = 1,071) or 10 microg epidural sufentanil and 12.5-25.0 mg bupivacaine (n = 1,112). Immediately after induction, a continuous epidural infusion of 0.083% bupivacaine plus 0.3 microg/ml sufentanil was begun in all patients and continued until delivery. Labor was managed by nurses, obstetricians, and obstetric residents who were unaware of the anesthetic technique used. RESULTS: Anesthetic technique lacked impact on our primary outcome: mode of delivery or labor duration. Infants whose mothers were allocated to the combined spinal-epidural group had a slightly higher umbilical artery carbon dioxide partial pressure (54.2 +/- 10.4 vs. 53.2 +/- 10.2 mmHg). However, only achieving at least 5 cm cervical dilation before induction of analgesia and having a cesarean delivery were independent risk factors for elevated umbilical artery carbon dioxide partial pressure. The frequencies of accidental dural puncture, failed epidural analgesia, headache, and epidural blood patch were low and similar in the two groups. CONCLUSIONS: Labor progress and outcome are similar among women receiving either combined spinal-epidural or epidural analgesia. The difference in neonatal outcome appears related to the presence of confounding variables. The combined spinal-epidural technique is not associated with an increased frequency of anesthetic complications. Either technique can safely provide effective labor analgesia.

Cost analysis in vitrectomy: monitored anesthesia care and general anesthesia.

A retrospective study was performed to compare differences in hospital charges between monitored anesthesia care with retrobulbar block and general anesthesia among patients having vitrectomy. Of 128 consecutive patients undergoing vitrectomy between July 1996 and July 1997, group 1 received general anesthesia (n = 41), group 2 received monitored care anesthesia with retrobulbar block (n = 59), and 28 patients were eliminated from the study. There were significant differences in anesthesia charges, operating room charges, pharmacy charges, and total hospital charges between groups 1 and 2. Charges associated with monitored care anesthesia with retrobulbar block are 20% less than charges associated with general anesthesia. Fewer patients in group 2 required postoperative intravenous narcotics than in group 1.

Evolution in the body of HIV nursing knowledge.

The role nurses occupy in the care of the HIV/AIDS affected has evolved over time. This evolution is exhibited in the body of nursing knowledge and is recorded in the published literature. The purpose of this study was to describe landmarks in the evolution of nursing's involvement in the provision of care to HIV/AIDS patients and to examine the body of nursing knowledge relative to HIV/AIDS, employing bibliometric analytic techniques. It was expected that the literature would grow in both breadth and depth concurrent with nursing's increased role in caring for those infected, or at risk for infection, with HIV.

The effect of patient-focused redesign on midlevel nurse managers' role responsibilities and work environment.

OBJECTIVE: The authors determine the effect of patient-focused redesign on midlevel nurse managers' role responsibilities and perceptions of work environment. BACKGROUND: Patient-focused redesign models have been initiated in a number of hospitals over the past 10 years. Few studies of the impact of these models on nurse leaders' roles and work responsibilities have been conducted. METHODS: Nine midlevel nurse managers were interviewed about their redesigned leadership roles and the challenges they experienced in implementing patient-focused redesign. RESULTS: Several themes emerged from the data. These themes focused on role change, ambiguity, position power, and environmental uncertainty and turbulence. Each of the nurse managers described feelings of frustration, disconnectedness, and inadequacy and spoke of how difficult it was to be the central figure in the eye of the storm. They noted that previously successful administrative strategies were not producing the same effect as in the past. CONCLUSION: This study provides beginning information about the magnitude of the impact of organizational redesign on midlevel nurse managers. Midlevel managers in this study struggled to keep up with the demands of the change and their own recognition of the importance of remaining committed to the uncertain goals of the institution. They were frustrated by their perceived inability to fix the situation and to meet the multiple needs of the staff. Nonetheless, they supported senior executives and attempted reasonable solutions to the problem.

Does epinephrine improve the diagnostic accuracy of aspiration during labor epidural analgesia?

UNLABELLED: Aspiration reliably detects almost all IV multiorifice epidural catheters. Although a supplemental epinephrine 15-microg test dose may detect the rare IV catheter that does not yield blood on aspiration, false-positive epinephrine responses may cause some women to unnecessarily undergo repeat epidural catheter insertion. We evaluated 532 consecutive eligible patients requesting neuraxial labor analgesia. Patients were excluded if they had a contraindication to epinephrine or if they received intrathecal sufentanil/bupivacaine. Multiorifice catheters were inserted 4-6 cm into the epidural space as part of an epidural (n = 305) or combined spinal-epidural (n = 270) technique. We used aspiration, a lidocaine/epinephrine test dose, and bolus injection or infusion of dilute bupivacaine/sufentanil solutions to systematically determine IV, intrathecal, or epidural catheter location. Aspiration alone detected 47 of 48 intravascular catheters. There were 10 positive epinephrine responses: 2 were true positives, 7 were falsely positive (subsequent local anesthetic injection/infusion produced bilateral sensory change and analgesia), and 1 catheter was removed without further testing. Aspiration detected almost all intravascular catheters. Although the epinephrine test dose did detect one catheter that proved to be in a blood vessel, 87.5% of positive responses occurred in women without intravascular catheters. IMPLICATIONS: Epidural catheters may enter a blood vessel. Many clinicians use epinephrine to detect these catheters. Because aspiration alone detects almost all IV multiorifice catheters in laboring women, a subsequent epinephrine test dose may be unnecessary.

The tat protein of HIV-1 induces galectin-3 expression.

Animal lectins play important roles in a variety of biological processes via their recognition of glycoconjugates. Galectin-3 is a beta-galactoside-binding lectin whose expression is associated with various pathological processes including human T lymphotropic virus (HTLV)-I-infection of human T cell lines and human immunodeficiency virus (HIV) infection of T-lymphoblastic Molt-3 cell line. In the case of HIV-infected cells, it has been suggested that the increase in galectin-3 expression could be related to the expression of the viral regulatory gene tat. These results prompt us to perform more extensive analyses of the relationship between galectin-3 and HIV-1 Tat expressions. In this study, we found that Tat protein expression induces an upregulation of galectin-3 in several human cell lines. In co-transfection experiments, the 5'-regulatory sequences of the galectin-3 gene were significantly upregulated by expression vectors encoding the Tat protein. Analysis performed with 5'-regulatory deleted sequences suggested that galectin-3 induction by Tat is dependent on activation of the Sp-1 binding transcription factor.

HIV/AIDS-related electronic queries and responses: a three-year analysis.

Although information about HIV and AIDS has become abundant and accessible, questions from health care providers and consumers alike continue to persist. As part of an HIV/AIDS outreach program begun in 1995, a Web-based model was created to facilitate access to relevant information. The model includes an interactive component whereby individuals can pose questions to HIV specialists. Web-based queries and responses have been captured and recorded since the project's inception. A total of 192 query encounters were collected, sorted, and analyzed with descriptive statistics.

Anesthesia for reduction of uterine incarceration: report of two cases.

We present two cases in which anesthesia was needed for the reduction of uterine incarceration. The first case was managed with a combined spinal/epidural technique and the second with a single intrathecal injection of opioid and low dose local anesthetic. The anesthetic issues pertinent to the reduction of an incarcerated uterus are discussed and the literature briefly reviewed.