Interrater Agreement Between Critical Care Providers for Background Classification and Seizure Detection After Implementation of Amplitude-Integrated Electroencephalography in Neonates, Infants, and Children.

PURPOSES: Amplitude-integrated EEG (aEEG) has been widely developed in neonatal intensive care unit, but few studies focused on pediatric intensive care unit. Furthermore, reliability of aEEG under real-life conditions is unknown. METHODS: Participants were nurses from a 12-bed pediatric intensive care unit in a referral university hospital in France. Amplitude EEG was implemented after standardized training, including e-learning course, individual feedback and bedside teaching concerning monitoring installation, background classification patterns recognition, artefact analysis, and seizure detection. The primary judgment criterion was the agreement (Cohen Kappa) between nurses and aEEG experts for the detection of abnormal aEEG traces (moderately or severely altered background pattern according to Hellström-Westas classification and/or seizure activity). RESULTS: During the study period, 196 consecutives traces from 79 patients were analyzed by 51 nurses. According to expert's classification, 53% of traces were abnormal, including 17.5% of severely abnormal traces (severely altered traces and/or seizure activity) and 14% exhibiting seizure activity. Moderate agreement between experts and nurses was found for detection of any abnormal trace (k = 0.53; 95% confidence interval [CI]: 0.39-0.67). Substantial agreement was found for severely altered traces (k = 0.71; 95% CI: 0.57-0.85). Finally, fair agreement was found for seizure detection (irrespective of background classification, k = 0.40; 95% CI: 0.25-0.54). CONCLUSIONS: These results suggest that aEEG monitoring may be implemented in routine nursing care in pediatric intensive care unit. Further training courses are needed to enhance nurses' skill in detecting seizures activity at the bedside.

Long-term damage to glass in Paris in a changing environment.

Glass weathering depends mainly on its chemical composition: Si-Ca-K mediaeval glass is low durable, while Si-Ca-Na Roman as well as modern glass are very durable. Mediaeval glass is subject to the superficial leaching of K and Ca ions leading to the formation of a hydrated silica-gel layer. Both types of glass develop a superficial stratum of deposited atmospheric particles cemented by crystals of gypsum (and syngenite in the case of Si-Ca-K glass), leading to an impairment of the optical properties: decrease of transparency and increase of haze. Dose-response functions established for the two types of glass reveal that haze depends only on pollution parameters (PM, SO(2), NO(2)), while leaching depends both on pollution and climate parameters (RH, T, SO(2), NO(2)). Instrumental records are available for temperature in Paris from 1800. Air pollution in Paris was estimated from statistics of fuel use from 1875 to 1943, measurements that started in the 1950s and projections across the 21st century. The estimated annual rate of haze development indicates a gradual rise from the 16th century. The increasing importance of coal as a fuel through the 19th century and enhanced sulphur dioxide concentration make a rapid increase in haze formation, which reaches a peak about 1950. The likely damage to mediaeval glass follows a rather similar pattern. The period of damage from aggressive pollutants looks later and for a briefer time in Paris than in London.