Analysis of Gamma-Band Activity from Human EEG Using Empirical Mode Decomposition.

The purpose of this paper is to determine whether gamma-band activity detection is improved when a filter, based on empirical mode decomposition (EMD), is added to the pre-processing block of single-channel electroencephalography (EEG) signals. EMD decomposes the original signal into a finite number of intrinsic mode functions (IMFs). EEGs from 25 control subjects were registered in basal and motor activity (hand movements) using only one EEG channel. Over the basic signal, IMF signals are computed. Gamma-band activity is computed using power spectrum density in the 30-60 Hz range. Event-related synchronization (ERS) was defined as the ratio of motor and basal activity. To evaluate the performance of the new EMD based method, ERS was computed from the basic and IMF signals. The ERS obtained using IMFs improves, from 31.00% to 73.86%, on the original ERS for the right hand, and from 22.17% to 47.69% for the left hand. As EEG processing is improved, the clinical applications of gamma-band activity will expand.

Differential diagnosis by EEG of dissociative status versus nonconvulsive status epilepticus.

INTRODUCTION: Nonconvulsive status epilepticus (NCSE) has different clinical presentations, from minimal confusion to bizarre behavioral manifestations, psychosis or coma. As a result, patients can sometimes be misdiagnosed and labeled as psychiatric cases. CLINICAL CASE: The patient was alert and disoriented in time, with disconnection episodes, generalized slowness, slow mental response, faltering language and slow answers. A differential diagnosis between dissociative status and NCSE was proposed. The physical and neurological examinations were normal. The cranial CT scan findings were normal. Only the EEG provided the definitive diagnostic data, consisting of generalized spike and wave discharges of 2-3 Hz against a desynchronized background. CONCLUSIONS: Diagnosis of NCSE requires the availability of an EEG. Often patients are on the border between medical conditions and mental disorders. Observation of the disease evolution and an open-minded attitude of physicians are necessary for the correct diagnosis and treatment.

Quantitative mapping of magnetic properties at the nanoscale with bimodal AFM.

We demonstrate that a force microscope operated in a bimodal configuration enables the mapping of magnetic interactions with high quantitative accuracy and high-spatial resolution (∼30 nm). Bimodal AFM operation doubles the number of observables with respect to conventional magnetic force microscopy methods which enables to determine quantitatively in a single processing step several magnetic properties. The theory of bimodal AFM provides analytical expressions for different magnetic force models, in particular those characterized by power-law and exponential distance dependences. Bimodal AFM provides a self-evaluation protocol to test the accuracy of the measurements. The agreement obtained between the experiments and theory for two different magnetic samples support the application of bimodal AFM to map quantitatively long-range magnetic interactions.

[Usefulness of failure mode and effects analysis to improve patient safety during the process of incorporating new nurses in an intensive care unit]. / Utilidad del análisis modal de fallos y efectos para la mejora de la seguridad de los pacientes, en el proceso de incorporación de nuevo personal de enfermería a un servicio de medicina intensiva.

OBJECTIVE: To analyze proactively the process of incorporating new nurses in the intensive care unit (ICU) in order to detect risk areas and establish improvements that increase critical patient safety. MATERIAL AND METHODS: Once the risk area was defined, the different phases of failure mode and effects analysis (FMEA) were applied: work team selection; process design; process phases definition; failure modes, possible causes and effects analysis; risk priority for each failure, and development of ameliorating and corrective actions. The proposed actions consisted of an orientation and training program (theoretical and practical) for new nurses, a supervision plan, a progressive responsibility program and ICU participation in personnel recruitment. RESULTS: Twelve nurses began to work in the ICU during the first 18 months of the program's implementation. Of these, only one nurse had full experience in critical care and three had partial experience. Participation of the ICU in personnel recruitment was nil. All the nurses with no or partial experience followed the orientation program (nursing supervisor interview, test of previous knowledge, handing over of the employee handbook, etc.), the theoretical and practical training program (supervision and tutorship) and the progressive responsibility program. More than half (63.6%) of the new nurses had another nurse duplicating their jobs during the training period and 54.5% of the new nurses attended the critical care course for nurses. Nurses participating in the orientation and training program expressed a high level of satisfaction. These measures helped nurses to decrease their stress and anxiety, increase and consolidate their knowledge, and provide safer care to critical patients. CONCLUSIONS: FMEA is a useful tool for improving ICU processes, even those involving human resources. The improvements implemented to decrease clinical risk related to the incorporation of new nurses in the ICU, based on previous training, will increase the safety of critical patient care by decreasing human errors due to inexperience.

Hospital Pharmacist experience in the Intensive Care Unit: Plan COVID.

The Intensive Care Unit (ICU) of the University Hospital of Fuenlabrada was  forced to critically increase its capacity in the COVID-19 pandemic. The objective of this work is to describe the activities promoted by the pharmacist in the care  of the critically ill patient in this context. A new organizational structure was  designed, analyzing the tasks necessary to make the processes profitable. Two  pharmacists joined the critical patient care to help the pharmacist who was  already integrated in the ICU team. The development of the operational  structure was carried out on three levels. The healthcare activity highlights the  daily participation of pharmacists in the two clinical sessions in which the ICU  teams evaluated all cases and made decisions. This in turn facilitated the  pharmaceutical validation that was carried out in the critical units themselves. In addition, one of the pharmacists created the Immuno-COVID Committee, in  which they participated together with different specialists for therapeutic  decision-making in the most complex cases. On the other hand, the availability  of human and material resources allowed the implantation of centralized  elaboration in the Pharmacy Service of many intravenous mixtures, including  antibiotics elastomers Pumps for continuous infusion, and non-sterile  elaborations. In logistics management, in addition to the acquisition of COVID- 19 therapies, the reconciliation with nursing activity stands out. The physical presence of the pharmacist favored the detection of needs, the  availability in time of medications in the unit, including sterile and non-sterile  preparations, and coordination with the central pharmacy. In knowledge  management, the participation of the pharmacist in the working group for the  development of the hospital management protocol COVID-19 stands out. The  daily presence in the unit and the joint work with the entire multidisciplinary team demonstrate the value that the pharmacist can bring. In addition to  efficient resource management, support for clinical decision-making and  improvement actions, it provides the climate of inter-professional trust necessary to respond to the complexity of the critical patient and promote joint  projects.

La Unidad de Cuidados Intensivos del Hospital Universitario de Fuenlabrada se  vio obligada a aumentar de manera crítica su capacidad en la pandemia por  COVID-19. El objetivo de este trabajo es describir las actividades impulsadas por el farmacéutico en la atención del paciente crítico en este contexto. Se diseñó  una estructura organizativa nueva, analizando las tareas necesarias para  rentabilizar los procesos. Dos farmacéuticos se incorporaron a la atención del  paciente crítico para ayudar al farmacéutico que ya estaba integrado en el  equipo de la Unidad de Cuidados Intensivos. El desarrollo de la estructura  operativa se llevó a cabo en tres niveles. En la actividad asistencial destaca la  participación diaria de los farmacéuticos en las dos sesiones clínicas en las que  los equipos de la Unidad de Cuidados Intensivos valoraban todos los casos y  tomaban las decisiones. Esto, a su vez, facilitaba la validación farmacéutica que  se realizaba en las propias unidades de críticos. Además, uno de los  farmacéuticos ideó el Comité Inmuno-COVID, en el que participaban junto a  diferentes especialistas para la toma de decisiones terapéuticas en los casos más complejos. Por otro lado, la disponibilidad de recursos humanos y materiales  permitió implantar la elaboración de forma centralizada en el Servicio de Farmacia de muchas mezclas intravenosas, incluyendo elastómeros de  antibioterapia en perfusión continua, y de elaboraciones no estériles. En la  gestión logística, además de la adquisición de las terapias COVID-19, destaca la  conciliación con la actividad de enfermería. La presencia física del farmacéutico  favorecía la detección de necesidades, la disponibilidad en tiempo de  medicamentos en la unidad, incluyendo las elaboraciones estériles y no estériles, y la coordinación con la Farmacia central. En la gestión del conocimiento destaca la participación del farmacéutico en el grupo de trabajo para desarrollo del  protocolo hospitalario de manejo de la COVID-19. La presencia diaria en la  unidad y el trabajo conjunto con todo el equipo multidisciplinar ponen de  manifiesto el valor que el farmacéutico puede aportar. Además de una gestión  eficiente de los recursos, soporte en la toma de decisiones clínicas y acciones de  mejora, proporciona el clima de confianza interprofesional necesario para dar  respuesta a la complejidad del paciente crítico y promover proyectos conjuntos.

Fast, quantitative and high resolution mapping of viscoelastic properties with bimodal AFM.

Quantitative mapping of viscoelastic properties of soft matter with a nanoscale spatial resolution is an active and relevant research topic in atomic force microscopy (AFM) and nanoscale science characterization. The AFM has demonstrated its accuracy to measure the energy dissipated on a sample surface with an atomic-scale resolution. However, the transformation of energy dissipation values associated with viscoelastic interactions to a material property remains very challenging. A key issue is to establish the relationship between the AFM observables and some material properties such as viscosity coefficient or relaxation time. Another relevant issue is to determine the accuracy of the measurements. We demonstrate that bimodal atomic force microscopy enables the accurate measurement of several viscoelastic parameters such as the Young's modulus, viscosity coefficient, retardation time or loss tangent. The parameters mentioned above are measured at the same time that the true topography. We demonstrate that the loss tangent is proportional to the viscosity coefficient. We show that the mapping of viscoelastic properties neither degrades the spatial resolution nor the imaging speed of AFM. The results are presented for homogeneous polymer and block co-polymer samples with Young's modulus, viscosity and retardation times ranging from 100 MPa to 3 GPa, 10 to 400 Pa s and 50 to 400 ns, respectively. Numerical simulations validate the accuracy of bimodal AFM to determine the viscoelastic parameters.

Enhancement of Mood but not Performance in Elite Athletes With Transcranial Direct-Current Stimulation.

PURPOSE: To determine if transcranial direct-current stimulation (tDCS) could be effective for the enhancement of swimming performance or mood state in elite athletes. METHODS: Eight male elite triathletes (age = 20 [2] y, maximal oxygen uptake = 71 [4] mL·kg-1·min-1) participated in this crossover, counterbalanced, sham-controlled, double-blind study. Participants received either actual (20 min of anodal stimulation of the motor cortex at 2 mA) or sham tDCS and performed an 800-m swimming test in which rating of perceived exertion and blood lactate response were measured. Mood state (Brunel Mood Scale) was assessed before and after each tDCS session and after the swimming test. Heart-rate variability and central nervous system readiness were assessed before and after each tDCS session. The chances of finding differences between conditions were determined using magnitude-based inferences. RESULTS: A significant and very likely higher Brunel Mood Scale-determined vigor self-perception was found with actual tDCS after the stimulation session (-0.1 [1.2] and 2.0 [2.3] for sham and actual tDCS, respectively; P = .018, effect size = 1.14) and after exercise (-4.1 [2.9] and -0.9 [3.6] for sham and actual tDCS, respectively; P = .022, effect size = 0.98). However, likely trivial and nonsignificant (P > .05) differences were found between conditions in performance (599 [38] s and 596 [39] s, respectively). Unclear and nonsignificant differences were observed between conditions for the rest of the study end points. CONCLUSIONS: tDCS elicited a marked increase in vigor self-perception that was maintained after exercise but failed to improve swimming performance in elite triathletes.

Dynamics of breaking intermolecular bonds in high-speed force spectroscopy.

Atomic force microscope based single-molecule force spectroscopy provides a description of a variety of intermolecular interactions such as those occurring between receptor molecules and their ligands. Advances in force spectroscopy have enabled performing measurements at high-speeds and sub-microsecond resolutions. We report experiments performed on a biotin-avidin system that reveal that the measured force decreases with the loading rate at high rates. This result is at odds with the established Bell-Evans theory that predicts a monotonic increase of the rupture force with the loading rate. We demonstrate that inertial and hydrodynamic forces generated during the breaking of the bond dominate the measured force at high loading rates. We develop a correction factor to incorporate those effects into the Bell-Evans theory. The correction is necessary to obtain accurate values of the intermolecular forces at high speeds.

Fast and high-resolution mapping of elastic properties of biomolecules and polymers with bimodal AFM.

Fast, high-resolution mapping of heterogeneous interfaces with a wide elastic modulus range is a major goal of atomic force microscopy (AFM). This goal becomes more challenging when the nanomechanical mapping involves biomolecules in their native environment. Over the years, several AFM-based methods have been developed to address this goal. However, none of these methods combine sub-nanometer spatial resolution, quantitative accuracy, fast data acquisition speed, wide elastic modulus range and operation in physiological solutions. Here, we present detailed procedures for generating high-resolution maps of the elastic properties of biomolecules and polymers using bimodal AFM. This requires the simultaneous excitation of the first two eigenmodes of the cantilever. An amplitude modulation (AM) feedback acting on the first mode controls the tip-sample distance, and a frequency modulation (FM) feedback acts on the second mode. The method is fast because the elastic modulus, deformation and topography images are obtained simultaneously. The method is efficient because only a single data point per pixel is needed to generate the aforementioned images. The main stages of the bimodal imaging are sample preparation, calibration of the instrument, tuning of the microscope and generation of the nanomechanical maps. In addition, with knowledge of the deformation, bimodal AFM enables reconstruction of the true topography of the surface. It takes ~9 h to complete the whole procedure.

Empirical mode decomposition processing to improve multifocal-visual-evoked-potential signal analysis in multiple sclerosis.

OBJECTIVE: To study the performance of multifocal-visual-evoked-potential (mfVEP) signals filtered using empirical mode decomposition (EMD) in discriminating, based on amplitude, between control and multiple sclerosis (MS) patient groups, and to reduce variability in interocular latency in control subjects. METHODS: MfVEP signals were obtained from controls, clinically definitive MS and MS-risk progression patients (radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS)). The conventional method of processing mfVEPs consists of using a 1-35 Hz bandpass frequency filter (XDFT). The EMD algorithm was used to decompose the XDFT signals into several intrinsic mode functions (IMFs). This signal processing was assessed by computing the amplitudes and latencies of the XDFT and IMF signals (XEMD). The amplitudes from the full visual field and from ring 5 (9.8-15° eccentricity) were studied. The discrimination index was calculated between controls and patients. Interocular latency values were computed from the XDFT and XEMD signals in a control database to study variability. RESULTS: Using the amplitude of the mfVEP signals filtered with EMD (XEMD) obtains higher discrimination index values than the conventional method when control, MS-risk progression (RIS and CIS) and MS subjects are studied. The lowest variability in interocular latency computations from the control patient database was obtained by comparing the XEMD signals with the XDFT signals. Even better results (amplitude discrimination and latency variability) were obtained in ring 5 (9.8-15° eccentricity of the visual field). CONCLUSIONS: Filtering mfVEP signals using the EMD algorithm will result in better identification of subjects at risk of developing MS and better accuracy in latency studies. This could be applied to assess visual cortex activity in MS diagnosis and evolution studies.

Mapping Elastic Properties of Heterogeneous Materials in Liquid with Angstrom-Scale Resolution.

Fast quantitative mapping of mechanical properties with nanoscale spatial resolution represents one of the major goals of force microscopy. This goal becomes more challenging when the characterization needs to be accomplished with subnanometer resolution in a native environment that involves liquid solutions. Here we demonstrate that bimodal atomic force microscopy enables the accurate measurement of the elastic modulus of surfaces in liquid with a spatial resolution of 3 Å. The Young's modulus can be determined with a relative error below 5% over a 5 orders of magnitude range (1 MPa to 100 GPa). This range includes a large variety of materials from proteins to metal-organic frameworks. Numerical simulations validate the accuracy of the method. About 30 s is needed for a Young's modulus map with subnanometer spatial resolution.

Induced gamma band activity from EEG as a possible index of training-related brain plasticity in motor tasks.

The aim of this study was proposing gamma band activity (GBA) as an index of training-related brain plasticity in the motor cortex. Sixteen controls underwent an experimental session where electroencephalography (EEG) activity was recorded at baseline (resting) and during a motor task (hand movements). GBA was obtained from the EEG data at baseline and during the task. Index of plasticity (IP) was defined as the relationship between GBA at the end of the motor task (GBAM_FIN), divided by GBA at the beginning of the task (GBAM_INI) for movements of both hands. There was a significant increase in GBA at the end of the task, compared to the initial GBA for the motor task (GBAM_FIN > GBAM_INI). No differences were found at baseline (GBAB_FIN ≈ GBAB_INI). Individual IP values had a positive (r = 0.624) and significant correlation with subject's handedness. Due to plastic changes, GBA could indirectly but objectively reveal changes in cerebral activity related to physical training. This method could be used as a future diagnostic test in the follow-up of patients undergoing rehabilitation. It could also have potential applications in the fields of sports medicine.

Using magnetoencephalography to study patterns of brain magnetic activity in Alzheimer's disease.

The use of magnetoencephalography to study neurophysiologic abnormalities associated with Alzheimer's disease is reviewed. The most consistent observation is that Alzheimer's disease patients exhibit an increase in focal slow-wave activity that covaried with cognitive performance. It is still unclear whether generation of focal slow-wave activity precedes or is a consequence of Alzheimer's disease-related neuropathology. Also reviewed is the use of magnetoencephalography to identify early functional changes preceding the diagnosis of dementia. Magnetoencephalography detected neurophysiologic abnormalities associated with cognitive deficits before the diagnosis of mild cognitive impairment. This is supported by evidence presented suggesting that some patients with subjective cognitive complaints, without evidence of dementia, show an increase in focal slow-wave generators. Further research is needed to determine whether the outstanding spatial and temporal resolution of the magnetoencephalography technique could complement other neuroimaging techniques in identifying neurophysiologic abnormalities preceding the diagnosis of Alzheimer's disease and mild cognitive impairment.

Magnetoencephalogram recording from secondary motor areas during imagined movements.

This study determined whether the activity of the secondary motor cortex (M2) could be recorded during imagined movements (IM) of the right and left hand using magnetoencephalography (MEG). Results during IM were compared with a somatosensory trial during a passive tactile stimulation in one subject. During the somatosensory trial, dipoles were detected in somatosensory (SS) and motor primary (M1) areas, scoring 94.4-98.4% for SS, 1.6-5.6% for M1 and 0% for M2. During the IM trial, dipoles were detected in SS, M1 and M2 areas, scoring 61.1-68.8% for SS, 2.6-9.3% for M1 and 28.6-29.6% for M2. These data support the hypothesis that M2 areas are activated during imagined hand movements. This study aims for the development of a diagnosis test for patients with motor deficits by evaluating the whole somatomotor network with specific interest in M2 areas.

Fundamental High-Speed Limits in Single-Molecule, Single-Cell, and Nanoscale Force Spectroscopies.

Force spectroscopy is enhancing our understanding of single-biomolecule, single-cell, and nanoscale mechanics. Force spectroscopy postulates the proportionality between the interaction force and the instantaneous probe deflection. By studying the probe dynamics, we demonstrate that the total force acting on the probe has three different components: the interaction, the hydrodynamic, and the inertial. The amplitudes of those components depend on the ratio between the resonant frequency and the frequency at which the data are measured. A force-distance curve provides a faithful measurement of the interaction force between two molecules when the inertial and hydrodynamic components are negligible. Otherwise, force spectroscopy measurements will underestimate the value of unbinding forces. Neglecting the above force components requires the use of frequency ratios in the 50-500 range. These ratios will limit the use of high-speed methods in force spectroscopy. The theory is supported by numerical simulations.

Induced Gamma-Band Activity During Voluntary Movement: EEG Analysis for Clinical Purposes.

OBJECTIVE: Propose a simplified method applicable in routine clinical practice that uses EEG to assess induced gamma-band activity (GBA) in the 30-90 Hz frequency range in cerebral motor areas. DESIGN: EEG recordings (25 healthy subjects) of cerebral activity (at rest, motor task). GBA was obtained as power spectral density (PSD). GBA - defined as the gamma index (Iγ) - was calculated using the basal GBA (γB) and motor GBA (γMOV) PSD values. RESULTS: The mean values of Iγ were (IγR (right hand) = 1.30, IγL (left hand) = 1.22). Manual laterality showed a correlation with Iγ. CONCLUSIONS: Iγ may provide a useful way of indirectly assessing operation of activated motor neuronal circuits. It could be applied to diagnosis of motor area pathologies and as follow up in rehabilitation processes. Likewise, Iγ could enable the assessment of motor capacity, physical training and manual laterality in sport medicine.

Prefrontal brain magnetic activity: effects of memory task demands.

Changes in spatiotemporal profiles of brain magnetic activity were investigated in healthy volunteers as a function of varying demands for phonological storage of spoken pseudowords. Greater activity for the phonological memory task was restricted to the dorsolateral prefrontal cortex (DLPFC) in the left hemisphere. During performance of the memory task, activity was initially found in the left superior temporal gyrus (between 100 and 200 ms), followed by activity in the ventrolateral prefrontal, motor, and premotor cortices (between 200 and 300 ms). Activity in DLPFCs was first observed consistently across participants later, between 300 and 400 ms. The data are consistent with the purported role of posterior temporal cortices in phonological analysis and in the online storage of phonological information, the contribution of ventrolateral and motor processing areas in establishment and short-term maintenance of articulatory representations through rehearsal, and the role of DLPFCs in the executive control of the maintenance operation.

Experiencia del farmacéutico de hospital en la unidad de cuidados intensivos: Plan COVID / Hospital Pharmacist experience in the Intensive Care Unit: Plan COVID

La Unidad de Cuidados Intensivos del Hospital Universitario de Fuenlabrada se vio obligada a aumentar de manera crítica su capacidad en la pandemia por COVID-19. El objetivo de este trabajo es describir las actividades impulsadas por el farmacéutico en la atención del paciente crítico en este contexto. Se diseñó una estructura organizativa nueva, analizando las tareas necesarias para rentabilizar los procesos. Dos farmacéuticos se incorporaron a la atención del paciente crítico para ayudar al farmacéutico que ya estaba integrado en el equipo de la Unidad de Cuidados Intensivos. El desarrollo de la estructura operativa se llevó a cabo en tres niveles. En la actividad asistencial destaca la participación diaria de los farmacéuticos en las dos sesiones clínicas en las que los equipos de la Unidad de Cuidados Intensivos valoraban todos los casos y tomaban las decisiones. Esto, a su vez, facilitaba la validación farmacéutica que se realizaba en las propias unidades de críticos. Además, uno de los farmacéuticos ideó el Comité Inmuno-COVID, en el que participaban junto a diferentes especialistas para la toma de decisiones terapéuticas en los casos más complejos. Por otro lado, la disponibilidad de recursos humanos y materiales permitió implantar la elaboración de forma centralizada en el Servicio de Farmacia de muchas mezclas intravenosas, incluyendo elastómeros de antibioterapia en perfusión continua, y de elaboraciones no estériles. En la gestión logística, además de la adquisición de las terapias COVID-19, destaca la conciliación con la actividad de enfermería. La presencia física del farmacéutico favorecía la detección de necesidades, la disponibilidad en tiempo de medicamentos en la unidad, incluyendo las elaboraciones estériles y no estériles, y la coordinación con la Farmacia central. En la gestión del conocimiento destaca la participación del farmacéutico en el grupo de trabajo para desarrollo del protocolo hospitalario de manejo de la COVID-19. La presencia diaria en la unidad y el trabajo conjunto con todo el equipo multidisciplinar ponen de manifiesto el valor que el farmacéutico puede aportar. Además de una gestión eficiente de los recursos, soporte en la toma de decisiones clínicas y acciones de mejora, proporciona el clima de confianza interprofesional necesario para dar respuesta a la complejidad del paciente crítico y promover proyectos conjuntos

The Intensive Care Unit (ICU) of the University Hospital of Fuenlabrada was forced to critically increase its capacity in the COVID-19 pandemic. The objective of this work is to describe the activities promoted by the pharmacist in the care of the critically ill patient in this context. A new organizational structure was designed, analyzing the tasks necessary to make the processes profitable. Two pharmacists joined the critical patient care to help the pharmacist who was already integrated in the ICU team. The development of the operational structure was carried out on three levels. The healthcare activity highlights the daily participation of pharmacists in the two clinical sessions in which the ICU teams evaluated all cases and made decisions. This in turn facilitated the pharmaceutical validation that was carried out in the critical units themselves. In addition, one of the pharmacists created the Immuno-COVID Committee, in which they participated together with different specialists for therapeutic decision-making in the most complex cases. On the other hand, the availability of human and material resources allowed the implantation of centralized elaboration in the Pharmacy Service of many intravenous mixtures, including antibiotics elastomers Pumps for continuous infusion, and non-sterile elaborations. In logistics management, in addition to the acquisition of COVID-19 therapies, the reconciliation with nursing activity stands out. The physical presence of the pharmacist favored the detection of needs, the availability in time of medications in the unit, including sterile and non-sterile preparations, and coordination with the central pharmacy. In knowledge management, the participation of the pharmacist in the working group for the development of the hospital management protocol COVID-19 stands out. The daily presence in the unit and the joint work with the entire multidisciplinary team demonstrate the value that the pharmacist can bring. In addition to efficient resource management, support for clinical decision-making and improvement actions, it provides the climate of inter-professional trust necessary to respond to the complexity of the critical patient and promote joint projects

Focal temporoparietal slow activity in Alzheimer's disease revealed by magnetoencephalography.

BACKGROUND: Patients suffering from Alzheimer's disease exhibit more activity in the conventional electroencephalographic delta and theta bands. This activity concurs with atrophy and reduced metabolic and perfusion rates, particularly in temporoparietal structures. METHODS: Whole-head magnetoencephalographic recordings were obtained from 15 patients diagnosed with Alzheimer's disease and 19 healthy control subjects during a resting condition. The generators of focal magnetic slow waves were located employing a single moving dipole model. RESULTS: Dipole density in the delta and theta bands was enhanced in the Alzheimer's disease group compared with healthy control subjects. Slow-wave activity differed significantly between groups in temporoparietal regions of both hemispheres. Right temporoparietal slow-wave activity covaried with cognitive performance, whereas left temporal delta activity varied with a functional status scale. CONCLUSIONS: Our results support the predominant role of the temporoparietal areas in the diagnosis of Alzheimer's disease. Magnetoencephalography and the source analysis of focal slow activity in particular provide interesting and potentially clinically useful tools to assess functional modifications of patients' brain and to evaluate its relationship with the cognitive status.

Limbic paroxysmal magnetoencephalographic activity in 12 obsessive-compulsive disorder patients: a new diagnostic finding.

BACKGROUND: We describe frontotemporal paroxysmal rhythmic activity recorded by magnetoencephalography (MEG) in patients with obsessive-compulsive disorder (OCD). METHOD: Twelve patients with OCD (per ICD-10 and DSM-IV criteria), aged 18 to 65 years, were assessed using MEG. Patients' classification according to the Yale Brown OCD Scale was as follows: severe = 8, moderate = 3, and mild = 1. MEG findings were compared with those of 12 age- and sex-matched healthy subjects (control group) with no previous history of psychiatric or neurologic disorders. All study participants underwent neurologic and basic medical examinations, including magnetic resonance imaging, electrocardiograms (EEGs), and electrooculograms. The study was conducted between January 2001 and January 2002. RESULTS: Two types of MEG activity were observed in patients with OCD: (1) frontotemporal paroxysmal rhythmic activity with low-amplitude spikes (< 1 picoTesla) in 92% (11/12) of patients and (2) intermittent isolated spikes and sharp waves in all patients (12/12). The OCD group had paroxysmal rhythmic MEG activity in the cingulate cortex (12/12), insula (10/12), hippocampus (9/12), temporal superior gyrus and angular and supramarginal gyri (9/12), precentral and post-central gyri (8/12), orbitofrontal cortex (5/12), and parietal lobes (5/12). MEG recordings were normal in the control group, and EEG findings were normal in both the OCD and control groups. CONCLUSIONS: Frontotemporal paroxysmal rhythmic activity with a preferential limbic distribution is a sensitive MEG finding in patients with OCD. Although the pathophysiology of this abnormality remains unknown, a corticostriatal network dysfunction was hypothesized.