Comprehensive Outcome Assessment and Quality of Life Following Epilepsy Surgery.

BACKGROUND: Seizure freedom without deficits is the primary goal for epilepsy surgery. However, patients with medically refractory epilepsy commonly suffer from many co-morbidities related to mood, cognition, and sleep as well as social problems and resultant stigma. While epilepsy surgery literature does describe quality of life (QOL) and neuropsychological outcomes, there is a paucity of information on various common non-seizure outcomes, especially pertaining to mood, sleep, cognition, and social aspects. The objective of this study was to evaluate the role of various non-seizure parameters on post-epilepsy surgery QOL. METHODS: Consecutive adult patients operated for refractory epilepsy at least 1 year prior to initiation of this study were included and classified as seizure-free (group 1) or non-seizure-free (group 2). QOL was assessed using the QOLIE-31 instrument; patients with a T score less than 40 were categorized as "poor QOL." Non-seizure parameters assessed were cognition, mood disturbances, social improvement, social stigma, and sleep disturbances. Categorization into "good" and "poor" outcome subgroups on each item was carried out by dichotomization of scores. RESULTS: Thirty-seven patients (16 F) [mean age 23.5 ± 5.6 years] were evaluated; 26 were seizure-free (group 1). In this group, impaired memory, lower language scores, depression, not having been employed, not receiving education prior to surgery, and experiencing social stigma were factors significantly associated with poor QOL. In group 2, all patients had poor QOL scores. CONCLUSION: Non-seizure factors related to common epilepsy co-morbidities and social issues are highly prevalent among seizure-free patients reporting poor QOL after epilepsy surgery.

Advanced Characterization of Ceramic State Polymer Electrolyte at Radio Frequencies.

Two newly developed non-contact dielectric measurement techniques were applied to characterize the complex permittivity spectra of a ceramic state polymer electrolyte. The Capacitance Bridge was employed to measure the electrolyte sample in a frequency range from 50 Hz to 20 KHz with a novel air gap method. The newly designed in-waveguide measurement by VNA (vector network analyzer) was applied to measure the electrolyte in the frequency range from 8.2 GHz to 40 GHz. Both methods are newly developed non-contact techniques and there was no physical contact on the polymer sample film surface during the measurement. The weak contact error in traditional measurement could be completely avoided in these non-contact methods. The ionic conductivity and complex electrical conductivity can be derived from the accurate complex dielectric spectra.

Restless legs syndrome/Willis-Ekbom disease among patients with resistant hypertension versus stroke patients-a prospective study.

BACKGROUND: Epidemiological studies have shown an increased prevalence and incidence of hypertension as well as a higher incidence of stroke among patients suffering from RLS. The objective of this study was to estimate the prevalence of RLS among patients with resistant hypertension (RH) and compare the clinical characteristics of these patients with patients of stroke pre-existing RLS and with patients with primary RLS presenting to the Sleep clinic. METHODS: Consecutive patients with RH (without any identifiable cause on extensive work up) and consecutive in-patients with stroke were enrolled over a 3-year-period. Patients with RH fulfilling revised-IRLSSG-criteria for RLS comprised group 1 and those with stroke and RLS formed group 2. These were compared with patients diagnosed to have idiopathic RLS (iRLS) (Group 3). Prevalence of RLS in groups 1 and 2 and RLS characteristics in all groups were compared. RESULTS: Sixteen out of 56 RH patients (29%) formed group 1 and 43 out 346 of stroke patients (12%) formed group 2, while 43 consecutive iRLS patients were included in group 3. Age was significantly higher, with male dominance in group 2. Median age at symptom onset was significantly lower in group 1. Positive family history was similar in RH and iRLS patients and was significantly less common in stroke patients. Asymmetrical/unilateral distribution of symptoms was significantly more common in stroke group, compared to RH and iRLS groups. CONCLUSION: This study demonstrated a high prevalence of RLS among patients with resistant hypertension. RLS characteristics are different from those in patients with stroke, and very similar to primary RLS.

The Triad of Cognition, Language, and Communication in Traumatic Brain Injury: A Correlational Study.

Objectives Traumatic brain injury (TBI) is associated with deficits in cognition, language, and communication along with physical and psychosocial consequences. This study aimed at evaluating the association between cognition, language, and communication in a cohort of patients with TBI in southern India using standardized language specific assessment tools. Materials and Methods The present correlational study included 30 patients with TBI of any severity, that is, mild, moderate, and severe within the postinjury period of 6 to 36 months. Comprehensive evaluation of cognition, language, and communication was done using National Institute of Mental Health and Neurosciences Neuropsychology Battery, Indian adapted versions of Western Aphasia Battery and La Trobe Communication Questionnaire (LCQ) respectively. Data Analysis Measures of descriptive statistics, that is, mean, median, percentages, and frequencies, were used. Raw scores, that is, aphasia quotient (AQ), and subdomain scores for LCQ, that is, LCQ-quality, quantity, relation, manner, and cognition, were calculated. Composite scores for the three neuropsychological domains, that is, attention and processing speed, executive function, learning and memory, were evaluated. Partial correlation was computed for identifying the association between the three variables by controlling for age, education, duration, and severity of injury. Results A significant correlation was found between AQ and measures of attention and executive functioning and all measures of LCQ except LCQ-manner. Further, a significant correlation was found between executive functioning and LCQ-total, LCQ-quantity, and LCQ cognition. No correlation was found between measures of attention and memory with communication. Conclusion A good language and executive functioning are associated with better communication abilities in patients with TBI thus emphasizing on the importance of a multidisciplinary team for the management of cognitive-communication impairments following a TBI.

Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India.

Objective Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI. Materials and Methods The present single-group intervention study with a pre-post design included 12 patients diagnosed with moderate to severe TBI within 3-24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale-Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention. Statistical Analysis Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test. Results The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved. Conclusion CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.

Modelling and prediction of the peak-radiated sound in subsonic axisymmetric air jets using acoustic analogy-based asymptotic analysis.

This paper uses asymptotic analysis within the generalized acoustic analogy formulation (Goldstein 2003 JFM 488, 315-333. (doi:10.1017/S0022112003004890)) to develop a noise prediction model for the peak sound of axisymmetric round jets at subsonic acoustic Mach numbers (Ma). The analogy shows that the exact formula for the acoustic pressure is given by a convolution product of a propagator tensor (determined by the vector Green's function of the adjoint linearized Euler equations for a given jet mean flow) and a generalized source term representing the jet turbulence field. Using a low-frequency/small spread rate asymptotic expansion of the propagator, mean flow non-parallelism enters the lowest order Green's function solution via the streamwise component of the mean flow advection vector in a hyperbolic partial differential equation. We then address the predictive capability of the solution to this partial differential equation when used in the analogy through first-of-its-kind numerical calculations when an experimentally verified model of the turbulence source structure is used together with Reynolds-averaged Navier-Stokes solutions for the jet mean flow. Our noise predictions show a reasonable level of accuracy in the peak noise direction at Ma = 0.9, for Strouhal numbers up to about 0.6, and at Ma = 0.5 using modified source coefficients. Possible reasons for this are discussed. Moreover, the prediction range can be extended beyond unity Strouhal number by using an approximate composite asymptotic formula for the vector Green's function that reduces to the locally parallel flow limit at high frequencies. This article is part of the theme issue 'Frontiers of aeroacoustics research: theory, computation and experiment'.

Role of Positive Airway Pressure Therapy for Obstructive Sleep Apnea in Patients With Stroke: A Randomized Controlled Trial.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is an independent risk factor for stroke. The objective of this study was to assess the effect of continuous positive airway pressure (CPAP) treatment on prevention of new vascular events among patients with stroke and OSA. METHODS: Consecutive conscious patients presenting with first imaging-confirmed arterial stroke were included, 6 weeks or more after ictus. All patients underwent clinical and polysomnography (PSG) testing. Patients with an apnea-hypopnea index (AHI) of > 15 events/h were randomized to posttitration nightly CPAP treatment and non-CPAP (received best medical treatment) groups. On follow-up at 3, 6, and 12 months from randomization, evaluation was carried out for any new vascular events as the primary outcome measure, and for clinical stroke outcomes (using the Barthel Index and modified Rankin scale) and neuropsychological parameters as the secondary outcome measures. RESULTS: Among the 679 patients with stroke who were screened, 116 reported for PSG, 83 had AHI > 15 events/h, and 70 (34 in CPAP and 36 in non-CPAP) were randomized. Thirteen patients could not be randomized because of a lack of CPAP devices. Four patients crossed over from the CPAP to the non-CPAP group. Age (mean age 53.41 ± 9.85 in CPAP versus 52.69 ± 13.23 years in non-CPAP, P = .81) and sex distribution (24 males in CPAP versus 33 males in non-CPAP, P = .79) were similar in both groups. At 12-month follow-up, there was 1 vascular event (3.33%) in the CPAP group and 6 events (15%) in the non-CPAP group (P = .23). Modified Rankin scale score improvement by ≥ 1 at 12-month follow-up was found in significantly more patients in the CPAP group than in the non-CPAP group (53% versus 27%). CONCLUSIONS: These findings suggest significantly better stroke outcomes and statistically nonsignificant favorable outcomes in terms of recurrence of vascular events for patients with stroke and OSA who use CPAP treatment. CLINICAL TRIAL REGISTRATION: Registry: Clinical Trials Registry - India, CTRI Registration No: CTRI/2016/07.007104, Title: Sleep Disordered Breathing in stroke patients: Effect of treatment trial, URL: http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=8682&EncHid=&userName=sleep%20disordered%20breathing.

Validation of a modified Hindi version of the Epworth Sleepiness Scale among a North Indian population.

BACKGROUND: Since a majority of population in India does not drive automobiles, one item on the Epworth Sleepiness Scale (ESS) requires modification and validation. In addition, data collected by us indicated that a majority of rural and urban Indians regularly spend time in prayer/spiritual activity. The main purpose of this study was to develop a cross-cultural adaptation of the ESS for a North Indian population, in Hindi language (ESS-I). The study also provides evidence of reliability and validity of the modified version. METHODOLOGY: The subjects included were normal volunteers aged 18-75 years (Group 1) (n = 70), compared with patients with complaints of excessive daytime sleepiness, who had undergone polysomnography (Group 2) (n = 22) and patients who had undergone multiple sleep latency test (Group 3) (n = 10). The study was carried out in four phases: Translation and retranslation of the original scale with modification of item 8 (mainly addition of option of question on "while offering prayers or in spiritual activity"); reliability (test-retest) (n = 30); internal consistency (using Cronbach's alpha index) (n = 102); and sensitivity to change (n = 8). RESULTS: Group 1 showed spiritual activity as a significantly more commonly practiced activity than driving. The Cronbach's alpha for the modified version was 0.892 (excellent), and this was not improved by removing the modified item. The alpha value for Group 1 versus Groups 2 and 3 was 0.667 and 0.892, respectively. The scale was reliable over time (test-retest), and it was sensitive to sleepiness change in patients with obstructive sleep apnea during treatment. CONCLUSION: The ESS-I, is comparable to the original scale. It is reliable, valid, and change-sensitive. It is proposed that the modified version can be very useful for detecting sleepiness among Indian population, especially those who do not drive their own vehicles.

Millimeter-wave dielectric properties of single-crystal ferroelectric and dielectric materials.

Transmittance measurements on various single crystal ferroelectric and dielectric materials, BaTiO(3), SrTiO(3), LiNbO(3), LiTaO(3), (PbMg(1/3)Nb(2/3)O(3))0.73-(PbTiO(3))0.27, LaAlO(3), and Bi(4)Ge(3)O(12), over a broad millimeter-wave (MMW) frequency range have been performed. Frequency dependence of the complex dielectric permittivity has been measured in the MMW region using high-power sources for the first time, using a free-space, quasi-optical MMW spectrometer equipped with high-power backward wave oscillators (BWOs) as sources of coherent radiation, tunable in the range from 30 to 120 and 180 to 260 GHz. These results are compared with MMW permittivity of these materials obtained by other methods as well as to RF, microwave, and optical frequency permittivities for all the materials tested. The effects of both crystallographic orientation and quality of the surface polishing of the crystals have been examined. Uncertainties and possible sources of instrumentation and measurement errors related to the freespace MMW technique are discussed. This work demonstrates that precise MMW permittivity data can be obtained even on relatively small and thin crystals of different surface conditions and orientations using the high-power BWO-based quasioptical approach.

Bioremediation of HCH-contaminated soil: elimination of inhibitory effects of the insecticide on radish and green gram seed germination.

The effects of technical grade hexachlorocyclohexane (tech-HCH) on the germination of different seeds were tested. Two types of seeds, radish and green gram showed marked reduction in germination percentage and seeding vigour index. The abnormalities and reduction in germination increased with increasing concentration of tech-HCH. At 100 microg HCH level the germination of radish and green gram seeds was inhibited almost completely on moist filter paper and soil. Protease and amylase activities were reduced in seeds grown in soil spiked with tech-HCH. Bioremediation of HCH-spiked soils with a HCH-degrading microbial consortium helped in eliminating the toxic effects of tech-HCH towards seed germination. The degradation of 25 microg tech-HCH g(-1) soil was complete by 120 h. The seed germination and the activities of the assayed enzymes, amylase and protease, were same as before or better in bioremediated soils.