Closed-Loop Neuromodulation and Self-Perception in Clinical Treatment of Refractory Epilepsy.

Background: Newer "closed-loop" neurostimulation devices in development could, in theory, induce changes to patients' personalities and self-perceptions. Empirically, however, only limited data of patient and family experiences exist. Responsive neurostimulation (RNS) as a treatment for refractory epilepsy is the first approved and commercially available closed-loop brain stimulation system in clinical practice, presenting an opportunity to observe how conceptual neuroethical concerns manifest in clinical treatment.Methods: We conducted ethnographic research at a single academic medical center with an active RNS treatment program and collected data via direct observation of clinic visits and in-depth interviews with 12 patients and their caregivers. We used deductive and inductive analyses to identify the relationship between these devices and patient changes in personality and self-perception.Results: Participants generally did not attribute changes in patients' personalities or self-perception to implantation of or stimulation using RNS. They did report that RNS affected patients' experiences and conceptions of illness. In particular, the capacity to store and display electrophysiological data produced a common frame of reference and a shared vocabulary among patients and clinicians.Discussion: Empirical experiences of a clinical population being treated with closed-loop neuromodulation do not corroborate theoretical concerns about RNS devices described by neuroethicists and technology developers. However, closed-loop devices demonstrated an ability to change illness experiences. Even without altering identify and self-perception, they provided new cultural tools and metaphors for conceiving of epilepsy as an illness and of the process of diagnosis and treatment. These findings call attention to the need to situate neuroethical concerns in the broader contexts of patients' illness experiences and social circumstances.

Optimization of Co2+ ions removal from water solutions via polymer enhanced ultrafiltration with application of PVA and sulfonated PVA as complexing agents.

The paper presents the results of the studies of UF-complexation process applied for the removal of Co(2+) ions from water solutions. As binding agents for cobalt ions, the PVA polymer (M(w)=10,000) and its sulfonated form, synthesized in the laboratory, have been used. The method of experimental design and response surface methodology have been employed to find out the optimal conditions for the complexation process and to evaluate the interaction between the input variables, i.e., initial cobalt concentration, pH and amount of the polymer used, expressed as a polymer/Co(2+) ratio r. The data collected by the designed experiments showed that sulfonation of polymer has improved significantly the binding ability of PVA. The optimal conditions of cobalt ions complexation established by response surface model for non-sulfonated PVA polymer have been found to be as follows: the initial concentration of Co(2+)=5.70 mg L(-1), the ratio between polymer and metal ions, r=8.58 and pH=5.93. The removal efficiency of Co(2+) in these conditions was 31.81%. For sulfonated PVA polymer, the optimal conditions determined are as follows: initial concentration of [Co(2+)](0)=10 mg L(-1), r=1.2 and pH=6.5. For these conditions, a removal efficiency of 99.98% has been determined. The experiments showed that Co(2+) removal ability of sulfonated PVA was much higher than its non-sulfonated precursor. Although the polymer concentrations used in the tests with sulfonated PVA were approximately ten times lower than the non-sulfonated one, the removal efficiency of cobalt ions was significantly higher.

Comparison of acidic polymers for the removal of cobalt from water solutions by polymer assisted ultrafiltration.

In this study, three sulfonated water-soluble polymers based on poly(vinyl alcohol) of different molecular weights (10,000, 50,000 and 100,000 Da) were prepared and tested against commercially available poly(acrylic acid) for the removal of cobalt using polymer assisted ultrafiltration. High rejection rates were obtained between pH 3 and 6 with sulfonated poly(vinyl alcohol) (PVA 10,000 and 50,000 Da) whereas poly(acrylic acid) (PAA) of similar molecular weights performed rather poorly in this pH range. Sulfonation improved significantly sorption capability of PVA. Sulfonated PVA 10,000 was the best complexing agent with rejection rate above 95% between pH 3 and 6. For unmodified PVA the rejection rate was only 30-45% at pH 6 and there was no rejection at pH 3 at all. PAA rejection rate was above 90% at pH 6 and only about 10% at pH 3. Large scale experiment in cross-flow, continuous apparatus conducted by using PVA-SO(3)H 10,000 Da to remove (60)Co radioisotope from water solutions showed excellent results demonstrating the potential of this polymer to purify acidic radioactive wastes containing cobalt radioisotopes.

Removal of cobalt ions from aqueous solutions by polymer assisted ultrafiltration using experimental design approach. part 1: optimization of complexation conditions.

The polymer assisted ultrafiltration process combines the selectivity of the chelating agent with the filtration ability of the membrane acting in synergy. Such hybrid process (complexation-ultrafiltration) is influenced by several factors and therefore the application of experimental design for process optimization using a reduced number of experiments is of great importance. The present work deals with the investigation and optimization of cobalt ions removal from aqueous solutions by polymer enhanced ultrafiltration using experimental design and response surface methodological approach. Polyethyleneimine has been used as chelating agent for cobalt complexation and the ultrafiltration experiments were carried out in dead-end operating mode using a flat-sheet membrane made from regenerated cellulose. The aim of this part of experiments was to find optimal conditions for cobalt complexation, i.e. the influence of initial concentration of cobalt in feed solution, polymer/metal ratio and pH of feed solution, on the rejection efficiency and binding capacity of the polymer. In this respect, the central compositional design has been used for planning the experiments and for construction of second-order response surface models applicable for predictions. The analysis of variance has been employed for statistical validation of regression models. The optimum conditions for maximum rejection efficiency of 96.65% has been figured out experimentally by gradient method and was found to be as follows: [Co(2+)](0)=65 mg/L, polymer/metal ratio=5.88 and pH 6.84.

Subjects' expectations in neuroimaging research.

PURPOSE: To explore subjects' attitudes and expectations concerning the detection and management of incidental findings in neuroimaging research. MATERIALS AND METHODS: Healthy control subjects (N = 105) who previously participated in neuroimaging studies in medical and nonmedical settings were surveyed about their expectations and attitudes toward unexpected clinical findings on their research brain scans. We hypothesized that even though the participants consented to a scanning procedure for research purposes alone, they would still expect pathology, if present, to be detected and reported to them. RESULTS: Fifty-four percent of participants reported that they expected research scans to detect abnormalities if they existed. Nearly all subjects (>90%) reported that they would want findings communicated to them, and many (59%) preferred this to be done by a physician affiliated with the research team. The participants responded in similar ways whether they were scanned in medical or nonmedical settings. CONCLUSION: Clarity about procedures for handling incidental findings when obtaining written and verbal informed consent is essential to ensure that the subjects' expectations are consistent with the purpose and scope of the research.