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Epilepsy is a prevalent brain disease, which is quite difficult-to-treat or cure. This study developed a novel automatic seizure detection method based on the persistent homology method. In this study, a Vietoris–Rips (VR) complex filtration model was constructed based on the EEG data. And the persistent homology method was applied to calculate the VR complex filtration barcodes to describe the topological changes of EEG recordings. Afterward, the barcodes as the topological characteristics of EEG signals were fed into the GoogLeNet for classification. The persistent homology is applicable for multi-channel EEG data analysis, where the global topological information is calculated and the features are extracted by considering the multi-channel EEG data as a whole, without the multiple calculations or the post-stitching. Three databases were used to evaluate the proposed approach and the results showed that the approach had high performances in the epilepsy detection. The results obtained from the CHB-MIT Database recordings revealed that the proposed approach can achieve a segment-based averaged accuracy, sensitivity and specificity values of 97.05%, 96.71% and 97.38%, and achieve an event-based averaged sensitivity value of 100% with 1.22 s average detection latency. In addition, on the Siena Scalp Database, the proposed method yields averaged accuracy, sensitivity and specificity values of 96.42%, 95.23% and 97.6%. Multiple tasks of the Bonn Database also showed achieved accuracy of 99.55%, 98.63%, 98.28% and 97.68%, respectively. The experimental results on these three EEG databases illustrate the efficiency and robustness of our approach for automatic detection of epileptic seizure.

As the fast development of wearable devices and Internet of things technologies, real-time monitoring of ECG signals is quite critical for cardiovascular diseases. However, dynamic ECG signals recorded in free-living conditions suffered from extremely serious noise pollution. Presently, most algorithms for ECG signal evaluation were designed to divide signals into acceptable and unacceptable. Such classifications were not enough for real-time cardiovascular disease monitoring. In the study, a wearable ECG quality database with 50,085 recordings was built, including A/B/C (or high quality/medium quality/low quality) three quality grades (A: high quality signals can be used for CVD detection; B: slight contaminated signals can be used for heart rate extracting; C: heavily polluted signals need to be abandoned). A new SQA classification method based on a three-layer wavelet scattering network and transfer learning LSTM was proposed in this study, which can extract more systematic and comprehensive characteristics by analyzing the signals thoroughly and deeply. Experimental results (mACC = 98.56%, mF1 = 98.55%, SeA = 97.90%, SeB = 98.16%, SeC = 99.60%, +PA = 98.52%, +PB = 97.60%, +PC = 99.54%, F1A = 98.20%, F1B = 97.90%, F1C = 99.60%) and real data validations proved that this proposed method showed the high accuracy, robustness, and computationally efficiency. It has the ability to evaluate the long-term dynamic ECG signal quality. It is advantageous to promoting cardiovascular disease monitoring by removing contaminating signals and selecting high-quality signal segments for further analysis.

BACKGROUND: Erinaceidae is a family of small mammals that include the spiny hedgehogs (Erinaceinae) and the silky-furred moonrats and gymnures (Galericinae). These animals are widely distributed across Eurasia and Africa, from the tundra to the tropics and the deserts to damp forests. The importance of these animals lies in the fact that they are the oldest known living placental mammals, which are well represented in the fossil record, a rarity fact given their size and vulnerability to destruction during fossilization. Although the Family has been well studied, their phylogenetic relationships remain controversial. To test previous phylogenetic hypotheses, we combined molecular and morphological data sets, including representatives of all the genera. METHODOLOGY AND PRINCIPAL FINDINGS: We included in the analyses 3,218 bp mitochondrial genes, one hundred and thirty-five morphological characters, twenty-two extant erinaceid taxa, and five outgroup taxa. Phylogenetic relationships were reconstructed using both partitioned and combined data sets. As in previous analyses, our results strongly support the monophyly of both subfamilies (Galericinae and Erinaceinae), the Hylomys group (to include Neotetracus and Neohylomys), and a sister-relationship of Atelerix and Erinaceus. As well, we verified that the extremely long branch lengths within the Galericinae are consistent with their fossil records. Not surprisingly, we found significant incongruence between the phylogenetic signals of the genes and the morphological characters, specifically in the case of Hylomys parvus, Mesechinus, and relationships between Hemiechinus and Paraechinus. CONCLUSIONS: Although we discovered new clues to understanding the evolutionary relationships within the Erinaceidae, our results nonetheless, strongly suggest that more robust analyses employing more complete taxon sampling (to include fossils) and multiple unlinked genes would greatly enhance our understanding of the Erinaceidae. Until then, we have left the nomenclature of the taxa unchanged; hence it does not yet precisely reflect their phylogenetic relationships or the depth of their genetic diversity.

Background Current pediatric cardiac arrest guidelines recommend depressing the chest by one-third anterior-posterior diameter (APD), which is presumed to equate to absolute age-specific chest compression depth targets (4 cm for infants and 5 cm for children). However, no clinical studies during pediatric cardiac arrest have validated this presumption. We aimed to study the concordance of measured one-third APD with absolute age-specific chest compression depth targets in a cohort of pediatric patients with cardiac arrest. Methods and Results This was a retrospective observational study from a multicenter, pediatric resuscitation quality collaborative (pediRES-Q [Pediatric Resuscitation Quality Collaborative]) from October 2015 to March 2022. In-hospital patients with cardiac arrest ≤12 years old with APD measurements recorded were included for analysis. One hundred eighty-two patients (118 infants >28 days old to <1 year old, and 64 children 1 to 12 years old) were analyzed. The mean one-third APD of infants was 3.2 cm (SD, 0.7 cm), which was significantly smaller than the 4 cm target depth ( P <0.001). Seventeen percent of the infants had one-third APD measurements within the 4 cm ±10% target range. For children, the mean one-third APD was 4.3 cm (SD, 1.1 cm). Thirty-nine percent of children had one-third APD within the 5 cm ±10% range. Except for children 8 to 12 years old and overweight children, the measured mean one-third APD of the majority of the children was significantly smaller than the 5 cm depth target ( P <0.05). Conclusions There was poor concordance between measured one-third APD and absolute age-specific chest compression depth targets, particularly for infants. Further study is needed to validate current pediatric chest compression depth targets and evaluate the optimal chest compression depth to improve cardiac arrest outcomes. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02708134.

Introduction: Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. "Cold" debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple pediatric centers., Methods: Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental survey of 18 international institutions in the Pediatric Resuscitation Quality (pediRES-Q) collaborative. Data from 283 IHCA events reported between February 2016 and April 2018 were analyzed. We used a Plus/Delta framework to collect debriefing content and performed a qualitative analysis utilizing a modified Team Emergency Assessment Measurement Framework. Univariate and regression models were applied, accounting for clustering by site., Results: CD occurred in 33% (93/283) of IHCA events. Median time to debriefing was 26 days [IQR 11, 41] with a median duration of 60 minutes [20, 60]. Attendance was variable across sites (profession, number per debriefing): physicians 12 [IQR 4, 20], nurses 1 [1, 6], respiratory therapists 0 [0, 1], and administrators 1 [0, 1]. "Plus" comments reported per event were most commonly clinical standards 47% (44/93), cooperation 29% (27/93), and communication 17% (16/93). "Delta" comments were in similar categories: clinical standards 44% (41/93), cooperation 26% (24/93), and communication 14% (13/93)., Conclusions: CDs were performed after 33% of cardiac arrests in this multicenter pediatric IHCA collaborative. The majority of plus and delta comments could be categorized as clinical standards, cooperation and communication., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: In the United States, post-cardiac arrest debriefing has increased, but historically it has occurred rarely in our pediatric intensive care unit (PICU). A fellow-led debriefing tool was developed as a tool for fellow development, as well as to enhance communication amongst a multidisciplinary team., Methods: A curriculum and debriefing tool for fellow facilitators was developed and introduced in a 41-bed cardiac and medical PICU. Pre- and post-intervention surveys were sent to multidisciplinary PICU providers to assess effectiveness of debriefings using newly-trained leaders, as well as changes in team communication., Results: Debriefing occurred after 84% (63/75) of cardiac arrests post-intervention. Providers in various team roles participated in pre-intervention (129 respondents/236 invitations) and post-intervention (96 respondents /232 invitations) surveys. Providers reported that frequently occurring debriefings increased from 9 to 58%, pre- and post-intervention respectively (p < .0001). Providers reported frequent identification and discussion of learning points increased from 32% pre- to 63% post-intervention. In the 12 months post-intervention, 62% of providers agreed that the overall quality of communication during arrests had improved, and 61% would be more likely to request a debriefing after cardiac arrest., Conclusion: The introduction of a fellow-led debriefing tool resulted in regularly performed debriefings after arrests. Despite post-intervention debriefings being led by newly-trained facilitators, the majority of PICU staff expressed satisfaction with the quality of debriefing and improvement in communication during arrests, suggesting that fellow facilitators can be effective debrief leaders.

Background: Debriefing after pediatric rapid response team activations (RRT-As) in a tertiary care children's hospital was identified to occur only sporadically. The lack of routine debriefing after RRT-As was identified as a missed learning opportunity., Objective: We implemented a formal debriefing program and assessed staff attitudes toward and experiences with debriefing after pediatric RRT-As., Methods: Real-time feedback for pediatrics residents captured clinical and debriefing data for each RRT-A from July 2014 to June 2016. The debriefing on physiology, team communication, and anticipation of clinical deterioration was introduced in July 2015. To assess debriefing perceptions, residents, intensive care fellows, nurses, and respiratory therapists participated in anonymous preintervention and postintervention surveys. We also developed a workshop to teach residents how to lead debriefing., Results: Debriefing after RRT-As increased from 26% preintervention to 46% postintervention ( P  < .0001). A total of 43 of 76 pediatrics residents (57%) attended at least 1 of 4 debriefing workshops. Both preintervention and postintervention, more than 80% (70 of 78 preintervention and 54 of 65 postintervention) of health professionals surveyed strongly agreed or agreed that there was a benefit to debriefing after RRT-As. Postintervention, 65% (26 of 40) of respondents strongly agreed or agreed that debriefing improved their understanding of the RRT-A process. The rate of debriefing was sustained at 46% (6 months after the end of the study period)., Conclusions: Debriefing frequency after pediatric RRT-As significantly increased with the introduction of a formal debriefing program. A majority of health professionals and trainees reported this practice was a valuable experience., Competing Interests: Conflict of interest: The authors declare they have no competing interests.