Publications by authors named "Westover B"

Background: Postoperative delirium is the most common complication following surgery among older adults, and has been consistently associated with increased mortality and morbidity, cognitive decline, and loss of independence, as well as markedly increased health-care costs. Electroencephalography (EEG) spectral slowing has frequently been observed during episodes of delirium, whereas intraoperative frontal alpha power is associated with postoperative delirium. We sought to identify preoperative predictors that could identify individuals at high risk for postoperative delirium, which could guide clinical decision-making and enable targeted interventions to potentially decrease delirium incidence and postoperative delirium-related complications.

View Article and Find Full Text PDF
Article Synopsis
  • Atrial fibrillation (AF) is often undetected due to its asymptomatic nature, presenting a significant risk for stroke and heart failure, making early prediction and management essential.
  • The study focused on analyzing 18,782 single-lead ECG recordings from 13,609 patients undergoing polysomnography (PSG) to identify individuals at high risk for developing AF, using both hand-crafted features and deep learning methods for prediction.
  • By employing advanced feature extraction techniques, the researchers aimed to enhance AF detection using PSG data, ultimately improving patient outcomes through early intervention.
View Article and Find Full Text PDF

Background: Electroencephalography (EEG) is needed to diagnose nonconvulsive seizures. Prolonged nonconvulsive seizures are associated with neuronal injuries and deleterious clinical outcomes. However, it is uncertain whether the rapid identification of these seizures using point-of-care EEG (POC-EEG) can have a positive impact on clinical outcomes.

View Article and Find Full Text PDF
Article Synopsis
  • Atrial fibrillation (AF) is often unnoticed but poses significant risks for stroke and heart failure, making early detection and management vital, especially since many AF patients also suffer from obstructive sleep apnea (OSA).
  • The study analyzed over 18,000 ECG recordings from patients at Massachusetts General Hospital to find indicators of AF by leveraging data from standard sleep assessments that included ECG monitoring.
  • A deep learning approach was used to enhance the prediction model, extracting features from the ECG data to forecast individuals who are at high risk of developing AF in the future.
View Article and Find Full Text PDF

Background And Objectives: Approximately 30% of critically ill patients have seizures, and more than half of these seizures do not have an overt clinical correlate. EEG is needed to avoid missing seizures and prevent overtreatment with antiseizure medications. Conventional-EEG (cEEG) resources are logistically constrained and unable to meet their growing demand for seizure detection even in highly developed centers.

View Article and Find Full Text PDF

Introduction: The 21-point Brain Care Score (BCS) was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke. We aimed to assess the associations of the BCS with risk of incident dementia and stroke.

Methods: The BCS was derived from the United Kingdom Biobank (UKB) baseline evaluation for participants aged 40-69 years, recruited between 2006-2010.

View Article and Find Full Text PDF

Study Objectives: To test the feasibility of a novel at-home salivary Dim Light Melatonin Onset (DLMO) assessment protocol to measure the endogenous circadian phase of 10 individuals ( 1 Advanced Sleep-Wake Phase Disorder patient (ASWPD), 4 Delayed Sleep-Wake Phase Disorder patients (DSWPD), and 5 controls).

Methods: The study tracked the sleep and activity patterns of 10 individuals over a 5-6 week period using self-reported online sleep diaries and objective actigraphy data. Participants completed two self-directed DLMO assessments, approximately one week apart, adhering to objective compliance measures.

View Article and Find Full Text PDF
Article Synopsis
  • Clinical diagnosis of epilepsy is complicated by the reliance on identifying interictal epileptiform discharges (IEDs) in EEGs, a process that can be biased and time-consuming.
  • There is a lack of automated methods to differentiate between epileptic EEGs, even those without IEDs, and normal EEGs, indicating a need for improved automated systems for EEG interpretation.
  • This study investigates various EEG features and background characteristics to enhance diagnosis accuracy and reports promising results with improved classification metrics for both IEDs and IED-independent EEG features.
View Article and Find Full Text PDF

Purpose: Robust prediction of progression on active surveillance (AS) for prostate cancer can allow for risk-adapted protocols. To date, models predicting progression on AS have invariably used traditional statistical approaches. We sought to evaluate whether a machine learning (ML) approach could improve prediction of progression on AS.

View Article and Find Full Text PDF

Epilepsy diagnosis based on Interictal Epileptiform Discharges (IEDs) in scalp electroencephalograms (EEGs) is laborious and often subjective. Therefore, it is necessary to build an effective IED detector and an automatic method to classify IED-free versus IED EEGs. In this study, we evaluate features that may provide reliable IED detection and EEG classification.

View Article and Find Full Text PDF

Background: Frailty has been associated with increased incidence of postoperative delirium and mortality. We hypothesised that postoperative delirium mediates a clinically significant (≥1%) percentage of the effect of frailty on mortality in older orthopaedic trauma patients.

Methods: This was a single-centre, retrospective observational study including 558 adults 65 yr and older, who presented with an extremity fracture requiring hospitalisation without initial ICU admission.

View Article and Find Full Text PDF

The diagnosis of epilepsy often relies on a reading of routine scalp electroencephalograms (EEGs). Since seizures are highly unlikely to be detected in a routine scalp EEG, the primary diagnosis depends heavily on the visual evaluation of Interictal Epileptiform Discharges (IEDs). This process is tedious, expert-centered, and delays the treatment plan.

View Article and Find Full Text PDF

Background And Purpose: Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology.

Materials And Methods: Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included.

View Article and Find Full Text PDF

Epilepsy diagnosis through visual examination of interictal epileptiform discharges (IEDs) in scalp electroencephalogram (EEG) signals is a challenging problem. Deep learning methods can be an automated way to perform this task. In this work, we present a new approach based on convolutional neural network (CNN) to detect IEDs from EEGs automatically.

View Article and Find Full Text PDF
Article Synopsis
  • Visual evaluation of EEG for identifying interictal epileptiform discharges (IEDs) has limitations such as time consumption, steep learning curves, and variability among different observers, highlighting the need for an automated detector.
  • The paper introduces a Convolutional Neural Networks (CNN)-based automated IED detector that outperforms traditional methods, showing high reliability with a mean precision-recall area of 0.838 and a low false detection rate.
  • Clinical validation at various hospitals indicates that the system matches or exceeds the performance of neurologists and can work with EEG recordings of any channel configuration.
View Article and Find Full Text PDF

Importance: Objective and early identification of hospitalized patients, and particularly those with novel coronavirus disease 2019 (COVID-19), who may require mechanical ventilation is of great importance and may aid in delivering timely treatment.

Objective: To develop, externally validate and prospectively test a transparent deep learning algorithm for predicting 24 hours in advance the need for mechanical ventilation in hospitalized patients and those with COVID-19.

Design: Observational cohort study SETTING: Two academic medical centers from January 01, 2016 to December 31, 2019 (Retrospective cohorts) and February 10, 2020 to May 4, 2020 (Prospective cohorts).

View Article and Find Full Text PDF

Objective: There are no validated methods for predicting the timing of seizures. Using machine learning, we sought to forecast 24-hour risk of self-reported seizure from e-diaries.

Methods: Data from 5,419 patients on SeizureTracker.

View Article and Find Full Text PDF

Purpose: Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE.

Methods: Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring.

Results: We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients.

View Article and Find Full Text PDF

This article summarizes the accomplishments and knowledge gained over the past 2 decades with respect to immediate dental root analogue implants (RAIs). It discusses how the artificial nature of the present dental implant materials and unnatural shapes cause complications, posing a threat to long-term biointegration, and how RAIs will influence the way that implants are produced. Will an osseointegrated RAI be the optimal immediate replacement for extracted teeth in the future? How will three-dimensional printing be involved in these more biomimetic RAI systems? The present research and developments seem promising and will continue to shape the future of implant prosthodontics.

View Article and Find Full Text PDF

Over and under-sedation are common in critically ill patients admitted to the Intensive Care Unit. Clinical assessments provide limited time resolution and are based on behavior rather than the brain itself. Existing brain monitors have been developed primarily for non-ICU settings.

View Article and Find Full Text PDF

Despite being first described over 50 years ago, periodic discharges continue to generate controversy as to whether they are always, sometimes, or never "ictal." Investigators and clinicians have proposed adjunctive markers to help clarify this distinction-in particular measures of perfusion and metabolism. Here, we review the growing number of neuroimaging studies using Fluorodeoxyglucose-PET, MRI diffusion, Magnetic resonance perfusion, Single Photon Emission Computed Tomography, and Magnetoencepgalography to gain further insight into the physiology and clinical significance of periodic discharges.

View Article and Find Full Text PDF

Objectives: The aims of this study were to determine the etiology, clinical features, and predictors of outcome of new-onset refractory status epilepticus.

Methods: Retrospective review of patients with refractory status epilepticus without etiology identified within 48 hours of admission between January 1, 2008, and December 31, 2013, in 13 academic medical centers. The primary outcome measure was poor functional outcome at discharge (defined as a score >3 on the modified Rankin Scale).

View Article and Find Full Text PDF