Roundtables
RT 1. Neurosciences
Thursday, 2 September, 09:15-10:45
Libertador B
Chair: Facundo Manes (Institute of Neurosciences, Favaloro University, Argentina)
In this roundtable, we will explore the way in which medical technology can prove extremely useful in studying higher cognitive functions and trying to dissect the complex underlying neurological mechanisms that feed such processes. We have begun by understanding the way in which functional neuroimaging can shed light onto the role of specific brain regions involved in language. Now, we will approach the very interesting issue of deep brain stimulation and the way in which fast scan cyclic voltammetry recordings can further contribute to the development of more efficient techniques. Finally, we will witness how different technologies can be employed in measuring awareness and consciousness. Attendees will gain insight into the role of medical technology across different fields of neuroscience through examples with a direct impact on clinical settings.
Fast Scan Cyclic Voltammetry recordings during Deep Brain Stimulation Neurosurgery in Humans
Kendall H. Lee1 and Kevin Bennet
Department of Neurologic Surgery1 and Division of Engineering2, Mayo Clinic, Rochester, MN, USA
Deep brain stimulation (DBS) is now an established neurosurgical treatment for several pathologies including Parkinson’s disease, Essential Tremor, epilepsy, depression, and chronic pain. To help elucidate the neurochemical mechanism of action of DBS, we have developed a wireless instantaneous neurotransmitter concentration sensor (WINCS) system, which combines digital telemetry with fast-scan cyclic voltammetry (FSCV) for real-time, chemically resolved measurements at an implanted microelectrode. Here we describe application of WINCS system in human patients during clinical subthalamic nucleus (STN) and ventralis intermedius (VIM) thalamic DBS neurosurgery. WINCS hardware is a micro-processor controlled, MRI-compatible, battery-powered instrument that combines Bluetooth digital telemetry with FSCV and constant potential amperometry. The WINCS base-station software (WINCSware) controls the wireless patient module, filters and processes the received data stream, and displays the results in nearly real time. The WINCS Electrode (WINCStrode) is based on an approved human extracellular tungsten electrophysiology electrode that was modified by the addition of a short section of carbon-fiber to enable FSCV recordings. The WINCS hardware, WINCSware, and WINCStrode were used successfully during clinical STN DBS neurosurgery. Leksell Model G Stereotactic headframe, MRI guided neuronavigation for surgical targeting, and Alpha-Omega computer driven electrode delivery system were also utilized. Our protocol was approved by the Mayo Clinic IRB for human studies. Successful real-time analysis of wireless FSCV recordings from WINCS using the WINCStrode was performed both in a flow cell in vitro and 4 human Parkinson’s disease or 1 Essential Tremor patients undergoing DBS neurosurgery. For FSCV, which consisted of application of a triangle wave scanned at 10 Hz between -0.4 and +1.5 V at a rate of 400 V/sec, the neurochemical data were transmitted by the WINCS hardware to the computer base station for presentation of a continuous three-dimensional color plot of sequential background-subtracted voltammograms. Following WINCS recording, all patients had good clinical response from the DBS system, without complications. These results demonstrate the feasibility and safety of performing FSCV recordings in humans undergoing DBS neurosurgery. Further, we believe the combination of these sophisticated in vivo techniques will provide important new insights into the neurobiological mechanisms of DBS action in humans. Finally, our results support the notion that FSCV may be used in the future as the sensing component of a "smart" DBS device providing enhanced utility to human patients.
Are you conscious? Cognitive gadgets to measure awareness
Tristan Bekinschtein
Cognition and Brain Sciences Unit, Cambridge University, UK
Attention, memory, perception, are common concepts nevertheless consciousness it is just now starting to be discussed as a scientific topic. I will present a series of experiments attempting to measure consciousness. Subliminal presentation of stimuli, unconscious learning, dreams and more will be reviewed to arrive to a common theoretical framework that should allows us to think of strategies to tackle communication without the need of verbal or motor responses. We will finish by looking at the last advances in brainreading, lie detection, and brain decoding.
RT 2. Public Health, Epidemiology and Surveillance
Thursday, 2 September, 16:00-17:30
Auditorium
Chair: Alvaro Margolis (Federación Médica del Interior - FEMI, Uruguay)
In this roundtable, the panelists will address the application of information systems for the enhancement of Public Health, Epidemiology and Surveillance.
Experts from Peru, Argentina and Uruguay will communicate their long-standing experience about these topics, ranging from the application of mobile phones for the follow-up of HIV patients in Peru, to the use of electronic health records as part of the strategy for management of frequent chronic conditions in Argentina. Countrywide experiences from Argentina and Uruguay will also be shown. In the case of Uruguay, details will be given about a project towards a federal electronic health record covering one fourth of the population.
Panelists:
Fernán González Bernaldo de Quirós, MD
He is ViceDirector of Strategic Planning in the Hospital Italiano de Buenos Aires (HIBA) Argentina. He also has academic appointments in the Internal Medicine Division and he is head of the Department of Human Physiology at the School of Medicine in HIBA and Head of the Area of Research at the Internal Medicine Division from July 2006. He has created fellowship programs on Healthcare Management in 1998, a 4-year Medical Informatics Residency Program that started in 2001, Clinical Management and Chronic Disease Management in 2003 and Clinical Research in Internal Medicine in 2007. More than 20 fellows have been trained in these programs under the supervision of the Department of Research and Education at HIBA. Dr. Quirós’ research focuses on the development of electronic medical records and disease management programs. He has published over 50 scientific peer-reviewed papers on different topics that include: internal medicine, medical informatics and disease management.
Alvaro Margolis, MD, MS
He is an internist from Uruguay with a Master’s degree in Medical Informatics from the University of Utah (USA). He has held academic positions in Internal Medicine and in Continuing Medical Education at the School of Medicine, Universidad de la República, Uruguay. Over the last decade he has coordinated and participated in several clinical informatics projects. Dr. Margolis is the President of the Federation of Health Informatics Societies in Latin America and the Caribbean, a chapter of the International Medical Informatics Association (IMIA-LAC). He has been and is a member of international scientific committees, such as Medinfo 2007 and 2010.
Walter H. Curioso, MD, MPH, PhD
Walter H. Curioso is a research professor at the Universidad Peruana Cayetano Heredia (UPCH) in Lima, Peru. He’s also an affiliate assistant professor in the Division of Biomedical and Health Informatics at the University of Washington (UW) in Seattle. Dr. Curioso received his MD from UPCH, his MPH from the UW, and he is a PhD candidate in Biomedical and Health Informatics at the UW. His latest projects involve using cell phones to support HIV antiretroviral adherence, diabetes and maternal health; and using cell phones and the Internet to develop a real-time surveillance system for adverse events. E-mail: wcurioso@uw.edu. Web: http://faculty.washington.edu/wcurioso/
Lino Bessonart, BSc, PMP
He was trained in computer science at Universidad de la República, Uruguay. He has coordinated several informatics projects in Uruguay, the latest one being FEMI Salud Digital, where an electronic health record and balanced scorecard are being implemented across a Federation of 24 institutions within the Country (Uruguay). He also is Coordinator of RAP Ceibal, a non-for-profit organization supporting the implementation of the one-laptop-per-child initiative for all elementary-school students in Uruguay.
Gastón Perman, MD
Dr. Gastón Perman is an Internal Medicine Specialist. Former fellow in Disease Management at the Hospital Italiano in Buenos Aires, he is now Head of Medical Programs at this institution. His research focus is on health services management and clinical effectiveness and cost-effectiveness. Committed to education in undergraduate and postgraduate courses, he is co-author of the first Chronic Disease Management on-line Course in Argentina. Currently Director of the Course for Educators in Diabetes Mellitus and Leading tutor in Public Health, he is also coordinator of the Healthcare Management and the Clinical Management and Chronic Disease Management fellowships at the School of Medicine of Hospital Italiano.
Juan Gil, MD, MPH, PhD
He is a research adjunct professor at the Department of Epidemiology and Quantitative Methods, School of Medicine, Universidad de la República, Uruguay. Dr. Gil received his MD from the Universidad de la República, his MPH from the Université Bordeaux 2 (France), and his PhD from the Université de Limoges (France). Over the last decade he has participated in several clinical and epidemiological studies and he is currently a member of the FEMI Salud Digital project (FEMI-IADB).
Rodrigo del Mónaco
A Software Engineer, he works for the Argentine Ministry of Health, IT Direction, as the lead developer of the National Surveillance Software (SNVS). For the past ten years he has been leading a team of developers that created Internet-based tools to support the Disease Surveillance Strategic Information Systems. This software now has over three thousand users, geographically disperse with different levels of integration.
Julián Antman, BA
An Epidemiologist holding a BA in Psychology degree. He works for the Argentine Ministry of Health, currently serving as coordinator of the surveillance area at de Epidemiologic Department. For the past seven years he has been leading the implementation of the Clinical surveillance module of the National Surveillance System.
