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  • Digital Twins in Health

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Jacquemet, Vincent;

    Atrial arrhythmias are the most frequent rhythm disorders in humans and often lead to severe complications such as heart failure and stroke. While different mapping techniques have provided significant information on the electrophysiological processes associated with atrial fibrillation (AF), the mechanisms underlying AF initiation and maintenance remain unclear. Hence the treatment of atrial arrhythmias is still based on empirical considerations. To assist the study of the complex spatio-temporal dynamics of AF, a realistic-size computer model of human atria was developed. The model geometry was derived from magnetic resonance images of the human heart. Mathematical models of cell electrophysiology describing the ionic currents through the cell membrane were used. By representing the domain as a three-dimensional monolayer, the computational load was sufficiently reduced to allow the simulation of more than 20 seconds of an arrhythmia. With this model, simulated AF, i.e. multiple reentrant wavelets, were induced using different clinically relevant protocols. The model outputs both transmembrane potential maps and electrograms at any location in the atria, facilitating comparisons of simulation results to experimental or clinical data. It is also possible to study separately the conditions leading to the initiation and perpetuation of AF, and, more generally, to uncouple the phenomena by controlling separately the parameters affecting the simulation. First, the mechanisms leading to AF initiation and perpetuation were investigated. In a model of normal conduction in the atria, electrically-induced AF was unsustained and converted to sinus rhythm after a few seconds. After remodeling (applied as an abrupt alteration of tissue properties), however, episodes of sustained AF were obtained. Simulated AF was observed as several wavelets propagating randomly over the whole atrial surface and undergoing anatomical and functional reentries, collisions, and annihilation by mutual interaction. The simulation studies suggest that the restitution dynamics (describing the dependence of the action potential duration on the previous diastolic interval) and the wavelength (effective refractory period × conduction velocity) play a crucial role in determining the duration of AF. Electrograms were then computed during simulated AF and their morphology was characterized by their amplitude and asymmetry. These simulated electrograms were similar to those recorded in humans. By simulating wavefront propagation in carefully prepared conditions, is was possible to determine the effect of the different components of AF dynamics (wavefront shape, collisions, conduction blocks, wavelength) as well as the influence of the underlying substrate (tissue conductivity, anisotropy, heterogeneity) on waveform morphology. Analysis of the amplitude and symmetry of unipolar atrial electrograms is believed to provide information about the electrophysiological substrate maintaining AF.

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    https://doi.org/10.5075/epfl-t...
    Other literature type . 2005
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      image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/ Infoscience - EPFL s...arrow_drop_down
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      https://doi.org/10.5075/epfl-t...
      Other literature type . 2005
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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Tim Hulsen;

    Abstract The metaverse is a virtual world that is being developed to allow people to interact with each other and with digital objects in a more immersive way. It involves the convergence of three major technological trends: telepresence, the digital twin, and blockchain. Telepresence is the ability of people to “be together” in a virtual way while not being close to each other. The digital twin is a virtual, digital equivalent of a patient, a medical device or even a hospital. Blockchain can be used by patients to keep their personal medical records secure. In medicine and healthcare, the metaverse could be used in several ways: (1) virtual medical consultations; (2) medical education and training; (3) patient education; (4) medical research; (5) drug development; (6) therapy and support; (7) laboratory medicine. The metaverse has the potential to enable more personalized, efficient, and accessible healthcare, improving patient outcomes and reducing healthcare costs. However, the implementation of the metaverse in medicine and healthcare will require careful consideration of ethical and privacy concerns, as well as social, technical and regulatory challenges. Overall, the future of the metaverse in healthcare looks bright, but new metaverse-specific laws should be created to help overcome any potential downsides.

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    Advances in Laboratory Medicine / Avances en Medicina de Laboratorio
    Article . 2023 . Peer-reviewed
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      Advances in Laboratory Medicine / Avances en Medicina de Laboratorio
      Article . 2023 . Peer-reviewed
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  • Authors: Samuel A. Neymotin; Cliff C. Kerr; Joseph T. Francis; William W. Lytton;

    Neuronal networks are complex, adaptive systems that typically display oscillatory dynamics. The extent to which these dynamics can be shaped by training remains unknown. We explored this dynamical training in a computer model of 6-layered sensory neocortex with 470 excitatory (E) and inhibitory (I) cells. AMPA, NMDA, and GABAA synapses were provided with Poisson input to provide baseline activation in the network. The learning rule employed spike-timing-dependent plasticity (STDP) at all AMPA synapses. We trained with a 1–16 Hz thalamic afferent signal to E4 cells (layer 4 E cells). At baseline, the power spectrum of the network activity showed oscillations with a low-amplitude peak near 6 Hz. Plasticity in the absence of a training signal (white noise input) attenuated the network response, due to the potentiation of E-to-I synapses. Plasticity coupled with an 8 Hz training signal enhanced the network's oscillations and shifted the peak to ∼20 Hz. This was due to increased synaptic connection strengths between E cells caused by the near-synchronous firing of E4 cells. Plasticity coupled with a 16 Hz training signal shifted the network towards epilepsy, with high-amplitude 8 Hz oscillations and synchronous firing across all layers. The shift into epilepsy was caused by further enhancement of E-to-E synapses. In summary, our simulations demonstrate the feasibility of using plasticity and neuroprosthetic input signals to train a neuronal network's oscillatory dynamics. We predict that in order for learning in the brain to avoid transition to epilepsy, homeostatic control mechanisms must balance learning at E-to-E and E-to-I synapses.

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    Authors: Eduardo Graells-Garrido; Feliu Serra-Burriel; Francisco Rowe; Fernando M. Cucchietti; +1 Authors

    As cities expand, human mobility has become a central focus of urban planning and policy making to make cities more inclusive and sustainable. Initiatives such as the “15-minutes city” have been put in place to shift the attention from monocentric city configurations to polycentric structures, increasing the availability and diversity of local urban amenities. Ultimately they expect to increase local walkability and increase mobility within residential areas. While we know how urban amenities influence human mobility at the city level, little is known about spatial variations in this relationship. Here, we use mobile phone, census, and volunteered geographical data to measure geographic variations in the relationship between origin-destination flows and local urban accessibility in Barcelona. Using a Negative Binomial Geographically Weighted Regression model, we show that, globally, people tend to visit neighborhoods with better access to education and retail. Locally, these and other features change in sign and magnitude through the different neighborhoods of the city in ways that are not explained by administrative boundaries, and that provide deeper insights regarding urban characteristics such as rental prices. In conclusion, our work suggests that the qualities of a 15-minutes city can be measured at scale, delivering actionable insights on the polycentric structure of cities, and how people use and access this structure. E.G-G., F.S-B., F.M.C. and P.R. were partly supported by the H2020 IoTwins project (Distributed Digital Twins for industrial SMEs: a big-data platform) funded by the EU under the call ICT-11-2018-2019, Grant Agreement No 857191. E.G-G. was partly funded by ANID Fondecyt de Iniciación 11180913. Peer Reviewed

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    https://doi.org/10.48550/arxiv...
    Article . 2021
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      https://doi.org/10.48550/arxiv...
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    Authors: Marwaha, Jayson S.; Landman, Adam B.; Brat, Gabriel A.; Dunn, Todd; +1 Authors

    AbstractIn recent years, the number of digital health tools with the potential to significantly improve delivery of healthcare services has grown tremendously. However, the use of these tools in large, complex health systems remains comparatively limited. The adoption and implementation of digital health tools at an enterprise level is a challenge; few strategies exist to help tools cross the chasm from clinical validation to integration within the workflows of a large health system. Many previously proposed frameworks for digital health implementation are difficult to operationalize in these dynamic organizations. In this piece, we put forth nine dimensions along which clinically validated digital health tools should be examined by health systems prior to adoption, and propose strategies for selecting digital health tools and planning for implementation in this setting. By evaluating prospective tools along these dimensions, health systems can evaluate which existing digital health solutions are worthy of adoption, ensure they have sufficient resources for deployment and long-term use, and devise a strategic plan for implementation.

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    npj Digital Medicine
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    Authors: A. Avanaki;

    This symposium will review recent advances in the simulation methods for evaluation of novel breast imaging systems – the subject of AAPM Task Group TG234. Our focus will be on the various approaches to development and validation of software anthropomorphic phantoms and their use in the statistical assessment of novel imaging systems using such phantoms along with computational models for the x-ray image formation process. Due to the dynamic development and complex design of modern medical imaging systems, the simulation of anatomical structures, image acquisition modalities, and the image perception and analysis offers substantial benefits of reduced cost, duration, and radiation exposure, as well as the known ground-truth and wide variability in simulated anatomies. For these reasons, Virtual Clinical Trials (VCTs) have been increasingly accepted as a viable tool for preclinical assessment of x-ray and other breast imaging methods. Activities of TG234 have encompassed the optimization of protocols for simulation studies, including phantom specifications, the simulated data representation, models of the imaging process, and statistical assessment of simulated images. The symposium will discuss the state-of-the-science of VCTs for novel breast imaging systems, emphasizing recent developments and future directions. Presentations will discuss virtual phantoms for intermodality breast imaging performance comparisons, extension of the breast anatomy simulation to the cellular level, optimized integration of the simulated imaging chain, and the novel directions in the observer models design. Learning Objectives: 1.Review novel results in developing and applying virtual phantoms for inter-modality breast imaging performance comparisons; 2.Discuss the efforts to extend the computer simulation of breast anatomy and pathology to the cellular level; 3.Summarize the state of the science in optimized integration of modules in the simulated imaging chain; 4.Compare novel directions in the design of observer models for task based validation of imaging systems. PB: Research funding support from the NIH, NSF, and Komen for the Cure; NIH funded collaboration with Barco, Inc. and Hologic, Inc.; Consultant to Delaware State Univ. and NCCPM, UK. AA: Employed at Barco Healthcare.; P. Bakic, NIH: (NIGMS P20 #GM103446, NCI R01 #CA154444); M. Das, NIH Research grants

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    Medical Physics
    Article . 2016 . Peer-reviewed
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      image/svg+xml Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Closed Access logo, derived from PLoS Open Access logo. This version with transparent background. http://commons.wikimedia.org/wiki/File:Closed_Access_logo_transparent.svg Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao
      Medical Physics
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  • image/svg+xml Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Closed Access logo, derived from PLoS Open Access logo. This version with transparent background. http://commons.wikimedia.org/wiki/File:Closed_Access_logo_transparent.svg Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao
    Authors: John R, Fitz-Clarke;

    The world record for a sled-assisted human breath-hold dive has surpassed 200 m. Lung compression during descent draws blood from the peripheral circulation into the thorax causing engorgement of pulmonary vessels that might impose a physiological limitation due to capillary stress failure. A computer model was developed to investigate cardiopulmonary interactions during immersion, apnea, and compression to elucidate hemodynamic responses and estimate vascular stresses in deep human breath-hold diving. The model simulates active and passive cardiovascular adjustments involving blood volumes, flows, and pressures during apnea at diving depths up to 200 m. Redistribution of blood volume from peripheral to central compartments increases with depth. Pulmonary capillary transmural pressures in the model exceed 50 mm Hg at record depth, producing stresses in the range known to cause alveolar capillary damage in animals. Capillary pressures are partially attenuated by blood redistribution to compliant extra-pulmonary vascular compartments. The capillary pressure differential is due mainly to a large drop in alveolar air pressure from outward elastic chest wall recoil. Autonomic diving reflexes are shown to influence systemic blood pressures, but have relatively little effect on pulmonary vascular pressures. Increases in pulmonary capillary stresses are gradual beyond record depth.

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    European Journal of Applied Physiology and Occupational Physiology
    Article . 2007 . Peer-reviewed
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      image/svg+xml Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao Closed Access logo, derived from PLoS Open Access logo. This version with transparent background. http://commons.wikimedia.org/wiki/File:Closed_Access_logo_transparent.svg Jakob Voss, based on art designer at PLoS, modified by Wikipedia users Nina and Beao
      European Journal of Applied Physiology and Occupational Physiology
      Article . 2007 . Peer-reviewed
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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Boon, Ian S.; Au Yong, Tracy P. T.; Boon, Cheng S.;

    The fields of radiotherapy and clinical oncology have been rapidly changed by the advances of technology. Improvement in computer processing power and imaging quality heralded precision radiotherapy allowing radiotherapy to be delivered efficiently, safely and effectively for patient benefit. Artificial intelligence (AI) is an emerging field of computer science which uses computer models and algorithms to replicate human-like intelligence and perform specific tasks which offers a huge potential to healthcare. We reviewed and presented the history, evolution and advancement in the fields of radiotherapy, clinical oncology and machine learning. Radiotherapy target delineation is a complex task of outlining tumour and organ at risks volumes to allow accurate delivery of radiotherapy. We discussed the radiotherapy planning, treatment delivery and reviewed how technology can help with this challenging process. We explored the evidence and clinical application of machine learning to radiotherapy. We concluded on the challenges, possible future directions and potential collaborations to achieve better outcome for cancer patients.

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    Europe PubMed Central
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    Authors: Bonert, Michael; Tate, Angela J.;

    Background Mitotic rate is routinely assessed in breast cancer cases and based on the assessment of 10 high power fields (HPF), a non-standard sample area, as per the College of American Pathologists cancer checklist. The effect of sample area variation has not been assessed. Methods A computer model making use of the binomial distribution was developed to calculate the misclassification rate in 1,000,000 simulated breast specimens using the extremes of field diameter (FD) and mitotic density cutoffs (3 and 8 mitoses/mm2), and for a sample area of 5 mm2. Mitotic counts were assumed to be a random sampling problem using a mitotic rate distribution derived from an experimental study (range 0–16.4 mitoses/mm2). The cellular density was 2500 cell/mm2. Results For the smallest microscopes (FD = 0.40 mm, area 1.26 mm2) 16% of cases were misclassified, compared to 9% of the largest (FD 0.69 mm, area 3.74 mm2), versus 8% for 5 mm2. An excess of 27% of score 2 cases were misclassified as 1 or 3 for the lower FD. Conclusion Mitotic scores based on ten HPFs of a small field area microscope are less reliable measures of the mitotic density than in a bigger field area microscope; therefore, the sample area should be standardized. When mitotic counts are close to the cut-offs the score is less reproducible. These cases could benefit from using larger sample areas. A measure of mitotic density variation due to sampling may assist in the interpretation of the mitotic score. Electronic supplementary material The online version of this article (doi:10.1186/s12938-016-0301-z) contains supplementary material, which is available to authorized users.

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    BioMedical Engineering OnLine
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  • Authors: Tasnim, Sinuff; Neill K J, Adhikari; Deborah J, Cook; Holger J, Schünemann; +3 Authors

    Risk-prediction models offer potential advantages over physician predictions of outcomes in the intensive care unit (ICU). Our systematic review compared the accuracy of ICU physicians' and scoring system predictions of ICU or hospital mortality of critically ill adults.MEDLINE (1966-2005), CINAHL (1982-2005), Ovid Healthstar (1975-2004), EMBASE (1980-2005), SciSearch (1980-2005), PsychLit (1985-2004), the Cochrane Library (Issue 1, 2005), PubMed "related articles," personal files, abstract proceedings, and reference lists.We considered all studies that compared physician predictions of ICU or hospital survival of critically ill adults to an objective scoring system, computer model, or prediction rule. We excluded studies if they focused exclusively on the development or economic evaluation of a scoring system, computer model, or prediction rule.We independently abstracted data and assessed study quality in duplicate. We determined summary receiver operating characteristic curves and areas under the summary receiver operating characteristic curves+/-se and summary diagnostic odds ratios.We included 12 observational studies of moderate methodological quality. The area under the summary receiver operating characteristic curves for seven studies was 0.85+/-0.03 for physician predictions compared with 0.63+/-0.06 for scoring system predictions (p=.002). Physicians' summary diagnostic odds ratios derived from the area under the summary receiver operating characteristic curves were significantly higher (12.43; 95% confidence interval 5.47, 27.11) than scoring systems' summary diagnostic odds ratios (2.25; 95% confidence interval 0.78, 6.52, p=.001). Combined results of all 12 studies indicated that physicians predict mortality more accurately than do scoring systems: ratio of diagnostic odds ratios (95% confidence interval) 1.92 (1.19, 3.08) (p=.007).Observational studies suggest that ICU physicians discriminate between survivors and nonsurvivors more accurately than do scoring systems in the first 24 hrs of ICU admission. The overall accuracy of both predictions of patient mortality was moderate, implying limited usefulness of outcome prediction in the first 24 hrs for clinical decision making.

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    Authors: Jacquemet, Vincent;

    Atrial arrhythmias are the most frequent rhythm disorders in humans and often lead to severe complications such as heart failure and stroke. While different mapping techniques have provided significant information on the electrophysiological processes associated with atrial fibrillation (AF), the mechanisms underlying AF initiation and maintenance remain unclear. Hence the treatment of atrial arrhythmias is still based on empirical considerations. To assist the study of the complex spatio-temporal dynamics of AF, a realistic-size computer model of human atria was developed. The model geometry was derived from magnetic resonance images of the human heart. Mathematical models of cell electrophysiology describing the ionic currents through the cell membrane were used. By representing the domain as a three-dimensional monolayer, the computational load was sufficiently reduced to allow the simulation of more than 20 seconds of an arrhythmia. With this model, simulated AF, i.e. multiple reentrant wavelets, were induced using different clinically relevant protocols. The model outputs both transmembrane potential maps and electrograms at any location in the atria, facilitating comparisons of simulation results to experimental or clinical data. It is also possible to study separately the conditions leading to the initiation and perpetuation of AF, and, more generally, to uncouple the phenomena by controlling separately the parameters affecting the simulation. First, the mechanisms leading to AF initiation and perpetuation were investigated. In a model of normal conduction in the atria, electrically-induced AF was unsustained and converted to sinus rhythm after a few seconds. After remodeling (applied as an abrupt alteration of tissue properties), however, episodes of sustained AF were obtained. Simulated AF was observed as several wavelets propagating randomly over the whole atrial surface and undergoing anatomical and functional reentries, collisions, and annihilation by mutual interaction. The simulation studies suggest that the restitution dynamics (describing the dependence of the action potential duration on the previous diastolic interval) and the wavelength (effective refractory period × conduction velocity) play a crucial role in determining the duration of AF. Electrograms were then computed during simulated AF and their morphology was characterized by their amplitude and asymmetry. These simulated electrograms were similar to those recorded in humans. By simulating wavefront propagation in carefully prepared conditions, is was possible to determine the effect of the different components of AF dynamics (wavefront shape, collisions, conduction blocks, wavelength) as well as the influence of the underlying substrate (tissue conductivity, anisotropy, heterogeneity) on waveform morphology. Analysis of the amplitude and symmetry of unipolar atrial electrograms is believed to provide information about the electrophysiological substrate maintaining AF.

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    Authors: Tim Hulsen;

    Abstract The metaverse is a virtual world that is being developed to allow people to interact with each other and with digital objects in a more immersive way. It involves the convergence of three major technological trends: telepresence, the digital twin, and blockchain. Telepresence is the ability of people to “be together” in a virtual way while not being close to each other. The digital twin is a virtual, digital equivalent of a patient, a medical device or even a hospital. Blockchain can be used by patients to keep their personal medical records secure. In medicine and healthcare, the metaverse could be used in several ways: (1) virtual medical consultations; (2) medical education and training; (3) patient education; (4) medical research; (5) drug development; (6) therapy and support; (7) laboratory medicine. The metaverse has the potential to enable more personalized, efficient, and accessible healthcare, improving patient outcomes and reducing healthcare costs. However, the implementation of the metaverse in medicine and healthcare will require careful consideration of ethical and privacy concerns, as well as social, technical and regulatory challenges. Overall, the future of the metaverse in healthcare looks bright, but new metaverse-specific laws should be created to help overcome any potential downsides.

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    Advances in Laboratory Medicine / Avances en Medicina de Laboratorio
    Article . 2023 . Peer-reviewed
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      Advances in Laboratory Medicine / Avances en Medicina de Laboratorio
      Article . 2023 . Peer-reviewed
      License: CC BY
      Data sources: Crossref
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  • Authors: Samuel A. Neymotin; Cliff C. Kerr; Joseph T. Francis; William W. Lytton;

    Neuronal networks are complex, adaptive systems that typically display oscillatory dynamics. The extent to which these dynamics can be shaped by training remains unknown. We explored this dynamical training in a computer model of 6-layered sensory neocortex with 470 excitatory (E) and inhibitory (I) cells. AMPA, NMDA, and GABAA synapses were provided with Poisson input to provide baseline activation in the network. The learning rule employed spike-timing-dependent plasticity (STDP) at all AMPA synapses. We trained with a 1–16 Hz thalamic afferent signal to E4 cells (layer 4 E cells). At baseline, the power spectrum of the network activity showed oscillations with a low-amplitude peak near 6 Hz. Plasticity in the absence of a training signal (white noise input) attenuated the network response, due to the potentiation of E-to-I synapses. Plasticity coupled with an 8 Hz training signal enhanced the network's oscillations and shifted the peak to ∼20 Hz. This was due to increased synaptic connection strengths between E cells caused by the near-synchronous firing of E4 cells. Plasticity coupled with a 16 Hz training signal shifted the network towards epilepsy, with high-amplitude 8 Hz oscillations and synchronous firing across all layers. The shift into epilepsy was caused by further enhancement of E-to-E synapses. In summary, our simulations demonstrate the feasibility of using plasticity and neuroprosthetic input signals to train a neuronal network's oscillatory dynamics. We predict that in order for learning in the brain to avoid transition to epilepsy, homeostatic control mechanisms must balance learning at E-to-E and E-to-I synapses.

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    Authors: Eduardo Graells-Garrido; Feliu Serra-Burriel; Francisco Rowe; Fernando M. Cucchietti; +1 Authors