Brigham and Women's Faulkner Hospital

Decades of research have demonstrated the complex intersection between sleep and epilepsy, which significantly impacts seizure control and epilepsy-related comorbidities. However, further investigation is needed to understand the underlying mechanisms linking sleep and epilepsy. Brain exchanges are dynamic processes that include blood-to-brain transport across the blood-brain barrier (BBB), where metabolism is regulated to sustain neural activity, and brain-to-blood and cerebrospinal fluid clearance via the glymphatic system. Together, the BBB and glymphatic system maintain brain milieu homeostasis, and dysfunction at any level can contribute to neurological disorders, including epilepsy. This review highlights the dynamics of water flow within the brain and explores the interrelationship between exchange and clearance pathways across the lifespan, as presented at the 2025 American Epilepsy Society Sleep and Epilepsy Special Interest Group Session. We provide an overview of (1) sleep-related breathing disturbances, their effects on seizures and cognitive function throughout the lifespan, and their implications for sudden unexpected death in epilepsy; and (2) the role of water dynamics mediated by the BBB and the glymphatic system in modulating sleep and epilepsy. These insights deepen our understanding of epilepsy severity and the role of sleep in modifying disease progression, offering promising directions for future research to advance therapeutic strategies.

Despite being the most common cause of dementia in the world, Alzheimer’s disease (AD) commonly remains underdiagnosed. The burden of AD is felt the most by the developing world and has been rising steadily with the increase in population longevity and increasing incidence of metabolic and vascular risk factors. Several advances have been made in understanding the neurobiological underpinnings of AD. AD is now diagnosed based on its biology, utilizing specific biomarkers as opposed to following the clinical approach, which is less precise. However, the currently used biomarkers (cerebrospinal fluid (CSF) biomarkers and Amyloid positron emission tomography (PET) scan findings) pose a huge challenge in terms of their global adoption because of their low affordability, poor accessibility, and perceived invasiveness. This challenge serves as a major roadblock in the timely and accurate diagnosis of AD, its prognostication, and in terms of pursuing newer targeted therapeutic approaches, which slow down the disease trajectory to some extent. As a result, blood-based biomarkers (BBMs) of AD are being developed. These have an immense potential to transform the landscape of AD diagnosis, treatment, prognostication, and research. Low- and middle-income countries like India should reflect on the role of BBMs of AD and consider ways to either develop them indigenously or adopt them in their healthcare systems to manage the worsening epidemic of AD. This paper discusses the opportunities and challenges faced by India in the context of utilizing BBMs of AD.

The aim of this study was to examine professional fulfillment, psychological safety, resilience, and their effect on burnout in the nursing workforce at a community teaching hospital. Nurses are at an increased risk for burnout, resulting in negative organizational impacts. To our knowledge, no study has analyzed well-being through professional fulfillment, psychological safety, and resilience in relation to burnout. This cross-sectional pilot study examined the concepts of professional fulfillment, burnout, psychological safety, and resilience of the nursing workforce at a community hospital. The sample of RNs (N = 96) had an inverse relationship between burnout and the other variables. Direct care nurses scored significantly lower than indirect care nurses on professional fulfillment (P = 0.001) and psychological safety (P = 0.011). Nurses with higher professional fulfillment were 22.6% less likely to experience burnout (odds ratio, 0.774). Future research is needed to explore specific opportunities for nurses' professional fulfillment and its influence on burnout.

The purpose of this study was to examine the impact of a contact-free continuous monitoring system on clinical outcomes including unplanned intensive care unit (ICU) transfer (primary), length of stay (LOS), code blue, and mortality. A secondary aim was to evaluate the return on investment associated with implementing the contact-free continuous monitoring program during the COVID public health emergency. An interrupted time series evaluation was conducted to examine the association between the use of contact-free continuous monitoring and clinical outcomes. A cost-benefit analysis was planned to evaluate the return on investment. Use of contact-free continuous monitoring was not significantly associated with unplanned ICU transfers, deaths, ICU LOS, and or rapid response team calls. However, there were significant increases in code blue events ( P = 0.02) and mean hospital LOS ( P = 0.01) in the postimplementation period when compared with the preimplementation period. Due to the lack of improvement, costs were calculated but a cost-benefit analysis was not conducted. Contact-free continuous monitoring bed use during the COVID-19 public health emergency was not associated with improvements in clinical outcomes, although there was substantial confounding. Future studies should include large randomized controlled trials to control for factors not under direct experimental control including unit staffing, staff turnover, and differences in the patient population related to surges in the COVID-19 pandemic.