On-demand EEG education through competition - A novel, app-based approach to learning to identify interictal epileptiform discharges

Objective

Misinterpretation of EEGs harms patients, yet few resources exist to help trainees practice interpreting EEGs. We therefore sought to evaluate a novel educational tool to teach trainees how to identify interictal epileptiform discharges (IEDs) on EEG.

Methods

We created a public EEG test within the iOS app DiagnosUs using a pool of 13,262 candidate IEDs. Users were shown a candidate IED on EEG and asked to rate it as epileptiform (IED) or not (non-IED). They were given immediate feedback based on a gold standard. Learning was analyzed using a parametric model. We additionally analyzed IED features that best correlated with expert ratings.

Results

Our analysis included 901 participants. Users achieved a mean improvement of 13% over 1,000 questions and an ending accuracy of 81%. Users and experts appeared to rely on a similar set of IED morphologic features when analyzing candidate IEDs. We additionally identified particular types of candidate EEGs that remained challenging for most users even after substantial practice.

Conclusions

Users improved in their ability to properly classify candidate IEDs through repeated exposure and immediate feedback.

Significance

This app-based learning activity has great potential to be an effective supplemental tool to teach neurology trainees how to accurately identify IEDs on EEG.

Towards a streamlined synthesis of peptides containing α,β-dehydroamino acids

Investigation of a strategy to streamline the synthesis of peptides containing α,β-dehydroamino acids (ΔAAs) is reported. The key step involves generating the alkene moiety via elimination of a suitable precursor after it has been inserted into a peptide chain. This process obviates the need to prepare ΔAA-containing azlactone dipeptides to facilitate coupling of these residues. Z-dehydroaminobutyric acid (Z-ΔAbu) could be constructed most efficiently via EDC/CuCl-mediated dehydration of Thr. Formation of Z-ΔPhe by this or other dehydration methods was unsuccessful. Production of the bulky ΔVal residue could be accomplished by DAST-promoted dehydrations of β-OHVal or by DBU-triggered eliminations of sulfonium ions derived from penicillamine derivatives. However, competitive formation of an oxazoline byproduct remains problematic.