Research
Main Research Area: Monitoring of Awareness during Anesthesia
Anaesthesia is a reversible state of drug-induced unconsciousness. During surgery, the administration of the anaesthetic drugs is accompanied with a neuromuscular blocking agent to prevent patient movements. It is possible that the patient becomes conscious during surgery, but due to the neuromuscular blocking agent, cannot make this evident. In this project are currently exploring the usage of EEG signals to assess the depth of anaesthesia with ultimate aim to produce a hardware solution, which will be used in operating theatres.
See Publications for relevant published works.
Figure: EEG data from patient volunteers during wakefulness (left), surgical anesthesia (centre) and deep anesthesia - burst suppression (right).
Ongoing projects:
Alzheimer's Association (Grant #: AARG-NTF-22-928616)
Principal Investigator: Dr Nicoletta Nicolaou
Research Team:
University of Nicosia Research Foundation: Prof Aleksandar Jovanovic (Co-Investigator), Dr Stelios Georgiades, Dr Stella Angeli, Dr Yiolanda Christou.
The Cyprus Institute of Neurology and Genetics: Prof Savvas Papacostas (Co-Investigator), Dr Ioanna Kousiappa (Co-Investigator), Dr Andreas Koupparis, Dr Stavros Bashiardes, Dr Andreas Hadjisavvas, Dr George Loucaides, Prof Mihalis Panayiotidis.
Our main objective in this project is to investigate whether administration of probiotics to patients with mild AD reduces neuroinflammation, improves cognitive functioning and modifies neurophysiological measures, compared to a patient group that receives placebo (no active probiotics). We hypothesize that, following probiotic administration, we will see a reduction in specific blood inflammatory markers, which will correlate with positive changes in neurophysiological activity and cognitive test scores, in the probiotics but not the placebo group. We will also study the microbiome composition of the participants to identify whether positive changes are related to specific microbiome profiles.
2. Leadership and management in the undergraduate medical curriculum (LEADER) (2021-2023)
UNic Medical School Research SEED Fund
PI: Prof Alexia Papageorgiou; Research Team members (UNIC): Dr Nicoletta Nicolaou, Dr Soulla Nicolaou, Dr Paola Nicolaides, Ms Cornelia Nicolaou
Physicians play a critical role in the healthcare team and medical graduates are expected to “provide leadership skills that enhance team functioning, the learning environment, and/or the healthcare delivery system”, as described by The Association of American Medical Colleges (AAMC). Even though leadership and management skills are recognised as important areas in postgraduate medical education by a number of associations, including the UK National Health Service (NHS) and the General Medical Council (GMC), there is lack of formal leadership, management and teamwork skills training at undergraduate level, with limited literature on how to incorporate these into the medical curriculum. In the proposed project, we will investigate the development of a leadership / management course tailored specifically to undergraduate medical students. The project will leverage inter-professional opportunities through partnering with the School of Management & MIS to develop a course that systematically strengthens the components of leadership currently found in our 6-year undergraduate Doctor of Medicine (MD) Programme curriculum with appropriately adapted material routinely taught to business students. The developed course will be delivered as a pilot to volunteer MD students. Participant opinions about the inclusion of such a course in the curriculum and course efficacy, as well as their opinions on the necessary knowledge and skills for leadership and management, and personality traits will be assessed through online questionnaires. The results are expected to inform the development of a course that could be incorporated as part of the MD programme curriculum reform. Such a novel and modern course will equip the MD programme students with necessary knowledge and skills required to work post-graduation as part of inter-professional teams, but also to take on leadership roles in healthcare.
3. Simulation in medical education: development of a stethoscope for realistic auscultation during clinical competence examinations (SimuSCOPE) (2021-2022)
UNic Medical School Research SEED Fund
PI: Dr Nicoletta Nicolaou; Research Team members: Dr Panayiota Demosthenous
The use of simulation in assessments of clinical competence, such as Objective Structured Clinical Examinations (OSCEs), provides an opportunity for more realistic assessment of the candidate’s clinical skills while examining real clinical features. The project involves the development of a stethoscope device that plays pre-selected (ab)normal auscultation sounds automatically and only when the device is in direct contact with the patient’s body, for use in assessment of clinical competence. The proposed device can offer advanced and realistic assessment of student skills and knowledge on interpretation of pre-recorded normal and/or abnormal auscultation sounds (heart, lung, gut) using simulated patients, which would otherwise require use of real patients. The device will comprise a standard stethoscope, into which has been integrated a standard MP3 played with pre-loaded auscultation sounds or a Bluetooth module that allows playback of selected sounds via a smartphone device, earphones, rechargeable battery, microprocessor unit and touch sensor. When the device is in contact with the body, the patient’s own physiological heart/lung sounds are masked and replaced with the pre-loaded auscultation sounds, allowing realistic clinical examination and diagnosis during the OSCE. The custom-made device will source off-the-shelf components and will address some drawbacks of current state-of-the-art at a fraction of the cost. Testing of the device will take place in the lab and in “real” examination conditions, with subsequent assessment of student, examiner and simulated actor opinions on the usefulness, practicality and realism offered by the device.
4. COST Action: The neural architecture of consciousness (CA18106)
Action Chair: Dr. Kristian Sandberg; Action Vice-chair: Prof Michał Wierzchon
Role: Management Committee member.
Action description: "To examine the role of cortical neural architecture in consciousness from a basic science as well as a clinical perspective. This will be achieved through detailed neuroarchitectural models from different kinds of brain data and relating these to behavioural data from healthy normal participants performing tasks associated with conscious perception/behaviour, as well as to clinical data from patients with disorders of consciousness. The relation between neural architecture and consciousness will be made using advanced statistical modelling, including machine learning."
Past funded projects:
1. IoT based Continuous Environmental Monitoring for Health Analytics (Snow-IoT) (June 2019 - February 2022)
Research in Enterprises (ENTERPRISES/0618), Cyprus Research Promotion Foundation.
Principal Investigator: CyRiC; Partners: University of Nicosia Medical School (via UNRF), Ygia Polyclinic.
Snow-IoT aims to research the applicability of Internet of Things enabled continuous environmental monitoring for better health care and better design of urban environments. The project plans to investigate methods to provide the general public continuous awareness of the environmental dangers, regarding health and sustainable living, related to their habitat environment. Snow-IoT will utilize data from IoT sensors as well as aggregated statistics from healthcare providers in order to better plan IoT sensor installation, provide analytics and insights on the environmental conditions and research causality models that can be derived by the data correlations observed.
Two main IoT networks covering the Larnaca and Limassol Bay regions will be established during the project. Continuous environmental monitoring will include very specific air and water sensors, which will allow longitudinal and continuous monitoring of air and water quality. The data from these sensors, together with relevant regional health data, will be combined to investigate the potential impact of environmental factors on public health in these areas. The results of the project will become available through an enhanced insights platform providing additional data to health care providers as well as continuously analysing risks and offer awareness to the general public.
2. Brain-Computer Music Interface for Monitoring and Inducing Affective States.
3. Intra-European Individual Marie-Curie Fellowship: Monitoring awareness during surgery: a multi-modal approach (AnaeWARE) (Imperial College London, UK, Aug. 2014 - Aug. 2016)
This project builds on my previous research by adding a multi-modal component to monitoring awareness during anaesthesia. This will be achieved though the recording of multi-modal signals during surgery, in addition to EEG activity, and the investigation of the causal / synchrony relationships between them.
Funding: This project received funding from the People Programme (Marie Curie Actions) of the European Union's Seventh Framework Programme (FP7/2007-2013) under REA grant agreement no623767.
4. Individual DIDAKTOR Fellowship: Monitoring awareness during surgery (University of Cyprus, Cyprus, May 2009-May 2012)
This project was performed in collaboration with Nicosia General Hospital (NGH). EEG data were collected at NGH from patients/volunteers during surgery under general anesthesia. Different measures were applied offline on the EEG data to investigate factors such as how the EEG is affected by the administration of different anesthetic agents and how to identify periods during which a patient may become conscious. By applying specific sets of measures we managed to capture what we believe is a manifestation of the underlying mechanisms of general anesthesia on the observed EEG, leading to in a universal measure that can be incorporated into a device for monitoring depth of anesthesia.
Funding: This project was funded under the Cyprus Research Promotion Foundation's Framework Programme for Research, Technological Development and Innovation 2008 (DESMI 2008), co-funded by the Republic of Cyprus and the European Regional Development Fund (Grant: DIDAKTOR/DISEK/0308/20).
5. Real-time music modification based on biosignals (RUMBA)
UNic Medical School Research SEED Fund
PI: Dr Nicoletta Nicolaou; Research Team members: Dr Evagoras Xydas - IREROBOT Ltd (Researcher), Prof Slawomir Nasuto (University of Reading, UK), Dr Marcela Vizcaychipi (Chelsea & Westminster Hospital London / Imperial College London, UK).
In the proposed project we will develop an automated prototype system that modifies music in real-time based on the listener's heart rate. Given that the tempo in particular is suggested to play a key role in actively modulating listener emotions by inducing changes in arousal (faster tempo is associated with higher arousal, and vice versa), the custom-built processing pipeline will implement a method for estimating the tempo of real (polyphonic) music and a method for manipulating the music such that an increase / decrease of the tempo is achieved based on changes in a biosignal that is indicative of arousal (heart rate). The proposed platform will be used as the basis for developing a more complex music manipulation methodology / system that utilizes a combination of physiological measures of arousal (brain, cardiovascular and respiratory activity) to modify additional musical features. The aim is to incorporate this methodology in a clinical setting for perioperative reduction of anxiety.
6. Concept maps as a novel assessment tool in medical education (CANVAS)
UNic Medical School Research SEED Fund
PI: Dr Stella Loizou; Research Team members (UNic Medical School): Dr Nicoletta Nicolaou, Prof Alexia Papageorgiou, Prof Peter McCrorie.
The project introduces Concept Maps (CMs) in a Problem-Based Learning setting, to investigate whether CMs help at improving clinical reasoning and deepening knowledge as part of medical education.
Relevant publications:
S Loizou, N Nicolaou, BA Pincus, A Papageorgiou, P McCrorie, 'Concept maps as a novel assessment tool in medical education', (under review), MedEdPublish, 2022.