0425 Severity of Insomnia Symptoms Differ by Cognitive Status in Adults with Down Syndrome

Introduction

Sleep is disturbed in Down syndrome (DS), with sleep apnea and insomnia prevalent throughout life. Sleep disturbance increases dementia risk and is more prevalent in dementia in non-DS populations. However, relationships between sleep and clinical status in DS remains unclear. We examined informant-reported sleep in adults with DS, with or without a consensus diagnosis of dementia, and related the severity of sleep disturbances to measures of adaptive behavior.

Methods

Insomnia (selected from Children’s Sleep Habits Questionnaire), daytime sleepiness (modified ESS), sleep apnea risk (modified STOP-BANG), and adaptive behavior (Vineland Adaptive Behavior Scales; VABS-3) questionnaires were collected from informants for 47 DS adults (52.1±6.6 years) enrolled in a Alzheimer’s disease biomarker study. Participants’ clinical statuses were categorized as cognitively unaffected (clinically significant impairment absent; n=38, 51.0±6.2 years), or as having definite dementia (clinically significant decline present; n=9, 56.6±6.4 years) using a standard consensus diagnosis procedure. Age was compared between groups using an independent samples t-test. ANCOVA was used to compare insomnia, daytime sleepiness, sleep apnea risk, and adaptive behavior measures across groups, while controlling for age. Partial correlation analyses examined associations between sleep measures and VABS-3 measures while controlling for clinical status.

Results

Participants categorized as definite dementia were older (t=-2.381, p=0.022). ANCOVA determined that insomnia symptoms, but not daytime sleepiness or apnea risk, were more severe in definite dementia participants (F=5.567, p=0.023), even when controlling for age. VABS-3 subscale scores differed by clinical status (all save play and leisure scores p<0.017). Partial correlation analyses adjusting for clinical status indicated that insomnia symptom severity worsened with lower adaptive functioning (e.g., daily living skills—coping r=-0.41, p=0.007; socialization r=-0.33, p=0.024) regardless of clinical status.

Conclusion

These findings indicate that insomnia may be related to functional impairment and dementia in DS adults, and raises the possibility that insomnia treatments may influence dementia course and clinical symptomatology in DS.

Support

NIH U01AG051412

Optimization and Validation of HPTLC Method for Estimation of Ulipristal Acetate in Presence of Its Forced Degradation Products

Ulipristal acetate (UPA) is used as emergency contraceptive and for uterine fibroids. No validated method has been reported to estimate UPA in presence of its degradation products. Therefore it is mandatory to develop method which can accurately measure it in presence of impurity. A simple and sensitive high-performance thin-layer chromatography (HPTLC) method was developed for the estimation of UPA. Pre-coated silica gel 60F254 TLC plates were as stationary phase and ethyl acetate:toluene:glacial acetic acid (4:7:0.3, v/v/v) was used as mobile phase. Drug was subjected to acid and alkali hydrolysis, oxidation, photo degradation and thermal degradation to study its degradation behavior. UPA eluted with Rf value 0.38 ± 0.02. The method was found to be linear in the concentration range of 400-3,600 ng/band. Limit of detection and limit of quantitation were found to be 72.7786 ng/band and 220.5412 ng/band, respectively. The % recovery of the proposed method was found to be 100.05-100.65%. The proposed method was specific to measure UPA in presence of degradants. The method was found to be accurate, precise, robust and can be useful for routine analysis of formulations containing UPA in presence of its degradation products.

Phytochemical Markers: Classification, Applications and Isolation

BACKGROUND

There has been aroused demand for herbal drugs/products worldwide because of their fewer side effects as compared to synthetic drugs. The major obstacle in the global acceptance of herbal products is the lack of proper standardization technique.

METHODS

Various test procedures have been used for authentication and quality control of botanicals among which marker based standardization has attained more attention. The major challenge faced by phytochemist is to select appropriate phytochemical marker for quality control of herbal drugs. Phytochemical markers used for standardization must be of known purity. Phytochemical markers which are not commercially available have to be isolated from respective medicinal plants. Various chromatographic techniques are reported for the purification of phytomarkers from plants. A comprehensive report on different purification techniques of isolation of phytochemical markers through in-depth review of scientific literature is required.

CONCLUSION

This article highlights various classifications of phytochemical markers along with their applications in standardization of herbal drugs and various classical and modern analytical techniques for their isolation.

Detection of Cross-Correlation between Gravitational Lensing and γ Rays

In recent years, many γ-ray sources have been identified, yet the unresolved component hosts valuable information on the faintest emission. In order to extract it, a cross-correlation with gravitational tracers of matter in the Universe has been shown to be a promising tool. We report here the first identification of a cross-correlation signal between γ rays and the distribution of mass in the Universe probed by weak gravitational lensing. We use data from the Dark Energy Survey Y1 weak lensing data and the Fermi Large Area Telescope 9-yr γ-ray data, obtaining a signal-to-noise ratio of 5.3. The signal is mostly localized at small angular scales and high γ-ray energies, with a hint of correlation at extended separation. Blazar emission is likely the origin of the small-scale effect. We investigate implications of the large-scale component in terms of astrophysical sources and particle dark matter emission.

HIV testing strategies outside of health care settings in the European Union (EU)/European Economic Area (EEA): a systematic review to inform European Centre for Disease Prevention and Control guidance

OBJECTIVES

In recent years, new technologies and new approaches to scale up HIV testing have emerged. The objective of this paper was to synthesize the body of recent evidence on strategies aimed at increasing the uptake and coverage of HIV testing outside of health care settings in the European Union (EU)/European Economic Area (EEA).

METHODS

Systematic searches to identify studies describing effective HIV testing interventions and barriers to testing were run in five databases (2010-2017) with no language restrictions; the grey literature was searched for similar unpublished studies (2014-2017). Study selection, data extraction and critical appraisal were performed by two independent reviewers following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Eighty studies on HIV testing in non-health care settings were identified, the majority set in Northern Europe. Testing was implemented in 65 studies, with men who have sex with men the risk group most often targeted. Testing coverage and positivity/reactivity rates varied widely by setting and population group. However, testing in community and outreach settings was effective at reaching people who had never previously been tested and acceptability of HIV testing, particularly rapid testing, outside of health care settings was found to be high. Other interventions aimed to increase HIV testing identified were: campaigns (n = 8), communication technologies (n = 2), education (n = 3) and community networking (n = 1).

CONCLUSIONS

This review has identified several strategies with potential to achieve high HIV testing coverage outside of health care settings. However, the geographical spread of studies was limited, and few intervention studies reported before and after data, making it difficult to evaluate the impact of interventions on test coverage.

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

OBJECTIVES

Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA).

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010-2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014-2017). Two reviewers independently performed study selection, data extraction and critical appraisal.

RESULTS

One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9-94% in primary care compared to 3.9-66% in emergency departments. HIV test positivity was lower in emergency departments (0-1.3%) and antenatal services (0-0.05%) than in other hospital departments (e.g. inpatients: 0-5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9-72% before to 12-85% after their implementation, with most studies reporting a 10-20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77-93%).

CONCLUSIONS

This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.

Dissociable dopaminergic and pavlovian influences in goal-trackers and sign-trackers on a model of compulsive checking in OCD

RATIONALE

Checking is a functional behaviour that provides information to guide behaviour. However, in obsessive-compulsive disorder (OCD), checking may escalate to dysfunctional levels. The processes underpinning the transition from functional to dysfunctional checking are unclear but may be associated with individual differences that support the development of maladaptive behaviour. We examined one such predisposition, sign-tracking to a pavlovian conditioned stimulus, which we previously found associated with dysfunctional checking. How sign-tracking interacts with another treatment with emerging translational validity for OCD-like checking, chronic administration of the dopamine D₂ receptor agonist quinpirole, is unknown.

OBJECTIVES

We tested how functional and dysfunctional checking in the rat observing response task (ORT) was affected by chronic quinpirole administration in non-autoshaped controls and autoshaped animals classified as sign-trackers or goal-trackers.

METHODS

Sign-trackers or goal-trackers were trained on the ORT before the effects of chronic quinpirole administration on checking were assessed. Subsequently, the effects on checking of different behavioural challenges, including reward omission and the use of unpredictable reinforcement schedules, were tested.

RESULTS

Prior autoshaping increased checking. Sign-trackers and goal-trackers responded differently to quinpirole sensitization, reward omission and reinforcement uncertainty. Sign-trackers showed greater elevations in dysfunctional checking, particularly during uncertainty. By contrast, goal-trackers predominantly increased functional checking responses, possibly in response to reduced discrimination accuracy in the absence of cues signalling which lever was currently active.

CONCLUSIONS

The results are discussed in terms of how pavlovian associations influence behaviour that becomes compulsive in OCD and how this may be dependent on striatal dopamine D₂ receptors.

Kangaroo father care to reduce paternal stress levels: A prospective observational before-after study

OBJECTIVE

The objective was to assess stress in fathers of preterm infants and use of "Kangaroo Father Care (KFC)" to mitigate it.

STUDY DESIGN

Stress levels of 30 fathers of preterm infants admitted in the NICU were assessed using the parental stressor scale: neonatal intensive care unit (PSS: NICU) before and after three sessions of KFC. The data was analysed using Wilcoxon signed rank sum test.

RESULT

There was a statistically significant reduction in stress levels after KFC (p = 0.006). Amongst all the four subscales, stress levels were found to be reduced in 'staff behaviour and communication' (p = 0.001) domain and 'baby looks and behaves' domain (p = 0.05).

CONCLUSION

Fathers of preterm infants admitted in the NICU experience a lot of stress, which can adversely affect their mental health. Kangaroo care is very effective in reducing this paternal stress levels.

Detection of CMB-Cluster Lensing using Polarization Data from SPTpol

We report the first detection of gravitational lensing due to galaxy clusters using only the polarization of the cosmic microwave background (CMB). The lensing signal is obtained using a new estimator that extracts the lensing dipole signature from stacked images formed by rotating the cluster-centered Stokes QU map cutouts along the direction of the locally measured background CMB polarization gradient. Using data from the SPTpol 500  deg^{2} survey at the locations of roughly 18 000 clusters with richness λ≥10 from the Dark Energy Survey (DES) Year-3 full galaxy cluster catalog, we detect lensing at 4.8σ. The mean stacked mass of the selected sample is found to be (1.43±0.40)×10^{14}M_{⊙} which is in good agreement with optical weak lensing based estimates using DES data and CMB-lensing based estimates using SPTpol temperature data. This measurement is a key first step for cluster cosmology with future low-noise CMB surveys, like CMB-S4, for which CMB polarization will be the primary channel for cluster lensing measurements.

Patterns of hysterectomy in India: a national and state-level analysis of the Fourth National Family Health Survey (2015-2016)

Objective

The National Family Health Survey‐4 in India provided the first nationally representative estimates of hysterectomy among women aged 15–49. This paper aims to examine the national and state‐level age‐specific prevalence of hysterectomy, individual and household level factors associated with the procedure, and state‐level indicators that may explain variation across states.

Design

Cross‐sectional, nationally representative household survey.

Setting

National Family Health Survey was conducted across all Indian states and union territories between 2015 and 2016.

Population

The survey covered 699 686 women between the ages of 15 and 49 years.

Methods

Descriptive analyses and multivariate logistic regression.

Main outcome measures

Women who reported ever having a hysterectomy and age at hysterectomy.

Results

Age‐specific prevalence of hysterectomy was 0.36% (0.33,0.39) among women aged 15‐29; 3.59% (3.45,3.74) among women aged 30‐39; and 9.20% (8.94,9.46) among women 40‐49 years. There was considerable variation in prevalence by state. Four states reported age‐specific prevalence similar to high‐income settings. Approximately two‐thirds of hysterectomies were conducted in private facilities, with similar patterns across age groups. At the national level, higher age and parity (at least two children); not having had formal schooling; rural residence (adjusted odds ratio [AOR] 1.36; 95% CI 1.27,1.45; P < 0.01) and higher wealth status were associated with higher odds of hysterectomy. Previously sterilised women had lower odds (AOR 0.64; 95% CI 0.61,0,68; P < 0.01) of reporting hysterectomy. Exploratory analyses suggest state‐level factors associated with prevalence of hysterectomy include caesarean section, female illiteracy, and women's employment.

Conclusions

Hysterectomy patterns among women aged 15–49 in India indicate the critical need to ensure treatment options for gynaecological morbidity and to address hysterectomy among young women in particular.

Funding

This study was part of the RASTA initiative of the Population Council's India country office under the Evidence Project supported by USAID.

Tweetable abstract

Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women.

Hysterectomy patterns in India highlight the need for alternatives to treat gynaecological morbidity among younger women.