1
|
Boardman JM, Cross ZR, Bravo MM, Andrillon T, Aidman E, Anderson C, Drummond SPA. Awareness of errors is reduced by sleep loss. Psychophysiology 2024; 61:e14523. [PMID: 38238554 DOI: 10.1111/psyp.14523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 04/17/2024]
Abstract
The ability to detect and subsequently correct errors is important in preventing the detrimental consequences of sleep loss. The Error Related Negativity (ERN), and the error positivity (Pe) are established neural correlates of error processing. Previous work has shown sleep loss reduces ERN and Pe, indicating sleep loss impairs error-monitoring processes. However, no previous work has examined behavioral error awareness, in conjunction with EEG measures, under sleep loss conditions, and studies of sleep restriction are lacking. Using combined behavioral and EEG measures, we report two studies investigating the impact of total sleep deprivation (TSD) and sleep restriction (SR) on error awareness. Fourteen healthy participants completed the Error Awareness Task under conditions of TSD and 27 completed the same task under conditions of SR. It was found that TSD did not influence behavioral error awareness or ERN or Pe amplitude, however, SR reduced behavioral error awareness, increased the time taken to detect errors, and reduced Pe amplitude. Findings indicate individuals who are chronically sleep restricted are at risk for reduced recognition of errors. Reduced error awareness may be one factor contributing to the increased accidents and injuries seen in contexts where sleep loss is prevalent.
Collapse
Affiliation(s)
- Johanna M Boardman
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Zachariah R Cross
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michelle M Bravo
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Thomas Andrillon
- Faculty of Arts, Monash Centre for Consciousness & Contemplative Studies, Monash University, Melbourne, Victoria, Australia
- Paris Brain Institute, Sorbonne Université, Inserm-CNRS, Paris, France
| | - Eugene Aidman
- Defence Science & Technology Group, Edinburgh, South Australia, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Stimson AM, Anderson C, Holt AM, Henderson AJ. Why don't women engage in muscle strength exercise? An integrative review. Health Promot J Austr 2024. [PMID: 38566279 DOI: 10.1002/hpja.857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
ISSUE ADDRESSED Women are 'at-risk' population for failing to meet muscle strengthening guidelines. Health benefits specific to this exercise mode include maintenance of muscle mass, which is associated with reduced risk of chronic disease and falls. Of significance is the progressive decline in muscle strength exercise participation in women aged 35-54 in Australia. This period is critical for maintaining muscle strength as it establishes foundations for older women's engagement. This integrative review examined available evidence regarding factors influencing muscle strength exercise participation, specifically in women aged 35-54. METHODS Seven databases were searched. Study inclusion criteria were: (1) peer reviewed, (2) English language, (3) sample populations of healthy female adults or general adult sample population differentiating females from males, (4) mean age between 35 and 54 years, (5) focused on muscle strength exercise and measured as the primary outcome factors of participation in muscle strength exercise. FINDINGS Five of 1895 studies met inclusion criteria. Five key factors were associated with participation in muscle strength exercise of women aged 35-54 years: perceived time constraints; knowledge and education; modality and intensity; social support and behavioural strategies. CONCLUSIONS Focused education on strength exercise and guidelines, plus initiatives and strategies that suit the needs of this cohort, are necessary to achieve health and wellbeing benefits. Responsive approaches by health professionals to these women's circumstances can potentially address current low participation levels. SO WHAT?: Creating conditions where health professionals respect a woman's exercise preferences can positively impact these women's musculoskeletal health into older age.
Collapse
Affiliation(s)
- A M Stimson
- School Nursing, Midwifery and Social Sciences, CQUniversity, Brisbane, Australia
| | - C Anderson
- School Nursing, Midwifery, University of Southern Queensland, Ipswich, Australia
| | - A-M Holt
- School of Medicine, University of Notre Dame, Freemantle, Australia
| | - A J Henderson
- School Nursing, Midwifery and Social Sciences, CQUniversity, Brisbane, Australia
| |
Collapse
|
3
|
Jeppe K, Ftouni S, Nijagal B, Grant LK, Lockley SW, Rajaratnam SMW, Phillips AJK, McConville MJ, Tull D, Anderson C. Accurate detection of acute sleep deprivation using a metabolomic biomarker-A machine learning approach. Sci Adv 2024; 10:eadj6834. [PMID: 38457492 DOI: 10.1126/sciadv.adj6834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/02/2024] [Indexed: 03/10/2024]
Abstract
Sleep deprivation enhances risk for serious injury and fatality on the roads and in workplaces. To facilitate future management of these risks through advanced detection, we developed and validated a metabolomic biomarker of sleep deprivation in healthy, young participants, across three experiments. Bi-hourly plasma samples from 2 × 40-hour extended wake protocols (for train/test models) and 1 × 40-hour protocol with an 8-hour overnight sleep interval were analyzed by untargeted liquid chromatography-mass spectrometry. Using a knowledge-based machine learning approach, five consistently important variables were used to build predictive models. Sleep deprivation (24 to 38 hours awake) was predicted accurately in classification models [versus well-rested (0 to 16 hours)] (accuracy = 94.7%/AUC 99.2%, 79.3%/AUC 89.1%) and to a lesser extent in regression (R2 = 86.1 and 47.8%) models for within- and between-participant models, respectively. Metabolites were identified for replicability/future deployment. This approach for detecting acute sleep deprivation offers potential to reduce accidents through "fitness for duty" or "post-accident analysis" assessments.
Collapse
Affiliation(s)
- Katherine Jeppe
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Suzanne Ftouni
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Brunda Nijagal
- Metabolomics Australia, Bio21 Molecular Science and Biotechnology Institute, Parkville, Australia
| | - Leilah K Grant
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven W Lockley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Shantha M W Rajaratnam
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Malcolm J McConville
- Metabolomics Australia, Bio21 Molecular Science and Biotechnology Institute, Parkville, Australia
| | - Dedreia Tull
- Metabolomics Australia, Bio21 Molecular Science and Biotechnology Institute, Parkville, Australia
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Edgbaston, UK
| |
Collapse
|
4
|
Lim JYL, Boardman JM, Anderson C, Dickinson DL, Bennett D, Drummond SPA. Sleep restriction alters the integration of multiple information sources in probabilistic decision-making. J Sleep Res 2024:e14161. [PMID: 38308529 DOI: 10.1111/jsr.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
The detrimental effects of sleep loss on overall decision-making have been well described. Due to the complex nature of decisions, there remains a need for studies to identify specific mechanisms of decision-making vulnerable to sleep loss. Bayesian perspectives of decision-making posit judgement formation during decision-making occurs via a process of integrating knowledge gleaned from past experiences (priors) with new information from current observations (likelihoods). We investigated the effects of sleep loss on the ability to integrate multiple sources of information during decision-making by reporting results from two experiments: the first implementing both sleep restriction (SR) and total sleep deprivation (TSD) protocols, and the second implementing an SR protocol. In both experiments, participants were administered the Bayes Decisions Task on which optimal performance requires the integration of Bayesian prior and likelihood information. Participants in Experiment 1 showed reduced reliance on both information sources after SR, while no significant change was observed after TSD. Participants in Experiment 2 showed reduced reliance on likelihood after SR, especially during morning testing sessions. No accuracy-related impairments resulting from SR and TSD were observed in both experiments. Our findings show SR affects decision-making through altering the way individuals integrate available sources of information. Additionally, the ability to integrate information during SR may be influenced by time of day. Broadly, our findings carry implications for working professionals who are required to make high-stakes decisions on the job, yet consistently receive insufficient sleep due to work schedule demands.
Collapse
Affiliation(s)
- Jeryl Y L Lim
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Johanna M Boardman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - David L Dickinson
- Department of Economics and CERPA, Appalachian State University, Boone, North Carolina, USA
- Economics Science Institute, Chapman University, Orange, California, USA
- Insititute of Labor Economics, Bonn, Germany
| | - Daniel Bennett
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
5
|
Cai AWT, Manousakis JE, Singh B, Francis-Pester E, Kuo J, Jeppe KJ, Rajaratnam SMW, Lenné MG, Howard ME, Anderson C. Subjective awareness of sleepiness while driving in younger and older adults. J Sleep Res 2024; 33:e13933. [PMID: 37315929 DOI: 10.1111/jsr.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/21/2023] [Accepted: 05/02/2023] [Indexed: 06/16/2023]
Abstract
Understanding whether drivers can accurately assess sleepiness is essential for educational campaigns advising drivers to stop driving when feeling sleepy. However, few studies have examined this in real-world driving environments, particularly among older drivers who comprise a large proportion of all road users. To examine the accuracy of subjective sleepiness ratings in predicting subsequent driving impairment and physiological drowsiness, 16 younger (21-33 years) and 17 older (50-65 years) adults drove an instrumented vehicle for 2 h on closed loop under two conditions: well-rested and 29 h sleep deprivation. Sleepiness ratings (Karolinska Sleepiness Scale, Likelihood of Falling Asleep scale, Sleepiness Symptoms Questionnaire) were obtained every 15min, alongside lane deviations, near crash events, and ocular indices of drowsiness. All subjective sleepiness measures increased with sleep deprivation for both age groups (p < 0.013). While most subjective sleepiness ratings significantly predicted driving impairment and drowsiness in younger adults (OR: 1.7-15.6, p < 0.02), this was only apparent for KSS, likelihood of falling asleep, and "difficulty staying in the lane for the older adults" (OR: 2.76-2.86, p = 0.02). This may be due to an altered perception of sleepiness in older adults, or due to lowered objective signs of impairment in the older group. Our data suggest that (i) younger and older drivers are aware of sleepiness; (ii) the best subjective scale may differ across age groups; and (iii) future research should expand on the best subjective measures to inform of crash risk in older adults to inform tailored educational road safety campaigns on signs of sleepiness.
Collapse
Affiliation(s)
- Anna W T Cai
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jessica E Manousakis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Bikram Singh
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Elly Francis-Pester
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jonny Kuo
- Seeing Machines, Fyshwick, Australian Capital Territory, Australia
| | - Katherine J Jeppe
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Michael G Lenné
- Seeing Machines, Fyshwick, Australian Capital Territory, Australia
| | - Mark E Howard
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
6
|
Chang AM, Anderson C, Cain SW, Reichenberger DA, Ronda JM, Lockley SW, Czeisler CA. Entrainment to gradual vs. immediate 8-hour phase advance shifts with and without short-wavelength enriched polychromatic green light. Sleep Health 2024; 10:S67-S75. [PMID: 37989626 DOI: 10.1016/j.sleh.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES For optimal health and well-being the sleep episode and the circadian timing system should be properly aligned. We evaluated the effectiveness of different dynamic light and sleep/wake shift schedules for rapid circadian entrainment following an 8-hour advance of sleep. METHODS Forty-three healthy participants completed an 8-day inpatient protocol in which the 8-hour sleep episode was advanced by 8 hours. Participants were assigned to one of five conditions: (1) dim ambient WHITE light and GRADUAL shift in which the sleep episode was incrementally advanced over 5days; (2) dim GREEN, short-wavelength (∼504 nm) polychromatic light and GRADUAL shift; (3) dim WHITE light and SLAM shift, including an abrupt 8-hour advance on day 3 following an extended 32-hour wake episode; (4) GREEN light and SLAM shift; or (5) COMBINED (higher illuminance WHITE plus GREEN) light and modified SLAM shift with 2 short naps scheduled on the day prior to the abrupt advance. Phase shifts of the plasma dim light melatonin onset and sleep measures were compared to examine effects of protocol condition. RESULTS After 5days, the COMBINED light/modified SLAM shift condition showed larger phase advances of dim light melatonin onset (4.02 ± 1.13 hours) compared to the other 4 conditions (range 1.50 ± 0.96-2.83 ± 2.23 hours; p < .05) and resulted in increased REM sleep duration and fewer sleep disruptions. CONCLUSIONS Consideration of the type of shift and the illuminance and wavelength of light may assist in designing lighting countermeasures to sleep and circadian disruption, which has implications for jetlag, shiftwork, and circadian rhythm sleep disorders.
Collapse
Affiliation(s)
- Anne-Marie Chang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA; Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania 16802, USA.
| | - Clare Anderson
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sean W Cain
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - David A Reichenberger
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Joseph M Ronda
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven W Lockley
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham & Women's Hospital, Boston, Massachusetts, USA; Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Anderson C, Cai AWT, Lee ML, Horrey WJ, Liang Y, O’Brien CS, Czeisler CA, Howard ME. Feeling sleepy? stop driving-awareness of fall asleep crashes. Sleep 2023; 46:zsad136. [PMID: 37158173 PMCID: PMC10636256 DOI: 10.1093/sleep/zsad136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 04/04/2023] [Indexed: 05/10/2023] Open
Abstract
STUDY OBJECTIVES To examine whether drivers are aware of sleepiness and associated symptoms, and how subjective reports predict driving impairment and physiological drowsiness. METHODS Sixteen shift workers (19-65 years; 9 women) drove an instrumented vehicle for 2 hours on a closed-loop track after a night of sleep and a night of work. Subjective sleepiness/symptoms were rated every 15 minutes. Severe and moderate driving impairment was defined by emergency brake maneuvers and lane deviations, respectively. Physiological drowsiness was defined by eye closures (Johns drowsiness scores) and EEG-based microsleep events. RESULTS All subjective ratings increased post night-shift (p < 0.001). No severe drive events occurred without noticeable symptoms beforehand. All subjective sleepiness ratings, and specific symptoms, predicted a severe (emergency brake) driving event occurring in the next 15 minutes (OR: 1.76-2.4, AUC > 0.81, p < 0.009), except "head dropping down". Karolinska Sleepiness Scale (KSS), ocular symptoms, difficulty keeping to center of the road, and nodding off to sleep, were associated with a lane deviation in the next 15 minutes (OR: 1.17-1.24, p<0.029), although accuracy was only "fair" (AUC 0.59-0.65). All sleepiness ratings predicted severe ocular-based drowsiness (OR: 1.30-2.81, p < 0.001), with very good-to-excellent accuracy (AUC > 0.8), while moderate ocular-based drowsiness was predicted with fair-to-good accuracy (AUC > 0.62). KSS, likelihood of falling asleep, ocular symptoms, and "nodding off" predicted microsleep events, with fair-to-good accuracy (AUC 0.65-0.73). CONCLUSIONS Drivers are aware of sleepiness, and many self-reported sleepiness symptoms predicted subsequent driving impairment/physiological drowsiness. Drivers should self-assess a wide range of sleepiness symptoms and stop driving when these occur to reduce the escalating risk of road crashes due to drowsiness.
Collapse
Affiliation(s)
- Clare Anderson
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Anna W T Cai
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Michael L Lee
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - William J Horrey
- Center for Behavioral Sciences, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
- AAA Foundation for Traffic Safety, Washington, DC, USA
| | - Yulan Liang
- Center for Behavioral Sciences, Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
| | - Conor S O’Brien
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Center for Innovation in Digital Healthcare, Mass General Hospital, Boston MA, USA
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Mark E Howard
- Turner Institute of Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC,Australia
| |
Collapse
|
8
|
Marinelli I, Walker JJ, Seneviratne U, D’Souza W, Cook MJ, Anderson C, Bagshaw AP, Lightman SL, Woldman W, Terry JR. Circadian distribution of epileptiform discharges in epilepsy: Candidate mechanisms of variability. PLoS Comput Biol 2023; 19:e1010508. [PMID: 37797040 PMCID: PMC10581478 DOI: 10.1371/journal.pcbi.1010508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/17/2023] [Accepted: 09/10/2023] [Indexed: 10/07/2023] Open
Abstract
Epilepsy is a serious neurological disorder characterised by a tendency to have recurrent, spontaneous, seizures. Classically, seizures are assumed to occur at random. However, recent research has uncovered underlying rhythms both in seizures and in key signatures of epilepsy-so-called interictal epileptiform activity-with timescales that vary from hours and days through to months. Understanding the physiological mechanisms that determine these rhythmic patterns of epileptiform discharges remains an open question. Many people with epilepsy identify precipitants of their seizures, the most common of which include stress, sleep deprivation and fatigue. To quantify the impact of these physiological factors, we analysed 24-hour EEG recordings from a cohort of 107 people with idiopathic generalized epilepsy. We found two subgroups with distinct distributions of epileptiform discharges: one with highest incidence during sleep and the other during day-time. We interrogated these data using a mathematical model that describes the transitions between background and epileptiform activity in large-scale brain networks. This model was extended to include a time-dependent forcing term, where the excitability of nodes within the network could be modulated by other factors. We calibrated this forcing term using independently-collected human cortisol (the primary stress-responsive hormone characterised by circadian and ultradian patterns of secretion) data and sleep-staged EEG from healthy human participants. We found that either the dynamics of cortisol or sleep stage transition, or a combination of both, could explain most of the observed distributions of epileptiform discharges. Our findings provide conceptual evidence for the existence of underlying physiological drivers of rhythms of epileptiform discharges. These findings should motivate future research to explore these mechanisms in carefully designed experiments using animal models or people with epilepsy.
Collapse
Affiliation(s)
- Isabella Marinelli
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| | - Jamie J. Walker
- EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, United Kingdom
| | - Udaya Seneviratne
- Department of Neurosciences, Monash Health, Clayton, Australia
- Department of Neuroscience, St. Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Wendyl D’Souza
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Mark J. Cook
- Department of Neuroscience, St. Vincent’s Hospital, University of Melbourne, Melbourne, Australia
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P. Bagshaw
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Stafford L. Lightman
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Wessel Woldman
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| | - John R. Terry
- Centre for Systems Modelling and Quantitative Biomedicine, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
9
|
Pena LC, Anderson C, Agarwal MS, Galvan E, Kelly W, Wagner TD. Retrospective Review of the Factors Limiting Optune Initiation in GBM patients. Int J Radiat Oncol Biol Phys 2023; 117:e93. [PMID: 37786216 DOI: 10.1016/j.ijrobp.2023.06.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Tumor Treating Fields (TTFields) are a proven treatment that prolongs survival in Glioblastoma Multiforme (GBM) patients. The duration of usage of TTFields correlates with its effectiveness. This study aims to identify socioeconomic and clinical factors that prevent GBM patients at a single institution from starting and remaining on TTFields treatment. MATERIALS/METHODS This is a retrospective review from a single institution. Data were analyzed for each patient with a diagnosis of GBM that was seen in new patient consultation with a radiation oncologist. Data from 2015 to present were available. 178 patients were included in the study. Insurance status (private vs Medicare/Medicaid vs uninsured), zip code, expected income status, race, ethnicity, preferred primary language, work status, performance status (KPS) at time of diagnosis, and family support at home (Spouse vs Other) were analyzed. For those that initiated TTFields, we examined the duration of treatment, usage rates, patient reported tolerability, and reasons for discontinuation. Early termination of treatment was defined as treatment with TTFields for less than 3 months. RESULTS Of the 178 diagnosed GBM patients, 96 (54%) were offered TTFields and 48 (27%) agreed to treatment, with 46 actually starting. Of 89 Non-Hispanic patients, 53 were offered TTFields (60%) whereas of 73 Hispanic patients, 35 were offered TTFields (48%) (no statistically significant difference). The number one reason for refusing TTFields treatment was rapid deterioration (14/48 patients). The next most common reason was the patient feeling overwhelmed by managing or wearing the device (10/48) as well as the patient's decision to participate in any other clinical trial (10/48). The 3-month dropout rate for patients who received TTFields was 35% (17/48). 5 of the 17 stopped early due to skin rash or annoyance with the device. Patient's median income and insurance status did not predict whether they would start TTFields. 33 out of 109 (31%) patients with spousal support at home started treatment with TTFields compared to 13 of 69 (19%) of those without spousal support (p = .0895, Chi-Square test). CONCLUSION TTFields were offered to more patients each successive year, but many patients had no documented discussion offering TTFields, which may indicate room for improvement at our institution. Median income and insurance status did not play a role in patient access to TTFields, most likely due to Novocure sponsorship of un- or under-insured patients. Among those who declined treatment, 21% did so because of perceived difficulty managing the device. The strongest single trend predictive of successful initiation of TTFields is spousal support at home. Further interventions may focus on improving patient support at home, such as home health nursing visits or community support.
Collapse
Affiliation(s)
- L Carranza Pena
- University of Texas Health Science Center San Antonio Joe R. & Teresa Lozano Long School of Medicine, San Antonio, TX
| | - C Anderson
- Department of Radiation Oncology, UT Health San Antonio, San Antonio, TX
| | - M S Agarwal
- Department of Radiation Oncology, UT Health San Antonio, San Antonio, TX
| | - E Galvan
- Department of Radiation Oncology, UT Health San Antonio, San Antonio, TX
| | - W Kelly
- Mays Cancer Center, UT Health San Antonio, San Antonio, TX
| | - T D Wagner
- Department of Radiation Oncology, UT Health San Antonio, San Antonio, TX
| |
Collapse
|
10
|
Dack K, Wilson A, Turner C, Anderson C, Hughes GJ. COVID-19 associated with universities in England, October 2020-February 2022. Public Health 2023; 224:106-112. [PMID: 37742583 DOI: 10.1016/j.puhe.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The aim of this study was to describe the epidemiology of COVID-19 cases at universities in England (October 2020-February 2022) and investigate factors associated with rates of COVID-19 among students during autumn/winter of 2021/22. STUDY DESIGN The study was an observational retrospective study using routine contact tracing data. METHODS Estimates of COVID-19 cases among students and staff at universities were described. Student cases aged 18-24 years were calculated as a percentage of all cases within that age group. Count regression was used to explore university characteristics associated with case numbers. RESULTS We identified 102,382 cases among students and 28,639 among staff. Student cases reflected trends in the wider population of the same age group, but the observed fraction aged 18-24 years who were students was consistently below the expected level (32%). Phased reopening of universities in March-May 2021 was associated with small peaks but low absolute numbers. Russell group membership, campus universities, and higher student proportions in halls of residence were all associated with increased case numbers. CONCLUSIONS COVID-19 case numbers among students in England varied considerably. At no time were the observed case numbers as high as expected from community prevalence. Characteristics of universities associated with higher case rates can inform future guidance for higher education settings.
Collapse
Affiliation(s)
- K Dack
- Field Service, United Kingdom Health Security Agency, London, UK
| | - A Wilson
- Field Service, United Kingdom Health Security Agency, London, UK
| | - C Turner
- Field Service, United Kingdom Health Security Agency, London, UK
| | - C Anderson
- Field Service, United Kingdom Health Security Agency, London, UK
| | - G J Hughes
- Field Service, United Kingdom Health Security Agency, Leeds, UK.
| |
Collapse
|
11
|
Wilson A, Anderson C, Mindlin M, Sawyer C, Verlander NQ, Hiironen I, Forde J, Paranthaman K, Chandra NL. Characteristics of women presenting with hepatitis B at antenatal care services in London, 2008-2018. J Public Health (Oxf) 2023; 45:584-592. [PMID: 37061977 DOI: 10.1093/pubmed/fdad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/17/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND To support interventions to prevent mother-to-child transmission of hepatitis B and fill gaps in surveillance, the Enhanced Surveillance of Antenatal Hepatitis B (ESAHB) programme was implemented in London from 2008 to 2018 to collect demographic information on women who tested positive for hepatitis B during antenatal screening. We describe the epidemiology of hepatitis B in pregnancy, as reported to ESAHB. METHODS The characteristics of pregnant women living with hepatitis B were described and rates were calculated by year, local authority and residence deprivation decile (1 being most deprived). Poisson regression tested the association between pregnant women living with hepatitis B and deprivation decile. RESULTS Between 2008 and 2018, 8879 women living with hepatitis B in London (0.35 per 1000 women) reported 11 193 pregnancies. Annual hepatitis B rates remained stable, but there was strong evidence for an inverse association between rate and deprivation decile (P < 0.001). The majority of women in the cohort presented late to antenatal care, were born outside the UK in a hepatitis B endemic area or required an interpreter for consultations. CONCLUSIONS ESAHB provided important data to inform service quality improvements for women living with hepatitis B. This analysis highlights the link between deprivation and hepatitis B.
Collapse
Affiliation(s)
- A Wilson
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - C Anderson
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - M Mindlin
- South London Health Protection Team, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - C Sawyer
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - N Q Verlander
- Statistics, Modelling and Economics Department, Data, Analytics and Surveillance Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - I Hiironen
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - J Forde
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - K Paranthaman
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| | - N L Chandra
- Field Service South East and London, Health Protections Operations Group, UK Health Security Agency, London, SW1P 3HX, UK
| |
Collapse
|
12
|
Mulhall M, Wilson K, Yang S, Kuo J, Sletten T, Anderson C, Howard ME, Rajaratnam S, Magee M, Collins A, Lenné MG. European NCAP Driver State Monitoring Protocols: Prevalence of Distraction in Naturalistic Driving. Hum Factors 2023:187208231194543. [PMID: 37599390 DOI: 10.1177/00187208231194543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
OBJECTIVE examine the prevalence of driver distraction in naturalistic driving when implementing European New Car Assessment Program (Euro NCAP)-defined distraction behaviours. BACKGROUND The 2023 introduction of Occupant Status monitoring (OSM) into Euro NCAP will accelerate uptake of Driver State Monitoring (DSM). Euro NCAP outlines distraction behaviours that DSM must detect to earn maximum safety points. Distraction behaviour prevalence and driver alerting and intervention frequency have yet to be examined in naturalistic driving. METHOD Twenty healthcare workers were provided with an instrumented vehicle for approximately two weeks. Data were continuously monitored with automotive grade DSM during daily work commutes, resulting in 168.8 hours of driver head, eye and gaze tracking. RESULTS Single long distraction events were the most prevalent, with .89 events/hour. Implementing different thresholds for driving-related and driving-unrelated glance regions impacts alerting rates. Lizard glances (primarily gaze movement) occurred more frequently than owl glances (primarily head movement). Visual time-sharing events occurred at a rate of .21 events/hour. CONCLUSION Euro NCAP-described driver distraction occurs naturalistically. Lizard glances, requiring gaze tracking, occurred in high frequency relative to owl glances, which only require head tracking, indicating that less sophisticated DSM will miss a substantial amount of distraction events. APPLICATION This work informs OEMs, DSM manufacturers and regulators of the expected alerting rate of Euro NCAP defined distraction behaviours. Alerting rates will vary with protocol implementation, technology capability, and HMI strategies adopted by the OEMs, in turn impacting safety outcomes, user experience and acceptance of DSM technology.
Collapse
Affiliation(s)
| | - Kyle Wilson
- Seeing Machines Ltd, Canberra, ACT, Australia
| | - Shiyan Yang
- Seeing Machines Ltd, Canberra, ACT, Australia
| | - Jonny Kuo
- Seeing Machines Ltd, Canberra, ACT, Australia
| | - Tracey Sletten
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Clare Anderson
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Mark E Howard
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Shantha Rajaratnam
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Michelle Magee
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, VIC, Australia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Allison Collins
- Institute for Breathing and Sleep, Austin Health, Heidelberg, VIC, Australia
| | - Michael G Lenné
- Seeing Machines Ltd, Canberra, ACT, Australia
- Monash University Accident Research Centre, Monash University, Clayton, VIC, Australia
| |
Collapse
|
13
|
Mohanna M, Roberts E, Whitty L, Gritzfeld JF, Pain CE, Girschick HJ, Preston J, Hadjittofi M, Anderson C, Ferguson PJ, Theos A, Hedrich CM. Priorities in Chronic nonbacterial osteomyelitis (CNO) - results from an international survey and roundtable discussions. Pediatr Rheumatol Online J 2023; 21:65. [PMID: 37391782 DOI: 10.1186/s12969-023-00851-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder that predominantly affects children and young people. The pathophysiology and molecular mechanisms of CNO remain poorly understood, and diagnostic criteria and biomarkers are lacking. As a result, treatment is empiric and follows personal experience, case series and expert consensus plans. METHODS A survey was designed to gain insight on clinician and patient experiences of diagnosing and treating CNO and to collate opinions on research priorities. A version containing 24 questions was circulated among international expert clinicians and clinical academics (27 contacted, 21 responses). An equivalent questionnaire containing 20 questions was shared to explore the experience and priorities of CNO patients and family members (93 responses). RESULTS Responses were used to select topics for four moderated roundtable discussions at the "International Conference on CNO and autoinflammatory bone disease" (Liverpool, United Kingdom, May 25-26th, 2022). The group identified deciphering the pathophysiology of CNO to be the highest priority, followed by clinical trials, necessary outcome measures and classification criteria. Surprisingly, mental wellbeing scored behind these items. CONCLUSIONS Agreement exists among clinicians, academics, patients and families that deciphering the pathophysiology of CNO is of highest priority to inform clinical trials that will allow for the approval of medications for the treatment of CNO by regulatory agencies.
Collapse
Affiliation(s)
- M Mohanna
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Roberts
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L Whitty
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J F Gritzfeld
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - C E Pain
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - H J Girschick
- Klinik Für Kinder- Und Jugendmedizin, Vivantes Netzwerk Für Gesundheit GmbH, Klinikum Im Friedrichshain, Berlin, Germany
| | - J Preston
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - M Hadjittofi
- Clinical Health Psychology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - C Anderson
- Royal Hospital for Children and Young People, Edinburgh, UK
| | - P J Ferguson
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - A Theos
- Department of Human Science, CRMO Patient/Parent Partner, Georgetown University, Washington, DC, USA
| | - C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| |
Collapse
|
14
|
Todtz SR, Schneider CW, Malakar T, Anderson C, Koska H, Zimmerman PM, Devery JJ. Controlling Catalyst Behavior in Lewis Acid-Catalyzed Carbonyl-Olefin Metathesis. J Am Chem Soc 2023; 145:13069-13080. [PMID: 37279356 PMCID: PMC10517625 DOI: 10.1021/jacs.3c01508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Lewis acid-catalyzed carbonyl-olefin metathesis has introduced a new means for revealing the behavior of Lewis acids. In particular, this reaction has led to the observation of new solution behaviors for FeCl3 that may qualitatively change how we think of Lewis acid activation. For example, catalytic metathesis reactions operate in the presence of superstoichiometric amounts of carbonyl, resulting in the formation of highly ligated (octahedral) iron geometries. These structures display reduced activity, decreasing catalyst turnover. As a result, it is necessary to steer the Fe-center away from inhibiting pathways to improve the reaction efficiency and augment yields for recalcitrant substrates. Herein, we examine the impact of the addition of TMSCl to FeCl3-catalyzed carbonyl-olefin metathesis, specifically for substrates that are prone to byproduct inhibition. Through kinetic, spectroscopic, and colligative experiments, significant deviations from the baseline metathesis reactivity are observed, including mitigation of byproduct inhibition as well as an increase in the reaction rate. Quantum chemical simulations are used to explain how TMSCl induces a change in catalyst structure that leads to these kinetic differences. Collectively, these data are consistent with the formation of a silylium catalyst, which induces the reaction through carbonyl binding. The FeCl3 activation of Si-Cl bonds to give the silylium active species is expected to have significant utility in enacting carbonyl-based transformations.
Collapse
Affiliation(s)
- Sophi R Todtz
- Department of Chemistry & Biochemistry, Loyola University Chicago, Flanner Hall, 1068 W Sheridan Road, Chicago, Illinois 60660, United States
| | - Cory W Schneider
- Department of Chemistry & Biochemistry, Loyola University Chicago, Flanner Hall, 1068 W Sheridan Road, Chicago, Illinois 60660, United States
| | - Tanmay Malakar
- Department of Chemistry, Barasat College, 10 K.N.C. Road, Barasat, Kolkata 700124, West Bengal, India
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor, Michigan 48109, United States
| | - Clare Anderson
- Department of Chemistry & Biochemistry, Loyola University Chicago, Flanner Hall, 1068 W Sheridan Road, Chicago, Illinois 60660, United States
| | - Heather Koska
- Department of Chemistry & Biochemistry, Loyola University Chicago, Flanner Hall, 1068 W Sheridan Road, Chicago, Illinois 60660, United States
| | - Paul M Zimmerman
- Department of Chemistry, University of Michigan, 930 North University Avenue, Ann Arbor, Michigan 48109, United States
| | - James J Devery
- Department of Chemistry & Biochemistry, Loyola University Chicago, Flanner Hall, 1068 W Sheridan Road, Chicago, Illinois 60660, United States
| |
Collapse
|
15
|
Harris R, Beatty CJ, Cori JM, Spitz G, Soleimanloo SS, Peterson SA, Naqvi A, Barnes M, Downey LA, Shiferaw BA, Anderson C, Tucker AJ, Clark A, Rajaratnam SMW, Howard ME, Sletten TL, Wolkow AP. The impact of break duration, time of break onset, and prior shift duration on the amount of sleep between shifts in heavy vehicle drivers. J Sleep Res 2023; 32:e13730. [PMID: 36193767 DOI: 10.1111/jsr.13730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to examine the impact of break duration between consecutive shifts, time of break onset, and prior shift duration on total sleep time (TST) between shifts in heavy vehicle drivers (HVDs), and to assess the interaction between break duration and time of break onset. The sleep (actigraphy and sleep diaries) and work shifts (work diaries) of 27 HVDs were monitored during their usual work schedule for up to 9 weeks. Differences in TST between consecutive shifts and days off were assessed. Linear mixed models (followed by pairwise comparisons) assessed whether break duration, prior shift duration, time of break onset, and the interaction between break duration and break onset were related to TST between shifts. Investigators found TST between consecutive shifts (mean [SD] 6.38 [1.38] h) was significantly less than on days off (mean [SD] 7.63 [1.93] h; p < 0.001). Breaks starting between 12:01 and 8:00 a.m. led to shorter sleep (p < 0.05) compared to breaks starting between 4:01 and 8:00 p.m. Break durations up to 7, 9, and 11 h (Australian and European minimum break durations) resulted in a mean (SD) of 4.76 (1.06), 5.66 (0.77), and 6.41 (1.06) h of sleep, respectively. The impact of shift duration prior to the break and the interaction between break duration and time of break were not significant. HVDs' sleep between workdays is influenced independently by break duration and time of break onset. This naturalistic study provides evidence that current break regulations prevent sufficient sleep duration in this industry. Work regulations should evaluate appropriate break durations and break onset times to allow longer sleep opportunities for HVDs.
Collapse
Affiliation(s)
- Rachael Harris
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Caroline J Beatty
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Jennifer M Cori
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Gershon Spitz
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shamsi Shekari Soleimanloo
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Scott A Peterson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Aqsa Naqvi
- Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Luke A Downey
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Brook A Shiferaw
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Victoria, Australia.,Seeing Machines Ltd., Fyshwick, Australian Capital Territory, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Andrew J Tucker
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Anna Clark
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Mark E Howard
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Alexander P Wolkow
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | | |
Collapse
|
16
|
Saroha B, Hendricks N, Thatiparthi B, Al-Shaikhli S, Rey K, Anderson C. Abstract No. 229 Clinical Outcomes and Safety of Percutaneous Lung Biopsy in Outpatient Setting. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
|
17
|
Tan N, Sri D, Tsang D, Nitkunan T, Anderson C, Qazi H, Issa R, Walker R, Seth J. Robotic colposuspension for female stress urinary incontinence: A prospective series. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
18
|
Tan N, Sri D, Tsang D, Nitkunan T, Anderson C, Qazi H, Issa R, Walker R, Seth J. Robotic-assisted laparoscopic colposuspension for female stress urinary incontinence: a prospective series. J Robot Surg 2023; 17:125-129. [PMID: 35384594 DOI: 10.1007/s11701-022-01409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
The suspension of use of sub-urethral mesh in the UK in 2018 has seen the resurgence of colposuspension in female SUI surgery. Open and laparoscopic colposuspension techniques are well recognised. We present data from 28 robotic-assisted laparoscopic colposuspension (RALCp) procedures, reporting on technique, safety and efficacy. Approval was obtained from the hospital New and Novel Procedures Committee. All patients had urodynamic assessment prior to surgery. Data was prospectively gathered and 24-h pad usage and Urinary Incontinence Short Form Questionnaire (ICIQ-UI-SF) scores were used to assess symptom severity and quality of life. PGII scores were used to assess patient satisfaction after the procedure. Paired T test analysis was conducted. Since May 2019, robotic colposuspension has been performed in 28 patients. The mean age and BMI were 49 and 27 (kg/m2), respectively, with a mean follow-up period of 12 months. 67.9% of patients had pure urodynamic SUI and 32.1% of patients had previous anti-SUI surgery. Average operating time was 127 min, blood loss 20 ml and length of stay 2 days. There was a significant 73% improvement in mean 24-h pad usage (p = 0.001) and an improvement in mean ICIQ-UI-SF scores from 18.1 to 9.4 (p = 0.0001). Day 1 mean pain score was 5/10. This is the largest series of its kind. Robotic colposuspension is safe and feasible with significant improvements seen in quality of life scores and number of pads used per day. It presents a minimally invasive treatment option in female SUI, however needs larger volume evaluation and longer follow-up for further evaluation.
Collapse
Affiliation(s)
- Nataniel Tan
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - D Sri
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - D Tsang
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - T Nitkunan
- Epsom and St Helier NHS Trust, Dorking Rd, Epsom, KT18 7EG, UK
| | - C Anderson
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - H Qazi
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - R Issa
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - R Walker
- Epsom and St Helier NHS Trust, Dorking Rd, Epsom, KT18 7EG, UK
| | - J Seth
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| |
Collapse
|
19
|
Fitzgerald ES, Stout JC, Glikmann-Johnston Y, Anderson C, Jackson ML. Sleep, Circadian Rhythms, and Cognitive Dysfunction in Huntington's Disease. J Huntingtons Dis 2023; 12:293-304. [PMID: 37599535 DOI: 10.3233/jhd-230578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
BACKGROUND In healthy people, sleep and circadian disruption are linked to cognitive deficits. People with Huntington's disease (HD), who have compromised brain function and sleep and circadian disturbances, may be even more susceptible to these cognitive effects. OBJECTIVE To conduct a comprehensive review and synthesis of the literature in HD on the associations of cognitive dysfunction with disturbed sleep and circadian rhythms. METHODS We searched MEDLINE via OVID, CINAHL Plus, EMBASE via OVID, and PubMed in May 2023. The first author then screened by title and abstract and conducted a full review of remaining articles. RESULTS Eight studies investigating the influence of sleep and/or circadian rhythms on cognitive function in HD were found. In manifest HD, poorer sleep was associated with worse cognitive function. For behavioral 24-hour (circadian) rhythms, two studies indicated that later wake times correlated with poorer cognitive function. No reported studies in HD examined altered physiological 24-hour (circadian) rhythms and cognitive impairment. CONCLUSION Some associations exist between poor sleep and cognitive dysfunction in manifest HD, yet whether these associations are present before clinical diagnosis is unknown. Whether circadian disturbances relate to cognitive impairment in HD also remains undetermined. To inform sleep and circadian interventions aimed at improving cognitive symptoms in HD, future research should include a range of disease stages, control for external factors, and utilize robust cognitive batteries targeted to the aspects of cognitive function known to be adversely affected in HD.
Collapse
Affiliation(s)
- Emily S Fitzgerald
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Yifat Glikmann-Johnston
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Clare Anderson
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Melinda L Jackson
- School of Psychological Sciences, and Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
20
|
Wilson E, Daniel M, Rao A, Torre D, Durning S, Anderson C, Goldhaber NH, Townsend W, Seifert CM. A scoping review of distributed cognition in acute care clinical decision-making. Diagnosis (Berl) 2022; 10:68-88. [PMID: 36512433 DOI: 10.1515/dx-2022-0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
Abstract
Abstract
Objectives
In acute care settings, interactions between providers and tools drive clinical decision-making. Most studies of decision-making focus on individual cognition and fail to capture critical collaborations. Distributed Cognition (DCog) theory provides a framework for examining the dispersal of tasks among agents and artifacts, enhancing the investigation of decision-making and error.
Content
This scoping review maps the evidence collected in empiric studies applying DCog to clinical decision-making in acute care settings and identifies gaps in the existing literature.
Summary and Outlook
Thirty-seven articles were included. The majority (n=30) used qualitative methods (observations, interviews, artifact analysis) to examine the work of physicians (n=28), nurses (n=27), residents (n=16), and advanced practice providers (n=12) in intensive care units (n=18), operating rooms (n=7), inpatient units (n=7) and emergency departments (n=5). Information flow (n=30) and task coordination (n=30) were the most frequently investigated elements of DCog. Provider-artifact (n=35) and provider-provider (n=30) interactions were most explored. Electronic (n=18) and paper (n=15) medical records were frequently described artifacts. Seven prominent themes were identified. DCog is an underutilized framework for examining how information is obtained, represented, and transmitted through complex clinical systems. DCog offers mechanisms for exploring how technologies, like EMRs, and workspaces can help or hinder clinical decision-making.
Collapse
Affiliation(s)
- Eric Wilson
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Michelle Daniel
- University of California, San Diego School of Medicine , La Jolla , CA , USA
| | - Aditi Rao
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Dario Torre
- University of Central Florida College of Medicine , Orlando , FL , USA
| | - Steven Durning
- Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Clare Anderson
- University of Michigan Medical School , Ann Arbor , MI , USA
| | - Nicole H. Goldhaber
- University of California, San Diego School of Medicine , La Jolla , CA , USA
| | - Whitney Townsend
- Taubman Health Sciences Library , University of Michigan , Ann Arbor , MI , USA
| | - Colleen M. Seifert
- Department of Psychology , University of Michigan College of Literature, Science, and the Arts , Ann Arbor , MI , USA
| |
Collapse
|
21
|
Drummond S, Lim J, Boardman J, Anderson C, Dickinson D. Sleep Restriction impairs the ability to integrate multiple pieces of information into a decision. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
22
|
Leota J, Hoffman D, Mascaro L, Czeisler ME, Nash K, Drummond SPA, Anderson C, Rajaratnam SMW, Facer-Childs ER. Home is where the hustle is: the influence of crowds on effort and home advantage in the National Basketball Association. J Sports Sci 2022; 40:2343-2352. [PMID: 36512468 DOI: 10.1080/02640414.2022.2154933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Studies have consistently shown crowds contribute to home advantage in the National Basketball Association (NBA) by inspiring home team effort, distracting opponents, and influencing referees. Quantifying the effect of crowds is challenging, however, due to potential co-occurring drivers of home advantage (e.g., travel, location familiarity). Our aim was to isolate the crowd effect using a "natural experiment" created by the Coronavirus disease 2019 (COVID-19) pandemic, which eliminated crowds in 53.4% of 2020/2021 NBA regular season games (N = 1080). Using mixed linear models, we show, in games with crowds, home teams won 58.65% of games and, on average, outrebounded and outscored their opponents. This was a significant improvement compared to games without crowds, of which home teams won 50.60% of games and, on average, failed to outrebound or outscore their opponents. Further, the crowd-related increase in rebound differential mediated the relationship between crowds and points differential. Taken together, these results suggest home advantage in the 2020/2021 NBA season was predominately driven by the presence of home crowds and their influence on the effort exerted to rebound the basketball. These findings are of considerable significance to a league where marginal gains can have immense competitive, financial, and historic consequences.
Collapse
Affiliation(s)
- Josh Leota
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia
| | - Daniel Hoffman
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia
| | - Luis Mascaro
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia
| | - Mark E Czeisler
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia.,Institute for Breathing and Sleep, Austin Health, Clayton, Australia.,Department of Psychiatry, Brigham and Women's Hospital, Suburban, Monash, USA
| | - Kyle Nash
- Department of Psychology, University of Alberta, Suburban, Edmonton, Canada
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia.,Institute for Breathing and Sleep, Austin Health, Clayton, Australia.,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Suburban, Monash, USA.,Division of Sleep Medicine, Harvard Medical School, Suburban, Monash, USA
| | - Elise R Facer-Childs
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Suburban, Australia.,Danny Frawley Centre for Health and Wellbeing, Melbourne, Australia
| |
Collapse
|
23
|
Lim JYL, Boardman J, Dyche J, Anderson C, Dickinson DL, Drummond SPA. Sex moderates the effects of total sleep deprivation and sleep restriction on risk preference. Sleep 2022; 45:6603432. [PMID: 35667000 PMCID: PMC9453615 DOI: 10.1093/sleep/zsac120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
Sleep loss has been shown to alter risk preference during decision-making. However, research in this area has largely focussed on the effects of total sleep deprivation (TSD), while evidence on the effects of sleep restriction (SR) or the potentially moderating role of sex on risk preference remains scarce and unclear. The present study investigated risky decision-making in 47 healthy young adults who were assigned to either of two counterbalanced protocols: well-rested (WR) and TSD, or WR and SR. Participants were assessed on the Lottery Choice Task (LCT), which requires a series of choices between two risky gambles with varying risk levels. Analyses on the pooled dataset indicated across all sleep conditions, participants were generally more risk-seeking when trying to minimise financial loss (LOSSES) than while trying to maximise financial gain (GAINS). On GAINS trials, female participants were more risk-averse during TSD and SR, whereas male participants remained unchanged. On LOSSES trials, female participants remained unchanged during TSD and SR, whereas male participants became more risk-seeking during TSD. Our findings suggest the relationship between sleep loss and risk preference is moderated by sex, whereby changes in risk preference after TSD or SR differ in men and women depending on whether the decision is framed in terms of gains or losses.
Collapse
Affiliation(s)
- Jeryl Y L Lim
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
| | - Johanna Boardman
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
| | - Jeff Dyche
- Department of Psychology, James Madison University , Harrisonburg, VA , USA
| | - Clare Anderson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
| | - David L Dickinson
- Department of Economics and CERPA, Appalachian State University , Boone, NC , USA
- Economics Science Institute, Chapman University , Orange, CA , USA
- Institute of Labor Economics , Bonn , Germany
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University , Melbourne, VIC , Australia
| |
Collapse
|
24
|
Anderson C. Acoustic enhancement of slow wave sleep—timing and tone: “the details create the big picture”. Sleep 2022; 45:6672582. [DOI: 10.1093/sleep/zsac191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Clare Anderson
- School of Psychological Sciences and Turner Institute for brain and Mental Health, Monash University , Clayton 3800 , Australia
| |
Collapse
|
25
|
Puls HT, Chung PJ, Anderson C. Universal Child Care as a Policy to Prevent Child Maltreatment. Pediatrics 2022; 150:188507. [PMID: 35909150 DOI: 10.1542/peds.2022-056660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri.,University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Paul J Chung
- Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, California.,Departments of Pediatrics and Health Policy & Management, UCLA, Los Angeles, California
| | - Clare Anderson
- Chapin Hall at the University of Chicago, Chicago, Illinois
| |
Collapse
|
26
|
Anderson C, Lund JL, Park J, Brewster W, Bae-Jump V, Olshan AF, Nichols HB. Adverse Urinary System Outcomes among Older Women with Endometrial Cancer. Cancer Epidemiol Biomarkers Prev 2022; 31:1508. [PMID: 35775217 DOI: 10.1158/1055-9965.epi-22-0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE OF THE STUDY Endometrial cancer and its treatment may cause damage to the urinary system, but few large-scale studies have examined the incidence of urinary-related outcomes among endometrial cancer survivors. We investigated the risk of several urinary disease diagnoses among older women with endometrial cancer compared to women without a cancer history. METHODS Women ages 66 years and older with an endometrial cancer diagnosis during 2004-2017 (N=44,386) and women without a cancer history (N=221,219) matched 5:1 on age, race/ethnicity, and state were identified in the Surveillance, Epidemiology, and End Results-Medicare linked data. ICD-9 and -10 diagnosis codes were used to identify urinary outcomes in the Medicare claims data. Cumulative incidences (IP) of urinary outcomes were estimated among women with and without endometrial cancer. Multivariable Cox proportional hazards regression models were used to estimate hazards ratios (HR) for urinary outcomes comparing women with and without endometrial cancer. HRs were also used to identify characteristics associated with urinary outcomes among endometrial cancer survivors. RESULTS Relative to women without cancer, endometrial cancer survivors had an increased risk of urinary system diagnoses, including renal failure (5-year IP: 25% vs 14%; HR=1.50; 95% CI: 1.47-1.53), chronic kidney disease (5-year IP: 20% vs 14%; HR=1.25; 95% CI: 1.22-1.28), calculus of the urinary tract (5-year IP: 7% vs 4%; HR=1.55; 95% CI: 1.50-1.61), lower urinary tract infection (5-year IP: 55% vs 33%; HR=1.75; 95% CI: 1.72, 1.78), and bladder diseases (5-year IP: 10% vs 6%; HR=1.57; 95% CI: 1.52, 1.62). These associations persisted in analyses limited to 1+ and 5+ years after endometrial cancer diagnosis. Non-Hispanic Black or Hispanic race/ethnicity, higher comorbidity index, higher stage or grade cancer, non-endometrioid histology, and treatment with chemotherapy and/or radiation were often predictors of urinary outcomes among women with endometrial cancer. CONCLUSIONS Our results suggest that, among older women, the risk of urinary outcomes is elevated after endometrial cancer. Monitoring for urinary diseases may be a critical part of long-term survivorship care for older women with an endometrial cancer history.
Collapse
|
27
|
Bellomo T, Fokas J, Tsao N, Anderson C, Becker C, Gioscia-Ryan R, Meurer W. Ethical Considerations during the Informed Consent Process for Acute Ischemic Stroke in International Clinical Trials. Ethics Hum Res 2022; 44:14-25. [PMID: 35802793 DOI: 10.1002/eahr.500133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We sought to investigate the experiences of researchers in existing active-control trials in acute ischemic stroke comparing investigational therapy to tissue plasminogen activator (tPA) in order to identify the approaches and challenges in obtaining informed consent. Out of 401 articles evaluated, 14 trials met inclusion criteria. Trial representatives were contacted to complete a survey concerning the consent process. None of the 14 trials published materials related to the informed consent process. Trials with 75% to 100% of patients directly consented had shorter door-to-treatment (DTT) times than trials that directly consented less than 50% of patients. Trials that had translators available (for recruiting participants who were not native speakers in the local language) and translated consent documents had longer DTT times. The study findings suggest that differences in the standards of informed consent internationally may allow more patients with moderate strokes to provide direct consent without delaying DTT time. Future trials should emphasize transparency to the public and scientific community in the informed consent process.
Collapse
Affiliation(s)
- Tiffany Bellomo
- Vascular surgery resident at the Massachusetts General Hospital
| | - Jennifer Fokas
- Neurology resident at McGaw Medical Center of Northwestern University
| | - Noah Tsao
- Medical student at the University of Rochester
| | | | | | | | - William Meurer
- Associate professor of emergency medicine at the University of Michigan
| |
Collapse
|
28
|
Leota J, Hoffman D, Czeisler MÉ, Mascaro L, Drummond SP, Anderson C, Rajaratnam SM, Facer-Childs ER. Eastward Jet Lag is Associated with Impaired Performance and Game Outcome in the National Basketball Association. Front Physiol 2022; 13:892681. [PMID: 35784873 PMCID: PMC9245584 DOI: 10.3389/fphys.2022.892681] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives: Elite athletes are often required to travel across time zones for national and international competitions, causing frequent jet lag. The aim of this study was to examine whether the direction of travel-related jet lag is associated with performance in the National Basketball Association (NBA), and if so, to explore potential mechanisms. Methods: Ten seasons comprising of 11,481 games of NBA data from the 2011/2012 to the 2020/2021 regular season were analyzed using multi-level mixed models with one fixed factor (three levels; jet lag direction: eastward vs westward vs no jet lag) and three random factors (team, opponent, game time). Predicted circadian resynchronization rate was accounted for, and home and away games were analysed separately. Mediation analyses were performed to examine potential mechanisms. Results: Among home teams, eastward (but not westward) jet lag was associated with reduced winning (Δ (i.e., change) = −6.03%, p = 0.051, marginal), points differential (Δ = −1.29 points, p = 0.015), rebound differential (Δ = −1.29 rebounds, p < 0.0001), and effective field goal percentage differential (Δ = −1.2%, p < 0.01). As the magnitude of eastward jet lag increased, home team points differential decreased (2 h Δ = −4.53 points, p < 0.05; 1 h Δ = −0.72 points, p = 0.07). No significant associations were found between jet lag and away team performance. Conclusion: Eastward jet lag was associated with impaired performance for home (but not away) teams. Sleep and circadian disruption associated with advancing phase following eastward travel may have significant adverse consequences on performance in the NBA, particularly when recovery time is limited. Sports organisations could consider chronobiology-informed scheduling and interventions to maximise recovery and performance of their athletes.
Collapse
Affiliation(s)
- Josh Leota
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Daniel Hoffman
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- St Kilda Football Club, Australian Football League, Melbourne, VIC, Australia
| | - Mark É. Czeisler
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Luis Mascaro
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Sean P.A. Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Shantha M.W. Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Melbourne, VIC, Australia
- Departments of Medicine and Neurology, Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Elise R. Facer-Childs
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- St Kilda Football Club, Australian Football League, Melbourne, VIC, Australia
- Danny Frawley Centre for Health and Wellbeing, Moorabbin, VIC, Australia
- *Correspondence: Elise R. Facer-Childs,
| |
Collapse
|
29
|
Crosby L, Lewer D, Appleby Y, Anderson C, Hayward A, Story A. Outcomes of a residential respite service for homeless people with tuberculosis in London, UK: a cross-sectional study. Perspect Public Health 2022; 143:89-96. [PMID: 35506684 PMCID: PMC10068400 DOI: 10.1177/17579139221093544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many countries are seeking to eliminate tuberculosis (TB), but incidence remains high in socially excluded groups such as people experiencing homelessness. There is limited research into the effectiveness of residential respite services (RRS), which provide accomodation and social and clinical support for homeless people with active TB. METHODS We used a register of all cases of TB diagnosed in London between 1 January 2010 and 3 October 2019 to compare characteristics and outcomes of patients treated in an RRS with patients receiving standard care. The primary outcome was successful treatment completion. We used logistic regression to compare likelihood of completing treatment, and simulation to estimate the absolute change in treatment completion resulting from this service. RESULTS A total of 78 homeless patients finished an episode of TB treatment at the RRS. Patients treated in the RRS were more likely than patients treated in standard care to have clinical and social risk factors including drug resistance, history of homelessness, drug or alcohol use, and need for directly observed therapy. After adjusting for these factors, patients treated in the RRS had 2.97 times the odds of completing treatment (95% CI = 1.44-6.96). Treatment ended in failure for 8/78 patients treated in the RRS (10%, 95% CI = 5%-20%). We estimated that in the absence of the RRS, treatment would have ended in failure for 17/78 patients (95% CI = 11-25). CONCLUSION The residential respite service for homeless TB patients with complex social needs was associated with better treatment outcomes.
Collapse
Affiliation(s)
- L Crosby
- Collaborative Centre for Inclusion Health, UCL, London, UK.,Research Department of Primary Care and Population Health, UCL, London, UK
| | - D Lewer
- Collaborative Centre for Inclusion Health, University College London, London, UK.,National Infections Service, Public Health England, London, UK
| | - Y Appleby
- Find & Treat, University College London Hospitals, London, UK
| | - C Anderson
- National Infections Service, Public Health England, London, UK
| | - A Hayward
- Collaborative Centre for Inclusion Health, UCL, London, UK
| | - A Story
- Collaborative Centre for Inclusion Health, UCL, London, UK.,Find & Treat, University College London Hospitals, London, UK
| |
Collapse
|
30
|
Schnabel A, Nashawi M, Anderson C, Felsenstein S, Lamoudi M, Poole-Cowley J, Lindell E, Oates B, Fowlie P, Walsh J, Ellis T, Hahn G, Goldspink A, Martin N, Mahmood K, Hospach T, Lj M, Hedrich CM. TNF-inhibitors or bisphosphonates in chronic nonbacterial osteomyelitis? - Results of an international retrospective multicenter study. Clin Immunol 2022; 238:109018. [PMID: 35460903 DOI: 10.1016/j.clim.2022.109018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 12/26/2022]
Abstract
Chronic nonbacterial osteomyelitis (CNO) can cause significant morbidity, including bone pain and damage. In the absence of clinical trials, treatments include non-steroidal anti-inflammatory drugs, corticosteroids, TNF-inhibitors (TNFi) and/or bisphosphonates. In a retrospective chart review in the United Kingdom and Germany, we investigated response to TNFi and/or pamidronate. Ninety-one patients were included, receiving pamidronate (n = 47), TNFi (n = 22) or both sequentially (n = 22). Patients with fatigue [p = 0.003] and/or arthritis [p = 0.002] were more frequently treated with TNFi than pamidronate. Both therapies were associated with clinical remission at 6 months, and reduction of bone lesions on MRI at 12 months. While not reaching statistical significance, pamidronate resulted in faster resolution of MRI lesions. Fewer flares were observed with TNFi. Failure to respond to pamidronate was associated with female sex [p = 0.027], more lesions on MRI [p = 0.01] and higher CRP levels [p = 0.03]. Randomized clinical trials are needed to confirm observations and generate evidence.
Collapse
Affiliation(s)
- A Schnabel
- Pädiatrische Rheumatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
| | - M Nashawi
- Pädiatrische Rheumatologie, Klinikum Stuttgart, Germany; Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - C Anderson
- Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - S Felsenstein
- Department of Infectious Disease and Immunology, Alder Hey Children's NHS Foundation Trust, United Kingdom
| | - M Lamoudi
- Royal Hospital for Children and Young People, Edinburgh, United Kingdom
| | - J Poole-Cowley
- Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - E Lindell
- University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - B Oates
- University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - P Fowlie
- Ninewells Hospital, Dundee, United Kingdom
| | - J Walsh
- Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - T Ellis
- Pädiatrische Rheumatologie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - G Hahn
- Department of Radiology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - A Goldspink
- Raigmore Hospital, Inverness, United Kingdom
| | - N Martin
- Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - K Mahmood
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - T Hospach
- Pädiatrische Rheumatologie, Klinikum Stuttgart, Germany
| | - McCann Lj
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - C M Hedrich
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom; Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom.
| |
Collapse
|
31
|
Ganesan S, Manousakis JE, Mulhall MD, Sletten TL, Tucker A, Howard ME, Anderson C, Rajaratnam SMW. Sleep, alertness and performance across a first and a second night shift in mining haul truck drivers. Chronobiol Int 2022; 39:769-780. [PMID: 35176952 DOI: 10.1080/07420528.2022.2034838] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This study examined the impact of first and second night shift work on sleep and performance in mining haul truck drivers. Sleep-wake patterns were monitored using wrist actigraphy. The Karolinska Sleepiness Scale (KSS), Psychomotor Vigilance Test (PVT) and a truck simulator were administered at the start and end of the first (N1) or second (N2) night shift (19:00-07:00 h). Participants were categorised into those who demonstrated a decline in performance (increase of one or more PVT lapses [reaction time >500 msec] from the start to the end of shift) or those who did not demonstrate a decline in performance (no increase in lapses) from the start to the end of shift. Total sleep time (TST) was longer in the 24 h prior to N1 (9.05 ± 1.49 h) compared to N2 (5.38 ± 1.32 h). PVT lapses and the slowest 10% of reaction times were similar at the start and end of N1, while greater impairments on these outcomes were observed at the end of N2 compared to the end of N1 (p < .05). In contrast, subjective sleepiness was equally impaired at the end of both night shifts. PVT performance (lapses and slowest 10% of reaction times) and drive violations demonstrated a similar direction of change on N1 and N2. Participants who demonstrated a decline in performance showed reduced TST in the 48 h prior to shifts compared to those who demonstrated no decline in performance across the shift. Likely due to short sleep prior, the end of N2 was associated with pronounced performance impairments on the PVT and drive violations compared to the start of the shift. The findings suggest that drive violations may be more sensitive to sleep loss compared to the other driving measures examined in this study. This study also emphasizes the need for adequate recovery sleep between night shifts.
Collapse
Affiliation(s)
- Saranea Ganesan
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Australia
| | - Jessica E Manousakis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
| | - Megan D Mulhall
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Australia
| | - Tracey L Sletten
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Australia
| | - Andrew Tucker
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Australia
| | - Mark E Howard
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Australia
| |
Collapse
|
32
|
Diep C, Ftouni S, Drummond SPA, Garcia‐Molina G, Anderson C. Heart rate variability increases following automated acoustic slow wave sleep enhancement. J Sleep Res 2022; 31:e13545. [DOI: 10.1111/jsr.13545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Charmaine Diep
- School of Psychological Sciences Turner Institute for Brain and Mental Health Monash University Clayton Victoria Australia
- Cooperative Research Centre for Alertness, Safety and Productivity Notting Hill Victoria Australia
| | - Suzanne Ftouni
- School of Psychological Sciences Turner Institute for Brain and Mental Health Monash University Clayton Victoria Australia
- Cooperative Research Centre for Alertness, Safety and Productivity Notting Hill Victoria Australia
| | - Sean P. A. Drummond
- School of Psychological Sciences Turner Institute for Brain and Mental Health Monash University Clayton Victoria Australia
| | - Gary Garcia‐Molina
- Department of Psychiatry University of Wisconsin‐Madison Madison Wisconsin USA
| | - Clare Anderson
- School of Psychological Sciences Turner Institute for Brain and Mental Health Monash University Clayton Victoria Australia
- Cooperative Research Centre for Alertness, Safety and Productivity Notting Hill Victoria Australia
| |
Collapse
|
33
|
Staite E, Howey L, Anderson C. How well do children in the North East of England function after a mental health crisis during the COVID-19 pandemic: A service evaluation. Clin Child Psychol Psychiatry 2022; 27:278-290. [PMID: 34362261 PMCID: PMC8811317 DOI: 10.1177/13591045211037268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic has affected millions of people, and some researchers postulate that a mental health crisis will follow. The immediate effects of the COVID-19 pandemic on children's mental health are now starting to be published, and results appear to be mixed. There is no research, to the authors' knowledge, that empirically examines the functioning of young people following intervention from Child and Adolescent Mental Health Services (CAMHS) Crisis Teams in the UK during the COVID-19 pandemic. This service evaluation aims to do this using data from an NHS trust that supports 1.4 million people in the North East of England. We compared functioning, as measured by the Outcome Rating Scale (ORS), before and after treatment for young people discharged from the CAMHS Crisis Team between December 2019 and December 2020. ORS scores were significantly higher at the end of treatment (t(420) = -57.36, p < 0.001) with a large effect size (d = -1.56). Fifty eight percent of patients exhibited significant and reliable change (i.e. functioning improved to a 'healthy' level). No patients significantly deteriorated in functioning after accessing the crisis service.
Collapse
Affiliation(s)
- Emily Staite
- School of Social Sciences, Humanities & Law, 5462Teesside University, Middlesbrough, UK
| | - Lynne Howey
- 3059Tees Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | - Clare Anderson
- 3059Tees Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| |
Collapse
|
34
|
Leung L, Sri D, Seth J, Sharma D, Tay A, Gonsalves M, Qazi H, Anderson C, Issa R. Robotic-Assisted Bladder Diverticulectomy (RABD): A safe alternative to open approach. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
35
|
Hussain F, Sonani H, Anderson C, Varshney N. Duodenal Duplication Cyst in adult male; An Extremely Rare Entity and a Diagnostic Pitfall leading to Whipple procedure. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction/Objective
Whipple procedure is a complex, invasive operation and has high morbidity and mortality. It is the most commonly indicated treatment for treating malignant tumors, however, it can be also used for benign entities as well including biliary stricture, chronic pancreatitis, choledochal cyst, inflammatory pseudotumour, and duodenal angiodysplasia.
Methods/Case Report
We report a case of a 50-year-old man who presented with symptoms of gastric outlet obstruction. Esophagogastroduodenoscopy and CT scan showed an obstruction at the level of the second part of the duodenum with proximal dilation. Subsequently, a Whipple procedure was performed based on high clinical suspicion of duodenal cancer. Gross examination revealed a unilocular thick walled cyst (4.2 cm) in the duodenum. Histopathologic examination showed a cyst lined by duodenal mucosa with thick smooth muscle wall and focal ectopic gastric tissue. This was finally diagnosed as a duodenal cyst consistent with duplication cyst.
Results (if a Case Study enter NA)
NA
Conclusion
Duplication cysts are rare congenital abnormality predominantly diagnosed in infancy and childhood. They are most commonly located in the distal ileum, followed by the esophagus and ileocecal region, and are extremely rare in duodenum. Differential diagnosis includes choledochocele, pancreatic pseudocyst, and cystic tumors of the pancreas, mesenteric cysts, and duodenal diverticulums. Treatment options include total excision, cystojejunostomy, and endoscopic marsupialization but occasionally may lead to more invasive measures such as the Whipple procedure. Although duodenal duplication cysts can have variable clinical presentation and radiological findings, making preoperative diagnosis very challenging, it is still pertinent to be aware of this entity for the optimal patient care.
Collapse
Affiliation(s)
- F Hussain
- Pathology, University of Mississippi Medical Center, Ridgeland, Mississippi, UNITED STATES
| | - H Sonani
- Pathology, University of Mississippi Medical Center, Ridgeland, Mississippi, UNITED STATES
| | - C Anderson
- Pathology, University of Mississippi Medical Center, Ridgeland, Mississippi, UNITED STATES
| | - N Varshney
- Pathology, University of Mississippi Medical Center, Ridgeland, Mississippi, UNITED STATES
| |
Collapse
|
36
|
Fugar S, Deka K, Anderson C, Lama Von Buchwald C, Geroux R, Al-Amoodi M, White J, Kavinsky C. Invasive and Doppler Transvalvular gradients after transcatheter aortic valve replacement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Differences in mean gradients after Transcatheter valve replacement (TAVR) vary depending on the valve type and the modality used to measure the gradients. Currently there is a paucity of data on the relationship between invasive and doppler derived gradients after TAVR.
Purpose
We sort to assess the difference in doppler, and catheter derived aortic valve gradients after TAVR
Methods
This is a single center retrospective study using consecutive patients who presented for TAVR on account of native aortic valve stenosis at our institution from May 2012 till December 2020. Patients with both intraoperative invasive and postoperative doppler derived pressure gradients were included in the analysis. Student T-test were used to compare mean gradients. Pearson's correlation test was used to examine the correlation between measured gradients.
Results
A total of 587 patients were included in our study. Fifty one percent were male and 462 (78.7%) underwent TAVR with a balloon expandable valve. In the entire cohort the mean gradient measured invasively was significantly lower than those measured by echo doppler (4.48±3.25 vs. 5.57±3.11, P<0.001). There, however, was a positive correlation between invasive and doppler measured gradients (figure 1). In those who received balloon expandable valves, the invasive gradient was 4.39±3.30 and the doppler derived gradient was 5.47±3.04 (P<0.001), while in those self-expanding valves, the invasive gradient was 4.81±3.04 and doppler derived gradient was 5.94±3.36 (P<0.001).
Conclusion
Post TAVR gradients were all significantly lower when measured invasively as compared to those measured using doppler. Self-expanding valves overall had higher residual gradients. Further studies are needed to assess the correlations between invasively measured gradients and clinical outcomes post TAVR.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S Fugar
- Rush University Medical Center, Chicago, United States of America
| | - K Deka
- Rush University Medical Center, Chicago, United States of America
| | - C Anderson
- Rush University Medical Center, Chicago, United States of America
| | | | - R Geroux
- Rush University Medical Center, Chicago, United States of America
| | - M Al-Amoodi
- Rush University Medical Center, Chicago, United States of America
| | - J White
- Rush University Medical Center, Chicago, United States of America
| | - C Kavinsky
- Rush University Medical Center, Chicago, United States of America
| |
Collapse
|
37
|
Garweg C, Bordachar P, Boveda S, Roberts P, Johansen J, Iacopino S, Clementy N, Winter S, Anderson C, Butler K, El-Chami M. Real-world experience on the safety and effectiveness of Micra TPS in patients with pre-existing in situ CIEDs. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Micra pre-market study showed that the Micra transcatheter pacing system could be safely implanted in patients with pacing indications. Patients with pre-existing cardiac implantable electronic devices (CIED) were excluded from this clinical trial; however, this group of patients might benefit from a leadless pacemaker especially when a lead fails or after incidence of system-related infections.
Objective
To determine the outcome of patients with a pre-existing CIED or lead that remains in situ at the time of Micra implant attempt.
Methods
Patients who had a pre-existing CIED and/or lead at the time of Micra implantation attempt were identified from the Micra Post-Approval Registry and Micra Acute Performance studies. Baseline characteristics were summarized, and a Fine-Gray competing risk model was used to compare risk for major complication through 24 months for patients with and without a pre-existing CIED.
Results
Of the 2323 patients included in the analysis, 111 patients had a pre-existing CIED or lead at the time of Micra implantation attempt that remained in situ. Types of pre-existing devices included 81 pacemakers (45 single chamber, 32 dual chamber, 4 of unknown type), 10 ICDs (2 single chamber, 2 dual chamber, 6 unknown type), 10 CRT devices (6 CRT-P, 4 CRT-D), 3 generators of unknown type, and 7 patients had only leads remaining. Patients with pre-existing devices were younger and less likely to have a pacing indication of bradyarrhythmia with atrial fibrillation compared to patients without pre-existing devices (p<0.001 for both). Patients with prior devices were more likely to have a condition precluding implant of a transvenous pacemaker (67.6% vs. 21.3%, p<0.001). The presence of a pre-existing CIED did not impact the outcome of the Micra TPS implant procedure: implant success was >99% for both cohorts. Mean follow-up duration was 21.2±14.3 months (range 0–56) for pre-existing devices patients and 23.3±15.8 months (range 0–62) for other patients. The rate of major complications through 24 months was 1.8% for patients with and 3.8% for patients without prior devices (p=0.36). There were no major complications related to device malfunction or device-device interaction. There were 6 system revisions in 4 patients with preexisting devices and 52 revisions in 51 patients without preexisting devices. Pacing thresholds for patients with and without prior devices were similar at implant (0.72 and 0.63, respectively; p=0.31) and remained stable through 12 months.
Conclusion
Micra can be safely and successfully implanted in patients with a pre-existing CIED remaining in situ. It should be considered a treatment option for patients in whom CIED extraction may be deemed high risk.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. Risk of major complications
Collapse
Affiliation(s)
- C Garweg
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - P Bordachar
- University Hospital of Bordeaux, Bordeaux, France
| | - S Boveda
- Clinic Pasteur, Toulouse, France
| | - P.R Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - S Iacopino
- Maria Cecilia Hospital, Cotignola, Italy
| | - N Clementy
- University Hospital of Tours, Tours, France
| | - S Winter
- St. Vinzenz-Hospital, Cologne, Germany
| | - C Anderson
- Medtronic, Mounds View, United States of America
| | - K Butler
- Medtronic, Mounds View, United States of America
| | - M.F El-Chami
- Emory University Hospital, Atlanta, United States of America
| |
Collapse
|
38
|
Cori JM, Gordon C, Jackson ML, Collins A, Philip R, Stevens D, Naqvi A, Hosking R, Anderson C, Barnes M, Howard ME, Vakulin A. The impact of aging on driving performance in patients with untreated obstructive sleep apnea. Sleep Health 2021; 7:652-660. [PMID: 34479826 DOI: 10.1016/j.sleh.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the influence of age on sleepiness-related driving performance in individuals with obstructive sleep apnea (OSA). DESIGN Extended wakefulness protocol comparing simulated driving performance in younger and older individuals with OSA. PARTICIPANTS Fifty-two individuals with OSA (15 female) were median split into younger (≤55 years, n = 26) and older (>55 years, n = 26) groups. MEASUREMENTS Participants underwent polysomnography to derive sleep parameters and confirm OSA diagnosis. One-to-2 weeks following polysomnography, participants completed a 60-minute driving simulation 4 hours prior to their habitual bedtime. Participants remained awake to 3 hours post habitual bedtime before repeating the task. RESULTS Median age was 44.5 years (25th, 75th centiles = 37.0, 48.0) for the younger group and 64.5 years (60.0, 70.0) for the older group. When comparing the performance change between baseline and extended wakefulness, the younger patients had greater deterioration on all driving simulator parameters (crashes, standard deviation of lateral position, speed deviation and braking reaction time, all p < .05), compared to the older group. Linear regression found a 10-year age increase was associated with an a ∼30%-41% reduction in crash occurrence when accounting for covariates (p = .023). Age also predicted standard deviation of lateral position deviation, but not when sleep efficiency and self-reported sleepiness were included as covariates. CONCLUSION Older participants with OSA were less vulnerable than younger participants to sleepiness-related driving simulator impairment when assessed at night-time following extended wakefulness. Future work should assess naturalistic on-road driving to determine if this extends to a variety of challenging driving scenarios.
Collapse
Affiliation(s)
- Jennifer M Cori
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia.
| | - Christopher Gordon
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Melinda L Jackson
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Allison Collins
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Rohit Philip
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - David Stevens
- Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Aqsa Naqvi
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Ruth Hosking
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia; Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew Vakulin
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, New South Wales, Australia; Adelaide Institute for Sleep Health/Flinders Health and Medical Research Institute Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| |
Collapse
|
39
|
Cori JM, Downey LA, Sletten TL, Beatty CJ, Shiferaw BA, Soleimanloo SS, Turner S, Naqvi A, Barnes M, Kuo J, Lenné MG, Anderson C, Tucker AJ, Wolkow AP, Clark A, Rajaratnam SMW, Howard ME. The impact of 7-hour and 11-hour rest breaks between shifts on heavy vehicle truck drivers' sleep, alertness and naturalistic driving performance. Accid Anal Prev 2021; 159:106224. [PMID: 34192654 DOI: 10.1016/j.aap.2021.106224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/01/2021] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND An inadequate rest break between shifts may contribute to driver sleepiness. This study assessed whether extending the major rest break between shifts from 7-hours (Australian industry standard) to 11-hours, improved drivers' sleep, alertness and naturalistic driving performance. METHODS 17 heavy vehicle drivers (16 male) were recruited to complete two conditions. Each condition comprised two 13-hour shifts, separated by either a 7- or 11-hour rest break. The initial 13-hour shift was the drivers' regular work. The rest break and following 13-hour shift were simulated. The simulated shift included 5-hours of naturalistic driving with measures of subjective sleepiness, physiological alertness (ocular and electroencephalogram) and performance (steering and lane departures). RESULTS 13 drivers provided useable data. Total sleep during the rest break was greater in the 11-hour than the 7-hour condition (median hours [25th to 75th percentile] 6.59 [6.23, 7.23] vs. 5.07 [4.46, 5.38], p = 0.008). During the simulated shift subjective sleepiness was marginally better for the 11-hour condition (mean Karolinska Sleepiness Scale [95th CI] = 4.52 [3.98, 5.07] vs. 5.12 [4.56, 5.68], p = 0.009). During the drive, ocular and vehicle metrics were improved for the 11-hour condition (p<0.05). Contrary to expectations, mean lane departures p/hour were increased during the 11-hour condition (1.34 [-0.38,3.07] vs. 0.63 [-0.2,1.47], p = 0.027). CONCLUSIONS Extending the major rest between shifts substantially increases sleep duration and has a modest positive impact on driver alertness and performance. Future work should replicate the study in a larger sample size to improve generalisability and assess the impact of consecutive 7-hour major rest breaks.
Collapse
Affiliation(s)
- Jennifer M Cori
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia.
| | - Luke A Downey
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
| | - Tracey L Sletten
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Caroline J Beatty
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Brook A Shiferaw
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia; Seeing Machines Ltd., 80 Mildura St., Fyshwick, ACT, Australia
| | - Shamsi Shekari Soleimanloo
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia; Institute for Social Science Research, The University of Queensland, Queensland, Australia
| | - Sophie Turner
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Aqsa Naqvi
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Australia
| | - Jonny Kuo
- Seeing Machines Ltd., 80 Mildura St., Fyshwick, ACT, Australia
| | - Michael G Lenné
- Seeing Machines Ltd., 80 Mildura St., Fyshwick, ACT, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Andrew J Tucker
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Alexander P Wolkow
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Anna Clark
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia; Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia; Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Australia; Department of Medicine, University of Melbourne, Australia
| |
Collapse
|
40
|
Cai AWT, Manousakis JE, Lo TYT, Horne JA, Howard ME, Anderson C. I think I'm sleepy, therefore I am - Awareness of sleepiness while driving: A systematic review. Sleep Med Rev 2021; 60:101533. [PMID: 34461582 DOI: 10.1016/j.smrv.2021.101533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
Driver drowsiness contributes to 10-20% of motor vehicle crashes. To reduce crash risk, ideally drivers would be aware of the drowsy state and cease driving. The extent to which drivers can accurately identify sleepiness remains under much debate. We systematically examined whether individuals are aware of sleepiness while driving, and whether this accurately reflects driving impairment, using meta-analyses and narrative review. Within this scope, there is high variability in measures of subjective sleepiness, driving performance and physiologically-derived drowsiness, and statistical analyses. Thirty-four simulated/naturalistic driving studies were reviewed. To summarise, drivers were aware of sleepiness, and this was associated to physiological drowsiness and driving impairment, such that high levels of sleepiness significantly predicted crash events and lane deviations. Subjective sleepiness was more strongly correlated (i) with physiological drowsiness compared to driving outcomes; (ii) under simulated driving conditions compared to naturalistic drives; and (iii) when examined using the Karolinska sleepiness scale (KSS) compared to other measures. Gaps remain in relation to how age, sex, and varying degrees of sleep loss may influence this association. This review provides evidence that drivers are aware of drowsiness while driving, and stopping driving when feeling 'sleepy' may significantly reduce crash risk.
Collapse
Affiliation(s)
- Anna W T Cai
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Jessica E Manousakis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Tiffany Y T Lo
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - James A Horne
- Sleep Research Centre, Loughborough University, Loughborough, UK
| | - Mark E Howard
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia; Institute for Breathing and Sleep, Austin Health, Heidelberg, 3084, VIC, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
| |
Collapse
|
41
|
Cori JM, Manousakis JE, Koppel S, Ferguson SA, Sargent C, Howard ME, Anderson C. An evaluation and comparison of commercial driver sleepiness detection technology: a rapid review. Physiol Meas 2021; 42. [PMID: 34338222 DOI: 10.1088/1361-6579/abfbb8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 04/26/2021] [Indexed: 11/11/2022]
Abstract
Objective. Sleepiness-related motor vehicle crashes, caused by lack of sleep or driving during night-time hours, often result in serious injury or fatality. Sleepiness detection technology is rapidly emerging as a sleepiness risk mitigation strategy for drivers. Continuous monitoring technologies assess and alert to driver sleepiness in real-time, while fit for duty technologies provide a single assessment of sleepiness state. The aim of this rapid review was to evaluate and compare sleepiness detection technologies in relation to specifications, cost, target consumer group and validity.Approach. We evaluated a range of sleepiness detection technologies suitable for consumer groups ranging from regular drivers in private vehicles through to work-related drivers within large businesses.Main results. Continuous monitoring technologies typically ranged between $100 and $3000 AUD and had ongoing monthly costs for telematics functionality and manager alerts. Fit for duty technologies had either a one-off purchase cost or a monthly subscription cost. Of concern, the majority of commercial continuous monitoring technologies lacked scientific validation. While some technologies had promising findings in terms of their ability to detect and reduce driver sleepiness, further validation work is required. Field studies that evaluate the sensitivity and specificity of technology alerts under conditions that are regularly experienced by drivers are necessary. Additionally, there is a need for longitudinal naturalistic driving studies to determine whether sleepiness detection technologies actually reduce sleepiness-related crashes or near-crashes.Significance. There is an abundance of sleepiness detection technologies on the market, but a majority lacked validation. There is a need for these technologies and their validation to be regulated by a driver safety body. Otherwise, consumers will base their technology choices on cost and features, rather than the ability to save lives.
Collapse
Affiliation(s)
- Jennifer M Cori
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jessica E Manousakis
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Sjaan Koppel
- Monash University Accident Research Centre, Monash University, Melbourne, Australia
| | - Sally A Ferguson
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
| | - Charli Sargent
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, South Australia, 5034, Australia
| | - Mark E Howard
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.,Department of Medicine, University of Melbourne, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
42
|
Watson LA, McGlashan EM, Hosken IT, Anderson C, Phillips AJK, Cain SW. Sleep and circadian instability in delayed sleep-wake phase disorder. J Clin Sleep Med 2021; 16:1431-1436. [PMID: 32347206 DOI: 10.5664/jcsm.8516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In patients with delayed sleep-wake phase disorder (DSWPD), the circadian clock may be more easily affected by light at night. This creates a potential vulnerability, whereby individuals with irregular schedules may have less stable circadian rhythms. We investigated the stability of circadian timing and regularity of sleep in patients with DSWPD and healthy controls. METHODS Participants completed 2 dim-light melatonin onset (DLMO) assessments approximately 2 weeks apart while keeping their habitual sleep/wake schedule. After the second DLMO assessment, light sensitivity was assessed using the phase-resetting response to a 6.5-hour 150-lux stimulus. The change in DLMO timing (DLMO instability) was assessed and related to light sensitivity and the sleep regularity index. RESULTS Relative to healthy controls, patients with DSWPD had later sleep rhythm timing relative to clock time, earlier sleep rhythm timing relative to DLMO, lower sleep regularity index, and greater DLMO instability. Greater DLMO instability was associated with increased light sensitivity across all participants, but not within groups. CONCLUSIONS We find that circadian timing is less stable and sleep is less regular in patients with DSWPD, which could contribute to etiology of the disorder. Measures of light sensitivity may be informative in generating DSWPD treatment plans.
Collapse
Affiliation(s)
- Lauren A Watson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Elise M McGlashan
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Ihaia T Hosken
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Sean W Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| |
Collapse
|
43
|
Barney J, Estee J, Lynch WG, Isobe T, Jhang G, Kurata-Nishimura M, McIntosh AB, Murakami T, Shane R, Tangwancharoen S, Tsang MB, Cerizza G, Kaneko M, Lee JW, Tsang CY, Wang R, Anderson C, Baba H, Chajecki Z, Famiano M, Hodges-Showalter R, Hong B, Kobayashi T, Lasko P, Łukasik J, Nakatsuka N, Olsen R, Otsu H, Pawłowski P, Pelczar K, Sakurai H, Santamaria C, Setiawan H, Taketani A, Winkelbauer JR, Xiao Z, Yennello SJ, Yurkon J, Zhang Y. The SπRIT time projection chamber. Rev Sci Instrum 2021; 92:063302. [PMID: 34243507 DOI: 10.1063/5.0041191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/23/2021] [Indexed: 06/13/2023]
Abstract
The Superconducting Analyzer for MUlti-particles from RAdioIsotope (SAMURAI) Pion-Reconstruction and Ion-Tracker Time Projection Chamber (SπRIT TPC) was designed to enable measurements of heavy ion collisions with the SAMURAI spectrometer at the RIKEN radioactive isotope beam factory and provides constraints on the equation of state of neutron-rich nuclear matter. The SπRIT TPC has a 50.5 cm drift length and an 86.4 × 134.4 cm2 pad plane with 12 096 pads that are equipped with the generic electronics for TPCs. The SπRIT TPC allows for an excellent reconstruction of particles and provides isotopic resolution for pions and other light charged particles across a wide range of energy losses and momenta. The details of the SπRIT TPC are presented, along with discussion of the TPC performance based on cosmic rays and charged particles emitted in heavy ion collisions.
Collapse
Affiliation(s)
- J Barney
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - J Estee
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - W G Lynch
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - T Isobe
- RIKEN Nishina Center, Hirosawa 2-1, Wako, Saitama 351-0198, Japan
| | - G Jhang
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | | | - A B McIntosh
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - T Murakami
- Department of Physics, Kyoto University, Kita-shirakawa, Kyoto 606-8502, Japan
| | - R Shane
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - S Tangwancharoen
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - M B Tsang
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - G Cerizza
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - M Kaneko
- RIKEN Nishina Center, Hirosawa 2-1, Wako, Saitama 351-0198, Japan
| | - J W Lee
- Department of Physics, Korea University, Seoul 02841, Republic of Korea
| | - C Y Tsang
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - R Wang
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - C Anderson
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - H Baba
- RIKEN Nishina Center, Hirosawa 2-1, Wako, Saitama 351-0198, Japan
| | - Z Chajecki
- Department of Physics, Western Michigan University, Kalamazoo, Michigan 49008, USA
| | - M Famiano
- Department of Physics, Western Michigan University, Kalamazoo, Michigan 49008, USA
| | - R Hodges-Showalter
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - B Hong
- Department of Physics, Korea University, Seoul 02841, Republic of Korea
| | - T Kobayashi
- Department of Physics, Tohoku University, Sendai 980-8578, Japan
| | - P Lasko
- Institute of Nuclear Physics PAN, ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - J Łukasik
- Institute of Nuclear Physics PAN, ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - N Nakatsuka
- RIKEN Nishina Center, Hirosawa 2-1, Wako, Saitama 351-0198, Japan
| | - R Olsen
- Gran Sasso National Laboratory-INFN, Via G. Acitelli 22, 67100 Assergi, L'Aquila AQ, Italy
| | - H Otsu
- RIKEN Nishina Center, Hirosawa 2-1, Wako, Saitama 351-0198, Japan
| | - P Pawłowski
- Institute of Nuclear Physics PAN, ul. Radzikowskiego 152, 31-342 Kraków, Poland
| | - K Pelczar
- Gran Sasso National Laboratory-INFN, Via G. Acitelli 22, 67100 Assergi, L'Aquila AQ, Italy
| | - H Sakurai
- RIKEN Nishina Center, Hirosawa 2-1, Wako, Saitama 351-0198, Japan
| | - C Santamaria
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - H Setiawan
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - A Taketani
- RIKEN Nishina Center, Hirosawa 2-1, Wako, Saitama 351-0198, Japan
| | - J R Winkelbauer
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - Z Xiao
- Department of Physics, Tsinghua University, Beijing 100084, People's Republic of China
| | - S J Yennello
- Cyclotron Institute, Texas A&M University, College Station, Texas 77843, USA
| | - J Yurkon
- National Superconducting Cyclotron Laboratory, East Lansing, Michigan 48824, USA
| | - Y Zhang
- Department of Physics, Tsinghua University, Beijing 100084, People's Republic of China
| |
Collapse
|
44
|
Manousakis JE, Mann N, Jeppe KJ, Anderson C. Awareness of sleepiness: Temporal dynamics of subjective and objective sleepiness. Psychophysiology 2021; 58:e13839. [PMID: 34032305 DOI: 10.1111/psyp.13839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/28/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
We systematically examined the temporal relationships between subjective sleepiness and both physiological drowsiness and performance impairment in a controlled laboratory setting. Eighteen healthy young adults (8 women; MAGE = 21.44 ± 3.24 years) underwent 40 hr of extended wakefulness, completing a bihourly Karolinska Sleepiness Scale (KSS) and 10-min Psychomotor Vigilance Task (PVT). Microsleeps and slow eye movements (SEMs) were scored during the PVT. KSS scores increased 3 hr prior to performance impairment (p < .001) and 4-6 hr prior to physiological sleepiness (p < .001). There were strong within-subject correlations between KSS and PVT lapses (r = 0.75, p < .001) and physiological drowsiness (r > 0.60, p < .001). Between-subjects product-moment correlations were more modest but showed a significant positive increase across time awake, suggesting that subjective sleepiness and objective outcomes were more tightly correlated after sleep loss. Cross-correlations showed significant positive correlations at 0-lag (p < .034); however, a high proportion of participants showed maximal correlations at positive lags, suggesting KSS was associated with future objective impairment. Within individuals, subjective sleepiness was highly correlated with objective impairment, between-subject correlations were more modest, possibly due to interindividual vulnerability to sleep loss. These results suggest that subjective sleepiness represents an inbuilt early warning system for subsequent drowsiness and performance impairment.
Collapse
Affiliation(s)
- Jessica E Manousakis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Nikita Mann
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Katherine J Jeppe
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
45
|
Garweg C, Clementy N, Mondoloy P, Winter S, Bordachar P, Sharman D, Jung W, Eschalier R, Theis C, Defaye P, Anderson C, Pol A, Roberts PR. A leadless pacemaker in the real-world setting: Patient profile and performance over time. Europace 2021. [DOI: 10.1093/europace/euab116.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic, Inc.
OnBehalf
Micra Acute Performance EMEA Investigators
Background
The first in-man implant of the Micra leadless pacemaker occurred in December 2013. While prior trials demonstrated a high implant success rate and favorable safety and efficacy results; whether the patient population and outcomes have changed over time is not well studied.
Purpose
To characterize the evolution of patient profile and outcomes for patients receiving a leadless pacemaker through the pre-market and post-market environment.
Methods
Patients undergoing a Micra leadless pacemaker implant attempt from the initial Micra Investigational Device Exemption [IDE] and current Micra studies (Micra post-approval registry [PAR], Micra acute performance [MAP] study) were analyzed. Patient characteristics and pericardial effusions regardless of severity were summarized.
Results
The 3466 patients included in the analysis underwent a Micra implant attempt and were enrolled during consecutive timeframes: patients from the Micra IDE study (n = 726) underwent a Micra implant attempt from 2013-2015, patients from the PAR (n = 1814) from 2015-2018, and patients from Micra MAP cohort (n = 926) from 2018 – 2020. Implant success was >99.0% in all 3 studies. Median age ranged from 78 – 79 years among the 3 studies without significant difference. There were more patients requiring dialysis in the MAP cohort compared to the PAR or IDE cohorts (10.3%, 7.9%, and 3.9%, respectively; P < 0.001), but fewer patients with congestive heart failure (8.3%, 13.1%, and 18.0%; P < 0.001). Pacing indication was significantly different between the studies, with fewer patients in MAP having an indication of bradyarrhythmia associated with atrial fibrillation (AF) and more having an indication associated with atrioventricular block without AF (P < 0.001). The number of patients considered to be precluded for a transvenous pacemaker implant increased significantly from the initial IDE study to the PAR and MAP studies (6.2%, 23.9%, and 44.1%, respectively, P < 0.001). Implant site placement was mostly apical for the IDE but shifted to mostly septal placement in the PAR and MAP (septal placement: 33.3%, 64.0%, and 79.5%, respectively). The rate of pericardial effusion regardless of severity was 1.79% (n = 13) in the IDE, 0.83% (n = 15) in the PAR, and 0.97% (n = 9) in MAP (figure). Mean pacing thresholds among MAP EMEA patients were low (0.61 ± 0.40V) at implant and remained stable through 12 months (0.62 +/- 0.41V).
Conclusion
Despite patient differences over time, the Micra leadless pacemaker was implanted with a high success rate and a low perforation rate, in-line with prior reports. Abstract Figure. Pericardial effusion rate by study
Collapse
Affiliation(s)
- C Garweg
- University Hospitals (UZ) Leuven, Cardiology, Leuven, Belgium
| | - N Clementy
- Centre Hospitalier Régional Universitaire de Tours, France, Tours, France
| | - P Mondoloy
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - S Winter
- St. Vinzenz Hospital (Köln), Cologne, Germany
| | - P Bordachar
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - D Sharman
- Northampton General Hospital (Cliftonville), Cliftonville, Northampton, United Kingdom of Great Britain & Northern Ireland
| | - W Jung
- Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - R Eschalier
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Theis
- Robert Bosch Hospital, Stuttgart, Germany
| | | | - C Anderson
- Medtronic, Mounds View, United States of America
| | - A Pol
- Bakken Research Center, Maastricht, Netherlands (The)
| | - PR Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
46
|
Boardman JM, Porcheret K, Clark JW, Andrillon T, Cai AWT, Anderson C, Drummond SPA. The impact of sleep loss on performance monitoring and error-monitoring: A systematic review and meta-analysis. Sleep Med Rev 2021; 58:101490. [PMID: 33894599 DOI: 10.1016/j.smrv.2021.101490] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/09/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
Awareness of performance deficits and errors during sleep loss could be protective against the consequences of sleep deprivation, however, it is unclear whether sleep deprived individuals have insight into their performance. We conducted a systematic review and meta-analysis of the impact of sleep loss (sleep duration <6 h) on monitoring of performance and errors using Embase, MEDLINE, PsycINFO & Cochrane Central. We identified 28 studies, 11 of which were appropriate for meta-analysis. The systematic review indicated limited consensus regarding sleep loss impacts on performance monitoring, due to substantial differences in study methodology. However, participants typically demonstrated more conservative estimates of performance during sleep loss. Error-monitoring literature was more consistent, indicating an impairment in error-monitoring following sleep loss. Meta-analyses supported the findings of the systematic review. In terms of methodology, we found the performance monitoring literature is limited by an overreliance on correlational designs, which are likely confounded by response bias. The error-monitoring literature is limited by very few studies utilising behavioural measures to directly measure error-awareness. Future performance monitoring studies must employ methods which control for confounds such as bias, and error-monitoring studies must incorporate combined behavioural and ERP measures to better understand the impact of sleep loss on error-monitoring.
Collapse
Affiliation(s)
- Johanna M Boardman
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Kate Porcheret
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia; Norwegian Centre for Violence and Traumatic Stress Studies, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Jacob W Clark
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Thomas Andrillon
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Anna W T Cai
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Clare Anderson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia
| | - Sean P A Drummond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Australia.
| |
Collapse
|
47
|
Anderson C, Bae-Jump V, Broaddus RR, Olshan AF, Nichols HB. Long-term Patterns of Excess Mortality among Endometrial Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1055-9965.epi-21-0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose of the study: Examining long-term patterns of mortality among cancer survivors compared to the general population may inform planning for surveillance and follow-up care. We investigated excess mortality after endometrial cancer using conditional relative survival estimates and standardized mortality ratios (SMRs). Methods: Women diagnosed with endometrial cancer during 2000–2017 (N = 183,153) were identified in the Surveillance, Epidemiology, and End Results (SEER) database. SMRs were calculated as observed deaths among endometrial cancer survivors over expected deaths among demographically similar women in the general U.S. population. Five-year relative survival was estimated at diagnosis and each additional year survived up to 12 years post-diagnosis, conditional on survival up to that year. Results: For the full cohort, 5-year relative survival was 87.7%, 96.2%, and 97.1% at 1, 5, and 10 years post- diagnosis. respectively. Conditional 5-year relative survival first exceeded 95%, reflecting minimal excess mortality compared to the general population, at 4 years post-diagnosis overall, but occurred later for Black women (8 years) compared to White (4 years), and also later for women with regional/distant stage, grade 3 disease, or non- endometrioid histology. The overall SMR for all-cause mortality decreased from 5.90 (95% CI: 5.81–5.99) in the first year after diagnosis to 1.16 (95% CI: 1.13–1.19) at 10+ years; SMRs were consistently higher for non-White women and those with higher stage or grade disease. Conclusions: Overall, endometrial cancer survivors had only a small survival deficit beyond 4 years post- diagnosis. However, excess mortality was greater in magnitude and persisted longer into survivorship for Black women and those with more advanced disease.
Collapse
|
48
|
Abstract
Abstract
Introduction
Significant alterations occur in human physiology and the way medications function in space (1). Understanding the efficacy and pitfalls of pharmacological intervention and developing space-related pharmacy services is therefore integral to ensuring a sustained presence for human spaceflight. In contemporary society, the pharmacist plays a significant role in a person’s health. However, pharmacist input towards the spaceflight participant’s health is minimal to nil.
Aim: T
o explore stakeholder perspectives towards the role of Astropharmacy in the space sector.
Methods
Pharmacists (n = 18) across the globe and space sector participants (n = 18) from governmental, commercial, and space tourism sectors participated, via 27 qualitative interviews and three focus groups. Participants were recruited via purposive and snowball sampling. A six-step thematic analysis was used and mapped into the Job Characteristics Model (JCM). JCM is a theory within work design, aiming to promote work experiences and personal outcomes. There are five job dimensions – skill variety, task identity, task significance, autonomy, and feedback which influence three psychological states required for a well-designed job. The three psychological states are meaningfulness, responsibility, and knowledge of work results, which lead to positive work and personal experiences (2).
Results
Three key themes were generated: medication management, medication research, and regulation/licensing. Medication management encompassed safeguarding the space traveller’s health, like space tourists, by conducting medication reviews (pre-and post-flight), medication advice (digital astro-telepharmacy information services during spaceflight) and developing personalised medication. Medication management also included ensuring shelf-life and continuous medication supply for deep space exploration. Medication research included novel drug development, innovative manufacturing, and understanding clinical applications of the pharmacokinetic and pharmacodynamic changes of medications in space. Innovative manufacturing like 3-D printing raises questions regarding the need for regulations/licensing of medications use and manufacturing in space. Based on the JCM our findings indicate that Astropharmacy possesses diverse duties eliciting meaningfulness, with clear responsibility and observable workplace results promoting task significance, and both the medication and patient focus promoting task identity. Autonomy was blurred within Astropharmacy as a degree of autonomy is needed due to the field’s novelty, but workforce regulations by governmental space agencies are expected. Lastly, workplace feedback can be achieved in Astropharmacy through performance reviews.
Conclusion
The Astropharmacy role is perceived to involve medication management, medication research and regulation/licensing of medications for space. The work design of astropharmacy is well-reflected in the JCM, implying that a novel and energising opportunity for the pharmacy profession is forthcoming. Although the data generated by qualitative research are not generalizable to other settings, these themes represent the first study to investigate the space sector qualitatively in the context of pharmacy, providing rich foundational data for future research. Consequently, the amalgamation of two previously distinct workplace domains may be a conceivable reality for the future of pharmacy practice.
References
1. Blue RS, Bayuse TM et al. Supplying a pharmacy for NASA exploration spaceflight: challenges and current understanding. Npj Microgravity. 2019;5(1):1–12.
2. Hackman RJ, Oldham G. Motivation through the design of work: Test of a theory. Organizational Behavior and Human Performance. 1976;16(2):250–279.
Collapse
Affiliation(s)
- L Sawyers
- University of Nottingham, School of Pharmacy
| | - C Anderson
- University of Nottingham, School of Pharmacy
| | - M Boyd
- University of Nottingham, School of Pharmacy
| | - P Williams
- University of Nottingham, School of Pharmacy
| | - L S Toh
- University of Nottingham, School of Pharmacy
| |
Collapse
|
49
|
Iqbal A, Toh LS, Knaggs RD, Anderson C. Factors promoting self-medication and irrational use of opioids in chronic non-malignant pain management in Pakistan: A qualitative in-depth investigation. International Journal of Pharmacy Practice 2021. [DOI: 10.1093/ijpp/riab015.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
In many Lower and Middle-Income Countries (LMICs) people self-medicate, with non-prescription and prescription drugs both of which are easily available over the counter (1). One of the most common causes for self-medication is chronic pain (2). The role of community pharmacists becomes critical especially in LMICs where medicines are freely available and pharmacists are directly involved in supply of opioid medicines. Unresolved, prolonged chronic non-malignant pain (CNMP) may lead to self-medication with opioid analgesics and can cause irrational use of opioids. The complications of self-medication with opioids are vast in terms of both scarce resources and adverse clinical consequences such as adverse drug reactions, drug interactions and mortality associated with the diversion from intended use of opioid medicines. Self- medication with opioid analgesics in LMICs have not been explored before.
Aim
This study was designed to explore the factors that might contribute in promoting self-medication and irrational opioid medicine use in CNMP management and exploring potential roles of community pharmacists in stopping/avoiding self-medication with opioids in one LMIC, Pakistan.
Method
Qualitative interviews involving various stakeholders such as pharmacy policy makers (n=10) and people suffering from CNMP (n=12) were conducted. Additionally, focus groups were conducted with community pharmacists (n=38) and doctors (n=30). A semi-structured interview guide was drafted after an extensive literature review and was used for individual interviews and focus groups for each stakeholder respectively. The study duration was from December 2019 to July 2020. Critical case sampling, a type of purposive sampling, was done in order to promote applicability to other cases. Data was analysed using a CAQDAS software N-vivo 12, using thematic analysis. Ethical approval was obtained.
Results
Non-availability of community pharmacists in all pharmacies and lack of medication review services are amongst the major factors that are contributing towards self-medication of opioid medicines. Additionally, lack of awareness of people about opioid medicines and absence of strict laws regarding sale of opioid medicines under a valid prescription allows easy availability and promotes aberrant drug seeking behaviour. These factors contribute towards people not seeking professional health care services for the management of CNMP and continue self-medicating with opioid medicines. As a result, they do not get effective analgesic relief and waste limited financial resources. The major themes and sub-themes are presented in Table 1.
Conclusion
Self-medication with opioid medicines can cause irrational, inappropriate, and ineffective use of medicines and can additionally burden the limited financial resources available for health care needs. This in-depth exploratory study identifies many barriers that can promote self-medication with opioids and recognises a need for a multi-faceted intervention involving community pharmacists to promote rational opioid medicine use. However, major limitations of the proposed intervention identified from this study are the absence of integrated health systems and under-utilisation of community pharmacy workforce. The government needs to invest in infrastructure development, develop new health policies regarding medicine sale and build the role and capacity of pharmacy workforce to perform specialised roles in public safety especially in opioid medicines.
References
1. Bennadi D. Self-medication: A current challenge. Journal of basic and clinical pharmacy. 2013;5(1):19.
2. Kaushal J, Gupta MC, Jindal P, Verma S. Self-medication patterns and drug use behavior in housewives belonging to the middle income group in a city in northern India. Indian journal of community medicine: official publication of Indian association of preventive & social medicine. 2012;37(1):16.
Collapse
Affiliation(s)
- A Iqbal
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, United Kingdom
| | - L S Toh
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, United Kingdom
| | - R D Knaggs
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, United Kingdom
- Primary Integrated Community Solutions, Nottingham, United Kingdom
| | - C Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, United Kingdom
| |
Collapse
|
50
|
McMahon WR, Ftouni S, Diep C, Collet J, Lockley SW, Rajaratnam SMW, Maruff P, Drummond SPA, Anderson C. The impact of the wake maintenance zone on attentional capacity, physiological drowsiness, and subjective task demands during sleep deprivation. J Sleep Res 2021; 30:e13312. [PMID: 33734527 DOI: 10.1111/jsr.13312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Abstract
We aimed to investigate the impact of the Wake Maintenance Zone (WMZ) on measures of drowsiness, attention, and subjective performance under rested and sleep deprived conditions. We studied 23 healthy young adults (18 males; mean age = 25.41 ± 5.73 years) during 40 hr of total sleep deprivation under constant routine conditions. Participants completed assessments of physiological drowsiness (EEG-scored slow eye movements and microsleeps), sustained attention (PVT), and subjective task demands every two hours, and four-hourly ocular motor assessment of inhibitory control (inhibition of reflexive saccades on an anti-saccade task). Tests were analyzed relative to dim light melatonin onset (DLMO); the WMZ was defined as the 3 hr prior to DLMO, and the preceding 3 hr window was deemed the pre-WMZ. The WMZ did not mitigate the adverse impact of ~37 hr sleep deprivation on drowsiness, sustained attention, response inhibition, and self-rated concentration and difficulty, relative to rested WMZ performance (~13 hr of wakefulness). Compared to the pre-WMZ, though, the WMZ improved measures of sustained attention, and subjective concentration and task difficulty, during sleep deprivation. Cumulatively, these results expand on previous work by characterizing the beneficial effects of the WMZ on operationally-relevant indices of drowsiness, inhibitory attention control, and self-rated concentration and task difficulty relative to the pre-WMZ during sleep deprivation. These results may inform scheduling safety-critical tasks at more optimal circadian times to improve workplace performance and safety.
Collapse
Affiliation(s)
- William Ryan McMahon
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Suzanne Ftouni
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Charmaine Diep
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Jinny Collet
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Steven W Lockley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Shantha M W Rajaratnam
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| | - Paul Maruff
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia.,Cogstate Ltd., Melbourne, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia.,Cooperative Research Centre for Alertness, Safety and Productivity, Melbourne, Victoria, Australia
| |
Collapse
|