Determinants of Sleepiness at Wheel and Missing Accidents in Patients With Obstructive Sleep Apnea

Study Objectives: Motor-vehicle crashes are frequent in untreated OSA patients but there is still uncertainty on prevalence as well as physiological or clinical determinants of sleepiness at the wheel (SW) in OSA patients. We assessed determinants of SW or sleepiness related near-miss car accident (NMA) in a group of non-professional drivers with OSA. Methods: A 237 consecutive, treatment-naïve PSG-diagnosed OSA patients (161 males, 53.1 ± 12.6 years) were enrolled. Self-reported SW was assessed by positive answer to the question, “Have you had episodes of falling asleep while driving or episodes of drowsiness at wheel that could interfere with your driving skill in the last year?” Occurrence of NMA in the last 3 years was also individually recorded. Habitual self-reported average sleep time was collected. Results: SW was found in 41.3% of patients but one-quarter of patients with SW did not report excessive daytime sleepiness. Predictors of SW were the following subjective factors: Epworth sleepiness scale score (ESS-OR 1.26; IC 1.1–1.4; p < 0.0001), depressive symptoms (BDI-OR 1.2; IC 1.06–1.18; p < 0.0001) and level of risk exposure (annual mileage-OR 1.9; IC 1.15–3.1; p = 0.007). NMAs were reported by 9.7% of patients, but more frequently by SW+ than SW– (22.4% vs. 0.7%; χ2 31, p < 0.0001). The occurrence of NMAs was significantly associated to ESS, BDI, habitual sleep duration and ODI (R2 = 0.41). Conclusion: SW is not predicted by severity of OSA. Evaluation of risk exposure, assessment of depressive symptoms, and reported NMA should be included in the clinical evaluation, particularly in patients with reduced habitual sleep time and severe nocturnal hypoxia

Tunable coaxial cavity resonator for linear and nonlinear microwave characterization of superconducting wires

We discuss experimental results obtained using a tunable cylindrical coaxial cavity constituted by an outer Cu cylinder and an inner Pb-BSCCO wire. We have used this device for investigating the microwave response of the superconducting wire, both in the linear and nonlinear regimes. In particular, by tuning the different modes of the cavity to make them resonant at exactly harmonic frequencies, we have detected the power emitted by the superconducting inner wire at the second- and third-harmonic frequency of the driving field. The results obtained in the nonlinear regime, whether for the microwave surface impedance or the harmonic emission, are qualitatively accounted for considering intergrain fluxon dynamics. The use of this kind of device can be of strong interest to investigate and characterise wires of large dimensions to be used for implementing superconducting-based microwave devices.Comment: 14 pages, 6 embedded figures, accepted for publication in Supercond. Sci. Techno

Second cohomology for finite groups of Lie type

Let $G$ be a simple, simply-connected algebraic group defined over $\mathbb{F}_p$. Given a power $q = p^r$ of $p$, let $G(\mathbb{F}_q) \subset G$ be the subgroup of $\mathbb{F}_q$-rational points. Let $L(\lambda)$ be the simple rational $G$-module of highest weight $\lambda$. In this paper we establish sufficient criteria for the restriction map in second cohomology $H^2(G,L(\lambda)) \rightarrow H^2(G(\mathbb{F}_q),L(\lambda))$ to be an isomorphism. In particular, the restriction map is an isomorphism under very mild conditions on $p$ and $q$ provided $\lambda$ is less than or equal to a fundamental dominant weight. Even when the restriction map is not an isomorphism, we are often able to describe $H^2(G(\mathbb{F}_q),L(\lambda))$ in terms of rational cohomology for $G$. We apply our techniques to compute $H^2(G(\mathbb{F}_q),L(\lambda))$ in a wide range of cases, and obtain new examples of nonzero second cohomology for finite groups of Lie type.Comment: 29 pages, GAP code included as an ancillary file. Rewritten to include the adjoint representation in types An, B2, and Cn. Corrections made to Theorem 3.1.3 and subsequent dependent results in Sections 3-4. Additional minor corrections and improvements also implemente

Identifying and validating the presence of guanine-quadruplexes (G4) within the blood fluke parasite schistosoma mansoni

Schistosomiasis is a neglected tropical disease that currently affects over 250 million individ-uals worldwide. In the absence of an immunoprophylactic vaccine and the recognition that mono-chemotherapeutic control of schistosomiasis by praziquantel has limitations, new strategies for managing disease burden are urgently needed. A better understanding of schistosome biology could identify previously undocumented areas suitable for the development of novel interventions. Here, for the first time, we detail the presence of G-quadru-plexes (G4) and putative quadruplex forming sequences (PQS) within the Schistosoma mansoni genome. We find that G4 are present in both intragenic and intergenic regions of the seven autosomes as well as the sex-defining allosome pair. Amongst intragenic regions, G4 are particularly enriched in 3´ UTR regions. Gene Ontology (GO) term analysis evi-denced significant G4 enrichment in the wnt signalling pathway (p<0.05) and PQS oligonu-cleotides synthetically derived from wnt-related genes resolve into parallel and anti-parallel G4 motifs as elucidated by circular dichroism (CD) spectroscopy. Finally, utilising a single chain anti-G4 antibody called BG4, we confirm the in situ presence of G4 within both adult female and male worm nuclei. These results collectively suggest that G4-targeted compounds could be tested as novel anthelmintic agents and highlights the possibility that G4-stabilizing molecules could be progressed as candidates for the treatment of schistosomiasis

Covid-19 pandemic and equal access to vaccines

The COVID-19 pandemic has evidenced the chronic inequality that exists between populations and communities as regards global healthcare. Vaccination, an appropriate tool for the prevention of infection, should be guaranteed by means of proportionate interventions to defeat such inequality in populations and communities affected by a higher risk of infection. Equitable criteria of justice should be identified and applied with respect to access to vaccination and to the order in which it should be administered. This article analyzes, as regards the worldwide distribution of anti-COVID-19 vaccines, the various ways the principle of equity has been construed and applied or even overlooked. The main obstacle to equal access to vaccines is vaccine nationalism. The perception of equity varies with the differing reference values adopted. Adequate response to needs appears to be the principal rule for achieving the criterion of equity in line with distributive justice. Priorities must be set equitably based on rational parameters in accordance with current needs. The entire process must be governed by transparency, from parameter identification to implementation. The issue of equal access to vaccination affects the entire world population, necessitating specific protective interventions. In light of this, the World Health Organization (WHO) has devised the COVAX plan to ensure that even the poorest nations of the world receive the vaccine; certain initiatives are also supported by the European Union (EU). This pandemic has brought to the fore the need to build a culture of equitable relationships both in each country's own domain and with the rest of the world

Mercury in fishes from Augusta Bay (southern Italy): Risk assessment and health implication

Our study reports on the total mercury (HgT) concentrations measured in the muscles and livers of several benthic, demersal and pelagic fish species caught inside and outside of Augusta Bay (southern Italy), a semi-enclosed marine area, highly contaminated by the uncontrolled (since the 1950s to 1978s) discharge of the largest European petrochemical plant. Mercury levels in fish tissues are discussed with regard to specific habitat, size and/or age of the specimens and HgT distribution in the bottom sediments. Results suggest a still active Hg release mechanism from the polluted sediments to the marine environment. Also, the high HgT concentrations measured in fishes caught in the external area of the bay imply a potential role of Augusta Bay as a pollutant source for the Mediterranean ecosystem. Finally, values of hazard target quotient (THQ) and estimated weekly intake (EWI) demonstrate that consumption of fishes caught inside the bay represents a serious risk for human health. Also, data indicate that intake of fishes caught from the external area of the bay, especially for that concern demersal and benthic species, could be represent a significant component of risk for the local population

Distance follow-up by a remote medical care centre improves adherence to CPAP in patients with obstructive sleep apnoea over the short and long term

Background: Adherence to continuous positive air pressure (CPAP) in patients with obstructive sleep apnoea (OSA) has remained invariably low over the last decades. Remote monitoring of the nocturnal CPAP treatment, within telemedicine (TM)-based follow-up programs, in these patients has been suggested as a potential tool to improve adherence and release the workload of sleep units. The aim of this study was therefore to assess whether a follow-up program carried out by a Remote Medical Care Centre (RMCC), outside the sleep unit, improves adherence to CPAP in the short and long term in patients with OSA. Methods: In this pilot protocol, we enrolled 37 patients starting CPAP in our Sleep Centre (SC). After three months of standard care in our SC, patients initiated a six-month remote follow-up carried out by the RMCC, functioning as an intermediary between patients and SC. Monthly reports and indication for face-to-face visits were sent to the SC for six months. After this period patients returned to usual care for one year. Results were compared with those obtained in 38 patients (controls) followed with usual care over the same time range. Results: Mean nightly use of CPAP increased from 3.2 ± 2.4 h pre-RMCC to 5.2 ± 1.9 h post-RMCC (p < 0.0001). Nights/month of CPAP use improved from 19.8 ± 9.2 to 25.2 ± 2.5 (p < 0.05) and nights/month with CPAP use >4 h from 12.5 ± 10 to 21.03 ± 8.9 (p < 0.05). This improvement remained stable after 12 months from the return of patients to usual care. No significant changes in CPAP use were observed in controls over the time. Conclusion: A six-month follow-up through a remote facility can significantly improve adherence to CPAP in the short and long term. This pilot study provides a solid base for the design of multicentre randomized trials focusing on new models which are able to increase the long-term efficacy of TM programs

Automated Stabilization, Enhancement and Capillaries Segmentation in Videocapillaroscopy

Oral capillaroscopy is a critical and non-invasive technique used to evaluate microcirculation. Its ability to observe small vessels in vivo has generated significant interest in the field. Capillaroscopy serves as an essential tool for diagnosing and prognosing various pathologies, with anatomic–pathological lesions playing a crucial role in their progression. Despite its importance, the utilization of videocapillaroscopy in the oral cavity encounters limitations due to the acquisition setup, encompassing spatial and temporal resolutions of the video camera, objective magnification, and physical probe dimensions. Moreover, the operator’s influence during the acquisition process, particularly how the probe is maneuvered, further affects its effectiveness. This study aims to address these challenges and improve data reliability by developing a computerized support system for microcirculation analysis. The designed system performs stabilization, enhancement and automatic segmentation of capillaries in oral mucosal video sequences. The stabilization phase was performed by means of a method based on the coupling of seed points in a classification process. The enhancement process implemented was based on the temporal analysis of the capillaroscopic frames. Finally, an automatic segmentation phase of the capillaries was implemented with the additional objective of quantitatively assessing the signal improvement achieved through the developed techniques. Specifically, transfer learning of the renowned U-net deep network was implemented for this purpose. The proposed method underwent testing on a database with ground truth obtained from expert manual segmentation. The obtained results demonstrate an achieved Jaccard index of 90.1% and an accuracy of 96.2%, highlighting the effectiveness of the developed techniques in oral capillaroscopy. In conclusion, these promising outcomes encourage the utilization of this method to assist in the diagnosis and monitoring of conditions that impact microcirculation, such as rheumatologic or cardiovascular disorders

Intraspecific divergence between Grapholitha molesta (Tortricidae, Lepidoptera) populations from Italy and Greece in relation to temperature.

Genetic changes contributing to phenotypic and phenological differences within or between species have been identified for a handful of traits, but the relationship between alleles underlying intraspecific polymorphism and interspecific divergence is largely unknown. Particularly for economically important insects macroscopic diagnosis and assessment of species boundaries and related population dynamics is often problematic because of the limited morphological and/or biological traits. In this work we attempt to compare temperature driven physiological responses of Grapholita molesta populations from different areas along with an initial phylogenetic analysis. To evaluate region-specific moth phenology patterns, we used the data sets of flights during two successive growth seasons (2011 and 2012). Population sizes of G. molesta moth phenology depended strongly on the particular location of research and model performance that were applied to predict population dynamics was less effective in predicting the related data sets. In addition, several individual from two populations (Italy and Greece) were screened with two mtDNA loci (761 bp and 627 bp in length) revealing the levels of intraspecific divergence within this species between different geographic regions. Beside that, however, DNA barcoding revealed that at least two species other than G. molesta were also attracted by the G. molesta lures. It was thus made evident that DNA-based approaches can shed more light into variation in phenology observed among populations of the same species. With that, more work is on the way, including a comprehensive population study and a rigorous sampling of many more geographical regions to offer a more robust explanation of intraspecific divergence