Agreement in the scoring of respiratory events and sleep among international sleep centers.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Abstract STUDY OBJECTIVES: The American Academy of Sleep Medicine (AASM) guidelines for polysomnography (PSG) scoring are increasingly being adopted worldwide, but the agreement among international centers in scoring respiratory events and sleep stages using these guidelines is unknown. We sought to determine the interrater agreement of PSG scoring among international sleep centers. DESIGN: Prospective study of interrater agreement of PSG scoring. SETTING: Nine center-members of the Sleep Apnea Genetics International Consortium (SAGIC). MEASUREMENTS AND RESULTS: Fifteen previously recorded deidentified PSGs, in European Data Format, were scored by an experienced technologist at each site after they were imported into the locally used analysis software. Each 30-sec epoch was manually scored for sleep stage, arousals, apneas, and hypopneas using the AASM recommended criteria. The computer-derived oxygen desaturation index (ODI) was also recorded. The primary outcome for analysis was the intraclass correlation coefficient (ICC) of the apnea-hypopnea index (AHI). The ICCs of the respiratory variables were: AHI = 0.95 (95% confidence interval: 0.91-0.98), total apneas = 0.77 (0.56-0.87), total hypopneas = 0.80 (0.66-0.91), and ODI = 0.97 (0.93-0.99). The kappa statistics for sleep stages were: wake = 0.78 (0.77-0.79), nonrapid eye movement = 0.77 (0.76-0.78), N1 = 0.31 (0.30-0.32), N2 = 0.60 (0.59-0.61), N3 = 0.67 (0.65-0.69), and rapid eye movement = 0.78 (0.77-0.79). The ICC of the arousal index was 0.68 (0.50-0.85). CONCLUSION: There is strong agreement in the scoring of respiratory events among the SAGIC centers. There is also substantial epoch-by-epoch agreement in scoring sleep variables. Our results suggest that centralized scoring of PSGs may not be necessary in future research collaboration among international sites where experienced, well-trained scorers are involved.NHLBI P01 HL094307 HL093463 Tzagournis Medical Research Endowment Funds of The Ohio State Universit

The human decatenation checkpoint

Chromatid catenation is actively monitored in human cells, with progression from G2 to mitosis being inhibited when chromatids are insufficiently decatenated. Mitotic delay was quantified in normal and checkpoint-deficient human cells during treatment with ICRF-193, a topoisomerase II catalytic inhibitor that prevents chromatid decatenation without producing topoisomerase-associated DNA strand breaks. Ataxia telangiectasia (A-T) cells, defective in DNA damage checkpoints, showed normal mitotic delay when treated with ICRF-193. The mitotic delay in response to ICRF-193 was ablated in human fibroblasts expressing an ataxia telangiectasia mutated- and rad3-related (ATR) kinase-inactive ATR allele (ATRki). BRCA1-mutant HCC1937 cells also displayed a defect in ICRF-193-induced mitotic delay, which was corrected by expression of wild-type BRCA1. Phosphorylations of hCds1 or Chk1 and inhibition of Cdk1 kinase activity, which are elements of checkpoints associated with DNA damage or replication, did not occur during ICRF-193-induced mitotic delay. Over-expression of cyclin B1 containing a dominant nuclear localization signal, and inhibition of Crm1-mediated nuclear export, reversed ICRF-193-induced mitotic delay. In combination, these results imply that ATR and BRCA1 enforce the decatenation G2 checkpoint, which may act to exclude cyclin B1/Cdk1 complexes from the nucleus. Moreover, induction of ATRki produced a 10-fold increase in chromosomal aberrations, further emphasizing the vital role for ATR in genetic stability

Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial.

RATIONALE: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation. OBJECTIVE: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia. METHODS AND MEASUREMENTS: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015. The primary outcome was neurocognitive (attention and information processing as measure with the Paced Auditory Serial Addition Task). Daytime sleepiness (Karolinska Sleepiness Scale) was a priori identified as the most important secondary outcome. MAIN RESULTS: 1810 incident cases were screened. 332 underwent full, portable polysomnography, 273 of whom had an apnoea hypopnoea index greater than 10. 160 tolerated at least 4 hours of CPAP during a 3-day run-in and were randomised. 149 participants (134 men, age 46±34 years, 81±57 days postinjury) completed the trial. CPAP use averaged 2.9±2.3 hours per night with 21% fully 'adherent' (at least 4 hours use on 5 days per week). Intention-to-treat analyses revealed no significant differences between groups in the Paced Auditory Serial Addition Task (mean improvement of 2.28, 95% CI -7.09 to 11.6; p=0.63). Controlling for premorbid intelligence, age and obstructive sleep apnoea severity (group effect -1.15, 95% CI -10 to 7.7) did not alter this finding. Sleepiness was significantly improved by CPAP on intention-to-treat analysis (mean difference -1.26, 95% CI -2.2 to -0.32; p=0.01). CONCLUSION: CPAP did not improve Paced Auditory Serial Addition Task scores but significantly reduced sleepiness after acute quadriplegia. TRIAL REGISTRATION NUMBER: ACTRN12605000799651

Exploring the contribution of alternative food networks to food security. A comparative analysis

[EN] Food (in)security has become a challenge not only for developing economies but also for High Income Countries. In parallel, food scholars have actively investigated the contribution of alternative food networks (AFNs) to the development of more sustainable and just food systems, paying attention to drivers, initiatives and policies supporting the development of alternatives to the dominant industrialised food system and its detrimental environmental and socio-economic impacts. However, few studies have directly addressed the contribution of AFNs to food security in the Global North. This paper aims to establish new linkages between food security debates and critical AFNs literature. For that purpose, we conduct a place-based approach to food security in a comparative analysis of initiatives of three different European contexts: Cardiff city-region (UK), the Flemish Region (Belgium) and the peri-urban area of the city of Valencia (Spain). The results unfold: i) how AFNs weave a more localised socio-economic fabric that creates new relationships between food security outcomes and specific territories, ii) hybridization processes within alternative but also conventional systems and iii) the role of advocacy and collective action at different levels. The analysis allows identification of key elements on which food security debates hinge and provides new insights to ground conceptual discussions on territorial and place-based food security approaches.This research is part of the project "Assessment of the impact of global drivers of change on Europe's food security" (TRANSMANGO), granted by the EU under 7th Framework Programme; theme KBBE.2013.2.5-01; Grant agreement no: 613532. Dr. Ana Moragues-Faus also acknowledges the funding of the European Commission and the Welsh Government that currently supports her Ser Cymru fellowship. 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The role of rapid maxillary expansion in the promotion of oral and general health

Rapid maxillary expansion (RME) is an effective orthopedic procedure that can be used to address problems concerned with the growth of the midface. This procedure also may produce positive side effects on the general health of the patient. The aim of the present consensus paper was to identify and evaluate studies on the changes in airway dimensions and muscular function produced by RME in growing patients. A total of 331 references were retrieved from a database search (PubMed). The widening of the nasal cavity base after midpalatal suture opening in growing patients allows the reduction in nasal airway resistance with an improvement of the respiratory pattern. The effects of RME on the upper airway, however, have been described as limited and local, and these effects become diminished farther down the airway, possibly as a result of soft-tissue adaptation. Moreover, limited information is available about the long-term stability of the airway changes produced by RME. Several studies have shown that maxillary constriction may play a role in the etiology of more severe breathing disorders such as obstructive sleep apnea (OSA) in growing subjects. Early orthodontic treatment with RME is able to reduce the symptoms of OSA and improve polysomnographic variables. Finally, early orthopedic treatment with RME also is beneficial to avoid the development of facial skeletal asymmetry resulting from functional crossbites that otherwise may lead to functional and structural disorders of the stomatognathic system later in life

Desempenho ocupacional das famílias cuidadoras de pessoas com transtornos mentais atendidas em dispositivo de atenção psicossocial

With the process of psychiatric institutionalization, treatment of people with mental disorders, characterized by long before psychiatric hospitalizations, chronicity and social exclusion, went on to defend the humanized care, the integration of the individual in the family and society. The family of the person with a mental disorder, for a considerable time was excluded from the assistance provided to his family. He is currently an important partner of care, since most people who were treated in closed institutions, today live daily with their caregivers, at home. However, families often are not prepared to act as caretakers of close family members with mental disorders, and thus experience a context of overloads in everyday life. It is not uncommon the fact they have not with satisfactory support to deal with the complex situation of caring for a relative who needs care at length in daily life. This research aims to describe the areas of occupational performance (work, rest and sleep, leisure and social participation), the caregivers families before and after the mental illness of his family and the repercussions of this fact in daily life and living conditions of family caregivers; Identify among the areas of occupational performance (work, rest and sleep, leisure and social participation), those considered most important for family caregivers, and the strategies used by them for the development of these areas, with a view to changes in their daily lives and their living conditions. This is a qualitative, critical and reflective study. Approved by the Research Ethics Committee (CEP) of the University Hospital Lauro Wanderley the Federal University of Paraíba, in the period from July 2014 to February 2015. The instrument for data collection was semi-structured interviews. Data collection took place in October and November 2014, after receiving the assent of the CEP. The material was subjected to the analysis of data according to Minayo (2008), following three methodological steps: pre-analysis, material exploration, processing of data and interpretation. The research findings revealed that with regard to the areas of occupational performance (work, rest and sleep, leisure and social participation) of family before becoming caregivers, four of them worked before the mental illness of their relatives and family, by the will of spouse, only performed housework. With regard to rest and sleep, the five family caregivers, two reported not enjoy a good rest and sleep before getting sick of your family, a fact surely occasioned negative impact on the dynamics of your everyday life . The other three caregivers had a good rest and sleep. It was identified that the leisure of the caregivers in this study, before the mental illness of the family, was designed and related to diverse aspects. The five family caregivers interviewed reported an active social participation, whether in church, community groups, in the family. With regard to the areas of occupational performance after mental illness the family, all family caregivers have had to stop work activities outside the home to care for relatives with mental disorders. The rest and sleep of them had to suffer. The leisure and social participation of family caregivers were determined by dynamic behavior of their relatives with mental disorders. With regard to the areas of occupational performance considered the most important by family caregivers, they elected two: rest and sleep and social participation. With the completion of this study, we can see the relevance of the intervention of health workers, because through dialogue and more systematic follow-up to these families, you can help minimize the impact of a life in organized care and overloads generated by these care and so contribute to improving the quality of life of families and caregivers also of users with mental disorders.Com o processo de desinstitucionalização psiquiátrica, o tratamento das pessoas com transtornos mentais antes caracterizados por longas internações psiquiátricas, cronificação e exclusão social, passou a defender o cuidado humanizado, a reinserção do indivíduo na família e na sociedade. A família da pessoa com transtorno mental, durante tempo considerável foi excluída da assistência prestada ao seu familiar. Atualmente é uma importante parceira do cuidado, pois muitas pessoas que eram tratadas em instituições fechadas, hoje convivem diariamente com seus cuidadores, no domicílio. Porém, as famílias, muitas vezes, não estão preparadas para atuar como cuidadoras desses familiares com transtornos mentais, e assim vivenciam um contexto de sobrecargas no cotidiano. Não é raro o fato de não contarem com suporte satisfatório para lidar com a complexa situação de cuidar de um familiar, o qual necessita de cuidados durante um tempo considerável no cotidiano. Esta pesquisa tem como objetivo descrever as áreas de desempenho ocupacional (trabalho; descanso e sono; lazer e participação social), das famílias cuidadoras, antes e após o adoecimento mental dos seus familiares e as repercussões desse fato no cotidiano e nas condições de vida dos familiares cuidadores; Identificar dentre as áreas de desempenho ocupacional (trabalho; descanso e sono; lazer e participação social), as que são consideradas mais importantes para os familiares cuidadores, e as estratégias utilizadas por eles para o desenvolvimento dessas áreas, com vistas a mudanças no seu cotidiano e nas suas condições de vida. Trata-se de estudo qualitativo, crítico e reflexivo. Aprovado pelo Comitê de Ética e Pesquisa (CEP) do Hospital Universitário Lauro Wanderley da Universidade Federal da Paraíba, desenvolvido no período de julho de 2014 a fevereiro de 2015. O instrumento para coleta de dados foi a entrevista semiestruturada. A coleta de dados aconteceu nos meses de outubro e novembro de 2014, após recebimento do parecer favorável do CEP. O material foi submetido a análise de dados segundo Minayo (2008), seguindo três passos metodológicos: pré-análise, exploração do material, tratamento dos dados obtidos e interpretação. Os achados da pesquisa revelaram que no tocante às áreas de desempenho ocupacional (trabalho, descanso e sono, lazer e participação social) dos familiares antes de se tornarem cuidadores, quatro delas trabalhavam antes do adoecimento mental de seus familiares e uma familiar, por vontade do esposo, só realizava trabalhos domésticos. No que diz respeito ao descanso e sono, das cinco cuidadoras familiares, duas relataram não desfrutarem de um bom descanso e sono, antes do processo de adoecimento do seu familiar, fato este, com certeza, que ocasionava repercussões negativas na dinâmica de seu dia a dia. As outras três cuidadoras apresentavam bom descanso e sono. Identificou-se que o lazer das cuidadoras desse estudo, antes do adoecimento mental do familiar, era concebido e relacionado a aspectos diversificados. As cinco cuidadoras familiares entrevistadas relataram uma participação social atuante, seja na igreja, nos grupos comunitários e na família. No que diz respeito às áreas de desempenho ocupacional após o adoecimento mental do familiar, todas as cuidadoras familiares tiveram de interromper as atividades de trabalho fora de casa para cuidar de familiares com transtornos mentais. O descanso e sono delas apresentavam-se prejudicados. O lazer e a participação social das cuidadoras familiares eram determinados pela dinâmica de comportamento dos seus familiares com transtornos mentais. No concernente às áreas de desempenho ocupacional consideradas as mais importantes pelas cuidadoras familiares, estas elegeram duas: descanso e sono e participação social. Com a realização desse estudo, percebe-se a relevância da intervenção dos trabalhadores da saúde, pois mediante o diálogo e acompanhamento mais sistemático a essas famílias, pode-se contribuir para minimizar o impacto de uma vida organizada em cuidados e sobrecargas geradas por esses cuidados e assim colaborar para a melhoria da qualidade de vida das famílias cuidadoras e também dos usuários com transtornos mentais

Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors JACC State-of-the-Art Review

Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed