A randomized controlled trial of CBT-I and PAP for obstructive sleep apnea and comorbid insomnia : main outcomes from the MATRICS study

Study Objectives -- To investigate treatment models using cognitive behavioral therapy for insomnia (CBT-I) and positive airway pressure (PAP) for people with obstructive sleep apnea (OSA) and comorbid insomnia. Methods -- 121 adults with OSA and comorbid insomnia were randomized to receive CBT-I followed by PAP, CBT-I concurrent with PAP, or PAP only. PAP was delivered following standard clinical procedures for in-lab titration and home setup and CBT-I was delivered in four individual sessions. The primary outcome measure was PAP adherence across the first 90 days, with regular PAP use (≥4 h on ≥70% of nights during a 30-day period) serving as the clinical endpoint. The secondary outcome measures were the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) with good sleeper (PSQI 7) serving as the clinical endpoints. Results -- No significant differences were found between the concomitant treatment arms and PAP only on PAP adherence measures, including the percentage of participants who met the clinical endpoint. Compared to PAP alone, the concomitant treatment arms reported a significantly greater reduction from baseline on the ISI (p = .0009) and had a greater percentage of participants who were good sleepers (p = .044) and remitters (p = .008). No significant differences were found between the sequential and concurrent treatment models on any outcome measure. Conclusions -- The findings from this study indicate that combining CBT-I with PAP is superior to PAP alone on insomnia outcomes but does not significantly improve adherence to PAP

Interventions to Improve Inpatients’ Sleep Quality in the Intensive Care Unit and Acute Ward Settings: A Qualitative Literature Review

Background: Sleep is essential for the physical and psychological restoration of inpatients, and lack of sleep results in sleep deprivation and poor sleep quality, with potentially harmful consequences. Aim: To summarise sleep-promoting interventions in the Intensive care unit (ICU) and acute ward setting. Method and results: Six databases were searched to obtain studies for review and eight studies were selected, appraised, analysed and produced two themes: sleep-disturbing factors and sleep-promoting strategies. Sleep-disturbing factors included environmental factors (such as light and noise), illness-related factors (such as pain, anxiety and discomfort), clinical care and diagnostics. Sleep-promoting strategies included using pharmacological aids (medication) and non-pharmacological aids (reducing noise and disturbances, eye masks, earplugs and educational and behavioural changes). Conclusion: The literature review showed that both ICU and acute ward settings affect patients' sleep and both use similar strategies to improve this. Nevertheless, noise and sleep disturbances remain the most critical sleep-inhibiting factors in both settings. The review recommended future research should focus on behavioural changes among health professionals to reduce noise and improve patients' sleep

Microstructure, texture and tensile behavior of pulsed electrodeposited Ni-Al composites produced using organic additive-free sulfamate bath loaded with Al nanoparticles

Nickel and Ni-Al composites with varying Al nanoparticle content were produced by pulsed electrodeposition using an organic additive-free sulfamate bath. The as-deposited Ni-Al composites exhibited increased compressive residual stresses with increasing Al nanoparticles. Detailed microstructural investigation revealed that Al codeposition led to significant refinement of the columnar morphology and grain structure of Ni matrix along with a texture change from strong to fiber texture parallel to the growth direction. The as-deposited Ni with bimodal grain structure displayed good tensile strength and ductility. The microhardness and tensile strength of the Ni deposits were increased initially with Al content and then decreased at higher particle content. Particle induced grain refinement and texture changes could be related to change in the growth of upcoming Ni nuclei on to the surface of well-dispersed Al nanoparticles. Significant grain refinement and lesser internal stresses along with good particle distribution and relatively harder fiber texture at lower particles concentration collectively contributed to the observed higher strengths in Ni-Al composites as compared to Ni deposits. There was substantial change in fracture morphology from spherical dimples to flat regions with increasing Al content due to agglomeration of nanoparticles at higher particle loading

Study on Variants of Solution Treatment and Aging Cycle of Titanium Alloy Ti6Al4V

Ti6Al4V with two different chemical compositions, one rich and the other lean in alpha-stabilizer oxygen were selected to study the effect of quench severity during solution treatment and their aging response. These two coupons were taken from two differently processed wrought products viz. rolled ring and closed die forging. The coupons were then subjected to solution treatment followed by employing different cooling rates to vary the quench severity and different aging treatments by changing the aging temperature and time. The microstructure and mechanical properties thus obtained are correlated with respect to the heat treatment conditions. It is noted that there is a significant increase in strength of the alloy retaining the ductility when it is aged in the aging temperature regime of 550-650 A degrees C and time of 8 h. Role of higher oxygen content is noted, which is more pronounced with higher severity of quench (by water quenching). Specimens representative of different heat treatment conditions were characterized using optical microscope, electron back-scattered diffraction, and electron microscope. The presence of martensitic (alpha') structure along with uniform distribution of fine primary alpha, secondary alpha precipitates and refined beta-grains, twins in the microstructure helps in improving the strength of the material. Also, during high temperature aging of 700 A degrees C, which incidentally falls in the range of annealing temperature of the alloy, overaging occurs which is similar to effect of annealing and hence retains the ductility as well

Microstructural evolution in Al–Mg–Sc alloy (AA5024): Effect of thermal treatment, compression deformation and friction stir welding.

Effect of thermal annealing and deformation in both compression and friction stir welding conditions on microstructural evolution in the cold rolled Al-4.36Mg-0.26Sc-0.09Zr (wt.%) alloy was investigated. To evaluate the thermal stability of the alloy, differential scanning calorimetry and static annealing experiments were carried out as a function of temperature. Microhardness measurements and quasi-static compression testing were performed on the as-received and annealed alloy samples. Friction stir welding was carried out on the as-received alloy sheet in butt configuration at two different tool traverse speeds of 250 and 500 mm/min. Upon annealing, the alloy showed continuous recrystallization with transformation of the elongated grain structure possessing strong rolling texture to coarse equiaxed microstructure with random orientation. The annealed alloy exhibited reduced hardness and compressive strength at room temperature. Detailed microstructural investigation of hot compression deformed and friction stir welded samples revealed formation of subgrain structure and followed by fine recrystallized grains with nearly random orientation. The analysis suggests that continuous dynamic recrystallization involving progressive subgrain rotation is the possible mechanism for microstructural changes occurring during hot deformation of Al–Mg-Sc alloy