Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis

Objectives: Despite sleep disturbances being a central complaint in patients with chronic fatigue syndrome (CFS), evidence of objective sleep abnormalities from over 30 studies is inconsistent. The present study aimed to identify whether sleep-specific phenotypes exist in CFS and explore objective characteristics that could differentiate phenotypes, while also being relevant to routine clinical practice. Design: A cross-sectional, single-site study. Setting: A fatigue clinic in the Netherlands. Participants: A consecutive series of 343 patients meeting the criteria for CFS, according to the Fukuda definition. Measures: Patients underwent a single night of polysomnography (all-night recording of EEG, electromyography, electrooculography, ECG and respiration) that was hand-scored by a researcher blind to diagnosis and patient history. Results: Of the 343 patients, 104 (30.3%) were identified with a Primary Sleep Disorder explaining their diagnosis. A hierarchical cluster analysis on the remaining 239 patients resulted in four sleep phenotypes being identified at saturation. Of the 239 patients, 89.1% met quantitative criteria for at least one objective sleep problem. A one-way analysis of variance confirmed distinct sleep profiles for each sleep phenotype. Relatively longer sleep onset latencies, longer Rapid Eye Movement (REM) latencies and smaller percentages of both stage 2 and REM characterised the first phenotype. The second phenotype was characterised by more frequent arousals per hour. The third phenotype was characterised by a longer Total Sleep Time, shorter REM Latencies, and a higher percentage of REM and lower percentage of wake time. The final phenotype had the shortest Total Sleep Time and the highest percentage of wake time and wake after sleep onset. Conclusions: The results highlight the need to routinely screen for Primary Sleep Disorders in clinical practice and tailor sleep interventions, based on phenotype, to patients presenting with CFS. The results are discussed in terms of matching patients’ self-reported sleep to these phenotypes in clinical practice

Researching Children’s Experience Hermeneutically and Holistically

This article is about the possibilities of conducting research with children productively. Children may need suitable prompts, occasions, or media for their expression. The discussion begins with an overview of the challenges or dynamics researchers can experience with any participants in qualitative research in the constructivist paradigm. It draws on key ideas from hermeneutics to clarify the importance of working holistically, attending to whole-part relationships, and having an increased sensitivity to language. Finally, two approaches are described and suggested as being helpful in research with children: the use of pre-interview activities and narrative approaches.Cet article porte sur les possibilités de mener des recherches productives avec les enfants. Il se peut que les enfants aient besoin de questions incitatives, d’occasions ou de médias pour s’exprimer. La discussion débute par un survol des défis qui peuvent se présenter aux chercheurs par rapport aux participants à une recherche qualitative entreprise selon le paradigme constructiviste. Notre approche s’appuie sur les idées clés de l’herméneutique pour souligner l’importance de travailler dans une perspective holistique en se penchant sur le rapport entre le tout et les parties qui le composent et en portant une attention particulière à la langue. Enfin, nous décrivons et recommandons deux approches utiles en recherche impliquant les enfants : l’emploi d’activités avant les entrevues et le recours à la méthode narrative

The Perfect Storm: How Pro-Abortion Activists in the Netherlands Incite Social Change From International Waters

This project is a sociological ethnography of the Women on Waves foundation, founded in 1999 by Dr. Rebecca Gomperts. As an international non-profit organization, they employ a direct action method: sailing to countries where abortion is illegal and providing safe abortion access. Local women board the ship that then travels 12 miles to international waters, where Dutch law applies, and the abortion pill can be administered legally. Using a feminist perspective, I interviewed five of the women at the organization in addition to the ship’s captain in order to understand the ideological beliefs about the reproductive rights that have inspired and motivated the organization’s mission. I examine their personal stories by critically looking at how they speak about their activism and the significance of these memories in their lives. I approach my study of the organization after a comprehensive summary of the history of abortion legalization in the Netherlands, specifically looking at pro-abortion feminist activism in the 1970s. Within the historical and socio-cultural framework of Dutch society, I discuss the history of the Women on Waves foundation and then provide a portrait of each interview. I also analyze the interviews as a collective group through thematic trends. I have come to the conclusion that through creative strategies, daring actions, and fervent passion, their ship will continue to help women everywhere to attain access to safe abortion and accurate reproductive health information

The Association between Daytime Napping and Cognitive Functioning in Chronic Fatigue Syndrome

OBJECTIVES The precise relationship between sleep and physical and mental functioning in chronic fatigue syndrome (CFS) has not been examined directly, nor has the impact of daytime napping. This study aimed to examine self-reported sleep in patients with CFS and explore whether sleep quality and daytime napping, specific patient characteristics (gender, illness length) and levels of anxiety and depression, predicted daytime fatigue severity, levels of daytime sleepiness and cognitive functioning, all key dimensions of the illness experience. METHODS 118 adults meeting the 1994 CDC case criteria for CFS completed a standardised sleep diary over 14 days. Momentary functional assessments of fatigue, sleepiness, cognition and mood were completed by patients as part of usual care. Levels of daytime functioning and disability were quantified using symptom assessment tools, measuring fatigue (Chalder Fatigue Scale), sleepiness (Epworth Sleepiness Scale), cognitive functioning (Trail Making Test, Cognitive Failures Questionnaire), and mood (Hospital Anxiety and Depression Scale). RESULTS Hierarchical Regressions demonstrated that a shorter time since diagnosis, higher depression and longer wake time after sleep onset predicted 23.4% of the variance in fatigue severity (p <.001). Being male, higher depression and more afternoon naps predicted 25.6% of the variance in objective cognitive dysfunction (p <.001). Higher anxiety and depression and morning napping predicted 32.2% of the variance in subjective cognitive dysfunction (p <.001). When patients were classified into groups of mild and moderate sleepiness, those with longer daytime naps, those who mainly napped in the afternoon, and those with higher levels of anxiety, were more likely to be in the moderately sleepy group. CONCLUSIONS Napping, particularly in the afternoon is associated with poorer cognitive functioning and more daytime sleepiness in CFS. These findings have clinical implications for symptom management strategies

Constraints on Sustainable Marine Fisheries in the United States: A Look at the Record

The factors that may either constrain or contribute to sustainable marine fisheries were examined by reviewing and analyzing the history and current status of several U.S. fisheries. Among major factors under consideration are inherent vulnerability (vulnerability in some species is high because of low intrinsic rates of increase and/or naturally infrequent recruitment); environmental degradation (fisheries may collapse because of anthropogenic habitat destruction); availability of data (information necessary co conduce accurate stock assessments may be inadequate for some species); quality of the scientific advice (inappropriate models or scientifically inaccurate assessments may be used); and effectiveness of management decisions (managers may disregard recommendations from scientific committees, and/or implement management measures chat are risk-prone). Fisheries that are examined include the Atlantic Coast striped bass Morone saxatilis fishery, the New England groundfish fishery, the Atlantic shark fishery, the Atlantic and Gulf reef fish fisheries, and the Pacific rockfish fishery. Although many of the factors listed above contributed co declines in these fisheries, the root cause in all cases was harvesting at rates that were much higher than could be sustained by recruitment. Management was largely ineffective because management decisions were risk-prone and motivated by short-term economic considerations rather than long-term sustainability. Only after passage of legislation not only authorizing but specifying mandatory stock rebuilding, has most management been sufficiently precautionary to allow sustainability.https://scholarworks.wm.edu/vimsbooks/1011/thumbnail.jp

Small Business Enterprise and Development: Consultation Modes

By  means  of four   illustrative  case studies,  consultation  interventions  in small  and  medium sized  (SMEs)  enterprises  are  explored     Recognized  consultation  intervention  modes  of 'expert ',  'doctor-patient' and  'process  consultation'  are found  to fluctuate  rapidly  within each case st11dy, making apparent the need for  consultants to be flexible  and adopt an appropriate stance for  client and contingencies of the situation.  The permeability  of the boundaries between content and process issues, with diagnosis and intervention inter-woven, is also apparent. The article concludes with a consideration of the conditions for success for different consultation modes with small businesses and implications for small businesses and enterprise development in their use of consultants

Four windows on Borderlands: Dimensions of place defined by land cover change data from historical maps

Perceptions of land cover changes from four areas located on the borderlands of Prekmurje, north-eastern Slovenia were determined from a set of historical maps. The principle goals of this research were the calculation of changes in area of land cover categories and analysis of the stability of the study areas from the perspective of land cover. Two approaches were applied to the map analysis: “stability mapping” followed by proportions of different land cover categories determined by time series cartography. Finally, these approaches were triangulated with ground truthing. The results presented demonstrate conclusively that the studied region maintained relatively stability although over several centuries inhabitants withdrew very slightly from both natural boundaries and political borders. As “windows” into the environmental psychology of borderland perception, each small site studied revealed some specifically localised characteristic