Does comorbid obstructive sleep apnea impair the effectiveness of cognitive and behavioral therapy for insomnia?

This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (Sept 2017) in accordance with the publisher’s archiving policyAims Comorbid insomnia and obstructive sleep apnea (OSA) represents a highly prevalent and debilitating condition; however, physicians and researchers are still uncertain about the most effective treatment approach. Several research groups have suggested that these patients should initially receive treatment for their insomnia before the sleep apnea is targeted. The current study aims to determine whether Cognitive and Behavioral Therapy for Insomnia (CBT-i) can effectively treat insomnia in patients with comorbid OSA and whether its effectiveness is impaired by the presence of OSA. Methods A retrospective chart review was conducted to examine 455 insomnia patients entering a CBT-i treatment program in a hospital out-patient setting. Three hundred and fourteen patients were diagnosed with insomnia alone and 141 with insomnia and comorbid OSA. Improvements in average sleep diary parameters, global insomnia severity, and several daytime functioning questionnaires from baseline, to post-treatment, to 3-month follow-up were compared between insomnia patients with and without comorbid OSA. Results Insomnia patients with comorbid OSA experienced significant improvements in insomnia symptoms, global insomnia severity, and other daytime functioning measures during and following treatment. Furthermore, improvements were no different between patients with or without comorbid OSA. Sleep apnea presence and severity were not related to rates of insomnia-remission or treatment-resistance following treatment. Conclusions CBT-i is an effective treatment in the presence of comorbid OSA. This information offers support for the suggestion that patients with comorbid insomnia and OSA should be treated with CBT-i prior to the treatment of the OSA

Policy mixes for incumbency: the destructive recreation of renewable energy, shale gas 'fracking,' and nuclear power in the United Kingdom

The notion of a ‘policy mix’ can describe interactions across a wide range of innovation policies, including ‘motors for creation’ as well as for ‘destruction’. This paper focuses on the United Kingdom’s (UK) ‘new policy direction’ that has weakened support for renewables and energy efficiency schemes while strengthening promotion of nuclear power and hydraulic fracturing for natural gas (‘fracking’). The paper argues that a ‘policy apparatus for incumbency’ is emerging which strengthens key regimebased technologies while arguably damaging emerging niche innovations. Basing the discussion around the three technology-based cases of renewable energy and efficiency, fracking, and nuclear power, this paper refers to this process as “destructive recreation”. Our study raises questions over the extent to which policymaking in the energy field is not so much driven by stated aims around sustainability transitions, as by other policy drivers. It investigates different ‘strategies of incumbency’ including ‘securitization’, ‘masking’, ‘reinvention’, and ‘capture.’ It suggests that analytical frameworks should extend beyond the particular sectors in focus, with notions of what counts as a relevant ‘policy maker’ correspondingly also expanded, in order to explore a wider range of nodes and critical junctures as entry points for understanding how relations of incumbency are forged and reproduced

ASSOCIATIVE LEARNING IN ANTS: ODOR LEARNING VS. COLOR LEARNING IN NOVOMESSOR COCKERELLI

Associative learning is a form of learning where an animal learns to associate a stimulus with a behavioral response. Associative learning has been generated in the laboratory for many species, including insects, by using classical conditioning. Previous experiments show that ants can learn to associate odors and colors with a sugar reward. When ants are trained to associate a stimulus with a sugar reward, they exhibit the proboscis extension response (PER) to the stimulus alone, but it was unknown whether ants are better at color association or odor association. In order to test this, two separate experiments were undertaken. The first used classical conditioning to train ants to associate a sucrose solution with an odor. The second used classical conditioning to train two groups of ants. The first group was trained to associate a sucrose solution with a blue light. The second group was trained to associate a sucrose solution with a green light. For both experiments a significant percentage of ants demonstrated learning by exhibiting PER when presented solely with the odor or light. There was, however, no significant difference between the percentages of ants that demonstrated learning from the blue light, the green light, or the odor

A bespoke data linkage of an IVF clinical quality registry to population health datasets; methods and performance

Introduction Assisted reproductive technologies (ART), such as in-vitro fertilisation (IVF), have revolutionised the treatment of infertility, with an estimated 8 million babies born worldwide. However, the long-term health outcomes for women and their offspring remain an area of concern. Linking IVF treatment data to long-term health data is the most efficient method for assessing such outcomes. Objectives To describe the creation and performance of a bespoke population-based data linkage of an ART clinical quality registry to state-based and national administrative datasets. Methods The linked dataset was created by deterministically and probabilistically linking the Australia and New Zealand Assisted Reproduction Database (ANZARD) to New South Wales (NSW) and Australian Capital Territory (ACT) administrative datasets (performed by NSW Centre for Health Record Linkage (CHeReL)) and to national claims datasets (performed by Australian Institute of Health and Welfare (AIHW)). The CHeReL's Master Linkage Key (MLK) was used as a bridge between ANZARD's partially identifiable patient data (statistical linkage key) and NSW and ACT administrative datasets. CHeReL then provided personal identifiers to the AIHW to obtain national content data. The results of the linkage were reported, and concordance between births recorded in ANZARD and perinatal data collections (PDCs) was evaluated. Results Of the 62,833 women who had ART treatment in NSW or ACT, 60,419 could be linked to the CHeReL MLK (linkage rate: 96.2%). A reconciliation of ANZARD-recorded births among NSW residents found that 94.2% (95% CI: 93.9-94.4%) of births were also recorded in state/territorybased PDCs. A high concordance was found in plurality status and birth outcome (≥99% agreement rate, Cohen's kappa ranged: 0.78-0.98) between ANZARD and PDCs. Conclusion The data linkage resource demonstrates that high linkage rates can be achieved with partially identifiable data and that a population spine, such as the CHeReL's MLK, can be successfully used as a bridge between clinical registries and administrative datasets