Sleep-Related Problems, Sleep-Related Distress, and Sleep-Related Functional Status Among Adult Inpatients Receiving Palliative Care

Palliative care patients may be at a higher risk for sleep-related problems and their negative effects compared to the general population, yet limited sleep research has been done with this population. The purpose of this dissertation was to determine prevalence rates for excessive sleepiness, insomnia, restless legs syndrome (RLS), and high risk for sleep apnea (HRSA); examine relationships between the aforementioned sleep-related problems, sleep-related distress (SD), and sleep-related functional status (SFS); and to determine which sleep-related problem measures along with age and gender predicted SD and SFS among a sample of adult palliative care inpatients. Secondary aims were to understand causes of SD and find out participant willingness to accept inconveniences/risks to alleviate SD. Participants (N = 38) were recruited from an urban, academic medical center in Virginia and asked to participate in an interview and complete sleep-related instruments. Measures included the STOP-Bang Questionnaire (STOP-Bang) for HRSA, Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), 2012 International Restless Legs Syndrome Study Group (IRLSSG) revised consensus diagnostic criteria, Sleep-Related Distress Thermometer (SDT), and Functional Outcomes of Sleep Questionnaire – 10 (FOSQ-10) for SFS. Prevalence rates were 62% for insomnia (ISI score \u3e 7), 57% for HRSA (STOP-Bang score \u3e 2), 41% for excessive sleepiness (ESS score \u3e 10), and 14% for RLS (met all IRLSSG criteria). Significant relationships (p \u3c 0.05) were found between insomnia and SD (Spearman’s ρ = 0.75, p \u3c 0.0001), and excessive sleepiness and SFS (Spearman’s ρ = -0.59, p = 0.0001). Based on regression models, ISI score was found to be a predictor of SD (F = 48.14, p \u3c 0.0001); and age, ISI score, and ESS score were found to be predictors of SFS (F = 10.85, p \u3c 0.0001). The most frequently reported causes of SD were anxiety/distressing thoughts (32%) and pain/physical discomfort (19%). Most participants expressed willingness to accept minimal risk interventions (97%), prescription medication (68%) and positive airway pressure therapy (57%) to alleviate SD. In conclusion, sleep-related problems were found to be common among the study sample, frequent causes of SD included anxiety/distressing thoughts and pain/physical discomfort, and the majority of participants were willing to accept the inconvenience of standard treatment options to alleviate SD. While associations were found between variables, due to limitations of the study including small sample size and uncertainty of the reliability/validity of the measures used with this population, more research is needed to better understand these relationships. Future research is also needed to establish tolerability and efficacy of interventions for sleep-related problems among palliative care inpatients

What is considered to be emotional suffering by psychotherapy patients and their therapists in Eastern versus Western Germany? : A mixed-methods study

PURPOSE This study examined what aspects of life in Eastern and Western Germany are considered by patients, therapists and society to cause (or indicate) emotional suffering so that outpatient psychotherapy is sought and warranted. METHODS In Germany, psychotherapy is covered by health insurance after patients submit an application accompanied by a written report from the therapist. We took a random sample of such applications and performed a qualitative text analysis of the reports, identifying all text units where some form of emotional suffering, distress or handicap was described. A coding system was developed based on the units, and all units were subsequently coded. The proportion of units per category was compared between reports from Western and Eastern Germany using chi-square tests. RESULTS Out of 500 randomly selected reports, 25 were from Eastern Germany. An age- and sex-matched sample from Western Germany was added. From these 50 reports, a total of 716 text units describing some form of emotional suffering were extracted (359 units from reports from Eastern Germany and 357 from Western Germany). Thirteen categories of emotional suffering emerged. In Eastern Germany, emotional suffering was considerably more frequently described in terms of somatic symptoms and in feeling nervous and tense. Patients from Western Germany were more often described as feeling depressed and hopeless, helpless, anxious and without drive (ϕ = 0.19, p = .02). CONCLUSION There is evidence that there are differences between Eastern and Western Germany in how emotional suffering is expressed and/or described

Impact of Immunosuppressive Drugs on Fibroblasts:: An In Vitro Study

Background: The aim of this study was to compare the direct impact of different agents for immunosuppressive therapy on mouse fibroblasts as a possible cause of drug-induced gingival overgrowth (DIGO). Methods: 3T3 mouse fibroblasts were cultivated in cell-specific media (2 × 104 cells/mL) and treated for 6, 24, 48 and 72 h with one of three immunosuppressive drugs (IsDs): cyclosporin a (CsA), tacrolimus (TaC) and sirolimus (SiR). Different concentrations (10–750 ng/mL) were used to mimic serum levels under active immunosuppressive therapy conditions. Cell population characteristics (cell number, viability and morphology) were assessed using computer-assisted cell analysis. Expression of pro-collagen type I carboxy-terminal propeptide (PICP) was identified using an ELISA assay. Results: The influence of IsDs on the biological status of 3T3 fibroblasts was time- and dose-dependent. Comparing CsA and TaC, the total cell amount was enhanced using concentrations in the range of 10–150 ng/mL (p > 0.05). In contrast, treatment with SiR resulted in a decrease in the average cell number (p 0.05). Conclusions: Our results revealed time-dependent effects of IsDs, with distinct influences on cell number. The cell morphology and the PICP balance of the investigated fibroblast cell line remained unaffected. Hence, the potential role of IsDs is not a unilateral mechanism of action but rather a multifactorial process

A passive vibration isolation stack for LIGO: Design, modeling, and testing

Multiple-stage seismic vibration isolation stacks, which consist of alternating layers of stiff masses and compliant springs, can provide significant passive filtering of ground vibration for experiments and equipment that are sensitive to mechanical noise. We describe the design, modeling and testing of a prototype of a stack suitable for use in the Laser Interferometer Gravitational-wave Observatory (LIGO). This is a four-stage elastomer (spring) and stainless steel (mass) stack, consisting of a table resting on three separate legs of three layers each. The viscoelastic properties of elastomer springs are exploited to damp the stack's normal modes while providing rapid roll-off of stack transmission above these modal frequencies. The stack's transmission of base motion to top motion was measured in vacuum and compared with three-dimensional finite-element models. In one tested configuration, at 100 Hz, horizontal transmission was 10^–7, vertical transmission was 3×10^–6, and the cross-coupling terms were between these values

Aggregation-triggering segments of SOD1 fibril formation support a common pathway for familial and sporadic ALS

ALS is a terminal disease of motor neurons that is characterized by accumulation of proteinaceous deposits in affected cells. Pathological deposition of mutated Cu/Zn superoxide dismutase (SOD1) accounts for ∼20% of the familial ALS (fALS) cases. However, understanding the molecular link between mutation and disease has been difficult, given that more than 140 different SOD1 mutants have been observed in fALS patients. In addition, the molecular origin of sporadic ALS (sALS) is unclear. By dissecting the amino acid sequence of SOD1, we identified four short segments with a high propensity for amyloid fibril formation. We find that fALS mutations in these segments do not reduce their propensity to form fibrils. The atomic structures of two fibril-forming segments from the C terminus, ^(101)DSVISLS^(107) and ^(147)GVIGIAQ^(153), reveal tightly packed β-sheets with steric zipper interfaces characteristic of the amyloid state. Based on these structures, we conclude that both C-terminal segments are likely to form aggregates if available for interaction. Proline substitutions in 101DSVISLS107 and ^(147)GVIGIAQ^(153) impaired nucleation and fibril growth of full-length protein, confirming that these segments participate in aggregate formation. Our hypothesis is that improper protein maturation and incompletely folded states that render these aggregation-prone segments available for interaction offer a common molecular pathway for sALS and fALS

A passive vibration isolation stack for LIGO: Design, modeling, and testing

Multiple-stage seismic vibration isolation stacks, which consist of alternating layers of stiff masses and compliant springs, can provide significant passive filtering of ground vibration for experiments and equipment that are sensitive to mechanical noise. We describe the design, modeling and testing of a prototype of a stack suitable for use in the Laser Interferometer Gravitational-wave Observatory (LIGO). This is a four-stage elastomer (spring) and stainless steel (mass) stack, consisting of a table resting on three separate legs of three layers each. The viscoelastic properties of elastomer springs are exploited to damp the stack's normal modes while providing rapid roll-off of stack transmission above these modal frequencies. The stack's transmission of base motion to top motion was measured in vacuum and compared with three-dimensional finite-element models. In one tested configuration, at 100 Hz, horizontal transmission was 10^–7, vertical transmission was 3×10^–6, and the cross-coupling terms were between these values

The Erotic and the Vulgar: Visual Culture and Organized Labor's Critique of U.S. Hegemony in Occupied Japan

This essay engages the colonial legacy of postwar Japan by arguing that the political cartoons produced as part of the postwar Japanese labor movement’s critique of U.S. cultural hegemony illustrate how gendered discourses underpinned, and sometimes undermined, the ideologies formally represented by visual artists and the organizations that funded them. A significant component of organized labor’s propaganda rested on a corpus of visual media that depicted women as icons of Japanese national culture. Japan’s most militant labor unions were propagating anti-imperialist discourses that invoked an engendered/endangered nation that accentuated the importance of union roles for men by subordinating, then eliminating, union roles for women

The Physics of LIGO

In the spring term of 1994, I organized a course at Caltech on the The Physics of LIGO (i.e., the physics of the Laser Interferometer Gravitational Wave Observatory). The course consisted of eighteen 1.5-hour-long tutorial lectures, delivered by members of the LIGO team and others, and it was aimed at advanced undergraduates and graduate students in physics, applied physics and in engineering and applied sciences and also at interested postdoctoral fellows, research staff, and faculty