Postsurgical behaviors in children with and without symptoms of sleep-disordered breathing

Abstract Background Although some children undergo formal preoperative testing for obstructive sleep apnea, it is likely that many children present for surgery with undetected sleep-related disorders. Given that these children may be at increased risk during the perioperative period, this study was designed to compare postoperative behaviors between those with and without symptoms of sleep-disordered breathing (SDB). Methods This study represents a secondary analysis of data from a study examining the effect of SDB on perioperative respiratory adverse events in children. Parents of children aged 2–14 years completed the Sleep-Related Breathing Disorder (SRBD) subscale of the Pediatric Sleep Questionnaire prior to surgery. Children were classified as having SDB if they had a positive score (≥0.33) on the SRBD subscale. Seven to ten days following surgery, the SRBD subscale was re-administered to the parents who also completed the Children’s Post Hospitalization Behavior Questionnaire. Children were classified as exhibiting increased problematic behaviors if their postoperative behaviors were considered to be “more/much more” relative to normal. Results Three hundred thirty-seven children were included in this study. Children with SDB were significantly more likely to exhibit problematic behaviors following surgery compared with children without SDB. Logistic regression identified adenotonsillectomy (OR 9.89 [3.2–30.9], P < 0.01) and posthospital daytime sleepiness (OR 2.8 [1.3–5.9], P < 0.01) as risk factors for postoperative problematic behaviors. Conclusions Children presenting for surgery with symptoms of SDB have an increased risk for problematic behaviors following surgery. These results are potentially important in questioning whether the observed increase in problematic behaviors is biologically grounded in SDB or simply a response to poor sleep habits/hygiene.http://deepblue.lib.umich.edu/bitstream/2027.42/109540/1/13741_2014_Article_36.pd

Efficacy of oral appliance therapy in patients following uvulopalatopharyngoplasty failure

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149311/1/lio2256.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149311/2/lio2256_am.pd

Transference of Citizen Science Program Impacts: A Theory Grounded in Public Participation in Scientific Research

Citizen science is known for increasing the geographic, spatial, and temporal scale from which scientists can gather data. It is championed for its potential to provide experiential learning opportunities to the public. Documentation of educational outcomes and benefits for citizen scientists continues to grow. This study proposes an added benefit of these collaborations: the transference of program impacts to individuals outside of the program. The experiences of fifteen citizen scientists in entomology citizen science programs were analyzed using a constructivist grounded theory methodology. We propose the substantive-level theory of transference to describe the social process by which the educational and attitudinal impacts intended by program leaders for the program participants are filtered by citizen scientists and transferred to others. This process involves individual and external phases, each with associated actions. Transference occurred in participants who had maintained a long-term interest in nature, joined a citizen science program, shared science knowledge and experiences, acquired an expert role to others, and influenced change in others. Transference has implications for how citizen scientists are perceived by professional communities, understanding of the broader impacts and contributions of citizen science to wicked problems, program evaluation, and the design of these programs as informal science education opportunities

Anemone bleaching impacts the larval recruitment success of an anemone-associated fish

In marine environments, mutualisms such as those between corals or sea anemones and their algal symbionts (Symbiodiniaceae) play a key role for supporting surrounding biodiversity. However, as the breakdown of the mutualism between corals and/or anemones and Symbiodiniaceae (i.e. bleaching) become increasingly frequent and severe, the risk of losing the additional species that rely on them may also increase. While the effects of anemone bleaching on the biology and ecology of anemone-associated fishes have been the subject of recent research, relatively little is known about the impacts that anemone bleaching might have on the recruitment of larval fish. Here, we report that climate change-induced anemone bleaching impairs a secondary mutualism between anemones and an anemone-associated fish species, the threespot dascyllus (Dascyllus trimaculatus). Field-based monitoring over a 1-year period showed anemones that bleached experienced decreased recruitment of larval D. trimaculatus compared to those that did not bleach, with abundances of newly settled D. trimaculatus three times lower in bleached versus unbleached anemones. A visual choice experiment showed that this pattern is associated with fish being less attracted to bleached anemones, and a predation experiment demonstrated that fish associated with bleached anemones experienced higher mortality compared to those associated with unbleached anemones. These results suggests that the decreased recruitment of D. trimaculatus observed in bleached anemones may be driven by hampered pre-settlement (habitat selection) and post-settlement (survival to predation) processes for larval D. trimaculatus in bleached hosts. This study highlights the risk of cascading mutualism breakdowns in coral reefs as conditions deteriorate and stresses the importance of protecting these mutualisms for the maintenance of coral reef biodiversity

Stillbirth is associated with perceived alterations in fetal activity - findings from an international case control study

Background Stillbirth after 28 weeks gestation affects between 1.3–8.8 per 1000 births in high-income countries. The majority of stillbirths in this setting occur in women without established risk factors. Identification of risk factors which could be identified and managed in pregnancy is a priority in stillbirth prevention research. This study aimed to evaluate women’s experiences of fetal movements and how these relate to stillbirth. Methods An international internet-based case–control study of women who had a stillbirth ≥28 weeks’ gestation within 30 days prior to completing the survey (n = 153) and women with an ongoing pregnancy or a live born child (n = 480). The online questionnaire was developed with parent stakeholder organizations using a mixture of categorical and open–ended responses and Likert scales. Univariate and multiple logistic regression was used to determine crude (unadjusted) and adjusted odds ratios (aOR) with 95% confidence intervals (CI). Summative content analysis was used to analyse free text responses. Results Women whose pregnancy ended in stillbirth were less likely to check fetal movements (aOR 0.54, 95% CI 0.35–0.83) and were less likely to be told to do so by a health professional (aOR 0.55, 95% CI 0.36–0.86). Pregnancies ending in stillbirth were more frequently associated with significant abnormalities in fetal movements in the preceding two weeks; this included a significant reduction in fetal activity (aOR 14.1, 95% CI 7.27–27.45) or sudden single episode of excessive fetal activity (aOR 4.30, 95% CI 2.25–8.24). Cases described their perception of changes in fetal activity differently to healthy controls e.g. vigorous activity was described as “frantic”, “wild” or “crazy” compared to “powerful” or “strong”. Conclusions Alterations in fetal activity are associated with increased risk of stillbirth. Pregnant women should be educated about awareness of fetal activity and reporting abnormal activity to health professionals

Factors contributing to delays in diagnosis of breast cancers in Ghana, West Africa

BACKGROUND: Late diagnoses and poor prognoses of breast cancer are common throughout Africa. METHODS: To identify responsible factors, we utilized data from a population-based case-control study involving 1,184 women with breast malignancies conducted in three hospitals in Accra and Kumasi, Ghana. Interviews focused on potential breast cancer risk factors as well as factors that might contribute to presentation delays. We calculated odds ratios (OR) and 95% confidence intervals (CI) comparing malignances with biopsy masses larger than 5 cm. (62.4% of the 1,027 cases with measurable lesions) to smaller lesions. RESULTS: In multivariate analyses, strong predictors of larger masses were limited education (OR=1.96, 95% CI 1.32–2.90 <primary vs. ≥senior secondary school), being separated/divorced or widowed (1.75, 1.18–2.60 and 2.25, 1.43–3.55, respectively, vs. currently married), delay in care seeking after onset of symptoms (2.64, 1.77–3.95 for ≥12 vs. ≤2 months), care having initially been sought from someone other than a doctor/nurse (1.86, 0.85–4.09), and frequent use of herbal medications/treatment (1.51, 0.95–2.43 for ≥3x/day usage vs. none),. Particularly high risks associated with these factors were found among less educated women; for example, women with less than junior secondary schooling who delayed seeking care for breast symptoms for 6 months or longer were at nearly 4-times the risk of more educated women who promptly sought assistance. CONCLUSIONS: Our findings suggest that additional communication, particularly among less educated women, could promote earlier breast cancer diagnoses. Involvement of individuals other than medical practitioners, including traditional healers, may be helpful in this process

Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling

Funder: GE Healthcare; doi: http://dx.doi.org/10.13039/100006775Funder: NIHR Newcastle Biomedical Research Centre; doi: http://dx.doi.org/10.13039/501100012295Funder: Newcastle UniversityAbstract: Objective: To use arterial spin labelling to investigate differences in perfusion in mild cognitive impairment with Lewy bodies (MCI-LB) compared to Alzheimer type MCI (MCI-AD) and healthy controls. Methods: We obtained perfusion images on 32 MCI-LB, 30 MCI-AD and 28 healthy subjects of similar age. Perfusion relative to cerebellum was calculated, and we aimed to examine differences in relative perfusion between MCI-LB and the other groups. This included whole brain voxelwise comparisons, as well as using predefined region-of-interest ratios of medial occipital to medial temporal, and posterior cingulate to precuneus. Differences in occipital perfusion in eyes open vs eyes closed conditions were also examined. Results: Compared to controls, the MCI-LB showed reduced perfusion in the precuneus, parietal, occipital and fusiform gyrus regions. In our predefined regions, the ratio of perfusion in occipital/medial temporal was significantly lower, and the posterior cingulate/precuneus ratio was significantly higher in MCI-LB compared to controls. Overall, the occipital perfusion was greater in the eyes open vs closed condition, but this did not differ between groups. Conclusion: We found patterns of altered perfusion in MCI-LB which are similar to those seen in dementia with Lewy bodies, with reduction in posterior parietal and occipital regions, but relatively preserved posterior cingulate

Mild cognitive impairment with Lewy bodies: blood perfusion with arterial spin labelling

Funder: GE Healthcare; doi: http://dx.doi.org/10.13039/100006775Funder: NIHR Newcastle Biomedical Research Centre; doi: http://dx.doi.org/10.13039/501100012295Funder: Newcastle UniversityAbstract: Objective: To use arterial spin labelling to investigate differences in perfusion in mild cognitive impairment with Lewy bodies (MCI-LB) compared to Alzheimer type MCI (MCI-AD) and healthy controls. Methods: We obtained perfusion images on 32 MCI-LB, 30 MCI-AD and 28 healthy subjects of similar age. Perfusion relative to cerebellum was calculated, and we aimed to examine differences in relative perfusion between MCI-LB and the other groups. This included whole brain voxelwise comparisons, as well as using predefined region-of-interest ratios of medial occipital to medial temporal, and posterior cingulate to precuneus. Differences in occipital perfusion in eyes open vs eyes closed conditions were also examined. Results: Compared to controls, the MCI-LB showed reduced perfusion in the precuneus, parietal, occipital and fusiform gyrus regions. In our predefined regions, the ratio of perfusion in occipital/medial temporal was significantly lower, and the posterior cingulate/precuneus ratio was significantly higher in MCI-LB compared to controls. Overall, the occipital perfusion was greater in the eyes open vs closed condition, but this did not differ between groups. Conclusion: We found patterns of altered perfusion in MCI-LB which are similar to those seen in dementia with Lewy bodies, with reduction in posterior parietal and occipital regions, but relatively preserved posterior cingulate

Assessment of autonomic symptoms may assist with early identification of mild cognitive impairment with Lewy bodies

Funder: GE Healthcare; Id: http://dx.doi.org/10.13039/100006775Funder: Alzheimer's Research UK; Id: http://dx.doi.org/10.13039/501100002283Funder: NIHR Newcastle Biomedical Research Centre; Id: http://dx.doi.org/10.13039/501100012295Abstract: Objectives: Autonomic symptoms are a common feature of the synucleinopathies, and may be a distinguishing feature of prodromal Lewy body disease. We aimed to assess whether the cognitive prodrome of dementia with Lewy bodies, mild cognitive impairment (MCI) with Lewy bodies (MCI‐LB), would have more severe reported autonomic symptoms than cognitively healthy older adults, with MCI due to Alzheimer's disease (MCI‐AD) also included for comparison. We also aimed to assess the utility of an autonomic symptom scale in differentiating MCI‐LB from MCI‐AD. Methods: Ninety‐three individuals with MCI and 33 healthy controls were assessed with the Composite Autonomic Symptom Score 31‐item scale (COMPASS). Mild cognitive impairment patients also underwent detailed clinical assessment and differential classification of MCI‐AD or MCI‐LB according to current consensus criteria. Differences in overall COMPASS score and individual symptom sub‐scales were assessed, controlling for age. Results: Age‐adjusted severity of overall autonomic symptomatology was greater in MCI‐LB (Ratio = 2.01, 95% CI: 1.37–2.96), with higher orthostatic intolerance and urinary symptom severity than controls, and greater risk of gastrointestinal and secretomotor symptoms. MCI‐AD did not have significantly higher autonomic symptom severity than controls overall. A cut‐off of 4/5 on the COMPASS was sensitive to MCI‐LB (92%) but not specific to this (42% specificity vs. MCI‐AD and 52% vs. healthy controls). Conclusions: Mild cognitive impairment with Lewy bodies had greater autonomic symptom severity than normal ageing and MCI‐AD, but such autonomic symptoms are not a specific finding. The COMPASS‐31 may therefore have value as a sensitive screening test for early‐stage Lewy body disease