Management of insomnia in sleep disordered breathing

Both obstructive sleep apnoea (OSA) and chronic insomnia disorder are highly prevalent in the general population. Whilst both disorders may occur together by mere coincidence, it appears that they share clinical features and that they may aggravate each other as a result of reciprocally adverse pathogenetic mechanisms. Comorbidity between chronic insomnia disorder and OSA is a clinically relevant condition that may confront practitioners with serious diagnostic and therapeutic challenges. Current data, while still scarce, advocate an integrated and multidisciplinary approach that seems superior over the isolated treatment of each sleep disorder alone

Reducing psychotropic drug use in nursing homes in Belgium : an implementation study for the roll-out of a practice improvement initiative

Background and Objective: Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper. Methods: The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017). Results: At baseline, participants' (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522). Conclusions: The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months

Hydrogeological conceptual model building and testing: A review

© 2018 Elsevier BV. 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 24 month embargo from date of publication (December 2018) in accordance with the publisher’s archiving policyHydrogeological conceptual models are collections of hypotheses describing the understanding of groundwater systems and they are considered one of the major sources of uncertainty in groundwater flow and transport modelling. A common method for characterizing the conceptual uncertainty is the multi-model approach, where alternative plausible conceptual models are developed and evaluated. This review aims to give an overview of how multiple alternative models have been developed, tested and used for predictions in the multi-model approach in international literature and to identify the remaining challenges. The review shows that only a few guidelines for developing the multiple conceptual models exist, and these are rarely followed. The challenge of generating a mutually exclusive and collectively exhaustive range of plausible models is yet to be solved. Regarding conceptual model testing, the reviewed studies show that a challenge remains in finding data that is both suitable to discriminate between conceptual models and relevant to the model objective. We argue that there is a need for a systematic approach to conceptual model building where all aspects of conceptualization relevant to the study objective are covered. For each conceptual issue identified, alternative models representing hypotheses that are mutually exclusive should be defined. Using a systematic, hypothesis based approach increases the transparency in the modelling workflow and therefore the confidence in the final model predictions, while also anticipating conceptual surprises. While the focus of this review is on hydrogeological applications, the concepts and challenges concerning model building and testing are applicable to spatio-temporal dynamical environmental systems models in general

Edge Transfer Lithography Using Alkanethiol Inks

Edge lithographic patterning techniques are based on the utilization of the edges of micrometer-sized template features for the reproduction of submicrometer structures. Edge transfer lithography (ETL) permits local surface modification in a single step by depositing self-assembled monolayers onto a metal substrate selectively along the feature edges of an elastomeric stamp. In this report two stamp designs are described that now allow for the use of alkanethiol inks in ETL and their use as etch resists to reproduce submicrometer structures in gold. Anisotropically modified stamps are shown to combine the potential for very high-resolution patterning with the versatility and simplicity of microcontact printing

Differential mucosal expression of Th17-related genes between the inflamed colon and ileum of patients with inflammatory bowel disease

<p>Abstract</p> <p>Background</p> <p>Immunological and genetic findings implicate Th17 effector cytokines in the pathogenesis of inflammatory bowel disease (IBD). Expression of Th17 pathway-associated genes is mainly studied in colonic disease. The present study assessed the mRNA expression levels of Th17 effector cytokines (<it>IL17A</it>, <it>IL17F</it>, <it>IL21</it>, <it>IL22 </it>and <it>IL26</it>) and genes involved in differentiation (<it>IL6</it>, <it>IL1B</it>, <it>TGFB1</it>, <it>IL23A </it>and <it>STAT3</it>) and recruitment of Th17 cells (<it>CCR6 </it>and <it>CCL20</it>) by quantitative real-time PCR analysis of colonic and ileal biopsies from 22 healthy control subjects, 26 patients with Crohn's disease (CD) and 12 patients with ulcerative colitis (UC). Inflammation was quantified by measuring expression of the inflammatory mediators <it>IL8 </it>and <it>TNF</it>.</p> <p>Results</p> <p>Evaluation of mRNA expression levels in colonic and ileal control samples revealed that <it>TNF</it>, <it>TGFB1</it>, <it>STAT3 </it>and <it>CCR6 </it>were expressed at higher levels in the ileum than in the colon. Expression of all the Th17 pathway-associated genes was increased in inflamed colonic samples. The increased expression of these genes was predominantly observed in samples from UC patients and was associated with more intense inflammation. Although increased expression of <it>IL17A</it>, <it>IL17F</it>, <it>IL21 </it>and <it>IL26 </it>was detected in inflamed ileal samples, expression of the indispensable Th17 cell differentiation factors <it>TGFB1 </it>and <it>IL23A</it>, the signaling molecule <it>STAT3 </it>and the Th17 recruitment factors <it>CCR6 </it>and <it>CCL20 </it>were unchanged.</p> <p>Conclusions</p> <p>Our findings suggest that immune regulation is different in colonic and ileal disease, which might have important consequences for therapeutic intervention.</p

Deciphering the morphology of motor evoked potentials

Motor Evoked Potentials (MEPs) are used to monitor disability progression in multiple sclerosis (MS). Their morphology plays an important role in this process. Currently, however, there is no clear definition of what constitutes a normal or abnormal morphology. To address this, five experts independently labeled the morphology (normal or abnormal) of the same set of 1,000 MEPs. The intra- and inter-rater agreement between the experts indicates they agree on the concept of morphology, but differ in their choice of threshold between normal and abnormal morphology. We subsequently performed an automated extraction of 5,943 time series features from the MEPs to identify a valid proxy for morphology, based on the provided labels. To do this, we compared the cross-validation performances of one-dimensional logistic regression models fitted to each of the features individually. We find that the approximate entropy (ApEn) feature can accurately reproduce the majority-vote labels. The performance of this feature is evaluated on an independent test set by comparing to the majority vote of the neurologists, obtaining an AUC score of 0.92. The model slightly outperforms the average neurologist at reproducing the neurologists consensus-vote labels. We can conclude that MEP morphology can be consistently defined by pooling the interpretations from multiple neurologists and that ApEn is a valid continuous score for this. Having an objective and reproducible MEP morphological abnormality score will allow researchers to include this feature in their models, without manual annotation becoming a bottleneck. This is crucial for large-scale, multi-center datasets. An exploratory analysis on a large single-center dataset shows that ApEn is potentially clinically useful. Introducing an automated, objective, and reproducible definition of morphology could help overcome some of the barriers that are currently obstructing broad adoption of evoked potentials in daily care and patient follow-up, such as standardization of measurements between different centers, and formulating guidelines for clinical use

NGC 2207/IC 2163: A Grazing Encounter with Large Scale Shocks

Radio continuum, Spitzer infrared, optical and XMM-Newton X-ray and UVM2 observations are used to study large-scale shock fronts, young star complexes, and the galactic nuclei in the interacting galaxies NGC 2207/IC 2163. There are two types of large-scale shock fronts in this galaxy pair. The shock front along the rim of the ocular oval in IC 2163 has produced vigorous star formation in a dusty environment. In the outer part of the companion side of NGC 2207, a large-scale front attributed to disk or halo scraping is particularly bright in the radio continuum but not in any tracers of recent star formation or in X-rays. This radio continuum front may be mainly in the halo on the back side of NGC 2207 between the two galaxies. Values of the flux density ratio S(8 um)/S(6 cm) of kpc-sized, Spitzer IRAC star-forming clumps in NGC 2207/IC 2163 are compared with those of giant H II regions in M81. We find evidence that in 2001 a radio supernova was present in the core of feature i, a mini-starburst on an outer arm of NGC 2207. X-ray emission is detected from the NGC 2207 nucleus and from nine discrete sources, one of which corresponds to SN 1999ec, and another may be a radio supernova or a background quasar. The X-ray luminosity and X-ray spectrum of the NGC 2207 nucleus suggests it is a highly absorbed, low luminosity AGN.Comment: 30 pages, including 12 embedded eps figure

Functional magnetic resonance imaging : cerebral function alterations in subthreshold and suprathreshold spinal cord stimulation

Peer reviewedPublisher PD