A randomised controlled trial of bright light therapy and morning activity for adolescents and young adults with Delayed Sleep-Wake Phase Disorder

© 2018 Elsevier. 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 (February 2018) in accordance with the publisher’s archiving policyA randomised controlled trial evaluated bright light therapy and morning activity for the treatment of Delayed Sleep-Wake Phase Disorder (DSWPD) in young people. 60 adolescents and young adults (range = 13–24 years, mean = 15.9 ± 2.2 y, 63% f) diagnosed with DSWPD were randomised to receive three weeks of post-awakening Green Bright Light Therapy (∼507 nm) and Sedentary Activity (sitting, watching TV), Green Bright Light Therapy and Morning Activity (standing, playing motion-sensing videogame), Red Light Therapy (∼643 nm) and Sedentary Activity or Red Light Therapy and Morning Activity. Sleep (ie sleep onset time, wake up time, sleep onset latency, total sleep time) and daytime functioning (ie morning alertness, daytime sleepiness, fatigue, functional impairment) were measured pre-treatment, post-treatment and at one and three month follow-up. Contrary to predictions, there were no significant differences in outcomes between treatment groups; and interaction effects between treatment group and time for all outcome variables were not statistically significant. However, adolescents and young adults in morning activity conditions did not meaningfully increase their objective activity (ie movement frequency). Overall, adolescents reported significantly improved sleep timing (d = 0.30–0.46), sleep onset latency (d = 0.32) and daytime functioning (d = 0.45–0.87) post-treatment. Improvements in sleep timing (d = 0.53–0.61), sleep onset latency (d = 0.57), total sleep time (d = 0.51), and daytime functioning (d = 0.52–1.02) were maintained, or improved upon, at the three month follow-up. However, relapse of symptomology was common and 38% of adolescents and young adults requested further treatment in addition to the three weeks of light therapy. Although there is convincing evidence for the short-term efficacy of chronobiological treatments for DSWPD, long-term treatment outcomes can be improved. To address this gap in our current knowledge, avenues for future research are discussed

Readiness to change and commitment as predictors of therapy compliance in adolescents with Delayed Sleep-Wake Phase Disorder

© 2018 Elsevier B.V. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ 12 month embargo from date of publication (Dec 2018) per publisher’s policyObjectives Recent evidence indicates that adolescents' motivation to change sleep-wake patterns is low, despite significant impact of adolescent sleep problems on many areas of daytime functioning. The aim of the present study is to evaluate components of adolescents' motivation, and subsequent changes in behaviour. Methods Fifty-six adolescents, aged 13–23 (M = 15.8 ± 2.3 y; 38% m) diagnosed with Delayed Sleep-Wake Phase Disorder (DSWPD) underwent three therapy sessions involving bright light therapy to phase advance sleep patterns. Adolescents were instructed to advance wake-up times by 30-min daily. Motivation ratings of desire, ability, reason, need and commitment to change sleep patterns were taken at baseline. Sleep diaries were taken at the end of treatment session 1, with sequentially earlier wake-up times in 30-min intervals indicating compliance. Results At the outset of therapy, adolescents indicated strong desire, reasons and need, yet moderate ability and commitment to advance their sleep-wake patterns. Following therapy, sleep-onset times were significantly advanced, total sleep time increased and sleep latency decreased (all p 0.05). Adolescents' desire to change (r = 0.30, p = 0.03) and commitment (r = 0.30, p = 0.03) were positively correlated with behaviour change, but their need, ability and reasons were not. A mediation analysis showed that ability and desire were important in predicting behaviour change, by total effects through commitment (ie, indirectly and directly). Conclusion Our findings suggest that the total effects of ability (ie, confidence) and desire to change are the best predictors of behavioural changes, thus clinicians should focus on these components of the readiness to change model when undertaking treatments with sleep-disordered adolescents

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

The nth country conundrum: The American and Soviet quest for nuclear nonproliferation, 1945--1970

In 1963, Secretary of State Dean Rusk told a Soviet diplomat that it was almost axiomatic that no nuclear power has any interest in seeing others become nuclear powers. This study probes the motivations behind U.S. and Soviet nuclear nonproliferation policy. American policy reflected the bureaucratic struggle between three groups of actors: disarmament advocates, nuclear nationalists, and arms control advocates. Although both powers strongly endorsed strict nuclear proliferation from 1945 to 1960, they actually pursued selective policies which sought to inhibit nuclear proliferation by their enemies while encouraging it by their allies. From 1961 to 1968, however, both countries shifted their priorities and pursued a strict nonproliferation policy in the wake of the French nuclear test and the increasing threat of further spread. Advocates of selective proliferation in the U.S. government nonetheless frustrated efforts to conclude an effective nonproliferation agreement. Only in 1968 did the Johnson administration succeed in signing the Nuclear Nonproliferation Treaty (NPT), which subsequently had a mixed history of enforcement. This issue continues to resonate with importance in the late 1990s, when both American and Russian presidents identify nuclear proliferation as one of the greatest risks to world peace.^ The first chapter explores the main themes and questions of this dissertation. Chapter II examines the Roosevelt administration\u27s conception of the role that nuclear weapons should play in the postwar world. The third and fourth chapters discuss the Baruch Plan for international control of atomic energy and the reasons for its failure. Chapter V details the Truman administration\u27s abandonment of nonproliferation from 1949 to 1953. The sixth and seventh chapters trace Dwight D. Eisenhower\u27s convoluted thinking regarding nonproliferation, which led him to pursue policies that sought to inhibit proliferation yet accelerated the threat. Chapters VIII and IX explain John F. Kennedy\u27s increased emphasis on controlling proliferation. The tenth and eleventh chapters probe Lyndon Johnson\u27s nonproliferation policies to determine why he eventually succeeded in concluding an NPT in 1968. Chapter XII tracks the development of U.S. nonproliferation policy from 1970 to the present and demonstrates that U.S. treaty to its treaty commitments continued to deviate from its public pronouncements.

The nth country conundrum: The American and Soviet quest for nuclear nonproliferation, 1945--1970

In 1963, Secretary of State Dean Rusk told a Soviet diplomat that it was almost axiomatic that no nuclear power has any interest in seeing others become nuclear powers. This study probes the motivations behind U.S. and Soviet nuclear nonproliferation policy. American policy reflected the bureaucratic struggle between three groups of actors: disarmament advocates, nuclear nationalists, and arms control advocates. Although both powers strongly endorsed strict nuclear proliferation from 1945 to 1960, they actually pursued selective policies which sought to inhibit nuclear proliferation by their enemies while encouraging it by their allies. From 1961 to 1968, however, both countries shifted their priorities and pursued a strict nonproliferation policy in the wake of the French nuclear test and the increasing threat of further spread. Advocates of selective proliferation in the U.S. government nonetheless frustrated efforts to conclude an effective nonproliferation agreement. Only in 1968 did the Johnson administration succeed in signing the Nuclear Nonproliferation Treaty (NPT), which subsequently had a mixed history of enforcement. This issue continues to resonate with importance in the late 1990s, when both American and Russian presidents identify nuclear proliferation as one of the greatest risks to world peace.^ The first chapter explores the main themes and questions of this dissertation. Chapter II examines the Roosevelt administration\u27s conception of the role that nuclear weapons should play in the postwar world. The third and fourth chapters discuss the Baruch Plan for international control of atomic energy and the reasons for its failure. Chapter V details the Truman administration\u27s abandonment of nonproliferation from 1949 to 1953. The sixth and seventh chapters trace Dwight D. Eisenhower\u27s convoluted thinking regarding nonproliferation, which led him to pursue policies that sought to inhibit proliferation yet accelerated the threat. Chapters VIII and IX explain John F. Kennedy\u27s increased emphasis on controlling proliferation. The tenth and eleventh chapters probe Lyndon Johnson\u27s nonproliferation policies to determine why he eventually succeeded in concluding an NPT in 1968. Chapter XII tracks the development of U.S. nonproliferation policy from 1970 to the present and demonstrates that U.S. treaty to its treaty commitments continued to deviate from its public pronouncements.

American Foreign Relations: Volume 2: Since 1895, 8th Edition

This best-selling text presents the best synthesis of current scholarship available to emphasize the theme of expansionism and its manifestations.https://epublications.marquette.edu/marq_fac-book/1258/thumbnail.jp

Gender differences in neural mechanisms underlying moral sensitivity

Researchers have proposed that females and males differ in the structure of their moral attitudes, such that females tend to adopt care-based moral evaluations and males tend to adopt justice-based moral evaluations. The existence of these gender differences remains a controversial issue, as behavioral studies have reported mixed findings. The current study investigated the neural correlates of moral sensitivity in females and males, to test the hypothesis that females would show increased activity in brain regions associated with care-based processing (posterior and anterior cingulate, anterior insula) relative to males when evaluating moral stimuli, and males would show increased activity in regions associated with justice-based processing (superior temporal sulcus) relative to females. Twenty-eight participants (14 females) were scanned using fMRI while viewing unpleasant pictures, half of which depicted moral violations, and rated each picture on the degree of moral violation that they judged to be present. As predicted, females showed a stronger modulatory relationship between posterior cingulate and insula activity during picture viewing and subsequent moral ratings relative to males. Males showed a stronger modulatory relationship between inferior parietal activity and moral ratings relative to females. These results are suggestive of gender differences in strategies utilized in moral appraisals