0915 Sleep Patterns and the Effect of Late Bedtime on School-Age Children and Adolescents: Preliminary Results

17 USC 105 interim-entered record; under review.The article of record as published may be found at https://doi.org/10.1093/sleep/zsaa056.911Introduction: School-age children (6-13yrs) and teenagers (14-17yrs) should receive 9-11hrs and 8-10hrs of sleep/day, respectively. Several studies have shown, however, that these age groups are chronically sleep deprived. Our study assessed the sleep patterns of a sample of children and teenagers in Athens, Greece. The study is part of a larger project investigating the association between orthodontic treatment and sleep disturbances. Methods: Participants (N=27; 69% females; 21 school-age children 9-13yrs, 6 teenagers 14-17yrs) were under treatment in the Orthodontic Clinic of the National and Kapodistrian University. Sleep was assessed with actigraphy/logs for 59±19 days. Results: Participants slept on average 7.36±0.42hrs/day. Nighttime sleep was on average 7.23±0.43hrs (percentage sleep: 87.3%±3.38%). Four (14.8%) participants napped at least once/week. Compared to the lowest sleep duration recommended for their age group, participants showed a chronic sleep deficit of 1.42±0.52hrs/day (range: 0.32-2.15hrs). The younger age group had an average sleep deficit of ~1.6hrs compared to ~0.8hrs for the teenagers (p=0.006). During the school year, daily sleep duration increased by ~0.73hrs on weekends (7.78±0.67hrs) compared to school nights (7.05±0.48hrs; p<0.001). On average, school-age participants slept from 23:13 (±31min) until 7:19 (±22min) on school nights and from 23:23 (±2:72hrs) until 8:49 (±39min) on weekends. Teenagers slept from 00:34 (±36min) until 7:40 (±14min) on school nights and from 01:34 (±41min) until 10:34 (±48min) on weekends. Conclusion: Our findings verify earlier survey results showing that restricted sleep is a problem for children and adolescents in Greece. To our surprise, both age groups go to bed quite late. The impact of late bedtime on sleep duration, however, is larger in the younger group due to their larger sleep needs. In contrast to earlier research in rural areas, napping was not common in our urban sample, probably due to extracurricular activities and studying at home

Leaning in to Address Sleep Disturbances and Sleep Disorders in Department of Defense and Defense Health Agency

Letter to the Editor, Military Medicine, 187, 5/6:155, 202217 USC 105 interim-entered record; under review.The article of record as published may be found at http://dx.doi.org/10.1177/0018720820906050In their article entitled, “Engaging Stakeholders to Optimize Sleep Disorders Management in the U.S. Military: A Qualitative Analysis,” Abdelwadoud and colleagues conducted focus groups of service members, primary care managers (PCMs), and administrative stakeholders about their perceptions, experiences, roles in sleep management, stated education needs, and management of sleep disorders.1 The qualitative methods are rigorous, and the findings reinforce and nuance prior results, especially regarding key requirements from PCMs. We feel compelled, however, to further nuance the authors’ conclusion that “current military sleep management practices are neither satisfactory nor maximally effective” and offer specific examples of actions taken by the Department of Defense (DoD) and Defense Health Agency (DHA) in recognition of the significance of optimal sleep in combat readiness and overall health of service members. We offer here a succinct list of concrete efforts to support and implement substantial clinical, operational, research, or educational efforts by the DoD or DHA to improve sleep in service members and associated clinical challenges in this unique population.Identified in text as U.S. Government work

A Continuum Description of Vibrated Sand

The motion of a thin layer of granular material on a plate undergoing sinusoidal vibrations is considered. We develop equations of motion for the local thickness and the horizontal velocity of the layer. The driving comes from the violent impact of the grains on the plate. A linear stability theory reveals that the waves are excited non-resonantly, in contrast to the usual Faraday waves in liquids. Together with the experimentally observed continuum scaling, the model suggests a close connection between the neutral curve and the dispersion relation of the waves, which agrees quite well with experiments. For strong hysteresis we find localized oscillon solutions.Comment: paper has been considerably extended (11 instead of 6 pages; 6 instead of 4 figures) much better agreement with experiment. obtain now oscillons in 1 dimensio

Stability of the Autism Diagnostic Interview—Revised from Pre-School to Elementary School Age in Children with Autism Spectrum Disorders

This study examined the stability of scores on the ADI-R from pre-school to elementary school age in children with autism spectrum disorders (ASD). Participants were 35 children who, at T1, all had a clinical diagnosis of ASD. On initial assessment (mean age 3.5 years; SD 0.6), all met ADI-R algorithm criteria for autism. ADI-R assessments were repeated at follow up (FU; mean age 10.5 years; SD 0.8). Changes in ADI-R total, domain and ADI-R algorithm item scores were assessed. Twentyeight children continued to score above the ADI-R cut-off for autism at FU, although significant decreases in ADI-R domain and item scores were also found. In conclusion, while classification of children according to ADI-R criteria, generally remained stable between pre-school and elementary school age, many children demonstrated significant improvements in symptom severity

Transport Coefficients for Granular Media from Molecular Dynamics Simulations

Under many conditions, macroscopic grains flow like a fluid; kinetic theory pred icts continuum equations of motion for this granular fluid. In order to test the theory, we perform event driven molecular simulations of a two-dimensional gas of inelastic hard disks, driven by contact with a heat bath. Even for strong dissipation, high densities, and small numbers of particles, we find that continuum theory describes the system well. With a bath that heats the gas homogeneously, strong velocity correlations produce a slightly smaller energy loss due to inelastic collisions than that predicted by kinetic theory. With an inhomogeneous heat bath, thermal or velocity gradients are induced. Determination of the resulting fluxes allows calculation of the thermal conductivity and shear viscosity, which are compared to the predictions of granular kinetic theory, and which can be used in continuum modeling of granular flows. The shear viscosity is close to the prediction of kinetic theory, while the thermal conductivity can be overestimated by a factor of 2; in each case, transport is lowered with increasing inelasticity.Comment: 14 pages, 17 figures, 39 references, submitted to PRE feb 199

Speech Communication

Contains reports on two research projects.National Institutes of Health (Grant 2 ROl1 NS04332)National Institutes of Health (Training Grant 5 T32 NS07040)C.J. LeBel FellowshipsNational Science Foundation (Grant BNS77-26871

The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study

Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve maternal and neonatal outcomes in the countdown to 2015

Use of machine learning to shorten observation-based screening and diagnosis of autism

The Autism Diagnostic Observation Schedule-Generic (ADOS) is one of the most widely used instruments for behavioral evaluation of autism spectrum disorders. It is composed of four modules, each tailored for a specific group of individuals based on their language and developmental level. On average, a module takes between 30 and 60 min to deliver. We used a series of machine-learning algorithms to study the complete set of scores from Module 1 of the ADOS available at the Autism Genetic Resource Exchange (AGRE) for 612 individuals with a classification of autism and 15 non-spectrum individuals from both AGRE and the Boston Autism Consortium (AC). Our analysis indicated that 8 of the 29 items contained in Module 1 of the ADOS were sufficient to classify autism with 100% accuracy. We further validated the accuracy of this eight-item classifier against complete sets of scores from two independent sources, a collection of 110 individuals with autism from AC and a collection of 336 individuals with autism from the Simons Foundation. In both cases, our classifier performed with nearly 100% sensitivity, correctly classifying all but two of the individuals from these two resources with a diagnosis of autism, and with 94% specificity on a collection of observed and simulated non-spectrum controls. The classifier contained several elements found in the ADOS algorithm, demonstrating high test validity, and also resulted in a quantitative score that measures classification confidence and extremeness of the phenotype. With incidence rates rising, the ability to classify autism effectively and quickly requires careful design of assessment and diagnostic tools. Given the brevity, accuracy and quantitative nature of the classifier, results from this study may prove valuable in the development of mobile tools for preliminary evaluation and clinical prioritization—in particular those focused on assessment of short home videos of children—that speed the pace of initial evaluation and broaden the reach to a significantly larger percentage of the population at risk

BRCA1 and BRCA2 germline mutation analysis in the Indonesian population

Specific mutations in BRCA1 and BRCA2 genes have been identified in specific populations and ethnic groups. However, little is known about the contribution of BRCA1 and BRCA2 mutations to breast cancers in the Indonesian population. One hundred-twenty moderate to high risk breast cancer patients were tested using PCR-DGGE, and any aberrant band was sequenced. Multiplex ligation-dependent probe amplification (MLPA) was performed on all samples to detect large deletions in the two genes. Twenty-three different mutations were detected in 30 individuals, ten were deleterious mutations and 20 were “unclassified variants” with uncertain clinical consequences. Three of seven (c.2784_2875insT, p.Leu1415X and del exon 13–15) and two of four (p.Glu2183X and p.Gln2894X) deleterious mutations that were found in BRCA1 and BRCA2 respectively, are novel. Several novel, pathogenic BRCA1 and BRCA2 germline mutations are found in early onset Indonesian breast cancer patients, these may therefore be specific for the Indonesian population

Speech Communication

Contains research objectives and summary of research on six research projects and reports on three research projects.National Institutes of Health (Grant 5 RO1 NS04332-13)National Institutes of Health (Fellowship 1 F22 MH5825-01)National Institutes of Health (Grant 1 T32 NS07040-01)National Institutes of Health (Fellowship 1 F22 NS007960)National Institutes of Health (Fellowship 1 F22 HD019120)National Institutes of Health (Fellowship 1 F22 HD01919-01)U. S. Army (Contract DAAB03-75-C-0489)National Institutes of Health (Grant 5 RO1 NS04332-12