The Association between Daytime Napping and Cognitive Functioning in Chronic Fatigue Syndrome

OBJECTIVES The precise relationship between sleep and physical and mental functioning in chronic fatigue syndrome (CFS) has not been examined directly, nor has the impact of daytime napping. This study aimed to examine self-reported sleep in patients with CFS and explore whether sleep quality and daytime napping, specific patient characteristics (gender, illness length) and levels of anxiety and depression, predicted daytime fatigue severity, levels of daytime sleepiness and cognitive functioning, all key dimensions of the illness experience. METHODS 118 adults meeting the 1994 CDC case criteria for CFS completed a standardised sleep diary over 14 days. Momentary functional assessments of fatigue, sleepiness, cognition and mood were completed by patients as part of usual care. Levels of daytime functioning and disability were quantified using symptom assessment tools, measuring fatigue (Chalder Fatigue Scale), sleepiness (Epworth Sleepiness Scale), cognitive functioning (Trail Making Test, Cognitive Failures Questionnaire), and mood (Hospital Anxiety and Depression Scale). RESULTS Hierarchical Regressions demonstrated that a shorter time since diagnosis, higher depression and longer wake time after sleep onset predicted 23.4% of the variance in fatigue severity (p <.001). Being male, higher depression and more afternoon naps predicted 25.6% of the variance in objective cognitive dysfunction (p <.001). Higher anxiety and depression and morning napping predicted 32.2% of the variance in subjective cognitive dysfunction (p <.001). When patients were classified into groups of mild and moderate sleepiness, those with longer daytime naps, those who mainly napped in the afternoon, and those with higher levels of anxiety, were more likely to be in the moderately sleepy group. CONCLUSIONS Napping, particularly in the afternoon is associated with poorer cognitive functioning and more daytime sleepiness in CFS. These findings have clinical implications for symptom management strategies

Preventing Domestic Abuse for Children and Young People (PEACH): A Mixed Knowledge Scoping Review

Background: A range of interventions that aim to prevent domestic abuse has been developed for children and young people in the general population. While these have been widely implemented, few have been rigorously evaluated. This study aimed to discover what was known about these interventions for children and what worked for whom in which settings. Review methods: This mixed knowledge review was informed by realist principles and comprised four overlapping phases: an online mapping survey to identify current provision; a systematic review of the existing literature; a review of the UK ‘grey’ literature; and consultation with young people and experts. Information from these four sources of evidence informed analysis of costs and benefits. Results: The evidence for interventions achieving changes in knowledge and attitudes was stronger than that for behavioural change. Shifting social norms in the peer group emerged as a key mechanism of change. Media campaigns act to influence the wider social climate within which more targeted interventions are received, and they are also a source for programme materials. While most interventions are delivered in secondary schools, they are increasingly targeted at younger children. The review emphasised the importance of a school’s ‘readiness’ to introduce preventative interventions which need to be supported across all aspects of school life. Involving young people in the design and delivery of programmes increases authenticity and this emerged as a key ingredient in achieving impact. Longer interventions delivered by appropriately trained staff appeared likely to be more effective. Teachers emerged as well placed to embed interventions in schools but they require training and support from those with specialist knowledge in domestic abuse. There was evidence that small groups of students who were at higher risk might have accounted for some results regarding effectiveness and that programme effectiveness may vary for certain subgroups. Increasingly, boys are being identified as a target for change. The study identified a need for interventions for disabled children and children and young people from black, Asian, minority ethnic and refugee groups and a particular lack of materials designed for lesbian, gay, bisexual and transgender young people. Limitations: Very little evidence was identified on costs and cost-effectiveness. Few studies showed an effect at the level of significance set for the review. Where it did exist, the effect size was small, except in respect of improved knowledge. The inability to calculate a response rate for the mapping survey, which used a snowballing approach, limits the ability to generalise from it. Conclusions: While it is appropriate to continue to deliver interventions to whole populations of children and young people, effectiveness appeared to be influenced by high-risk children and young people, who should be directed to additional support. Programmes also need to make provision to manage any resulting disclosures. Interventions appear to be context specific, and so those already being widely delivered in the UK and which are likely to be acceptable should be robustly tested. Funding: The National Institute for Health Research Public Health Research programme

Scale-Invariant Curvature Fluctuations from an Extended Semiclassical Gravity

We present an extension of the semiclassical Einstein equations which couples n-point correlation functions of a stochastic Einstein tensor to the n-point functions of the quantum stress-energy tensor. We apply this extension to calculate the quantum fluctuations during an inflationary period, where we take as a model a massive conformally coupled scalar field on a perturbed de Sitter space and describe how a renormalization independent, almost-scale-invariant power spectrum of the scalar metric perturbation is produced. Furthermore, we discuss how this model yields a natural basis for the calculation of non-Gaussianities of the considered metric fluctuations.Comment: 16 pages, 2 figures; final versio

Examining intellectual ability, not social prowess: removing barriers from the doctoral viva for autistic candidates

The doctoral viva voce (‘viva’) has been variously described in the literature as mysterious, unpredictable and potentially frightening for students. Here we present a set of reasonable adjustments designed to remove social barriers from existing viva process for the benefit of autistic doctoral viva candidates. Our objective is to ensure that autistic students, who experience atypical differences in social interaction, social communication, and social imagination, are examined on intellectual ability, not social prowess. Recommendations are based on our many years of work with autistic adults in higher education and elsewhere and relevant literature. It is our view that these proposals could also benefit non-autistic doctoral candidates. Key proposals are to allow candidates the choice of a ‘virtual viva’ via electronic mail; to prepare a ‘needs assessment’ pre-viva; and to ensure that those involved understand autism sufficiently to appreciate issues specific to the individual and their viva. Academic rigour and integrity would not be compromised but the playing field might be flattened

Semantic categorisation of a word supports its phonological integrity in verbal short-term memory

In three immediate serial recall (ISR) experiments we tested the hypothesis that interactive processing between semantics and phonology supports phonological coherence in verbal short-term memory (STM). Participants categorised spoken words in six-item lists as they were presented, according to their semantic or phonological properties, then repeated the items in presentation order (Experiment 1). Despite matched categorisation performance between conditions, semantically-categorised words were correctly recalled more often than phonologically-categorised words. This accuracy advantage in the semantic condition was accompanied by fewer phoneme recombination errors. Comparisons with a no- categorisation ISR baseline (Experiment 2) indicated that, although categorisations were disruptive overall, recombination errors were specifically rarer following semantic cate- gorisation. Experiment 3 replicated the key findings from Experiment 1 and also revealed fewer phonologically-related errors following semantic categorisation compared to a per- ceptual categorisation of high or low pitch. Therefore, augmented activation of semantic representations stabilises the phonological traces of words within verbal short-term memory, in line with the ‘‘semantic binding” hypothesis

Unitarized pion-nucleon scattering amplitude from inverse amplitude method

In a recent work on low energy pion-nucleon scattering, instead of using chiral perturbation theory (ChPT) amplitude, we started from a pion-nucleon {\it soft-pion} result and used elastic unitarity directly as a dynamical constraint to construct first-order unitarity corrected amplitudes. The resulting amplitudes are crossing symmetric but, as the ChPT ones, satisfy only approximate unitarity relation. In the present work, we reconsider our approach and we apply the inverse amplitude method (IAM) in order to access the energy resonance region. We present the resulting S- and P-wave phase shifts that are shown to be in qualitative agreement with experimental data.Comment: 6 pages, 3 figure

Postpartum ketoprofen treatment does not alter stress biomarkers in cows and calves experiencing assisted and unassisted parturition: a randomised controlled trial

Dystocia is considered painful and stressful for both the dam and the calf, although systematic evidence of this is limited. Few studies have investigated biochemical markers of stress and pain postpartum and whether any adverse effects are ameliorated by administration of analgesia. In this study, cow–calf pairs experiencing both mild to moderate farmer assistance and no assistance at parturition were randomly assigned to either treatment or placebo group in a two-by-two design (animals subject to veterinary intervention were excluded). The treatments were the NSAID ketoprofen or saline, administered within three hours of parturition. Blood samples taken in the immediate postpartum period, and at 24 hours, 48 hours and 7 days after parturition, were analysed for plasma concentrations of creatine kinase and cortisol (cows and calves) and plasma L-lactate and total protein concentration (calves). Stress biomarkers were highest in the immediate postpartum period and declined over time (P&lt;0.05). Cow plasma cortisol was higher in animals experiencing assisted parturition in the immediate postpartum period (P=0.023); by 24 hours no difference was evident. Intervention with NSAID analgesia did not result in beneficial changes in stress biomarkers. Based on biomarkers alone, this suggests limited benefits of NSAID treatment in unassisted or mild to moderately assisted parturition

Factors contributing to resilience in parents and carers

With increasing demand on the role of being a foster carer, it can be difficult to maintain a stable placement for the child in care. Resilience is a crucial factor in individuals successfully overcoming challenges and adversity, something that is ever present for foster carers. The aim of this qualitative study was to explore what factors enable and maintain resilience in foster carers, in addition to considering the challenges they face. Fourteen foster carers (2 male and 12 female) who had maintained a long term placement (for a year or more) with a looked after child, were recruited from a Local Authority in the North West of England. Foster carers were interviewed and their verbatim transcripts were analysed using a grounded theory methodology. A theoretical framework, including enabling, maintaining and resilience challenging factors, were found to emerge from the data and identified as likely in demonstrating foster carers' resilience and influencing placement stability. This theoretical framework provides an insight into clinical implications such as ensuring that foster carers receive the appropriate support when they are faced with increasing challenges, in order to maintain a stable placement. Keywords: Foster Carers; Resilience; Children in Care; Grounded Theor

Developmentally regulated instability of the GPI-PLC mRNA is dependent on a short-lived protein factor.

The expression of the vast majority of protein coding genes in trypanosomes is regulated exclusively at the post-transcriptional level. Developmentally regulated mRNAs that vary in levels of expression have provided an insight into one mechanism of regulation; a decrease in abundance is due to a shortened mRNA half-life. The decrease in half-life involves cis-acting elements in the 3' untranslated region of the mRNA. The trans-acting factors necessary for the increased rate of degradation remain uncharacterized. The GPI-PLC gene in Trypanosoma brucei encodes a phospholipase C expressed in mammalian bloodstream form, but not in the insect procyclic form. Here, it is reported that the differential expression of the GPI-PLC mRNA also results from a 10-fold difference in half-life. Second, the instability of the GPI-PLC mRNA in procyclic forms can be reversed by the inhibition of protein synthesis. Third, specifically blocking the translation of the GPI-PLC mRNA in procyclic forms by the inclusion of a hairpin in the 5' untranslated region does not result in stabilization of the mRNA. Thus, the effect of protein synthesis inhibitors in stabilizing the GPI-PLC mRNA operates in trans through a short-lived factor dependent on protein synthesis