Factors Influencing Sleep Difficulty and Sleep Quantity in the Citizen Pscientist Psoriatic Cohort.

IntroductionSleep is essential for overall health and well-being, yet more than one-third of adults report inadequate sleep. The prevalence is higher among people with psoriasis, with up to 85.4% of the psoriatic population reporting sleep disruption. Poor sleep among psoriasis patients is particularly concerning because psoriasis is independently associated with many of the same comorbidities as sleep dysfunction, including cardiovascular disease, obesity, and depression. Given the high prevalence and serious consequences of disordered sleep in psoriasis, it is vital to understand the nature of sleep disturbance in this population. This study was designed to help meet this need by using survey data from Citizen Pscientist, an online patient portal developed by the National Psoriasis Foundation.MethodsOur analysis included 3118 participants who identified as having a diagnosis by a physician of psoriasis alone or psoriasis with psoriatic arthritis. Demographic information, psoriasis severity and duration, sleep apnea status, smoking and alcohol consumption, itch timing, and sleep characteristics were included. Two separate multivariate logistic regression models in STATA were used to determine whether the presence of psoriatic arthritis, age, gender, body mass index, comorbid sleep apnea, psoriasis severity, timing of worst itch, smoking status, or high-risk alcohol consumption were associated with sleep difficulty or low sleep quantity, defined by the American Academy of Sleep Medicine as less than 7 h of sleep per night on average.ResultsResults from the multivariate logistic regressions found that sleep difficulty was associated with psoriatic arthritis (OR 2.15, 95% CI [1.79-2.58]), female gender (2.03 [1.67-2.46]), obese body mass index (BMI ≥ 30) (1.25 [1.00-1.56]), sleep apnea (1.41 [1.07-1.86]), psoriasis severity of moderate (1.59 [1.30-1.94]) or severe (2.40 [1.87-3.08]), and smoking (1.60 [1.26-2.02]). Low sleep quantity was associated with obese BMI (1.62 [1.29-2.03]), sleep apnea (1.30 [1.01-1.68]), psoriasis severity of moderate (1.41 [1.16-1.72]) or severe (1.40 [1.11-1.76]), and smoking (1.62 [1.31-2.00]). Sleep difficulty and low sleep quantity were not associated with age, alcohol consumption, or timing of worst itch.ConclusionThese results are potentially meaningful in several aspects. We identify an important distinction between sleep difficulty and sleep quantity in psoriatic disease, whereby having psoriatic arthritis and being female are each associated with sleep difficulty despite no association with low sleep quantity. Furthermore, there is conflicting evidence from prior studies as to whether psoriasis severity is associated with sleep difficulty, but this well-powered, large study revealed a strong, graded relationship between psoriasis severity and both sleep difficulty and low sleep quantity. Overall, our results show that both sleep difficulty and low sleep quantity were associated with multiple factors in this analysis of a large psoriatic cohort. These findings suggest that dermatologists may gather clinically useful information by screening psoriatic patients for trouble sleeping and low sleep quantity to identify potential comorbidities and to more effectively guide disease management

Advanced imaging capabilities by incorporating plasmonics and metamaterials in detectors

Ultraviolet detection is often required to be made in the presence of a strong background of solar radiation which needs to be suppressed, but materials limitations at these wavelengths can impact both filter and sensor performance. In this work, we explore the use of 1D photonic bandgap structures integrated directly onto a Si sensor that can operate with solar blindness. These filters take advantage of the improved admittance with silicon to significantly improve throughput over conventional stand-alone bandpass filter elements. At far ultraviolet wavelengths these filters require the use of non-absorbing dielectrics such as the metal fluoride materials of MgF_2, AlF_3 and LiF. The latest performance of these 1D multilayer filters on Si photodiodes and CCD imaging sensors is demonstrated. We have also extended these 1D structures to more complex multilayers guided by the design concepts of metamaterials and metatronics, and to 2D patterned plasmonic hole array filters fabricated in aluminum. The performance of sensors and test filter structures is presented with an emphasis on UV throughput

Short-Term Rationing of Combination Antiretroviral Therapy: Impact on Morbidity, Mortality, and Loss to Follow-Up in a Large HIV Treatment Program in Western Kenya

Background. There was a 6-month shortage of antiretrovirals (cART) in Kenya. Methods. We assessed morbidity, mortality, and loss to follow-up (LTFU) in this retrospective analysis of adults who were enrolled during the six-month period with restricted cART (cap) or the six months prior (pre-cap) and eligible for cART at enrollment by the pre-cap standard. Cox models were used to adjust for potential confounders. Results. 9009 adults were eligible for analysis: 4,714 pre-cap and 4,295 during the cap. Median number of days from enrollment to cART initiation was 42 pre-cap and 56 for the cap (P < 0.001). After adjustment, individuals in the cap were at higher risk of mortality (HR = 1.21; 95% CI : 1.06–1.39) and LTFU (HR = 1.12; 95% CI : 1.04–1.22). There was no difference between the groups in their risk of developing a new AIDS-defining illness (HR = 0.92 95% CI 0.82–1.03). Conclusions. Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes

New Tests of Magnetospheric Accretion in T Tauri Stars

We examine 3 analytic theories of magnetospheric accretion onto classical T Tauri stars under the assumption that the magnetic field strength does not vary appreciably from star to star. From these investigations we derive predicted relationships among the stellar mass, radius, rotation period, and disk accretion rate. Data from 5 studies of the accretion parameters of CTTSs are used to test the predicted correlations. We generally find that the data do not display the predicted correlations except for that predicted by the model of Shu et al. as detailed by Ostriker and Shu and extended here to include non-dipole field topologies. Their identification of the trapped flux as an important quantity in the model appears to be critical for reconciling the observed data to the theory. While the data do generally support the extended Ostriker and Shu predictions, only one of the two studies for which the requisite data exist show the highest correlation when considering all the relevant parameters. This suggests great care must be taken when trying to use existing observations to test the theory.Comment: 36 pages, including figure

Single Photon Counting UV Solar-Blind Detectors Using Silicon and III-Nitride Materials

Ultraviolet (UV) studies in astronomy, cosmology, planetary studies, biological and medical applications often require precision detection of faint objects and in many cases require photon-counting detection. We present an overview of two approaches for achieving photon counting in the UV. The first approach involves UV enhancement of photon-counting silicon detectors, including electron multiplying charge-coupled devices and avalanche photodiodes. The approach used here employs molecular beam epitaxy for delta doping and superlattice doping for surface passivation and high UV quantum efficiency. Additional UV enhancements include antireflection (AR) and solar-blind UV bandpass coatings prepared by atomic layer deposition. Quantum efficiency (QE) measurements show QE > 50% in the 100–300 nm range for detectors with simple AR coatings, and QE ≅ 80% at ~206 nm has been shown when more complex AR coatings are used. The second approach is based on avalanche photodiodes in III-nitride materials with high QE and intrinsic solar blindness

BARRIERS TO THE USE OF MODERN CONTRACEPTIVES AND IMPLICATIONS FOR WOMAN-CONTROLLED PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS IN MADAGASCAR

Globally, unplanned pregnancies and sexually transmitted infections (STIs) persist as significant threats to women’s reproductive health. Barriers to the use of modern contraceptives by women might inhibit uptake of novel woman-controlled methods for preventing STIs/HIV. Use of modern contraceptives and perceptions and attitudes towards contraceptive use were investigated among women in Antananarivo, Madagascar using qualitative research. The hypothetical acceptability of the diaphragm, a woman-controlled barrier contraceptive device that also holds promise of protecting against STI/HIV, was assessed. Women consecutively seeking care for vaginal discharge at a public health clinic were recruited for participation in a semi-structured interview (SSI) or focus group discussion (FGD). Audiotaped SSIs and FGDs were transcribed, translated, and coded for predetermined and emerging themes. Of 46 participating women, 70% reported occasional use of male condoms, mostly for preventing pregnancy during their fertile days. Although women could name effective contraceptive methods, only 14% reported using hormonal contraception. Three barriers to use of modern contraceptives emerged: gaps in knowledge about the range of available contraceptive methods; misinformation and negative perceptions about some methods; and concern about social opposition to contraceptive use, mainly from male partners. These results demonstrate the need for programs in both family planning and STI prevention to improve women’s knowledge of modern contraceptives and methods to prevent STI and to dispel misinformation and negative perceptions of methods. In addition, involvement of men will likely be a critical component of increased uptake of woman-controlled pregnancy and STI/HIV prevention methods and improved health

Strategic Public Procurement: An Overview

The paper provides an overview of the development of public procurement (PP) rules in the EU and in selected international organisations. The EU rules were originally designed to foster competition and efficiency, and the dominant award criterion was the price. Over time, and in particular in the context of the "EU 2020" strategy, PP rules have been extended to address not only economic objectives, but also social and environmental goals as well as innovation aspects. As a result, such "strategic" elements of PP have in 2014 been legalised by the new EU Procurement Directives. However, as long as strategic PP remains an isolated policy, it will have only limited ramifications on Community-wide sustainability. Strategic PP should rather complement sustainability policies in their respective areas and should thus become an integral part of overall EU policies

Vaginal microbicide and diaphragm use for sexually transmitted infection prevention: A randomized acceptability and feasibility study among high-risk women in Madagascar (Sex Transm Dis (2008) 35(9) 818-26)

In preparation for a randomized controlled trial (RCT), we conducted a pilot RCT of the acceptability and feasibility of diaphragms and candidate vaginal microbicide for sexually transmitted infection prevention among high-risk women in Madagascar

Advanced imaging capabilities by incorporating plasmonics and metamaterials in detectors

Ultraviolet detection is often required to be made in the presence of a strong background of solar radiation which needs to be suppressed, but materials limitations at these wavelengths can impact both filter and sensor performance. In this work, we explore the use of 1D photonic bandgap structures integrated directly onto a Si sensor that can operate with solar blindness. These filters take advantage of the improved admittance with silicon to significantly improve throughput over conventional stand-alone bandpass filter elements. At far ultraviolet wavelengths these filters require the use of non-absorbing dielectrics such as the metal fluoride materials of MgF_2, AlF_3 and LiF. The latest performance of these 1D multilayer filters on Si photodiodes and CCD imaging sensors is demonstrated. We have also extended these 1D structures to more complex multilayers guided by the design concepts of metamaterials and metatronics, and to 2D patterned plasmonic hole array filters fabricated in aluminum. The performance of sensors and test filter structures is presented with an emphasis on UV throughput