Differentiating acute from chronic insomnia with machine learning from actigraphy time series data.

Acute and chronic insomnia have different causes and may require different treatments. They are investigated with multi-night nocturnal actigraphy data from two sleep studies. Two different wrist-worn actigraphy devices were used to measure physical activities. This required data pre-processing and transformations to smooth the differences between devices. Statistical, power spectrum, fractal and entropy analyses were used to derive features from the actigraphy data. Sleep parameters were also extracted from the signals. The features were then submitted to four machine learning algorithms. The best performing model was able to distinguish acute from chronic insomnia with an accuracy of 81%. The algorithms were then used to evaluate the acute and chronic groups compared to healthy sleepers. The differences between acute insomnia and healthy sleep were more prominent than between chronic insomnia and healthy sleep. This may be associated with the adaptation of the physiology to prolonged periods of disturbed sleep for individuals with chronic insomnia. The new model is a powerful addition to our suite of machine learning models aiming to pre-screen insomnia at home with wearable devices.

An image-based eyelid lesion management service-evaluation of a pilot.

BACKGROUND/AIMS: Oculoplastics is a predominantly visual specialty and many of the pathologies can be diagnosed based on external appearance. An image-based eyelid lesion management service was piloted to reduce the number of patients who would require outpatient clinic review. The aim of this study was to determine its accuracy and feasibility, both as a hospital-based and community optometrist-based service. If successful, the service was envisaged to significantly reduce the number of patients that require face-to-face (F2F) review, in accordance with current post-COVID-19 principles of social distancing. METHODS: Patients with lid lesions attending an oculoplastics clinic were assessed by consultant oculoplastic surgeons in an F2F consultation (Arm A). The lesions were photographed by a professional clinical photographer (Arm B) and by an optometrist with a handheld digital camera (Arm C). These images were reviewed by independent consultants masked to the outcome of the F2F clinical encounter. Data were collected prospectively including patient demographics, diagnosis, suspicion of malignancy and management. The image-based clinic results were compared to the F2F clinic results. RESULTS: Ninety-five patients were included. Clinical diagnoses were compared for intra-observer variability and substantial agreement was demonstrated between gold-standard F2F clinic visit (Arm A) and Arm B (Ƙ = 0.708) and C (Ƙ = 0.776). There was no statistically significant difference in the rate of discharge and all cases of malignancy were either identified or flagged for F2F review in the image-based arms. CONCLUSION: This pilot demonstrated substantial diagnostic agreement of image-based diagnoses with F2F consultation and image review alone did not miss any cases of malignancy.

Outcomes of rapid digital transformation of large-scale communications during the COVID-19 pandemic.

Objective This study examined the content and impact of a new digital communication medium, called a VIDCAST, implemented at a large hospital and health service when the COVID-19 pandemic was announced, and the key concerns held by staff at the time when the health service was preparing for the COVID-19 pandemic to arrive in this health service. Methods A mixed-methods approach was used. Thematic analysis of 20 transcripts of daily VIDCASTS broadcast between 30 March and 24 April 2020 was undertaken, in addition to descriptive analysis of feedback from an anonymous online survey. Results Survey feedback from 322 staff indicated almost universal satisfaction with this new communication method. The VIDCASTS provided a new COVID-safe method for the Executive to connect to staff at a time of uncertainty. Thematic analysis of the content of the VIDCASTS revealed three themes: 'Accurate Information', 'Reassurance and Support' and 'Innovation'. The Executive was able to reassure staff about what the organisation was doing to safeguard the health and wellbeing of all, and enabled an effective response to the pandemic. Conclusions The digital communication channel of VIDCASTS, rapidly operationalised at a major Australian hospital and health service in March 2020, provided important information and support for staff as it prepared for the anticipated COVID-19 surge. What is known about the topic? When the COVID-19 pandemic began, traditional face-to-face staff meetings were disrupted and many hospitals and their staff were left scrambling for information, and for reassurance about their safety, as they prepared to receive increasing numbers of COVID-19 patients. What does this paper add? The implementation of a digital communication tool was able to address many of the concerns raised by hospital staff in other geographic locations dealing with surging COVID-19 cases and underpinned a globally leading COVID-19 response. What are the implications for practitioners? New digitised communication methods provided an effective vehicle to inform and support staff in the early stages of pandemic preparation.

A machine learning model for multi-night actigraphic detection of chronic insomnia: development and validation of a pre-screening tool.

We propose a novel machine learning-based method for analysing multi-night actigraphy signals to objectively classify and differentiate nocturnal awakenings in individuals with chronic insomnia (CI) and their cohabiting healthy partners. We analysed nocturnal actigraphy signals from 40 cohabiting couples with one partner seeking treatment for insomnia. We extracted 12 time-domain dynamic and nonlinear features from the actigraphy signals to classify nocturnal awakenings in healthy individuals and those with CI. These features were then used to train two machine learning classifiers, random forest (RF) and support vector machine (SVM). An optimization algorithm that incorporated the predicted quality of each night for each individual was used to classify individuals into CI or healthy sleepers. Using the proposed actigraphic signal analysis technique, coupled with a rigorous leave-one-out validation approach, we achieved a classification accuracy of 80% (sensitivity: 76%, specificity: 82%) in classifying CI individuals and their healthy bed partners. The RF classifier (accuracy: 80%) showed a better performance than SVM (accuracy: 75%). Our approach to analysing the multi-night nocturnal actigraphy recordings provides a new method for screening individuals with CI, using wrist-actigraphy devices, facilitating home monitoring.

Network-based Responses to the Psychomotor Vigilance Task during Lapses in Adolescents after Short and Extended Sleep.

Neuroimaging studies of the Psychomotor Vigilance Task (PVT) have revealed brain regions involved in attention lapses in sleep-deprived and well-rested adults. Those studies have focused on individual brain regions, rather than integrated brain networks, and have overlooked adolescence, a period of ongoing brain development and endemic short sleep. This study used functional MRI (fMRI) and a contemporary analytic approach to assess time-resolved peri-stimulus response of key brain networks when adolescents complete the PVT, and test for differences across attentive versus inattentive periods and after short sleep versus well-rested states. Healthy 14-17-year-olds underwent a within-subjects randomized protocol including 5-night spans of extended versus short sleep. PVT was performed during fMRI the morning after each sleep condition. Event-related independent component analysis (eICA) identified coactivating functional networks and corresponding time courses. Analysis of salient time course characteristics tested the effects of sleep condition, lapses, and their interaction. Seven eICA networks were identified supporting attention, executive control, motor, visual, and default-mode functions. Attention lapses, after either sleep manipulation, were accompanied by broadly increased response magnitudes post-stimulus and delayed peak responses in some networks. Well-circumscribed networks respond during the PVT in adolescents, with timing and intensity impacted by attentional lapses regardless of experimentally shortened or extended sleep.

Evening types demonstrate reduced SSRI treatment efficacy.

Selective serotonin reuptake inhibitors (SSRIs) have a profound effect on the circadian system's response to environmental light, which may impact treatment outcomes for patients depending on their habitual light exposure patterns. Here, we investigated the relationship between time-of-day preference, depressive symptoms and self-reported antidepressant treatment response. Evening types reported having taken a higher number of antidepressant medications in the previous 5 years and lower SSRI efficacy than morning types. While undergoing SSRI treatment, evening types also reported more depressive symptoms and suicidality. It is concluded that time-of-day preference may prove informative in predicting SSRI treatment responses.

Incidence of periorbital necrotising fasciitis in the UK population: a BOSU study.

BACKGROUND: Periorbital necrotising fasciitis (PNF) is a devastating infection of subcutaneous soft tissue and underlying fascia causing severe morbidity and even loss of life. Few case reports of PNF exist and there are no prospective epidemiological studies. METHODS: A prospective observational study was undertaken using the British Ophthalmological Surveillance Unit reporting system. Questionnaires were sent to reporting ophthalmologists in the UK seeking cases of PNF over a 2-year period. RESULTS: 30 new cases were confirmed. 16 of the reported cases followed a precipitating event, 9 cases followed trauma and 3 followed surgery. ß-haemolytic Streptococcus A was the causative organism identified in 76%, either alone or with concurrent infection, and antibiotic sensitivities are discussed. Systemic complications occurred in the majority of cases (66.6%), with sepsis and death occurring in 10%. Over 50% of surviving patients had subsequent morbidity, reduced acuity (<6/18) being common. CONCLUSION: PNF is a rare, dangerous condition. This study identified an incidence of 0.24 per 1,000,000 per annum in the UK. ß-haemolytic Streptococcus A is the most common causative organism. Mortality remains a potential outcome, and survivors suffer significant morbidity. Early intravenous antibiotic management with a consensus favouring penicillin and clindamycin combined with debridement.

Morfologia e biometria do timo em araras dos gêneros Ara e Anodorhynchus / Morphology and biometry of the thymus gland in macaw of Ara and Anodorhynchus genera

Foram utilizados 12 exemplares de Ara ararauna - seis fêmeas e seis machos -, cinco exemplares de Ara chloropterus (uma fêmea e quatro machos) e dois exemplares de Anodorhynchus hyacinthinus - uma fêmea e um macho -, todos adultos, doados por criadouro particular, após óbito natural. Os lobos foram dissecados e medidos com paquímetro - comprimento x largura x espessura - e analisados quanto ao peso, à topografia e à morfologia individual. Independentemente do gênero, foram identificados, em 17 casos (89,5%), lobos tímicos nos antímeros cervicais esquerdo e direito, e em oito casos (42,1%), lobos na cavidade celomática. Os lobos apresentaram formatos alongados - 52,6% -, arredondados - 21,1% - ou ovalados - 15,8% -, posicionados preferencialmente ventromedialmente ao longo do plexo vasculoneural do pescoço, com número médio de cinco lobos por antímero, tamanho médio de 0,49cm de comprimento, 0,12cm de largura e 0,05cm de espessura e peso médio de 0,076g.

Twelve samples of Ara ararauna - six females and six males -, five samples of Ara chloropterus (one female and four males) and two samples of Anodorhynchus hyacinthinus (one female and one male), all adults from a Breeding Park, were used after natural death. The lobes were dissected and measured with electronic calliper (length x width x thickness) and analyzed taking their weight, topography and individual morphology into account. Regardless of gender, 89.5% of the cases presented timic lobes in the left and right cervical antimere, and 42.1% of the cases presented lobes in the celomatic cavity. The lobes were shown in shapes - long (52.6%), round (21.1%) or oval (15.8%), positioned mostly ventromedially, along the neurovascular plexus of the neck, with an average of five lobes per antimere, and an average size of 0.49cm length, 0.12cm width, and 0.05cm thick and average weight of 0.076g.

The monitoring of gingival crevicular fluid volume during orthodontic treatment: a longitudinal randomized split-mouth study.

UNLABELLED: This randomized split-mouth study was aimed at evaluating whether an orthodontic appliance per se or orthodontic tooth movement can induce detectable changes in gingival crevicular fluid (GCF) volume, and thus whether GCF volume is a predictable biomarker for tissue remodelling incident to orthodontic tooth movement. MATERIALS AND METHODS: Sixteen healthy orthodontic patients (7 females and 9 males; mean age, 17.7 years; range, 13-27 years) with the need for extraction of the first upper premolars were enrolled. One randomly chosen maxillary canine was subjected to a distalizing force by a 0.017 × 0.025 inch titanium-molybdenum alloy archwire and considered as the test tooth (TT). The contralateral canine, which was not subjected to any force but was included in an orthodontic appliance, was used as a control (CT). GCF sampling was performed at both mesial and distal sites of the CTs and TTs at baseline, immediately before applying the orthodontic appliance, and after 1 hour, 24 hours, and 7, 14, and 21 days. A Periotron was used to measure the GCF volume. A modest but significant increase in the GCF volume over time was seen in both the CTs (mesial sites) and the TTs (both mesial and distal sites) with no differences between the experimental teeth. Subclinical tissue inflammation consequent to the placement of the orthodontic appliance might be responsible for these GCF volume changes. The GCF volume does not appear to be a reliable biomarker for tissue remodelling during orthodontic treatment.

Conserving biodiversity in production landscapes.

Alternative land uses make different contributions to the conservation of biodiversity and have different implementation and management costs. Conservation planning analyses to date have generally assumed that land is either protected or unprotected, and that the unprotected portion does not contribute to conservation goals. We develop and apply a new planning approach that explicitly accounts for the contribution of a diverse range of land uses to achieving conservation goals. Using East Kalimantan (Indonesian Borneo) as a case study, we prioritize investments in alternative conservation strategies and account for the relative contribution of land uses ranging from production forest to well-managed protected areas. We employ data on the distribution of mammals and assign species-specific conservation targets to achieve equitable protection by accounting for life history characteristics and home range sizes. The relative sensitivity of each species to forest degradation determines the contribution of each land use to achieving targets. We compare the cost effectiveness of our approach to a plan that considers only the contribution of protected areas to biodiversity conservation, and to a plan that assumes that the cost of conservation is represented by only the opportunity costs of conservation to the timber industry. Our preliminary results will require further development and substantial stakeholder engagement prior to implementation; nonetheless we reveal that, by accounting for the contribution of unprotected land, we can obtain more refined estimates of the costs of conservation. Using traditional planning approaches would overestimate the cost of achieving the conservation targets by an order of magnitude. Our approach reveals not only where to invest, but which strategies to invest in, in order to effectively and efficiently conserve biodiversity.

The effect of including a conventional snack (cereal bar) and a nonconventional snack (almonds) on hunger, eating frequency, dietary intake and body weight.

BACKGROUND: With the increasing prevalence of being overweight and obesity, dietary strategies to curb hunger levels and increase satiety at lower energy intakes are sought. The frequency of eating and type of snack may influence total energy intake. The present study aimed to assess the impact of providing either a conventional snack (cereal bar) or a nonconventional snack (almonds) on eating frequency, hunger rating, dietary intake, body weight and blood lipids. METHODS: Forty-five healthy men (aged 25-50 years, body mass index = 25-35 kg m(-2)) were recruited and allocated to a control, cereal bar or almond snack group. Two packets of cereal bars and almonds were introduced for 12 weeks to the cereal bar group and the almond snack group, respectively. Dietary intakes and eating frequency were assessed by 4-day unweighed diet diaries; visual analogue scales were used to assess hunger ratings; and fasting blood parameters (i.e. glucose, insulin, total cholesterol, triglycerides, low-density lipoprotein cholesterol and high-density lipoprotein cholesterol) were measured at baseline, 6 and 12 weeks. In addition, anthropometric measures (height, weight, skinfold thickness, waist and hip circumference) were measured at baseline, 6 and 12 weeks. RESULTS: The present study found no significant change in the eating frequency within groups at 12 weeks. However, the almond snack group had a significantly higher eating frequency than the control group (P < or = 0.05) and cereal bar group (P < or = 0.01). This did not result in higher energy intake, body weight or percentage body fat in the almond snack group. CONCLUSION: The present study demonstrated that snacking on almonds, in comparison to cereal bars, promoted a higher eating frequency, but not a higher energy intake. Advice to snack on either almonds or cereal bars did not result in weight gain, suggesting that energy compensation took place.

Prospective surveillance of women with a family history of breast cancer: auditing the risk threshold.

To evaluate current guidelines criteria for inclusion of women in special 'breast cancer family history' surveillance programmes, records were reviewed of women referred to Scottish breast cancer family clinics between January 1994 and December 2003 but discharged as at 'less than 'moderate' familial risk'. The Scottish Cancer Registry was then interrogated to determine subsequent age-specific incidence of breast cancer in this cohort and corresponding Scottish population figures. Among 2074 women, with an average follow-up of 4.0 years, 28 invasive breast cancers were recorded up to December 2003, where 14.4 were expected, a relative risk (RR) of 1.94. Eleven further breast cancers were recorded between January 2004 and February 2006 (ascertainment incomplete for this period). The overall RR for women in the study cohort exceeded the accepted 'cutoff' level (RR=1.7) for provision of special counselling and surveillance. The highest RR was found for the age group 45-59 years and this group also generated the majority of breast cancers. The National Institute for Clinical Excellence ('NICE') guidelines appear to be more accurate than those of the Scottish Intercollegiate Guidelines Network ('SIGN') in defining 'moderate' familial risk, and longer follow-up of this cohort could generate an evidence base for further modification of familial breast cancer services.

A protocol for isolating Xenopus oocyte nuclear envelope for visualization and characterization by scanning electron microscopy (SEM) or transmission electron microscopy (TEM).

This protocol details methods for the isolation of oocyte nuclear envelopes (NEs) from the African clawed toad Xenopus laevis, immunogold labeling of component proteins and subsequent visualization by field-emission scanning electron microscopy (FESEM) and transmission electron microscopy (TEM). This procedure involves the initial removal of the ovaries from mature female X. laevis, the dissection of individual oocytes, then the manual isolation of the giant nucleus and subsequent preparation for high-resolution visualization. Unlike light microscopy, and its derivative technologies, electron microscopy enables 3-5 nm resolution of nuclear structures, thereby giving unrivalled opportunities for investigation and immunological characterization in situ of nuclear structures and their structural associations. There are a number of stages where samples can be stored, although we recommend that this protocol take no longer than 2 d. Samples processed for FESEM can be stored for weeks under vacuum, allowing considerable time for image acquisition.

Generation of cell-free extracts of Xenopus eggs and demembranated sperm chromatin for the assembly and isolation of in vitro-formed nuclei for Western blotting and scanning electron microscopy (SEM).

This protocol details methods for the generation of cell-free extracts and DNA templates from the eggs and sperm chromatin, respectively, of the clawed toad Xenopus laevis. We have used this system with scanning electron microscopy (SEM), as detailed herein, to analyze the biochemical requirements and structural pathways for the biogenesis of eukaryotic nuclear envelopes (NEs) and nuclear pore complexes (NPCs). This protocol requires access to female frogs, which are induced to lay eggs, and a male frog, which is killed for preparation of the sperm chromatin. Egg extracts should be prepared in 1 d and can be stored for many months at -80 degrees C. Demembranated sperm chromatin should take only approximately 2-3 h to prepare and can be stored at -80 degrees C almost indefinitely. The time required for assembly of structurally and functionally competent nuclei in vitro depends largely on the quality of the cell-free extracts and, therefore, must be determined for each extract preparation.

Visualization of the nucleus and nuclear envelope in situ by SEM in tissue culture cells.

Our previous work characterizing the biogenesis and structural integrity of the nuclear envelope and nuclear pore complexes (NPCs) has been based on amphibian material but has recently progressed into the analysis of tissue-culture cells. This protocol describes methods for the high resolution visualization, by field-emission scanning electron microscopy (FESEM), of the nucleus and associated structures in tissue culture cells. Imaging by fluorescence light microscopy shows general nuclear and NPC information at a resolution of approximately 200 nm, in contrast to the 3-5 nm resolution provided by FESEM or transmission electron microscopy (TEM), which generates detail at the macromolecular level. The protocols described here are applicable to all tissue culture cell lines tested to date (HeLa, A6, DLD, XTC and NIH 3T3). The processed cells can be stored long term under vacuum. The protocol can be completed in 5 d, including 3 d for cell growth, 1 d for processing and 1 d for imaging.

Origem e distribuição do nervo obturatório em suínos (Sus Scrofa Domesticus Linnaeus, 1758) da linhagem Ag-1050 / Origin and distribution of obituary nerve in swine (Sus Scrofa Domesticus - Linnaeus, 1758) of Age-1050 Lineage / Origen y distribución del nervio obturador en cerdos (Sus srofa domesticus - linnaeus, 1758) dell linaje ag-1050

Trinta fetos de suínos Sus scrofa da linhagem AG-1050 foram avaliadas com o objetivo de determinar a origem e distribuição do nervo obturatório. Os materiais foram preparados com injeção de solução aquosa de formol a 10 através da aorta descendente torácica, e mantidos em recipientes apropriados. Para melhor identificação do nervo obturatório, empregou-se solução de álcool absoluto e ácido acético glacial na proporção 70/30 respectivamente. Constatou-se sua origem nos ramos ventrais do nervo espinhal L4 em 96,65, L5 em todos os casos e L6 em 56,65 dos espécimes analisados. Originou-se, em todos, os espécimes em conjunto com o nervo femoral e em 56,65 com o nervo isquiático em ambos os antímeros e se distribuiu nos músculos grácil, pectíneo, adutor, obturadores interno e externo, quadrado femoral, semimembranáceo e sartório.

Thirty fetuses of Sus scrofa swine of AG-1050 lineage were studied, aiming at determining the origin and distribution of the obituary nerve. The material used was prepared with the injection of aqueous solution of formol 10 through thoracic descendent aorta and it was maintained in appropriate recipients. To a better identification of the obituary nerve, we used solution of absolute alcohol and acetic glacial acid in proportion of 70 to 30, respectively. The origin was observed in the ventral branches of L4 spinal nerve (96.65), L5 in all occasions, and L6 (56.65), in the analyzed specimen. In all animals studied the obituary nerve was originated together with femoral nerve and in 56.65 with sciatic nerve in both of the antimeres, and it was distributed to the muscles: gracilis, pectinea, adductor, internal and external obituaries, femoral quadrate, semimembrane and sartorius.

Treinta fetos de cerdos Sus scrofa domesticus del linaje AG-1050 han sido evaluados con el objetivo de determinar el origen y distribución del nervio obturador. Los materiales han sido preparados con inyección de solución acuosa de formol a 10 através de la aorta descendente torácica, y mantenidos en recipientes apropiados. Para mejor identificación del nervio obturador se empleó solución de alcohol absoluto y ácido acético glacial en la proporción 70/30 respectivamente. Se constató su origen en los ramos ventrales del nervio espinal L4 (96,65), L5, en todos los casos y L6 (56,25) de los especímenes en conjunto con el nervio femoral y en 56,65 con el nervio isquiático en ambos antímeros, y se ha distribuído en los músculos gracili, pectíneo, aductor, obturadores interno y externo, cuadrado femoral, semimembranoso y sartorio.

Visual acuity and the ability of the visually impaired to read medication instructions.

BACKGROUND/AIMS: Although medical information is often communicated in writing, little attention is given as to whether patients can read it--for example, the miniscule writing on the side of the medication bottles (equivalent to 6/6 reduced Snellen). The authors wished to determine a distance visual acuity threshold, using routine assessments of visual acuity (VA), beyond which patients are unable to read their instructions. METHODS: 180 patients, subgrouped according to the best line of Snellen acuity (from 6/9 to 6/60) achieved in either eye were recruited. Subjects were asked to read the printed manufacturer's instructions on the side of the drops box without magnification. RESULTS: Those subjects with best corrected VA of lower than or equal to 6/24 showed a significantly diminished ability to read the instructions on their eye drops bottles (p<0.001 for each comparison). When this group selected a font size of their choosing, the mode for preferred Arial font sizes were 16 for the 6/24 group, 18 for 6/36, and 22 for 6/60. CONCLUSION: This study documents the inability of patients with visual impairment to read the instructions on their bottle of eye drops. There is evidence of a distance VA threshold effect such that, although the majority of patients with 6/18 VA are able to read their instructions, patients whose VA is worse cannot. This latter group would benefit from a larger font size, a size of Arial 22 being sufficient. We recommend that all printed information for patients with visual acuities between 6/24 and 6/60 be printed in font Arial 22 or equivalent.