Background
Sleep disturbances and neurodegenerative disease are prevalent in later life and may worsen life quality. Home sleep monitoring may help allow early recognition of disease progression and ...offer therapeutic intervention targets. In the Remote Evaluation of Sleep To enhance understanding of Early Dementia (RESTED) study, we explored feasibility and acceptability of digital technologies to characterise sleep in cognitive impaired individuals.
Method
Recruitment and data collection is ongoing as of January 2023. We included data from seven RESTED participants who completed an end‐of‐study interview which includes individuals with early Alzheimer’s Dementia (AD) or Lewy Body Dementia (LBD), the prodromal state of Mild Cognitive Impairment (MCI) due to AD or LBD, healthy older adults from memory clinics and databases at the North Bristol NHS Trust. A wrist‐worn actigraph monitored sleep and trial activities were triggered through a mobile application for 8 weeks. During one week in‐depth monitoring included EEG headband worn nightly, overnight oximetry, circadian saliva samples and daily short cognitive tests.
Results
Preliminary data from the interview were analysed using thematic analysis. Participants were asked questions to draw off The Capability, Opportunity, Motivation, Behaviour and Unified theory of acceptance and use of technology model. Overall, Participants were able to use the technologies either independently or with support from a carer or family member. Some participants found it difficult to wear the headband, and doing the cognitive test made them feel anxious and worried about their memory. Using technologies did not negatively impact their relationship with their partner. Carer motivation was a major determinant of data completeness. This study made them aware of the importance of sleep for brain health.
Conclusions
Future research should review the ergonomic design principles by considering the infrastructure to make them more suitable for the targeted population. Our work also demonstrates some challenges in conducting this category of user experience study in healthcare, including time investment from carers, adherence to the continued interview and retrospective biases. This user experience study in dementia suggests remote sleep monitoring is preferred, holds the potential to enhance well‐being, improve participant‐carer relationships, and may provide a means to feel empowered and acquire new skills.
Abstract
Background
Sleep disturbance is commonly reported in Alzheimer’s disease (AD), Lewy body dementia (LBD) and mild cognitive impairment (MCI). Early identification of sleep changes is crucial ...as poor sleep could contribute to cognitive decline and worsen disease progression. Sleep‐related breathing disorders (SBD), including obstructive sleep apnoea, have been associated with dementia and its treatment using continuous positive airway pressure (CPAP) may improve cognitive trajectory (Osorio et al., 2015). The Remote Evaluation of Sleep To enhance understanding of Early Dementia (RESTED) study is an ongoing cohort study conducted at the University of Bristol, aiming to characterise sleep changes in early dementia using remote tools. Here, we outline preliminary data from a small group of RESTED participants undergoing overnight pulse oximetry to screen for SBD.
Method
Older adults with AD or MCI due to AD (AD‐MCI), LBD or MCI due to DLB/PD (LBD) and age‐matched healthy controls (HC) were recruited from memory clinics and volunteer databases at North Bristol NHS Trust. Participants completed baseline questionnaires including Epworth Sleepiness Scale (ESS) and STOP‐BANG, in addition to undergoing pulse oximetry testing on two consecutive nights at home. Parameters including oxygen desaturation index 3% (ODI3%) and pulse rise index were analysed. Those with suspected SBD were referred to tertiary sleep services. Mann‐Whitney test was conducted to investigate differences in ODI3% between ESS or STOP‐BANG classification cut‐offs.
Results
Overnight pulse oximetry was well‐tolerated across groups, with all participants completing at least one full night’s recording. Preliminary results demonstrated an abnormal ODI3% in eight of 13 participants (AD‐MCI n = 3/6, LBD n = 3/3, HC n = 2/4). Of the remaining 5, 2 (HC) were referred for further testing due to abnormal pulse rise index and 3 (AD‐MCI) did not demonstrate suspicion of SBD. No significant difference in ODI3% was found between ESS≤10 and >10 (p = 0.28) or STOP‐BANG<3 and ≥3 (p = 0.15).
Conclusion
Overnight pulse oximetry serves as an easy to use, objective method in screening for SBD, which could provide an additional avenue for targeting dementia risk. Routine screening may be implicated for older adults with cognitive impairment who may otherwise not be considered high risk for SBD, particularly in the absence of subjective daytime sleepiness.
The objective of this study was to develop a portable and modular brain-computer interface (BCI) software platform independent of input and output devices. We implemented this platform in a case ...study of a subject with cervical spinal cord injury (C5 ASIA A).
BCIs can restore independence for individuals with paralysis by using brain signals to control prosthetics or trigger functional electrical stimulation. Though several studies have successfully implemented this technology in the laboratory and the home, portability, device configuration, and caregiver setup remain challenges that limit deployment to the home environment. Portability is essential for transitioning BCI from the laboratory to the home.
The BCI platform implementation consisted of an Activa PC + S generator with two subdural four-contact electrodes implanted over the dominant left hand-arm region of the sensorimotor cortex, a minicomputer fixed to the back of the subject's wheelchair, a custom mobile phone application, and a mechanical glove as the end effector. To quantify the performance for this at-home implementation of the BCI, we quantified system setup time at home, chronic (14-month) decoding accuracy, hardware and software profiling, and Bluetooth communication latency between the App and the minicomputer. We created a dataset of motor-imagery labeled signals to train a binary motor imagery classifier on a remote computer for online, at-home use.
Average bluetooth data transmission delay between the minicomputer and mobile App was 23 ± 0.014 ms. The average setup time for the subject's caregiver was 5.6 ± 0.83 min. The average times to acquire and decode neural signals and to send those decoded signals to the end-effector were respectively 404.1 ms and 1.02 ms. The 14-month median accuracy of the trained motor imagery classifier was 87.5 ± 4.71% without retraining.
The study presents the feasibility of an at-home BCI system that subjects can seamlessly operate using a friendly mobile user interface, which does not require daily calibration nor the presence of a technical person for at-home setup. The study also describes the portability of the BCI system and the ability to plug-and-play multiple end effectors, providing the end-user the flexibility to choose the end effector to accomplish specific motor tasks for daily needs. Trial registration ClinicalTrials.gov: NCT02564419. First posted on 9/30/2015.
In an effort to respond promptly to new evidence, the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) Task Force on Practice Guidelines has created a "focused update" ...process to revise the existing guideline recommendations that are affected by evolving data or opinion. Specific criteria/considerations for inclusion of new data include the following: publication in a peer-reviewed journal; large randomized, placebo-controlled trial(s); nonrandomized data deemed important on the basis of results that affect current safety and efficacy assumptions; strength/weakness of research methodology and findings; likelihood of additional studies influencing current findings; impact on current performance measure(s) and/or likelihood of need to develop new performance measure(s); requests and requirements for review and update from the practice community, key stakeholders, and other sources free of relationships with industry or other potential bias; number of previous trials showing consistent results; and need for consistency with a new guideline or guideline revision. Death/MI/CVA/revascularization: 15.8 versus 13.7; P=0.44 Appendix 6 Outcomes of PCI Versus CABG for Unprotected Left Main Coronary Artery Disease CABG indicates coronary artery bypass graft surgery; CI, confidence interval; CVA, cerebrovascular accident; HR, hazard ratio; MACE, major adverse cardiac events; MI, myocardial infarction; NS, not significant; OR, odds ratio; RR, relative risk; and PCI, percutaneous coronary intervention.When possible, 95% CIs reported were provided for RR, OR, or HR calculations along with probability values.
Coal is one of the most abundant and economic sources for global energy production. However, the burning of coal is widely recognized as a significant contributor to atmospheric particulate matter ...linked to deleterious respiratory impacts. Recently, we have discovered that burning coal generates large quantities of otherwise rare Magnéli phase titanium suboxides from TiO
minerals naturally present in coal. These nanoscale Magnéli phases are biologically active without photostimulation and toxic to airway epithelial cells
and to zebrafish
. Here, we sought to determine the clinical and physiological impact of pulmonary exposure to Magnéli phases using mice as mammalian model organisms. Mice were exposed to the most frequently found Magnéli phases, Ti
O
, at 100 parts per million (ppm) via intratracheal administration. Local and systemic titanium concentrations, lung pathology, and changes in airway mechanics were assessed. Additional mechanistic studies were conducted with primary bone marrow derived macrophages. Our results indicate that macrophages are the cell type most impacted by exposure to these nanoscale particles. Following phagocytosis, macrophages fail to properly eliminate Magnéli phases, resulting in increased oxidative stress, mitochondrial dysfunction, and ultimately apoptosis. In the lungs, these nanoparticles become concentrated in macrophages, resulting in a feedback loop of reactive oxygen species production, cell death, and the initiation of gene expression profiles consistent with lung injury within 6 weeks of exposure. Chronic exposure and accumulation of Magnéli phases ultimately results in significantly reduced lung function impacting airway resistance, compliance, and elastance. Together, these studies demonstrate that Magnéli phases are toxic in the mammalian airway and are likely a significant nanoscale environmental pollutant, especially in geographic regions where coal combustion is a major contributor to atmospheric particulate matter.
Neighbourhood environments are a known social determinant of health. Vacant and abandoned buildings and lots and poor or hazardous housing conditions, combined with crime and violence, can affect ...residents’ health and wellbeing. Nationwide Children’s Hospital and its partners launched the Healthy Homes initiative in 2008, which sought to improve nearby residents’ health and wellbeing by rejuvenating vacant and abandoned properties and increasing homeownership in the South Side neighbourhood of Columbus, Ohio. Between 2008 and mid-2019 the initiative funded 273 repairs or renovations in this neighbourhood. We conducted a ZIP-code-level comparative case study of the Healthy Homes housing interventions using synthetic control methodology to evaluate changes in crime rate in the intervention area compared with those in a synthetic control area. While findings were mixed, we found some evidence of reduced thefts in the Healthy Homes area, relative to its synthetic control. This initiative to repair, rebuild and increase ownership of housing has the potential to reduce crime rates for neighbours of the Nationwide Children’s Hospital.
IntroductionAntibiotics are time-critical in the management of sepsis. When infectious organisms are unknown, patients are treated with empiric antibiotics to include coverage for gram-negative ...organisms, such as antipseudomonal cephalosporins and penicillins. However, in observational studies, some antipseudomonal cephalosporins (eg, cefepime) are associated with neurologic dysfunction while the most common antipseudomonal penicillin (piperacillin–tazobactam) is associated with acute kidney injury (AKI). No randomised control trials have compared these regimens. This manuscript describes the protocol and analysis plan for a trial designed to compare the effects of antipseudomonal cephalosporins and antipseudomonal penicillins among acutely ill patients receiving empiric antibiotics.Methods and analysisThe Antibiotic Choice On ReNal outcomes trial is a prospective, single-centre, non-blinded randomised trial being conducted at Vanderbilt University Medical Center. The trial will enrol 2500 acutely ill adults receiving gram-negative coverage for treatment of infection. Eligible patients are randomised 1:1 to receive cefepime or piperacillin–tazobactam on first order entry of a broad-spectrum antibiotic covering gram-negative organisms. The primary outcome is the highest stage of AKI and death occurring between enrolment and 14 days after enrolment. This will be compared between patients randomised to cefepime and randomised to piperacillin–tazobactam using an unadjusted proportional odds regression model. The secondary outcomes are major adverse kidney events through day 14 and number of days alive and free of delirium and coma in 14 days after enrolment. Enrolment began on 10 November 2021 and is expected to be completed in December 2022.Ethics and disseminationThe trial was approved by the Vanderbilt University Medical Center institutional review board (IRB#210591) with a waiver of informed consent. Results will be submitted to a peer-reviewed journal and presented at scientific conferences.Trial registration numberNCT05094154.
It is unknown why some patients with psoriasis experience long-term effectiveness with their first biologic monotherapy. Our aim was to compare the baseline demographic, disease, genotypic, clinical ...and lifestyle characteristics of patients with psoriasis registered in the British Association of Dermatologists Biologics and Immunomodulators Register and the aligned Biomarkers and Stratification to Optimise outcomes in Psoriasis study who were designated as ‘super responders’ (SRs), defined as patients on their first biologic with more than 5 years continuous biologic monotherapy, or ‘super nonresponders’ (SNRs), defined as patients on their first biologic who had discontinued at least two biologics in their first year of treatment, to biologic therapy. Female sex, shorter study follow-up, higher Dermatology Life Quality Index, high frequency of adalimumab, less frequency of ustekinumab at registration, and higher number of comorbidities were associated with SNRs compared with SRs.
Recent progress in scientific research has facilitated accurate genetic and neuropathological diagnosis of congenital myopathies. However, given their relatively low incidence, congenital myopathies ...remain unfamiliar to the majority of care providers, and the levels of patient care are extremely variable. This consensus statement aims to provide care guidelines for congenital myopathies. The International Standard of Care Committee for Congenital Myopathies worked through frequent e-mail correspondences, periodic conference calls, 2 rounds of online surveys, and a 3-day workshop to achieve a consensus for diagnostic and clinical care recommendations. The committee includes 59 members from 10 medical disciplines. They are organized into 5 working groups: genetics/diagnosis, neurology, pulmonology, gastroenterology/nutrition/speech/oral care, and orthopedics/rehabilitation. In each care area the authors summarize the committee’s recommendations for symptom assessments and therapeutic interventions. It is the committee’s goal that through these recommendations, patients with congenital myopathies will receive optimal care and improve their disease outcome.
PDF
