Predicting drowsy driving in real-time situations: Using an advanced driving simulator, accelerated failure time model, and virtual location-based services.

PubMed

Wang, Junhua; Sun, Shuaiyi; Fang, Shouen; Fu, Ting; Stipancic, Joshua

2017-02-01

This paper aims to both identify the factors affecting driver drowsiness and to develop a real-time drowsy driving probability model based on virtual Location-Based Services (LBS) data obtained using a driving simulator. A driving simulation experiment was designed and conducted using 32 participant drivers. Collected data included the continuous driving time before detection of drowsiness and virtual LBS data related to temperature, time of day, lane width, average travel speed, driving time in heavy traffic, and driving time on different roadway types. Demographic information, such as nap habit, age, gender, and driving experience was also collected through questionnaires distributed to the participants. An Accelerated Failure Time (AFT) model was developed to estimate the driving time before detection of drowsiness. The results of the AFT model showed driving time before drowsiness was longer during the day than at night, and was longer at lower temperatures. Additionally, drivers who identified as having a nap habit were more vulnerable to drowsiness. Generally, higher average travel speeds were correlated to a higher risk of drowsy driving, as were longer periods of low-speed driving in traffic jam conditions. Considering different road types, drivers felt drowsy more quickly on freeways compared to other facilities. The proposed model provides a better understanding of how driver drowsiness is influenced by different environmental and demographic factors. The model can be used to provide real-time data for the LBS-based drowsy driving warning system, improving past methods based only on a fixed driving. Copyright © 2016 Elsevier Ltd. All rights reserved.

Research on Vehicle-Based Driver Status/Performance Monitoring, Part III

DOT National Transportation Integrated Search

1996-09-01

A driver drowsiness detection/alarm/countermeasures system was specified, tested and evaluated, resulting in the development of revised algorithms for the detection of driver drowsiness. Previous algorithms were examined in a test and evaluation stud...

Research On Vehicle-Based Driver Status/Performance Monitoring, Part I

DOT National Transportation Integrated Search

1996-09-01

A driver drowsiness detection/alarm/countermeasures system was specified, tested and evaluated, resulting in the development of revised algorithms for the detection of driver drowsiness. Previous algorithms were examined in a test and evaluation stud...

Drowsiness detection during different times of day using multiple features.

PubMed

Sahayadhas, Arun; Sundaraj, Kenneth; Murugappan, Murugappan

2013-06-01

Driver drowsiness has been one of the major causes of road accidents that lead to severe trauma, such as physical injury, death, and economic loss, which highlights the need to develop a system that can alert drivers of their drowsy state prior to accidents. Researchers have therefore attempted to develop systems that can determine driver drowsiness using the following four measures: (1) subjective ratings from drivers, (2) vehicle-based measures, (3) behavioral measures and (4) physiological measures. In this study, we analyzed the various factors that contribute towards drowsiness. A total of 15 male subjects were asked to drive for 2 h at three different times of the day (00:00-02:00, 03:00-05:00 and 15:00-17:00 h) when the circadian rhythm is low. The less intrusive physiological signal measurements, ECG and EMG, are analyzed during this driving task. Statistically significant differences in the features of ECG and sEMG signals were observed between the alert and drowsy states of the drivers during different times of day. In the future, these physiological measures can be fused with vision-based measures for the development of an efficient drowsiness detection system.

Automatic Detection of Driver Fatigue Using Driving Operation Information for Transportation Safety.

PubMed

Li, Zuojin; Chen, Liukui; Peng, Jun; Wu, Ying

2017-05-25

Fatigued driving is a major cause of road accidents. For this reason, the method in this paper is based on the steering wheel angles (SWA) and yaw angles (YA) information under real driving conditions to detect drivers' fatigue levels. It analyzes the operation features of SWA and YA under different fatigue statuses, then calculates the approximate entropy (ApEn) features of a short sliding window on time series. Using the nonlinear feature construction theory of dynamic time series, with the fatigue features as input, designs a "2-6-6-3" multi-level back propagation (BP) Neural Networks classifier to realize the fatigue detection. An approximately 15-h experiment is carried out on a real road, and the data retrieved are segmented and labeled with three fatigue levels after expert evaluation, namely "awake", "drowsy" and "very drowsy". The average accuracy of 88.02% in fatigue identification was achieved in the experiment, endorsing the value of the proposed method for engineering applications.

Vision-based method for detecting driver drowsiness and distraction in driver monitoring system

NASA Astrophysics Data System (ADS)

Jo, Jaeik; Lee, Sung Joo; Jung, Ho Gi; Park, Kang Ryoung; Kim, Jaihie

2011-12-01

Most driver-monitoring systems have attempted to detect either driver drowsiness or distraction, although both factors should be considered for accident prevention. Therefore, we propose a new driver-monitoring method considering both factors. We make the following contributions. First, if the driver is looking ahead, drowsiness detection is performed; otherwise, distraction detection is performed. Thus, the computational cost and eye-detection error can be reduced. Second, we propose a new eye-detection algorithm that combines adaptive boosting, adaptive template matching, and blob detection with eye validation, thereby reducing the eye-detection error and processing time significantly, which is hardly achievable using a single method. Third, to enhance eye-detection accuracy, eye validation is applied after initial eye detection, using a support vector machine based on appearance features obtained by principal component analysis (PCA) and linear discriminant analysis (LDA). Fourth, we propose a novel eye state-detection algorithm that combines appearance features obtained using PCA and LDA, with statistical features such as the sparseness and kurtosis of the histogram from the horizontal edge image of the eye. Experimental results showed that the detection accuracies of the eye region and eye states were 99 and 97%, respectively. Both driver drowsiness and distraction were detected with a success rate of 98%.

Challenges in detecting drowsiness based on driver’s behavior

NASA Astrophysics Data System (ADS)

Triyanti, V.; Iridiastadi, H.

2017-12-01

Drowsiness while driving has been a critical issue within the context of transportation safety. A number of approaches have been developed to reduce the risks of drowsy drivers. The mechanisms in detecting fatigue and sleepiness while driving has been categorized into three broad approaches, including vehicle-based, physiological-based, and behavior-based approaches. This paper will discuss recent studies in recognizing drowsy drivers based on their behaviors, particularly changes in eyes and facial characteristics. This paper will also address challenges in capturing aspects of natural expressions, driver responses, behavior, and task environment associated with sleepiness. Additionally, a number of technical aspects should be seriously considered, including correctly capturing face and eye characteristics from unwanted movements, unsuitable task environments, technological limitations, and individual differences.

Evaluation of reaction time performance and subjective drowsiness during whole-body vibration exposure

NASA Astrophysics Data System (ADS)

Azizan, A.; Zali, Z.; Padil, H.

2018-05-01

Despite the automotive industry’s interest in how vibration affects the level of human comfort, there is little focus on the effect of vibration on drowsiness level. Thus, this study involves eighteen healthy male participants to study the effect of exposure to vibration on the drowsiness level. Prior to the experiment, the total transmitted vibration measured at interfaces between the seat pan and seat back to the human body for each participant was modified to become 0.2 ms-2 r.m.s and 0.4 ms-2 r.m.s. During the experiment, the participants were seated and exposed to 20-minutes of Gaussian random vibration with frequency band 1-15 Hz at two level of amplitude (low vibration amplitude and medium vibration amplitude) on separate days. The level of drowsiness was measured using a PVT test prior and after exposure to the vibration while participants rated their subjective drowsiness by using the Karolinska Sleepiness Scale (KSS). The significant increase in the number of lapse and reaction time because of the exposure to vibration in both conditions provide strong evidence of drowsiness. In this regard, the medium vibration amplitude shows a more prominent effect. All participants have shown a steady increase of drowsiness level in KSS. Meanwhile, there are no significant differences found between low vibration amplitude and medium vibration amplitude in the KSS. These findings suggest that human alertness level is greatly affected by the exposure to vibration and these effects are more pronounced at higher vibration amplitude. Both findings indicate that the presence of vibration promotes drowsiness, especially at higher vibration amplitude.

Driver drowsiness detection using ANN image processing

NASA Astrophysics Data System (ADS)

Vesselenyi, T.; Moca, S.; Rus, A.; Mitran, T.; Tătaru, B.

2017-10-01

The paper presents a study regarding the possibility to develop a drowsiness detection system for car drivers based on three types of methods: EEG and EOG signal processing and driver image analysis. In previous works the authors have described the researches on the first two methods. In this paper the authors have studied the possibility to detect the drowsy or alert state of the driver based on the images taken during driving and by analyzing the state of the driver’s eyes: opened, half-opened and closed. For this purpose two kinds of artificial neural networks were employed: a 1 hidden layer network and an autoencoder network.

Research On Vehicle-Based Driver Status/Performance Monitoring; Development, Validation, And Refinement Of Algorithms For Detection Of Driver Drowsiness, Final Report

DOT National Transportation Integrated Search

1994-12-01

THIS REPORT SUMMARIZES THE RESULTS OF A 3-YEAR RESEARCH PROJECT TO DEVELOP RELIABLE ALGORITHMS FOR THE DETECTION OF MOTOR VEHICLE DRIVER IMPAIRMENT DUE TO DROWSINESS. THESE ALGORITHMS ARE BASED ON DRIVING PERFORMANCE MEASURES THAT CAN POTENTIALLY BE ...

Design of DroDeASys (Drowsy Detection and Alarming System)

NASA Astrophysics Data System (ADS)

Juvale, Hrishikesh B.; Mahajan, Anant S.; Bhagwat, Ashwin A.; Badiger, Vishal T.; Bhutkar, Ganesh D.; Dhabe, Priyadarshan S.; Dhore, Manikrao L.

The paper discusses the Drowsy Detection & Alarming System that has been developed, using a non-intrusive approach. The system is basically developed to detect drivers dozing at the wheel at night time driving. The system uses a small infra-red night vision camera that points directly towards the driver`s face and monitors the driver`s eyes in order to detect fatigue. In such a case when fatigue is detected, a warning signal is issued to alert the driver. This paper discusses the algorithms that have been used to detect drowsiness. The decision whether the driver is dozing or not is taken depending on whether the eyes are open for a specific number of frames. If the eyes are found to be closed for a certain number of consecutive frames then the driver is alerted with an alarm.

Drowsiness/alertness algorithm development and validation using synchronized EEG and cognitive performance to individualize a generalized model

PubMed Central

Johnson, Robin R.; Popovic, Djordje P.; Olmstead, Richard E.; Stikic, Maja; Levendowski, Daniel J.; Berka, Chris

2011-01-01

A great deal of research over the last century has focused on drowsiness/alertness detection, as fatigue-related physical and cognitive impairments pose a serious risk to public health and safety. Available drowsiness/alertness detection solutions are unsatisfactory for a number of reasons: 1) lack of generalizability, 2) failure to address individual variability in generalized models, and/or 3) they lack a portable, un-tethered application. The current study aimed to address these issues, and determine if an individualized electroencephalography (EEG) based algorithm could be defined to track performance decrements associated with sleep loss, as this is the first step in developing a field deployable drowsiness/alertness detection system. The results indicated that an EEG-based algorithm, individualized using a series of brief "identification" tasks, was able to effectively track performance decrements associated with sleep deprivation. Future development will address the need for the algorithm to predict performance decrements due to sleep loss, and provide field applicability. PMID:21419826

Drowsiness/alertness algorithm development and validation using synchronized EEG and cognitive performance to individualize a generalized model.

PubMed

Johnson, Robin R; Popovic, Djordje P; Olmstead, Richard E; Stikic, Maja; Levendowski, Daniel J; Berka, Chris

2011-05-01

A great deal of research over the last century has focused on drowsiness/alertness detection, as fatigue-related physical and cognitive impairments pose a serious risk to public health and safety. Available drowsiness/alertness detection solutions are unsatisfactory for a number of reasons: (1) lack of generalizability, (2) failure to address individual variability in generalized models, and/or (3) lack of a portable, un-tethered application. The current study aimed to address these issues, and determine if an individualized electroencephalography (EEG) based algorithm could be defined to track performance decrements associated with sleep loss, as this is the first step in developing a field deployable drowsiness/alertness detection system. The results indicated that an EEG-based algorithm, individualized using a series of brief "identification" tasks, was able to effectively track performance decrements associated with sleep deprivation. Future development will address the need for the algorithm to predict performance decrements due to sleep loss, and provide field applicability. Copyright © 2011 Elsevier B.V. All rights reserved.

Eye blink detection for different driver states in conditionally automated driving and manual driving using EOG and a driver camera.

PubMed

Schmidt, Jürgen; Laarousi, Rihab; Stolzmann, Wolfgang; Karrer-Gauß, Katja

2018-06-01

In this article, we examine the performance of different eye blink detection algorithms under various constraints. The goal of the present study was to evaluate the performance of an electrooculogram- and camera-based blink detection process in both manually and conditionally automated driving phases. A further comparison between alert and drowsy drivers was performed in order to evaluate the impact of drowsiness on the performance of blink detection algorithms in both driving modes. Data snippets from 14 monotonous manually driven sessions (mean 2 h 46 min) and 16 monotonous conditionally automated driven sessions (mean 2 h 45 min) were used. In addition to comparing two data-sampling frequencies for the electrooculogram measures (50 vs. 25 Hz) and four different signal-processing algorithms for the camera videos, we compared the blink detection performance of 24 reference groups. The analysis of the videos was based on very detailed definitions of eyelid closure events. The correct detection rates for the alert and manual driving phases (maximum 94%) decreased significantly in the drowsy (minus 2% or more) and conditionally automated (minus 9% or more) phases. Blinking behavior is therefore significantly impacted by drowsiness as well as by automated driving, resulting in less accurate blink detection.

Online Detection of Driver Fatigue Using Steering Wheel Angles for Real Driving Conditions

PubMed Central

Li, Zuojin; Li, Shengbo Eben; Li, Renjie; Cheng, Bo; Shi, Jinliang

2017-01-01

This paper presents a drowsiness on-line detection system for monitoring driver fatigue level under real driving conditions, based on the data of steering wheel angles (SWA) collected from sensors mounted on the steering lever. The proposed system firstly extracts approximate entropy (ApEn) features from fixed sliding windows on real-time steering wheel angles time series. After that, this system linearizes the ApEn features series through an adaptive piecewise linear fitting using a given deviation. Then, the detection system calculates the warping distance between the linear features series of the sample data. Finally, this system uses the warping distance to determine the drowsiness state of the driver according to a designed binary decision classifier. The experimental data were collected from 14.68 h driving under real road conditions, including two fatigue levels: “wake” and “drowsy”. The results show that the proposed system is capable of working online with an average 78.01% accuracy, 29.35% false detections of the “awake” state, and 15.15% false detections of the “drowsy” state. The results also confirm that the proposed method based on SWA signal is valuable for applications in preventing traffic accidents caused by driver fatigue. PMID:28257094

Vehicle-based drowsy driver detection : current status and future prospects

DOT National Transportation Integrated Search

1994-01-01

Driver drowsiness is a major, though elusive, cause of traffic crashes. As part of its : IVHS/human factors program, NHTSA is supporting research to develop in-vehicle systems . : to continuously monitor driver alertness and performance. Scientific s...

Vital Sign Monitoring and Mobile Phone Usage Detection Using IR-UWB Radar for Intended Use in Car Crash Prevention.

PubMed

Leem, Seong Kyu; Khan, Faheem; Cho, Sung Ho

2017-05-30

In order to avoid car crashes, active safety systems are becoming more and more important. Many crashes are caused due to driver drowsiness or mobile phone usage. Detecting the drowsiness of the driver is very important for the safety of a car. Monitoring of vital signs such as respiration rate and heart rate is important to determine the occurrence of driver drowsiness. In this paper, robust vital signs monitoring through impulse radio ultra-wideband (IR-UWB) radar is discussed. We propose a new algorithm that can estimate the vital signs even if there is motion caused by the driving activities. We analyzed the whole fast time vital detection region and found the signals at those fast time locations that have useful information related to the vital signals. We segmented those signals into sub-signals and then constructed the desired vital signal using the correlation method. In this way, the vital signs of the driver can be monitored noninvasively, which can be used by researchers to detect the drowsiness of the driver which is related to the vital signs i.e., respiration and heart rate. In addition, texting on a mobile phone during driving may cause visual, manual or cognitive distraction of the driver. In order to reduce accidents caused by a distracted driver, we proposed an algorithm that can detect perfectly a driver's mobile phone usage even if there are various motions of the driver in the car or changes in background objects. These novel techniques, which monitor vital signs associated with drowsiness and detect phone usage before a driver makes a mistake, may be very helpful in developing techniques for preventing a car crash.

Vital Sign Monitoring and Mobile Phone Usage Detection Using IR-UWB Radar for Intended Use in Car Crash Prevention

PubMed Central

Leem, Seong Kyu; Khan, Faheem; Cho, Sung Ho

2017-01-01

In order to avoid car crashes, active safety systems are becoming more and more important. Many crashes are caused due to driver drowsiness or mobile phone usage. Detecting the drowsiness of the driver is very important for the safety of a car. Monitoring of vital signs such as respiration rate and heart rate is important to determine the occurrence of driver drowsiness. In this paper, robust vital signs monitoring through impulse radio ultra-wideband (IR-UWB) radar is discussed. We propose a new algorithm that can estimate the vital signs even if there is motion caused by the driving activities. We analyzed the whole fast time vital detection region and found the signals at those fast time locations that have useful information related to the vital signals. We segmented those signals into sub-signals and then constructed the desired vital signal using the correlation method. In this way, the vital signs of the driver can be monitored noninvasively, which can be used by researchers to detect the drowsiness of the driver which is related to the vital signs i.e., respiration and heart rate. In addition, texting on a mobile phone during driving may cause visual, manual or cognitive distraction of the driver. In order to reduce accidents caused by a distracted driver, we proposed an algorithm that can detect perfectly a driver's mobile phone usage even if there are various motions of the driver in the car or changes in background objects. These novel techniques, which monitor vital signs associated with drowsiness and detect phone usage before a driver makes a mistake, may be very helpful in developing techniques for preventing a car crash. PMID:28556818

Real-time monitoring of drowsiness through wireless nanosensor systems

NASA Astrophysics Data System (ADS)

Ramasamy, Mouli; Varadan, Vijay K.

2016-04-01

Detection of sleepiness and drowsiness in human beings has been a daunting task for both engineering and medical technologies. Accuracy, precision and promptness of detection have always been an issue that has to be dealt by technologists. Generally, the bio potential signals - ECG, EOG, EEG and EMG are used to classify and discriminate sleep from being awake. However, the potential drawbacks may be high false detections, low precision, obtrusiveness, aftermath analysis, etc. To overcome the disadvantages, this paper reviews the design aspects of a wireless and a real time monitoring system to track sleep and detect fatigue. This concept involves the use of EOG and EEG to measure the blink rate and asses the person's condition. In this user friendly and intuitive approach, EOG and EEG signals are obtained by the textile based nanosensors mounted on the inner side of a flexible headband. The acquired signals are then electrically transmitted to the data processing and transmission unit, which transmits the processed data to the receiver/monitoring module through ZigBee communication. This system is equipped with a software program to process, feature extract, analyze, display and store the information. Thereby, immediate detection of a person falling asleep is made feasible and, tracking the sleep cycle continuously provides an insight about the fatigue level. This approach of using a wireless, real time, dry sensor on a flexible substrate mitigates obtrusiveness that is expected from a wearable system. We have previously presented the results of the aforementioned wearable systems. This paper aims to extend our work conceptually through a review of engineering and medical techniques involved in wearable systems to detect drowsiness.

Drowsy driver mobile application: Development of a novel scleral-area detection method.

PubMed

Mohammad, Faisal; Mahadas, Kausalendra; Hung, George K

2017-10-01

A reliable and practical app for mobile devices was developed to detect driver drowsiness. It consisted of two main components: a Haar cascade classifier, provided by a computer vision framework called OpenCV, for face/eye detection; and a dedicated JAVA software code for image processing that was applied over a masked region circumscribing the eye. A binary threshold was performed over the masked region to provide a quantitative measure of the number of white pixels in the sclera, which represented the state of eye opening. A continuously low white-pixel count would indicate drowsiness, thereby triggering an alarm to alert the driver. This system was successfully implemented on: (1) a static face image, (2) two subjects under laboratory conditions, and (3) a subject in a vehicle environment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving Night Time Driving Safety Using Vision-Based Classification Techniques.

PubMed

Chien, Jong-Chih; Chen, Yong-Sheng; Lee, Jiann-Der

2017-09-24

The risks involved in nighttime driving include drowsy drivers and dangerous vehicles. Prominent among the more dangerous vehicles around at night are the larger vehicles which are usually moving faster at night on a highway. In addition, the risk level of driving around larger vehicles rises significantly when the driver's attention becomes distracted, even for a short period of time. For the purpose of alerting the driver and elevating his or her safety, in this paper we propose two components for any modern vision-based Advanced Drivers Assistance System (ADAS). These two components work separately for the single purpose of alerting the driver in dangerous situations. The purpose of the first component is to ascertain that the driver would be in a sufficiently wakeful state to receive and process warnings; this is the driver drowsiness detection component. The driver drowsiness detection component uses infrared images of the driver to analyze his eyes' movements using a MSR plus a simple heuristic. This component issues alerts to the driver when the driver's eyes show distraction and are closed for a longer than usual duration. Experimental results show that this component can detect closed eyes with an accuracy of 94.26% on average, which is comparable to previous results using more sophisticated methods. The purpose of the second component is to alert the driver when the driver's vehicle is moving around larger vehicles at dusk or night time. The large vehicle detection component accepts images from a regular video driving recorder as input. A bi-level system of classifiers, which included a novel MSR-enhanced KAZE-base Bag-of-Features classifier, is proposed to avoid false negatives. In both components, we propose an improved version of the Multi-Scale Retinex (MSR) algorithm to augment the contrast of the input. Several experiments were performed to test the effects of the MSR and each classifier, and the results are presented in experimental results section of this paper.

Improving Night Time Driving Safety Using Vision-Based Classification Techniques

PubMed Central

Chien, Jong-Chih; Chen, Yong-Sheng; Lee, Jiann-Der

2017-01-01

The risks involved in nighttime driving include drowsy drivers and dangerous vehicles. Prominent among the more dangerous vehicles around at night are the larger vehicles which are usually moving faster at night on a highway. In addition, the risk level of driving around larger vehicles rises significantly when the driver’s attention becomes distracted, even for a short period of time. For the purpose of alerting the driver and elevating his or her safety, in this paper we propose two components for any modern vision-based Advanced Drivers Assistance System (ADAS). These two components work separately for the single purpose of alerting the driver in dangerous situations. The purpose of the first component is to ascertain that the driver would be in a sufficiently wakeful state to receive and process warnings; this is the driver drowsiness detection component. The driver drowsiness detection component uses infrared images of the driver to analyze his eyes’ movements using a MSR plus a simple heuristic. This component issues alerts to the driver when the driver’s eyes show distraction and are closed for a longer than usual duration. Experimental results show that this component can detect closed eyes with an accuracy of 94.26% on average, which is comparable to previous results using more sophisticated methods. The purpose of the second component is to alert the driver when the driver’s vehicle is moving around larger vehicles at dusk or night time. The large vehicle detection component accepts images from a regular video driving recorder as input. A bi-level system of classifiers, which included a novel MSR-enhanced KAZE-base Bag-of-Features classifier, is proposed to avoid false negatives. In both components, we propose an improved version of the Multi-Scale Retinex (MSR) algorithm to augment the contrast of the input. Several experiments were performed to test the effects of the MSR and each classifier, and the results are presented in experimental results section of this paper. PMID:28946643

The influence of vibration on seated human drowsiness

PubMed Central

AZIZAN, Amzar; FARD, Mohammad; AZARI, Michael F.; BENEDIKTSDÓTTIR, Bryndís; ARNARDÓTTIR, Erna Sif; JAZAR, Reza; MAEDA, Setsuo

2016-01-01

Although much is known about human body vibration discomfort, there is little research data on the effects of vibration on vehicle occupant drowsiness. A laboratory experimental setup has been developed. Vibration was applied to the volunteers sitting on the vehicle seat mounted on the vibration platform. Seated volunteers were exposed to a Gaussian random vibration, with 1–15 Hz frequency bandwidth at 0.2 ms−2 r.m.s., for 20-minutes. Two drowsiness measurement methods were used, Psychomotor Vigilance Test (PVT) and Karolinska Sleepiness Scale (KSS). Significant changes in PVT (p<0.05) and KSS (p<0.05) were detected in all eighteen volunteers. Furthermore, a moderate correlation (r>0.4) was observed between objective measurement (PVT) and subjective measurement (KSS). The results suggest that exposure to vibration even for 20-minutes can cause significant drowsiness impairing psychomotor performance. This finding has important implications for road safety. PMID:26829971

Investigating Driver Fatigue versus Alertness Using the Granger Causality Network.

PubMed

Kong, Wanzeng; Lin, Weicheng; Babiloni, Fabio; Hu, Sanqing; Borghini, Gianluca

2015-08-05

Driving fatigue has been identified as one of the main factors affecting drivers' safety. The aim of this study was to analyze drivers' different mental states, such as alertness and drowsiness, and find out a neurometric indicator able to detect drivers' fatigue level in terms of brain networks. Twelve young, healthy subjects were recruited to take part in a driver fatigue experiment under different simulated driving conditions. The Electroencephalogram (EEG) signals of the subjects were recorded during the whole experiment and analyzed by using Granger-Causality-based brain effective networks. It was that the topology of the brain networks and the brain's ability to integrate information changed when subjects shifted from the alert to the drowsy stage. In particular, there was a significant difference in terms of strength of Granger causality (GC) in the frequency domain and the properties of the brain effective network i.e., causal flow, global efficiency and characteristic path length between such conditions. Also, some changes were more significant over the frontal brain lobes for the alpha frequency band. These findings might be used to detect drivers' fatigue levels, and as reference work for future studies.

Investigating Driver Fatigue versus Alertness Using the Granger Causality Network

PubMed Central

Kong, Wanzeng; Lin, Weicheng; Babiloni, Fabio; Hu, Sanqing; Borghini, Gianluca

2015-01-01

Driving fatigue has been identified as one of the main factors affecting drivers’ safety. The aim of this study was to analyze drivers’ different mental states, such as alertness and drowsiness, and find out a neurometric indicator able to detect drivers’ fatigue level in terms of brain networks. Twelve young, healthy subjects were recruited to take part in a driver fatigue experiment under different simulated driving conditions. The Electroencephalogram (EEG) signals of the subjects were recorded during the whole experiment and analyzed by using Granger-Causality-based brain effective networks. It was that the topology of the brain networks and the brain’s ability to integrate information changed when subjects shifted from the alert to the drowsy stage. In particular, there was a significant difference in terms of strength of Granger causality (GC) in the frequency domain and the properties of the brain effective network i.e., causal flow, global efficiency and characteristic path length between such conditions. Also, some changes were more significant over the frontal brain lobes for the alpha frequency band. These findings might be used to detect drivers’ fatigue levels, and as reference work for future studies. PMID:26251909

Identification of common features of vehicle motion under drowsy/distracted driving: A case study in Wuhan, China.

PubMed

Chen, Zhijun; Wu, Chaozhong; Zhong, Ming; Lyu, Nengchao; Huang, Zhen

2015-08-01

Drowsy/distracted driving has become one of the leading causes of traffic crash. Only certain particular drowsy/distracted driving behaviors have been studied by previous studies, which are mainly based on dedicated sensor devices such as bio and visual sensors. The objective of this study is to extract the common features for identifying drowsy/distracted driving through a set of common vehicle motion parameters. An intelligent vehicle was used to collect vehicle motion parameters. Fifty licensed drivers (37 males and 13 females, M=32.5 years, SD=6.2) were recruited to carry out road experiments in Wuhan, China and collecting vehicle motion data under four driving scenarios including talking, watching roadside, drinking and under the influence of drowsiness. For the first scenario, the drivers were exposed to a set of questions and asked to repeat a few sentences that had been proved valid in inducing driving distraction. Watching roadside, drinking and driving under drowsiness were assessed by an observer and self-reporting from the drivers. The common features of vehicle motions under four types of drowsy/distracted driving were analyzed using descriptive statistics and then Wilcoxon rank sum test. The results indicated that there was a significant difference of lateral acceleration rates and yaw rate acceleration between "normal driving" and drowsy/distracted driving. Study results also shown that, under drowsy/distracted driving, the lateral acceleration rates and yaw rate acceleration were significantly larger from the normal driving. The lateral acceleration rates were shown to suddenly increase or decrease by more than 2.0m/s(3) and the yaw rate acceleration by more than 2.5°/s(2). The standard deviation of acceleration rate (SDA) and standard deviation of yaw rate acceleration (SDY) were identified to as the common features of vehicle motion for distinguishing the drowsy/distracted driving from the normal driving. In order to identify a time window for effectively extracting the two common features, a double-window method was used and the optimized "Parent Window" and "Child Window" were found to be 55s and 6s, respectively. The study results can be used to develop a driving assistant system, which can warn drivers when any one of the four types of drowsy/distracted driving is detected. Copyright © 2015. Published by Elsevier Ltd.

Modeling EEG fractal dimension changes in wake and drowsy states in humans--a preliminary study.

PubMed

Bojić, Tijana; Vuckovic, Aleksandra; Kalauzi, Aleksandar

2010-01-21

Aim of this preliminary study was to examine and compare topographic distribution of Higuchi's fractal dimension (FD, measure of signal complexity) of EEG signals between states of relaxed wakefulness and drowsiness, as well as their FD differences. The experiments were performed on 10 healthy individuals using a fourteen-channel montage. An explanation is offered on the causes of the detected FD changes. FD values of 60s records belonging to wake (Hori's stage 1) and drowsy (Hori's stages 2-4) states were calculated for each channel and each subject. In 136 out of 140 epochs an increase in FD was obtained. Relationship between signal FD and its relative alpha amplitude was mathematically modeled and we quantitatively demonstrated that the increase in FD was predominantly due to a reduction in alpha activity. The model was generalized to include other EEG oscillations. By averaging FD values for each channel across 10 subjects, four clusters (O2O1; T6P4T5P3; C3F3F4C4F8F7; T4T3) for the wake and two clusters (O2O1P3T6P4T5; C3C4F4F3F8T4T3F7) for the drowsy state were statistically verified. Topographic distribution of FD values in wakefulness showed a lateral symmetry and a partial fronto-occipital gradient. In drowsiness, a reduction in the number of clusters was detected, due to regrouping of channels T3, T4, O1 and O2. Topographic distribution of absolute FD differences revealed largest values at F7, O1 and F3. Reorganization of channel clusters showed that regionalized brain activity, specific for wakefulness, became more global by entering into drowsiness. Since the global increase in FD during wake-to-drowsy transition correlated with the decrease of alpha power, we inferred that increase of EEG complexity may not necessarily be an index of brain activation.

Improving Driver Alertness through Music Selection Using a Mobile EEG to Detect Brainwaves

PubMed Central

Liu, Ning-Han; Chiang, Cheng-Yu; Hsu, Hsiang-Ming

2013-01-01

Driving safety has become a global topic of discussion with the recent development of the Smart Car concept. Many of the current car safety monitoring systems are based on image discrimination techniques, such as sensing the vehicle drifting from the main road, or changes in the driver's facial expressions. However, these techniques are either too simplistic or have a low success rate as image processing is easily affected by external factors, such as weather and illumination. We developed a drowsiness detection mechanism based on an electroencephalogram (EEG) reading collected from the driver with an off-the-shelf mobile sensor. This sensor employs wireless transmission technology and is suitable for wear by the driver of a vehicle. The following classification techniques were incorporated: Artificial Neural Networks, Support Vector Machine, and k Nearest Neighbor. These classifiers were integrated with integration functions after a genetic algorithm was first used to adjust the weighting for each classifier in the integration function. In addition, since past studies have shown effects of music on a person's state-of-mind, we propose a personalized music recommendation mechanism as a part of our system. Through the in-car stereo system, this music recommendation mechanism can help prevent a driver from becoming drowsy due to monotonous road conditions. Experimental results demonstrate the effectiveness of our proposed drowsiness detection method to determine a driver's state of mind, and the music recommendation system is therefore able to reduce drowsiness. PMID:23803789

Fatigued and drowsy driving: a survey of attitudes, opinions and behaviors.

PubMed

Vanlaar, Ward; Simpson, Herb; Mayhew, Dan; Robertson, Robyn

2008-01-01

There is evidence suggesting that the problem of fatigued or drowsy driving is an important contributor to road crashes. However, not much is known about public perceptions of the issue. The purpose of this study was to obtain information on attitudes, opinions, and professed practices related to fatigued or drowsy driving. The data were gathered by means of a public opinion poll among a representative sample of 750 Ontario drivers. A majority of drivers (58.6%) admitted that they occasionally drive while fatigued or drowsy. Of greater importance, 14.5% of respondents admitted that they had fallen asleep or "nodded off" while driving during the past year. Nearly 2% were involved in a fatigue or drowsy driving related crash in the past year. Respondents were also asked about measures they take to overcome fatigue or drowsiness. Results indicate that relatively ineffective measures such as opening the window or playing music are the most popular; the most effective preventive measure--taking a rest--is the least popular. The prevalence of the behavior, coupled with the ineffective prevention measures favored by the public suggest there is a need for increasing their level of awareness and knowledge about the problem. Results from this study further emphasize the importance of increasing the fatigued and drowsy driving knowledge base and the need to educate the public about it.

Motivational factors associated with drowsy driving behavior: a qualitative investigation of college students.

PubMed

Beck, Kenneth H; Lee, Clark J; Weiner, Talia

2018-02-01

This qualitative investigation sought to identify the motivational factors that contribute to drowsy driving in college students and to discover important messaging strategies that may help prevent or reduce this behavior in this population. Four focus groups of college students. A large university in the Washington, DC, metropolitan area during the Fall 2016 term. Twenty-six undergraduate students between the ages of 18 and 25 years. Notes and transcripts from the focus group sessions were analyzed to identify recurring themes regarding attitudes, motivations, experiences, influences, and potential preventive messaging strategies related to drowsy driving. Although most participants had heard of drowsy driving and were concerned about it, they did not associate it with legal risks and were more concerned about alcohol-impaired and distracted driving as crash risks. Participants viewed drowsy driving as a normal and unavoidable part of their lives over which they had little control. For potential anti-drowsy driving messaging strategies, participants preferred messages delivered via audiovisual or social media that featured graphic and emotional portrayals of crashes and their consequences. Participants also voiced strong support for preventive messaging strategies equating various degrees of sleep deprivation to known impairing levels of alcohol, as well as messages providing cues to action to actual drowsy drivers on roadways. Increased enforcement, education, and public messaging campaigns are needed to increase knowledge and influence attitudes and opinions among young drivers about the dangers and social unacceptability of drowsy driving. Copyright © 2018 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Real-time driver drowsiness feedback improves driver alertness and self-reported driving performance.

PubMed

Aidman, Eugene; Chadunow, Carolyn; Johnson, Kayla; Reece, John

2015-08-01

Driver drowsiness has been implicated as a major causal factor in road accidents. Tools that allow remote monitoring and management of driver fatigue are used in the mining and road transport industries. Increasing drivers' own awareness of their drowsiness levels using such tools may also reduce risk of accidents. The study examined the effects of real-time blink-velocity-derived drowsiness feedback on driver performance and levels of alertness in a military setting. A sample of 15 Army Reserve personnel (1 female) aged 21-59 (M=41.3, SD=11.1) volunteered to being monitored by an infra-red oculography-based Optalert Alertness Monitoring System (OAMS) while they performed their regular driving tasks, including on-duty tasks and commuting to and from duty, for a continuous period of 4-8 weeks. For approximately half that period, blink-velocity-derived Johns Drowsiness Scale (JDS) scores were fed back to the driver in a counterbalanced repeated-measures design, resulting in a total of 419 driving periods under "feedback" and 385 periods under "no-feedback" condition. Overall, the provision of real-time feedback resulted in reduced drowsiness (lower JDS scores) and improved alertness and driving performance ratings. The effect was small and varied across the 24-h circadian cycle but it remained robust after controlling for time of day and driving task duration. Both the number of JDS peaks counted for each trip and their duration declined in the presence of drowsiness feedback, indicating a dynamic pattern that is consistent with a genuine, entropy-reducing feedback mechanism (as distinct from random re-alerting) behind the observed effect. Its mechanisms and practical utility have yet to be fully explored. Direct examination of the alternative, random re-alerting explanation of this feedback effect is an important step for future research. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Screening for delirium with the Intensive Care Delirium Screening Checklist (ICDSC): Symptom profile and utility of individual items in the identification of delirium dependent on the level of sedation.

PubMed

Boettger, Soenke; Meyer, Rafael; Richter, André; Fernandez, Susana Franco; Rudiger, Alain; Schubert, Maria; Jenewein, Josef; Nuñez, David Garcia

2018-05-24

The importance of the proper identification of delirium, with its high incidence and adversities in the intensive care setting, has been widely recognized. One common screening instrument is the Intensive Care Delirium Screening Checklist (ICDSC); however, the symptom profile and key features of delirium dependent on the level of sedation have not yet been evaluated. In this prospective cohort study, the ICDSC was evaluated versus the Diagnostic and Statistical Manual, 4th edition, text revision, diagnosis of delirium set as standard with respect to the symptom profile, and correct identification of delirium. The aim of this study was to identify key features of delirium in the intensive care setting dependent on the Richmond Agitation and Sedation Scale levels of sedation: drowsiness versus alert and calmness.ResultThe 88 delirious patients of 225 were older, had more severe disease, and prolonged hospitalization. Irrespective of the level of sedation, delirium was correctly classified by items related to inattention, disorientation, psychomotor alterations, inappropriate speech or mood, and symptom fluctuation. In the drowsy patients, inattention reached substantial sensitivity and specificity, whereas psychomotor alterations and sleep-wake cycle disturbances were sensitive lacked specificity. The positive prediction was substantial across items, whereas the negative prediction was only moderate. In the alert and calm patient, the sensitivities were substantial for psychomotor alterations, sleep-wake cycle disturbances, and symptom fluctuations; however, these fluctuations were not specific. The positive prediction was moderate and the negative prediction substantial. Between the nondelirious drowsy and alert, the symptom profile was similar; however, drowsiness was associated with alterations in consciousness.Significance of resultsIn the clinical routine, irrespective of the level of sedation, delirium was characterized by the ICDSC items for inattention, disorientation, psychomotor alterations, inappropriate speech or mood and symptom fluctuation. Further, drowsiness caused altered levels of consciousness.

Effects of vibration on occupant driving performance under simulated driving conditions.

PubMed

Azizan, Amzar; Fard, M; Azari, Michael F; Jazar, Reza

2017-04-01

Although much research has been devoted to the characterization of the effects of whole-body vibration on seated occupants' comfort, drowsiness induced by vibration has received less attention to date. There are also little validated measurement methods available to quantify whole body vibration-induced drowsiness. Here, the effects of vibration on drowsiness were investigated. Twenty male volunteers were recruited for this experiment. Drowsiness was measured in a driving simulator, before and after 30-min exposure to vibration. Gaussian random vibration, with 1-15 Hz frequency bandwidth was used for excitation. During the driving session, volunteers were required to obey the speed limit of 100 kph and maintain a steady position on the left-hand lane. A deviation in lane position, steering angle variability, and speed deviation were recorded and analysed. Alternatively, volunteers rated their subjective drowsiness by Karolinska Sleepiness Scale (KSS) scores every 5-min. Following 30-min of exposure to vibration, a significant increase of lane deviation, steering angle variability, and KSS scores were observed in all volunteers suggesting the adverse effects of vibration on human alertness level. Copyright © 2016 Elsevier Ltd. All rights reserved.

Awareness during drowsiness: dynamics and electrophysiological correlates

NASA Technical Reports Server (NTRS)

Makeig, S.; Jung, T. P.; Sejnowski, T. J.

2000-01-01

During drowsy periods, performance on tasks requiring continuous attention becomes intermittent. Previously, we have reported that during drowsy periods of intermittent performance, 7 of 10 participants performing an auditory detection task exhibited episodes of non-responding lasting about 18 s (Makeig & Jung, 1996). Further, the time patterns of these episodes were repeated precisely in subsequent sessions. The 18-s cycles were accompanied by counterbalanced power changes within two frequency bands in the vertex EEG (near 4 Hz and circa 40 Hz). In the present experiment, performance patterns and concurrent EEG spectra were examined in four participants performing a continuous visuomotor compensatory tracking task in 15-20 minute bouts during a 42-hour sleep deprivation study. During periods of good performance, participants made compensatory trackball movements about twice per second, attempting to keep a target disk near a central ring. Autocorrelations of time series representing the distance of the target disk from the ring centre showed that during periods of poor performance marked near-18-s cycles in performance again appeared. There were phases of poor or absent performance accompanied by an increase in EEG power that was largest at 3-4 Hz. These studies show that in drowsy humans, opening and closing of the gates of behavioural awareness is marked not by the appearance of (12-14 Hz) sleep spindles, but by prominent EEG amplitude changes in the low theta band. Further, both EEG and behavioural changes during drowsiness often exhibit stereotyped 18-s cycles.

Fusion of Optimized Indicators from Advanced Driver Assistance Systems (ADAS) for Driver Drowsiness Detection

PubMed Central

Daza, Iván G.; Bergasa, Luis M.; Bronte, Sebastián; Yebes, J. Javier; Almazán, Javier; Arroyo, Roberto

2014-01-01

This paper presents a non-intrusive approach for monitoring driver drowsiness using the fusion of several optimized indicators based on driver physical and driving performance measures, obtained from ADAS (Advanced Driver Assistant Systems) in simulated conditions. The paper is focused on real-time drowsiness detection technology rather than on long-term sleep/awake regulation prediction technology. We have developed our own vision system in order to obtain robust and optimized driver indicators able to be used in simulators and future real environments. These indicators are principally based on driver physical and driving performance skills. The fusion of several indicators, proposed in the literature, is evaluated using a neural network and a stochastic optimization method to obtain the best combination. We propose a new method for ground-truth generation based on a supervised Karolinska Sleepiness Scale (KSS). An extensive evaluation of indicators, derived from trials over a third generation simulator with several test subjects during different driving sessions, was performed. The main conclusions about the performance of single indicators and the best combinations of them are included, as well as the future works derived from this study. PMID:24412904

Not in My Navy. A Legal Guide to Drug Abuse.

DTIC Science & Technology

1984-06-01

opiates produces drowsiness, sleep, and a reduction in physical activity. Side effects can include nausea and vomiting, constipation, itching, flushing...diarrhea, pallor, and dilation of the pupils. Such effects are generally seen only with high doses or as occasional side effects with therapeutic doses...that will produce low-level side effects . or, a person might be drowsy from ingesting a nonprescription product - such as an antihistamine. A clue to

A Fuzzy Model to Interpret Data of Drive Performances from Patients with Sleep Deprivation

PubMed Central

Sena, Pasquale; Attianese, Paolo; Carbone, Francesca; Pellegrino, Arcangelo; Pinto, Aldo; Villecco, Francesco

2012-01-01

The search for safe vehicles is increasing with both diffusion of high traffic density over the world and availability of new technologies providing sophisticated tools previously impossible to realize. Design and development of the necessary devices may be based on simulation tests that reduce cost allowing trials in many directions. A proper choice of the arrangement of the drive simulators, as much as of the parameters to be monitored, is of basic importance as they can address the design of devices somehow responsible for the drivers safety or, even their lives. This system setup, consisting of a free car simulator equipped with a monitoring system, collects in a nonintrusive way data of the car lateral position within the road lane and of its first derivative. Based on these measured parameters, the system is able to detect symptoms of drowsiness and sleepiness. The analysis is realized by a fuzzy inferential process that provides an immediate warning signal as soon as drowsiness is detected with a high level of certainty. Enhancement of reliability and minimisation of the false alarm rate are obtained by operating continuous comparison between learned driver typical modalities of operation on the control command of the vehicle the pattern recorded. PMID:22969834

Monitoring alert and drowsy states by modeling EEG source nonstationarity

NASA Astrophysics Data System (ADS)

Hsu, Sheng-Hsiou; Jung, Tzyy-Ping

2017-10-01

Objective. As a human brain performs various cognitive functions within ever-changing environments, states of the brain characterized by recorded brain activities such as electroencephalogram (EEG) are inevitably nonstationary. The challenges of analyzing the nonstationary EEG signals include finding neurocognitive sources that underlie different brain states and using EEG data to quantitatively assess the state changes. Approach. This study hypothesizes that brain activities under different states, e.g. levels of alertness, can be modeled as distinct compositions of statistically independent sources using independent component analysis (ICA). This study presents a framework to quantitatively assess the EEG source nonstationarity and estimate levels of alertness. The framework was tested against EEG data collected from 10 subjects performing a sustained-attention task in a driving simulator. Main results. Empirical results illustrate that EEG signals under alert versus drowsy states, indexed by reaction speeds to driving challenges, can be characterized by distinct ICA models. By quantifying the goodness-of-fit of each ICA model to the EEG data using the model deviation index (MDI), we found that MDIs were significantly correlated with the reaction speeds (r  =  -0.390 with alertness models and r  =  0.449 with drowsiness models) and the opposite correlations indicated that the two models accounted for sources in the alert and drowsy states, respectively. Based on the observed source nonstationarity, this study also proposes an online framework using a subject-specific ICA model trained with an initial (alert) state to track the level of alertness. For classification of alert against drowsy states, the proposed online framework achieved an averaged area-under-curve of 0.745 and compared favorably with a classic power-based approach. Significance. This ICA-based framework provides a new way to study changes of brain states and can be applied to monitoring cognitive or mental states of human operators in attention-critical settings or in passive brain-computer interfaces.

Confronting Drowsy Driving: The American Academy of Sleep Medicine Perspective.

PubMed

Watson, Nathaniel F; Morgenthaler, Timothy; Chervin, Ronald; Carden, Kelly; Kirsch, Douglas; Kristo, David; Malhotra, Raman; Martin, Jennifer; Ramar, Kannan; Rosen, Ilene; Weaver, Terri; Wise, Merrill

2015-11-15

Drowsy driving is a serious public health concern which is often difficult for individual drivers to identify. While it is important for drivers to understand the causes of drowsy driving, there is still insufficient scientific knowledge and public education to prevent drowsy driving. As a result, the AASM is calling upon institutions and policy makers to increase public awareness and improve education on the issue, so our society can better recognize and prevent drowsy driving. The AASM has adopted a position statement to educate both healthcare providers and the general public about drowsy driving risks and countermeasures. © 2015 American Academy of Sleep Medicine.

The relationship between nurse work schedules, sleep duration, and drowsy driving.

PubMed

Scott, Linda D; Hwang, Wei-Ting; Rogers, Ann E; Nysse, Tami; Dean, Grace E; Dinges, David F

2007-12-01

Recent studies have shown that extended shifts worked by hospital staff nurses are associated with significantly higher risk of errors, yet little information is available about the ability to remain alert during the nurses' commutes following the completion of an extended work shift. The purpose of this study is to describe the prevalence of drowsy driving episodes and the relationship between drowsy driving and nurse work hours, alertness on duty, working at night, and sleep duration. Data were collected from 2 national random samples of registered nurses (n=895). Full-time hospital staff nurses (n=895) completed logbooks on a daily basis for 4 weeks providing information concerning work hours, sleep duration, drowsy and sleep episodes at work, and drowsy driving occurrences. Almost 600 of the nurses (596/895) reported at least 1 episode of drowsy driving, and 30 nurses reported experiencing drowsy driving following every shift worked. Shorter sleep durations, working at night, and difficulties remaining awake at work significantly increased the likelihood of drowsy driving episodes. Given the large numbers of nurses who reported struggling to stay awake when driving home from work and the frequency with which nurses reported drowsy driving, greater attention should be paid to increasing nurse awareness of the risks and to implementing strategies to prevent drowsy driving episodes to ensure public safety. Without mitigation, fatigued nurses will continue to put the public and themselves at risk.

Confronting Drowsy Driving: The American Academy of Sleep Medicine Perspective

PubMed Central

Watson, Nathaniel F.; Morgenthaler, Timothy; Chervin, Ronald; Carden, Kelly; Kirsch, Douglas; Kristo, David; Malhotra, Raman; Martin, Jennifer; Ramar, Kannan; Rosen, Ilene; Weaver, Terri; Wise, Merrill

2015-01-01

Drowsy driving is a serious public health concern which is often difficult for individual drivers to identify. While it is important for drivers to understand the causes of drowsy driving, there is still insufficient scientific knowledge and public education to prevent drowsy driving. As a result, the AASM is calling upon institutions and policy makers to increase public awareness and improve education on the issue, so our society can better recognize and prevent drowsy driving. The AASM has adopted a position statement to educate both healthcare providers and the general public about drowsy driving risks and countermeasures. Citation: Watson NF, Morgenthaler T, Chervin R, Carden K, Kirsch D, Kristo D, Malhotra R, Martin J, Ramar K, Rosen I, Weaver T, Wise M. Confronting drowsy driving: the american academy of sleep medicine perspective. J Clin Sleep Med 2015;11(11):1335–1336. PMID:26414989

Intentions and willingness to drive while drowsy among university students: An application of an extended theory of planned behavior model.

PubMed

Lee, Clark J; Geiger-Brown, Jeanne; Beck, Kenneth H

2016-08-01

A web-based questionnaire was used to assess the utility of constructs from the Theory of Planned Behavior (TPB) and the Prototype Willingness Model (PWM) to predict intentions and willingness to engage in drowsy driving in a sample of 450 university students. Those students who reported more favorable attitudes and subjective norm and greater perceived control and willingness in relation to drowsy driving behavior were more likely to report stronger intentions to engage in drowsy driving behavior. Augmenting the TPB constructs with the PWM construct of willingness significantly explained up to an additional 8 percent of the variance in drowsy driving intention. Perceived behavioral control and willingness were consistently the strongest predictors of drowsy driving intention in the augmented model, which together with the control (personal) variables explained up to 70 percent of the variance in intention. Thus, the Theory of Planned Behavior and the Prototype Willingness Model may be useful for understanding motivational influences on drowsy driving behavior in young people and present promising theoretical frameworks for designing more effective interventions against drowsy driving in this population. Copyright © 2016 Elsevier Ltd. All rights reserved.

Driver drowsiness detection using multimodal sensor fusion

NASA Astrophysics Data System (ADS)

Andreeva, Elena O.; Aarabi, Parham; Philiastides, Marios G.; Mohajer, Keyvan; Emami, Majid

2004-04-01

This paper proposes a multi-modal sensor fusion algorithm for the estimation of driver drowsiness. Driver sleepiness is believed to be responsible for more than 30% of passenger car accidents and for 4% of all accident fatalities. In commercial vehicles, drowsiness is blamed for 58% of single truck accidents and 31% of commercial truck driver fatalities. This work proposes an innovative automatic sleep-onset detection system. Using multiple sensors, the driver"s body is studied as a mechanical structure of springs and dampeners. The sleep-detection system consists of highly sensitive triple-axial accelerometers to monitor the driver"s upper body in 3-D. The subject is modeled as a linear time-variant (LTV) system. An LMS adaptive filter estimation algorithm generates the transfer function (i.e. weight coefficients) for this LTV system. Separate coefficients are generated for the awake and asleep states of the subject. These coefficients are then used to train a neural network. Once trained, the neural network classifies the condition of the driver as either awake or asleep. The system has been tested on a total of 8 subjects. The tests were conducted on sleep-deprived individuals for the sleep state and on fully awake individuals for the awake state. When trained and tested on the same subject, the system detected sleep and awake states of the driver with a success rate of 95%. When the system was trained on three subjects and then retested on a fourth "unseen" subject, the classification rate dropped to 90%. Furthermore, it was attempted to correlate driver posture and sleepiness by observing how car vibrations propagate through a person"s body. Eight additional subjects were studied for this purpose. The results obtained in this experiment proved inconclusive which was attributed to significant differences in the individual habitual postures.

Short and long sleep duration and risk of drowsy driving and the role of subjective sleep insufficiency.

PubMed

Maia, Querino; Grandner, Michael A; Findley, James; Gurubhagavatula, Indira

2013-10-01

Experimental sleep restriction increases sleepiness and impairs driving performance. However, it is unclear whether short sleep duration in the general population is associated with drowsy driving. The goal of the present study was to evaluate whether individuals in the general population who obtained sleep of 6h or less are more likely to report drowsy driving, and evaluate the role of perceived sleep sufficiency. Data exploring whether subgroups of short sleepers (those who report the most or least unmet sleep need) show different risk profiles for drowsy driving are limited. From the 2009 Behavioral Risk Factor Surveillance System (N=31,522), we obtained the following self-reported data: (1) sleep duration (≤5, 6, 7, 8, 9, or ≥10 h/night); (2) number of days/week of perceived insufficient sleep; (3) among drivers, yes/no response to: "During the past 30 days, have you ever nodded off or fallen asleep, even just for a brief moment, while driving?" (4) demographics, physical/mental health. Using 7 h/night as reference, logistic regression analyses evaluated whether self-reported sleep duration was associated with drowsy driving. Overall, 3.6% reported drowsy driving. Self-identified short-sleepers reported drowsy driving more often, and long sleepers, less often. Among those who perceived sleep as always insufficient, drowsy driving was reported more often when sleep duration was ≤5 h, 6 h, or ≥10 h. Among those who perceived sleep as always sufficient, drowsy driving was reported more often among ≤5 h and 6h sleepers. Overall, drowsy driving was common, particularly in self-identified short-sleepers as a whole, as well as subgroups based on sleep insufficiency. Copyright © 2013 Elsevier Ltd. All rights reserved.

Assessment of a drowsy driver warning system for heavy-vehicle drivers : final report

DOT National Transportation Integrated Search

2009-04-01

Drowsiness has a globally negative impact on performance, slowing reaction time, decreasing situational awareness, and impairing judgment. A field operational test of an early prototype Drowsy Driver Warning System was conducted as a result of 12 yea...

An assessment of driver drowsiness, distraction, and performance in a naturalistic setting

DOT National Transportation Integrated Search

2011-02-01

This report documents the results of a study to characterize episodes of driver drowsiness and to assess the impact of drowsiness on driving performance. This data mining effort performed additional analyses on the data collected in an earlier FMCSA ...

EEG quantification of alertness: methods for early identification of individuals most susceptible to sleep deprivation

NASA Astrophysics Data System (ADS)

Berka, Chris; Levendowski, Daniel J.; Westbrook, Philip; Davis, Gene; Lumicao, Michelle N.; Olmstead, Richard E.; Popovic, Miodrag; Zivkovic, Vladimir T.; Ramsey, Caitlin K.

2005-05-01

Electroencephalographic (EEG) and neurocognitive measures were simultaneously acquired to quantify alertness from 24 participants during 44-hours of sleep deprivation. Performance on a three-choice vigilance task (3C-VT), paired-associate learning/memory task (PAL) and modified Maintenance of Wakefulness Test (MWT), and sleep technician-observed drowsiness (eye-closures, head-nods, EEG slowing) were quantified. The B-Alert system automatically classifies each second of EEG on an alertness/drowsiness continuum. B-Alert classifications were significantly correlated with technician-observations, visually scored EEG and performance measures. B-Alert classifications during 3C-VT, and technician observations and performance during the 3C-VT and PAL evidenced progressively increasing drowsiness as a result of sleep deprivation with a stabilizing effect observed at the batteries occurring between 0600 and 1100 suggesting a possible circadian effect similar to those reported in previous sleep deprivation studies. Participants were given an opportunity to take a 40-minute nap approximately 24-hours into the sleep deprivation portion of the study (i.e., 7 PM on Saturday). The nap was followed by a transient period of increased alertness. Approximately 8 hours after the nap, behavioral and physiological measures of drowsiness returned to levels prior to the nap. Cluster analysis was used to stratify individuals into three groups based on their level of impairment as a result of sleep deprivation. The combination of B-Alert and neuro-behavioral measures may identify individuals whose performance is most susceptible to sleep deprivation. These objective measures could be applied in an operational setting to provide a "biobehavioral assay" to determine vulnerability to sleep deprivation.

Impact of Modafinil Add-on with Atypical Anti-psychotics on Excessive Daytime Drowsiness

PubMed Central

Prasuna, P Lakshmi; Sudhakar, TP

2015-01-01

Background: Atypical antipsychotic drugs are known to cause many side effects which include daytime drowsiness. So many add on drugs are tried to reduce the same. Materials and Methods: 72 patients who were on atypical antipsychotic drugs were randomly assigned to either Modafinil or placebo and were followed for a period of 12 weeks. Daytime drowsiness, was taken at baseline, week 3, and at week 12 by using VAS, EDD scales. Results: The results were analyzed and showed that the Modafinil add on therapy significantly reduced the daytime Drowsiness. Conclusions: Modafinil could be a potential candidate in selected group of patients to decrease some of the unwanted adverse events like daytime drowsiness produced by atypical antipsychotics. PMID:26702168

Driver Performance in the Moments Surrounding a Microsleep

PubMed Central

Boyle, Linda Ng; Tippin, Jon; Paul, Amit; Rizzo, Matthew

2009-01-01

This study examined if individuals who are at increased risk for drowsy-driving because of obstructive sleep apnea syndrome (OSAS), have impairments in driving performance in the moments during microsleep episodes as opposed to during periods of wakefulness. Twenty-four licensed drivers diagnosed with OSAS based on standard clinical and polysomnographic criteria, participated in an hour-long drive in a high-fidelity driving simulator with synchronous electroencephalographic (EEG) recordings for identification of microsleeps. The drivers showed significant deterioration in vehicle control during the microsleep episodes compared to driving performance in the absence of microsleeps on equivalent segments of roadway. The degree of performance decrement correlated with microsleep duration, particularly on curved roads. Results indicate that driving performance deteriorates during microsleep episodes. Detecting microsleeps in real-time and identifying how these episodes of transition between wakefulness and sleep impair driver performance is relevant to the design and implementation of countermeasures such as drowsy driver detection and alerting systems that use EEG technology. PMID:20090864

Optical flow and driver's kinematics analysis for state of alert sensing.

PubMed

Jiménez-Pinto, Javier; Torres-Torriti, Miguel

2013-03-28

Road accident statistics from different countries show that a significant number of accidents occur due to driver's fatigue and lack of awareness to traffic conditions. In particular, about 60% of the accidents in which long haul truck and bus drivers are involved are attributed to drowsiness and fatigue. It is thus fundamental to improve non-invasive systems for sensing a driver's state of alert. One of the main challenges to correctly resolve the state of alert is measuring the percentage of eyelid closure over time (PERCLOS), despite the driver's head and body movements. In this paper, we propose a technique that involves optical flow and driver's kinematics analysis to improve the robustness of the driver's alert state measurement under pose changes using a single camera with near-infrared illumination. The proposed approach infers and keeps track of the driver's pose in 3D space in order to ensure that eyes can be located correctly, even after periods of partial occlusion, for example, when the driver stares away from the camera. Our experiments show the effectiveness of the approach with a correct eyes detection rate of 99.41%, on average. The results obtained with the proposed approach in an experiment involving fifteen persons under different levels of sleep deprivation also confirm the discriminability of the fatigue levels. In addition to the measurement of fatigue and drowsiness, the pose tracking capability of the proposed approach has potential applications in distraction assessment and alerting of machine operators.

Optical Flow and Driver's Kinematics Analysis for State of Alert Sensing

PubMed Central

Jiménez-Pinto, Javier; Torres-Torriti, Miguel

2013-01-01

Road accident statistics from different countries show that a significant number of accidents occur due to driver's fatigue and lack of awareness to traffic conditions. In particular, about 60% of the accidents in which long haul truck and bus drivers are involved are attributed to drowsiness and fatigue. It is thus fundamental to improve non-invasive systems for sensing a driver's state of alert. One of the main challenges to correctly resolve the state of alert is measuring the percentage of eyelid closure over time (PERCLOS), despite the driver's head and body movements. In this paper, we propose a technique that involves optical flow and driver's kinematics analysis to improve the robustness of the driver's alert state measurement under pose changes using a single camera with near-infrared illumination. The proposed approach infers and keeps track of the driver's pose in 3D space in order to ensure that eyes can be located correctly, even after periods of partial occlusion, for example, when the driver stares away from the camera. Our experiments show the effectiveness of the approach with a correct eyes detection rate of 99.41%, on average. The results obtained with the proposed approach in an experiment involving fifteen persons under different levels of sleep deprivation also confirm the discriminability of the fatigue levels. In addition to the measurement of fatigue and drowsiness, the pose tracking capability of the proposed approach has potential applications in distraction assessment and alerting of machine operators. PMID:23539029

Measuring neurophysiological signals in aircraft pilots and car drivers for the assessment of mental workload, fatigue and drowsiness.

PubMed

Borghini, Gianluca; Astolfi, Laura; Vecchiato, Giovanni; Mattia, Donatella; Babiloni, Fabio

2014-07-01

This paper reviews published papers related to neurophysiological measurements (electroencephalography: EEG, electrooculography EOG; heart rate: HR) in pilots/drivers during their driving tasks. The aim is to summarise the main neurophysiological findings related to the measurements of pilot/driver's brain activity during drive performance and how particular aspects of this brain activity could be connected with the important concepts of "mental workload", "mental fatigue" or "situational awareness". Review of the literature suggests that exists a coherent sequence of changes for EEG, EOG and HR variables during the transition from normal drive, high mental workload and eventually mental fatigue and drowsiness. In particular, increased EEG power in theta band and a decrease in alpha band occurred in high mental workload. Successively, increased EEG power in theta as well as delta and alpha bands characterise the transition between mental workload and mental fatigue. Drowsiness is also characterised by increased blink rate and decreased HR values. The detection of such mental states is actually performed "offline" with accuracy around 90% but not online. A discussion on the possible future applications of findings provided by these neurophysiological measurements in order to improve the safety of the vehicles will be also presented. Copyright © 2012 Elsevier Ltd. All rights reserved.

Fusing Multiple Sensor Modalities for Complex Physiological State Monitoring

DTIC Science & Technology

2012-12-01

sleep-alpha variants (drowsiness alpha activity and REM -alpha bursts) over frontal, central, parietal and occipital regions. Note the higher spectral...contribution of the slowest components (7.8–8.6 Hz) during REM alpha bursts as compared with drowsiness-alpha activity (13...occipital regions of the brain during the drowsiness state as compared to REM sleep and other states, as seen in figure 1 (13). Furthermore, using EEG

Anesthesia Practice and Clinical Trends in Interventional Radiology: A European Survey

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haslam, Philip J.; Yap, Bernard; Mueller, Peter R.

Purpose: To determine current European practice in interventional radiology regarding nursing care, anesthesia, and clinical care trends.Methods: A survey was sent to 977 European interventional radiologists to assess the use of sedoanalgesia, nursing care, monitoring equipment, pre- and postprocedural care, and clinical trends in interventional radiology. Patterns of sedoanalgesia were recorded for both vascular and visceral interventional procedures. Responders rated their preferred level of sedoanalgesia for each procedure as follows: (a) awake/alert, (b) drowsy/arousable, (c) asleep/arousable, (d) deep sedation, and (e) general anesthesia. Sedoanalgesic drugs and patient care trends were also recorded. A comparison was performed with data derived frommore » a similar survey of interventional practice in the United States.Results: Two hundred and forty-three of 977 radiologists responded (25%). The total number of procedures analyzed was 210,194. The majority (56%) of diagnostic and therapeutic vascular procedures were performed at the awake/alert level of sedation, 32% were performed at the drowsy/arousable level, and 12% at deeper levels of sedation. The majority of visceral interventional procedures were performed at the drowsy/arousable level of sedation (41%), 29% were performed at deeper levels of sedation, and 30% at the awake/alert level. In general, more sedoanalgesia is used in the United States. Eighty-three percent of respondents reported the use of a full-time radiology nurse, 67% used routine blood pressure/pulse oximetry monitoring, and 46% reported the presence of a dedicated recovery area. Forty-nine percent reported daily patient rounds, 30% had inpatient hospital beds, and 51% had day case beds.Conclusion: This survey shows clear differences in the use of sedation for vascular and visceral interventional procedures. Many, often complex, procedures are performed at the awake/alert level of sedation in Europe, whereas deeper levels of sedation are used in the United States. Trends toward making interventional radiology a clinical specialty are evident, with 51% of respondents having day case beds, and 30% having inpatient beds.« less

Drowsiness

MedlinePlus

... of your drowsiness. Alternative Names Sleepiness - during the day; Hypersomnia; Somnolence References Chokroverty S, Avidan AY. Sleep and its disorders. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in ...

The Impact of Delirium | NIH MedlinePlus the Magazine

MedlinePlus

... delusions Variable levels of consciousness or awareness Disrupted sleep patterns, drowsiness Confusion (disorientation) about time or place Declines in short-term memory and recall Disorganized thinking, talking in a way that doesn't make sense ...

Sopite syndrome - A sometimes sole manifestation of motion sickness. [drowsiness in rotating environment

NASA Technical Reports Server (NTRS)

Graybiel, A.; Knepton, J.

1976-01-01

Sopite syndrome is understood to mean a symptom complex centering around 'drowsiness' produced by motion sickness. The typical symptoms of the syndrome are: yawning; drowsiness; disinclination to work either physically or mentally; and lack of participation in group activities. The present study is based on data obtained in rotating rooms, at sea, in the air, and in orbital flight. When the sopite syndrom occurs either before other typical symptoms of motion sickness appear or after their disappearance, they are distinguished, respectively, by the terms 'early sopite syndrome' and 'late sopite syndrome'. Further distinction is made between brief and prolonged exposures. Evidence is presented indicating that drowsiness and mental depression caused by prolonged motion sickness are only part of the symptom complex that is termed sopite syndrome.

Helmet-based physiological signal monitoring system.

PubMed

Kim, Youn Sung; Baek, Hyun Jae; Kim, Jung Soo; Lee, Haet Bit; Choi, Jong Min; Park, Kwang Suk

2009-02-01

A helmet-based system that was able to monitor the drowsiness of a soldier was developed. The helmet system monitored the electrocardiogram, electrooculogram and electroencephalogram (alpha waves) without constraints. Six dry electrodes were mounted at five locations on the helmet: both temporal sides, forehead region and upper and lower jaw strips. The electrodes were connected to an amplifier that transferred signals to a laptop computer via Bluetooth wireless communication. The system was validated by comparing the signal quality with conventional recording methods. Data were acquired from three healthy male volunteers for 12 min twice a day whilst they were sitting in a chair wearing the sensor-installed helmet. Experimental results showed that physiological signals for the helmet user were measured with acceptable quality without any intrusions on physical activities. The helmet system discriminated between the alert and drowsiness states by detecting blinking and heart rate variability (HRV) parameters extracted from ECG. Blinking duration and eye reopening time were increased during the sleepiness state compared to the alert state. Also, positive peak values of the sleepiness state were much higher, and the negative peaks were much lower than that of the alert state. The LF/HF ratio also decreased during drowsiness. This study shows the feasibility for using this helmet system: the subjects' health status and mental states could be monitored without constraints whilst they were working.

Truck driver fatigue assessment using a virtual reality system.

DOT National Transportation Integrated Search

2016-10-17

In this study, a fully immersive Virtual Reality (VR) based driving simulator was developed to serve : as a proof-of-concept that VR can be utilized to assess the level of fatigue (or drowsiness) truck : drivers typically experience during real...

Crashes & Fatalities Related To Driver Drowsiness/Fatigue

DOT National Transportation Integrated Search

1994-11-01

THIS REPORT SUMMARIZES RECENT NATIONAL STATISTICS ON THE INCIDENCE AND CHARACTERISTICS OF CRASHES INVOLVING DRIVER FATIGUE, DROWSINESS, OR "ASLEEP-AT-THE-WHEEL." FOR THE PURPOSES OF THIS REPORT, THESE TERMS ARE : CONSIDERED SYNONYMOUS. PRINCIPAL DATA...

Drowsy driving and automobile crashes

DOT National Transportation Integrated Search

1998-04-01

Drowsy driving is a serious problem that leads to : thousands of automobile crashes each year. This : report, sponsored by the National Center on : Sleep Disorders Research (NCSDR) of the National : Heart, Lung, and Blood Institute of the : National ...

Distraction and drowsiness in motorcoach drivers : research brief.

DOT National Transportation Integrated Search

2016-11-01

Motorcoach crasheswhen they occurcan involve multiple injuries and deaths, beyond what is typically experienced in light vehicle crashes. Driver error is often cited as a factor in these crashes, with distraction and drowsiness being primary co...

Design of a Fatigue Detection System for High-Speed Trains Based on Driver Vigilance Using a Wireless Wearable EEG.

PubMed

Zhang, Xiaoliang; Li, Jiali; Liu, Yugang; Zhang, Zutao; Wang, Zhuojun; Luo, Dianyuan; Zhou, Xiang; Zhu, Miankuan; Salman, Waleed; Hu, Guangdi; Wang, Chunbai

2017-03-01

The vigilance of the driver is important for railway safety, despite not being included in the safety management system (SMS) for high-speed train safety. In this paper, a novel fatigue detection system for high-speed train safety based on monitoring train driver vigilance using a wireless wearable electroencephalograph (EEG) is presented. This system is designed to detect whether the driver is drowsiness. The proposed system consists of three main parts: (1) a wireless wearable EEG collection; (2) train driver vigilance detection; and (3) early warning device for train driver. In the first part, an 8-channel wireless wearable brain-computer interface (BCI) device acquires the locomotive driver's brain EEG signal comfortably under high-speed train-driving conditions. The recorded data are transmitted to a personal computer (PC) via Bluetooth. In the second step, a support vector machine (SVM) classification algorithm is implemented to determine the vigilance level using the Fast Fourier transform (FFT) to extract the EEG power spectrum density (PSD). In addition, an early warning device begins to work if fatigue is detected. The simulation and test results demonstrate the feasibility of the proposed fatigue detection system for high-speed train safety.

Drowsy driving and automobile crashes : report and recommendations.

DOT National Transportation Integrated Search

2013-08-01

Drowsy driving is a serious problem that leads to thousands of automobile crashes each year. This report, sponsored by the National Center on Sleep Disorders Research (NCSDR) of the National Heart, Lung, and Blood Institute of the National Institutes...

Asleep at the Wheel-The Road to Addressing Drowsy Driving

DOT National Transportation Integrated Search

2017-01-25

Drowsy driving is a dangerous behavior that leads to thousands of deaths and injuries each year. It is also a controllable factor for drivers. Drivers are capable of modifying this behavior if given sufficient information and motivation. Our goal is ...

National survey of distracted and drowsy driving attitudes and behavior : 2002. Volume 3, Methods

DOT National Transportation Integrated Search

2003-03-01

This report represents the findings on distracted driving (including cell phone use) and drowsy driving. The data come from a pair of studies undertaken by National Highway Traffic Safety Administration (NHTSA) to better understand drivers behavio...

National survey of distracted and drowsy driving attitudes and behaviors : 2002. Volume 1, Findings

DOT National Transportation Integrated Search

2003-04-01

This report represents the findings on distracted driving (including cell phone use) and drowsy driving. The data come from a pair of studies undertaken by the National Highway Traffic Safety Administration (NHTSA) to better understand drivers' behav...

Drowsy Driving

MedlinePlus

... Ford ES, Croft JB. Drowsy driving and risk behaviors—10 states and Puerto Rico, 2011-2012. MMWR Morb Mortal Wkly Rep . 2014; 63:557-562. Available at http://www.cdc.gov/mmwr/pdf/wk/mm6326.pdf . Jackson ML, Croft RJ, Kennedy GA, Owens K, Howard ME. Cognitive components of simulated ...

Design of a Fatigue Detection System for High-Speed Trains Based on Driver Vigilance Using a Wireless Wearable EEG

PubMed Central

Zhang, Xiaoliang; Li, Jiali; Liu, Yugang; Zhang, Zutao; Wang, Zhuojun; Luo, Dianyuan; Zhou, Xiang; Zhu, Miankuan; Salman, Waleed; Hu, Guangdi; Wang, Chunbai

2017-01-01

The vigilance of the driver is important for railway safety, despite not being included in the safety management system (SMS) for high-speed train safety. In this paper, a novel fatigue detection system for high-speed train safety based on monitoring train driver vigilance using a wireless wearable electroencephalograph (EEG) is presented. This system is designed to detect whether the driver is drowsiness. The proposed system consists of three main parts: (1) a wireless wearable EEG collection; (2) train driver vigilance detection; and (3) early warning device for train driver. In the first part, an 8-channel wireless wearable brain-computer interface (BCI) device acquires the locomotive driver’s brain EEG signal comfortably under high-speed train-driving conditions. The recorded data are transmitted to a personal computer (PC) via Bluetooth. In the second step, a support vector machine (SVM) classification algorithm is implemented to determine the vigilance level using the Fast Fourier transform (FFT) to extract the EEG power spectrum density (PSD). In addition, an early warning device begins to work if fatigue is detected. The simulation and test results demonstrate the feasibility of the proposed fatigue detection system for high-speed train safety. PMID:28257073

78 FR 17123 - Amitraz; Pesticide Tolerances

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-20

... inhalation routes of exposure. Further, it is not a skin or eye irritant, nor is it a skin sensitizer..., neurotoxic effects such as dry mouth, drowsiness, decreased temperature, and bradycardia were seen within 90... mg/ subjects. LOAEL = 0.25 mg/kg/day FQPA SF = UFDB = 10x kg/day. based on dry mouth, drowsiness...

Survey and comparison of sleep quality among fixed and changing shift staff in a steel factory in Tehran, Iran.

PubMed

Mohammadian, Farugh; Abbasinia, Marzieh; Rahmani, Abdolrasoul; Monazzam, Mohammad Reza; Asghari, Mehdi; Ahmadnezhad, Iman; Asadi, Ali

2013-01-01

Given the hazardous nature of the work in steel factories and that the staff has to deal with hazardous equipment and machines, improper sleep quality and drowsiness among the works tackles performance and boosts rate of job accidents. This study is aimed to survey the quality of sleep and sleepiness status and the pertinent factors among the workers in a rolling mill and a steel production company in Tehran, Iran. In a Cross-Sectional study 2011, 180 workers were selected randomly from a rolling mill and a steel production company in Tehran. A questionnaire was designed to collect demographic data and variables of work condition. Pitersborg's sleep quality questionnaire was used to survey quality and problems of Participants' sleep. Epworth Sleepiness questionnaire was used to deals with sleepiness during work, studying, watching TV, or during time spent in public. Average score of sleep quality for the fixed shift staff and changing shift staff were 7.5±2.82 and 8.49±2.95 respectively. Surveys of sleep quality for the two groups of the participants based on T-test showed a significant difference between the two groups so that the changing shift staff group suffered poorer sleep quality (p=0.03). Comparison of average drowsiness scores between the two groups of participants based on Mann-Whitney test showed no significant difference (p>0.005). Chi square test showed a significant difference between severity of drowsiness and type of working shift (p =0.028 and 0.009). Staff in revolving shifts suffers poor sleep quality comparing with staff with fixed working shift. Moreover, type of working shift greatly affects severity of drowsiness as staff at different work shift experienced different level of sleepiness. It is essential to survey sleep disorder of the staff in the industry and pay more emphasis on sleep disorder epidemic in other fields of industry.

Tracking wakefulness as it fades: Micro-measures of alertness.

PubMed

Jagannathan, Sridhar R; Ezquerro-Nassar, Alejandro; Jachs, Barbara; Pustovaya, Olga V; Bareham, Corinne A; Bekinschtein, Tristan A

2018-08-01

A major problem in psychology and physiology experiments is drowsiness: around a third of participants show decreased wakefulness despite being instructed to stay alert. In some non-visual experiments participants keep their eyes closed throughout the task, thus promoting the occurrence of such periods of varying alertness. These wakefulness changes contribute to systematic noise in data and measures of interest. To account for this omnipresent problem in data acquisition we defined criteria and code to allow researchers to detect and control for varying alertness in electroencephalography (EEG) experiments under eyes-closed settings. We first revise a visual-scoring method developed for detection and characterization of the sleep-onset process, and adapt the same for detection of alertness levels. Furthermore, we show the major issues preventing the practical use of this method, and overcome these issues by developing an automated method (micro-measures algorithm) based on frequency and sleep graphoelements, which are capable of detecting micro variations in alertness. The validity of the micro-measures algorithm was verified by training and testing using a dataset where participants are known to fall asleep. In addition, we tested generalisability by independent validation on another dataset. The methods developed constitute a unique tool to assess micro variations in levels of alertness and control trial-by-trial retrospectively or prospectively in every experiment performed with EEG in cognitive neuroscience under eyes-closed settings. Copyright © 2018. Published by Elsevier Inc.

Objective assessment of drowsiness and reaction time during intermittent Ramadan fasting in young men: a case-crossover study

PubMed Central

2013-01-01

Background Ramadan fasting and its attendant lifestyle changes induce changes in the circadian rhythm and in associated physiological and metabolic functions. Previous studies that have assessed psychomotor performance during Ramadan fasting have reported conflicting results. Therefore, we designed this study to objectively assess the effects of intermittent fasting during and outside Ramadan (to control for lifestyle changes) on drowsiness, blink total duration and mean reaction time (MRT) test while controlling for potential confounders. Methods Eight healthy volunteers with a mean age of 25.3 ± 2.9 years and a mean body mass index (BMI) of 23.4 ± 3.2 kg/m2 reported to the sleep laboratory on four occasions for polysomnography (PSG) and drowsiness and psychomotor assessments as follows: 1) adaptation; 2) 4 weeks before Ramadan while performing the Islamic fasting for 1 week (baseline fasting) (BLF); 3) 1 week before Ramadan (non-fasting baseline) (BL); and 4) during the second week of Ramadan while fasting (Ramadan). OPTALERT™ was used to objectively assess daytime drowsiness using the Johns Drowsiness Scale (JDS), and blink total duration and a visual reaction time test were used to assess MRT. Results Rapid eye movement (REM) sleep percentage was significantly lower at BLF (17.7 ± 8.1%) and at Ramadan (18.6 ± 10.7%) compared with BL (25.6 ± 4.8%) (p < 0.05). There were no significant differences between JDS scores and blink total duration during the two test periods in BL, BLF and Ramadan. There were no significant changes in MRT during BL, BLF and Ramadan. Conclusions Under controlled conditions of fixed light/dark exposure, caloric intake, sleep/wake schedule and sleep quality, the Islamic intermittent fasting has no impact on drowsiness and vigilance as measured by the JDS, total blink duration and MRT. PMID:23937904

Objective assessment of drowsiness and reaction time during intermittent Ramadan fasting in young men: a case-crossover study.

PubMed

Bahammam, Ahmed S; Nashwan, Samar; Hammad, Omeima; Sharif, Munir M; Pandi-Perumal, Seithikurippu R

2013-08-12

Ramadan fasting and its attendant lifestyle changes induce changes in the circadian rhythm and in associated physiological and metabolic functions. Previous studies that have assessed psychomotor performance during Ramadan fasting have reported conflicting results. Therefore, we designed this study to objectively assess the effects of intermittent fasting during and outside Ramadan (to control for lifestyle changes) on drowsiness, blink total duration and mean reaction time (MRT) test while controlling for potential confounders. Eight healthy volunteers with a mean age of 25.3 ± 2.9 years and a mean body mass index (BMI) of 23.4 ± 3.2 kg/m2 reported to the sleep laboratory on four occasions for polysomnography (PSG) and drowsiness and psychomotor assessments as follows: 1) adaptation; 2) 4 weeks before Ramadan while performing the Islamic fasting for 1 week (baseline fasting) (BLF); 3) 1 week before Ramadan (non-fasting baseline) (BL); and 4) during the second week of Ramadan while fasting (Ramadan). OPTALERT™ was used to objectively assess daytime drowsiness using the Johns Drowsiness Scale (JDS), and blink total duration and a visual reaction time test were used to assess MRT. Rapid eye movement (REM) sleep percentage was significantly lower at BLF (17.7 ± 8.1%) and at Ramadan (18.6 ± 10.7%) compared with BL (25.6 ± 4.8%) (p < 0.05). There were no significant differences between JDS scores and blink total duration during the two test periods in BL, BLF and Ramadan. There were no significant changes in MRT during BL, BLF and Ramadan. Under controlled conditions of fixed light/dark exposure, caloric intake, sleep/wake schedule and sleep quality, the Islamic intermittent fasting has no impact on drowsiness and vigilance as measured by the JDS, total blink duration and MRT.

Low-cost EEG-based sleep detection.

PubMed

Van Hal, Bryan; Rhodes, Samhita; Dunne, Bruce; Bossemeyer, Robert

2014-01-01

A real-time stage 1 sleep detection system using a low-cost single dry-sensor EEG headset is described. This device issues an auditory warning at the onset of stage 1 sleep using the "NeuroSky Mindset," an inexpensive commercial entertainment-based headset. The EEG signal is filtered into low/high alpha and low/high beta frequency bands which are analyzed to indicate the onset of sleep. Preliminary results indicate an 81% effective rate of detecting sleep with all failures being false positives of sleep onset. This device was able to predict and respond to the onset of drowsiness preceding stage 1 sleep allowing for earlier warnings with the result of fewer sleep-related accidents.

The effect of age and comedication on lamotrigine clearance, tolerability, and efficacy.

PubMed

Arif, Hiba; Svoronos, Alexandra; Resor, Stanley R; Buchsbaum, Richard; Hirsch, Lawrence J

2011-10-01

To compare pharmacokinetics, tolerability, and efficacy of lamotrigine (LTG) in older versus younger adults. We studied 686 adult outpatients seen at our center over 5 years. We compared apparent clearance (CL) of LTG in the youngest (16-36 years; n = 247) and oldest (55-92 years; n = 155) tertiles. We analyzed one-year retention for younger and older adults newly started on LTG, frequency of adverse effects causing intolerability, and rates of specific adverse effects. We also investigated 6-month seizure freedom. Median LTG CL of older adults taking LTG in monotherapy was approximately 22% lower compared to younger adults (28.8 vs. 36.5 ml/h/kg; p < 0.001). LTG CL in older adults was lower compared to younger adults in patients on polytherapy and on polytherapy without enzyme inducers or valproate. One-year retention for LTG was comparable in older (78.1%, 121/155) and younger (72.4%, 179/247) adults. Intolerability to LTG was higher in older (34.8%) versus younger adults (24.2%; p = 0.005). Imbalance, drowsiness, and dizziness were common intolerable side effects in both groups. Older patients had higher rates of intolerability due to imbalance (16% vs. 4%), drowsiness (13% vs. 7%), and tremor (5% vs. 2%) compared with younger patients. Rates of 6-month seizure freedom were comparable, and small numbers of each group benefited from very high levels of LTG (>15 μg/ml). LTG CL in monotherapy in older adults is approximately 20% lower than in younger adults. For a given serum LTG level, older adults are twice as likely to have significant adverse effects compared to younger adults. Older patients are more likely to experience imbalance, drowsiness, and tremor than younger patients. Younger adults tolerate LTG better than older adults, but one-year retention is comparable. Some patients may benefit from high serum levels of LTG. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

Asleep at the Wheel-The Road to Addressing Drowsy Driving.

PubMed

Higgins, J Stephen; Michael, Jeff; Austin, Rory; Åkerstedt, Torbjörn; Van Dongen, Hans P A; Watson, Nathaniel; Czeisler, Charles; Pack, Allan I; Rosekind, Mark R

2017-02-01

Drowsy driving is a dangerous behavior that leads to thousands of deaths and injuries each year. It is also a controllable factor for drivers. Drivers are capable of modifying this behavior if given sufficient information and motivation. Our goal is to establish a comprehensive and strategic effort to end drowsy driving crashes and deaths. This article highlights some of the conclusions of a unique recent meeting of sleep experts and highway safety professionals and describes the first steps the community has taken and plans to take in the future to address this issue. Published by Oxford University Press on behalf of Sleep Research Society (SRS) 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Intrusions of a drowsy mind: neural markers of phenomenological unpredictability.

PubMed

Noreika, Valdas; Canales-Johnson, Andrés; Koh, Justin; Taylor, Mae; Massey, Irving; Bekinschtein, Tristan A

2015-01-01

The transition from a relaxed to a drowsy state of mind is often accompanied by hypnagogic experiences: most commonly, perceptual imagery, but also linguistic intrusions, i.e., the sudden emergence of unpredictable anomalies in the stream of inner speech. This study has sought to describe the contents of such intrusions, to verify their association with the progression of sleep onset, and to investigate the electroencephalographic processes associated with linguistic intrusions as opposed to more common hypnagogic perceptual imagery. A single participant attended 10 experimental sessions in the EEG laboratory, where he was allowed to drift into a drowsy state of mind, while maintaining metacognition of his own experiences. Once a linguistic intrusion or a noticeable perceptual image occurred, the participant pressed a button and reported it verbally. An increase in the EEG-defined depth of drowsiness as assessed by the Hori system of sleep onset was observed in the last 20 s before a button press. Likewise, EEG Dimension of Activation values decreased before the button press, indicating that the occurrence of cognitively incongruous experiences coincides with the rapid change of EEG predictability patterns. EEG hemispheric asymmetry analysis showed that linguistic intrusions had a higher alpha and gamma power in the left hemisphere electrodes, whereas perceptual imagery reports were associated with a higher beta power over the right hemisphere. These findings indicate that the modality as well as the incongruence of drowsiness-related hypnagogic experiences is strongly associated with distinct EEG signatures in this participant. Sleep onset may provide a unique possibility to study the neural mechanisms accompanying the fragmentation of the stream of consciousness in healthy individuals.

Insufficient sleep rather than the apnea-hypopnea index can be associated with sleepiness-related driving problems of Japanese obstructive sleep apnea syndrome patients residing in metropolitan areas.

PubMed

Matsui, Kentaro; Sasai-Sakuma, Taeko; Ishigooka, Jun; Inoue, Yuichi

2017-05-01

Obstructive sleep apnea syndrome (OSAS) and insufficient sleep might increase the risk of drowsy driving and sleepiness-related vehicular accidents. This study retrospectively investigated the factors associated with these driving problems, particularly addressing OSAS severity and sleep amounts of affected drivers. This study examined 161 patients (146 male and 15 female) with OSAS (apnea-hypopnea index [AHI] ≥ 5) who drove on a routine basis and who completed study questionnaires. To investigate factors associated with drowsy driving during the prior year and sleepiness-related vehicular accidents or near-miss events during the prior five years, logistic regression analyses were performed with age, body mass index, monthly driving distance, habitual sleep duration on weekdays, the Japanese version of Epworth Sleepiness Scale score, AHI, and periodic limb movement index as independent variables. Of the patients, 68 (42.2%) reported drowsy driving experiences, and 86 (53.4%) reported sleepiness-related vehicular accidents or near-miss events. Analyses revealed the following: older age (46-65 years, ≥66 years) was negatively associated with drowsy driving (p <0.05, p <0.05), and habitually shorter sleep duration on weekdays (≤6 hours) was positively associated with drowsy driving (p <0.01). Habitual sleep duration of ≤6 hours (p <0.01) and Epworth Sleepiness Scale score of ≥11 (p <0.01) were positively associated with sleepiness-related vehicular accidents and near-miss events. However, AHI was not associated with these driving problems. Insufficient sleep, rather than severity of OSAS, was associated with sleepiness-related driving problems in these Japanese OSAS patients. Copyright © 2016 Elsevier B.V. All rights reserved.

Intrusions of a drowsy mind: neural markers of phenomenological unpredictability

PubMed Central

Noreika, Valdas; Canales-Johnson, Andrés; Koh, Justin; Taylor, Mae; Massey, Irving; Bekinschtein, Tristan A.

2015-01-01

The transition from a relaxed to a drowsy state of mind is often accompanied by hypnagogic experiences: most commonly, perceptual imagery, but also linguistic intrusions, i.e., the sudden emergence of unpredictable anomalies in the stream of inner speech. This study has sought to describe the contents of such intrusions, to verify their association with the progression of sleep onset, and to investigate the electroencephalographic processes associated with linguistic intrusions as opposed to more common hypnagogic perceptual imagery. A single participant attended 10 experimental sessions in the EEG laboratory, where he was allowed to drift into a drowsy state of mind, while maintaining metacognition of his own experiences. Once a linguistic intrusion or a noticeable perceptual image occurred, the participant pressed a button and reported it verbally. An increase in the EEG-defined depth of drowsiness as assessed by the Hori system of sleep onset was observed in the last 20 s before a button press. Likewise, EEG Dimension of Activation values decreased before the button press, indicating that the occurrence of cognitively incongruous experiences coincides with the rapid change of EEG predictability patterns. EEG hemispheric asymmetry analysis showed that linguistic intrusions had a higher alpha and gamma power in the left hemisphere electrodes, whereas perceptual imagery reports were associated with a higher beta power over the right hemisphere. These findings indicate that the modality as well as the incongruence of drowsiness-related hypnagogic experiences is strongly associated with distinct EEG signatures in this participant. Sleep onset may provide a unique possibility to study the neural mechanisms accompanying the fragmentation of the stream of consciousness in healthy individuals. PMID:25814962

High risk of near-crash driving events following night-shift work

PubMed Central

Lee, Michael L.; Howard, Mark E.; Horrey, William J.; Liang, Yulan; Anderson, Clare; Shreeve, Michael S.; O’Brien, Conor S.; Czeisler, Charles A.

2016-01-01

Night-shift workers are at high risk of drowsiness-related motor vehicle crashes as a result of circadian disruption and sleep restriction. However, the impact of actual night-shift work on measures of drowsiness and driving performance while operating a real motor vehicle remains unknown. Sixteen night-shift workers completed two 2-h daytime driving sessions on a closed driving track at the Liberty Mutual Research Institute for Safety: (i) a postsleep baseline driving session after an average of 7.6 ± 2.4 h sleep the previous night with no night-shift work, and (ii) a postnight-shift driving session following night-shift work. Physiological measures of drowsiness were collected, including infrared reflectance oculography, electroencephalography, and electrooculography. Driving performance measures included lane excursions, near-crash events, and drives terminated because of failure to maintain control of the vehicle. Eleven near-crashes occurred in 6 of 16 postnight-shift drives (37.5%), and 7 of 16 postnight-shift drives (43.8%) were terminated early for safety reasons, compared with zero near-crashes or early drive terminations during 16 postsleep drives (Fishers exact: P = 0.0088 and P = 0.0034, respectively). Participants had a significantly higher rate of lane excursions, average Johns Drowsiness Scale, blink duration, and number of slow eye movements during postnight-shift drives compared with postsleep drives (3.09/min vs. 1.49/min; 1.71 vs. 0.97; 125 ms vs. 100 ms; 35.8 vs. 19.1; respectively, P < 0.05 for all). Night-shift work increases driver drowsiness, degrading driving performance and increasing the risk of near-crash drive events. With more than 9.5 million Americans working overnight or rotating shifts and one-third of United States commutes exceeding 30 min, these results have implications for traffic and occupational safety. PMID:26699470

High risk of near-crash driving events following night-shift work.

PubMed

Lee, Michael L; Howard, Mark E; Horrey, William J; Liang, Yulan; Anderson, Clare; Shreeve, Michael S; O'Brien, Conor S; Czeisler, Charles A

2016-01-05

Night-shift workers are at high risk of drowsiness-related motor vehicle crashes as a result of circadian disruption and sleep restriction. However, the impact of actual night-shift work on measures of drowsiness and driving performance while operating a real motor vehicle remains unknown. Sixteen night-shift workers completed two 2-h daytime driving sessions on a closed driving track at the Liberty Mutual Research Institute for Safety: (i) a postsleep baseline driving session after an average of 7.6 ± 2.4 h sleep the previous night with no night-shift work, and (ii) a postnight-shift driving session following night-shift work. Physiological measures of drowsiness were collected, including infrared reflectance oculography, electroencephalography, and electrooculography. Driving performance measures included lane excursions, near-crash events, and drives terminated because of failure to maintain control of the vehicle. Eleven near-crashes occurred in 6 of 16 postnight-shift drives (37.5%), and 7 of 16 postnight-shift drives (43.8%) were terminated early for safety reasons, compared with zero near-crashes or early drive terminations during 16 postsleep drives (Fishers exact: P = 0.0088 and P = 0.0034, respectively). Participants had a significantly higher rate of lane excursions, average Johns Drowsiness Scale, blink duration, and number of slow eye movements during postnight-shift drives compared with postsleep drives (3.09/min vs. 1.49/min; 1.71 vs. 0.97; 125 ms vs. 100 ms; 35.8 vs. 19.1; respectively, P < 0.05 for all). Night-shift work increases driver drowsiness, degrading driving performance and increasing the risk of near-crash drive events. With more than 9.5 million Americans working overnight or rotating shifts and one-third of United States commutes exceeding 30 min, these results have implications for traffic and occupational safety.

Integration of Body Sensor Networks and Vehicular Ad-hoc Networks for Traffic Safety.

PubMed

Reyes-Muñoz, Angelica; Domingo, Mari Carmen; López-Trinidad, Marco Antonio; Delgado, José Luis

2016-01-15

The emergence of Body Sensor Networks (BSNs) constitutes a new and fast growing trend for the development of daily routine applications. However, in the case of heterogeneous BSNs integration with Vehicular ad hoc Networks (VANETs) a large number of difficulties remain, that must be solved, especially when talking about the detection of human state factors that impair the driving of motor vehicles. The main contributions of this investigation are principally three: (1) an exhaustive review of the current mechanisms to detect four basic physiological behavior states (drowsy, drunk, driving under emotional state disorders and distracted driving) that may cause traffic accidents is presented; (2) A middleware architecture is proposed. This architecture can communicate with the car dashboard, emergency services, vehicles belonging to the VANET and road or street facilities. This architecture seeks on the one hand to improve the car driving experience of the driver and on the other hand to extend security mechanisms for the surrounding individuals; and (3) as a proof of concept, an Android real-time attention low level detection application that runs in a next-generation smartphone is developed. The application features mechanisms that allow one to measure the degree of attention of a driver on the base of her/his EEG signals, establish wireless communication links via various standard wireless means, GPRS, Bluetooth and WiFi and issue alarms of critical low driver attention levels.

Integration of Body Sensor Networks and Vehicular Ad-hoc Networks for Traffic Safety

PubMed Central

Reyes-Muñoz, Angelica; Domingo, Mari Carmen; López-Trinidad, Marco Antonio; Delgado, José Luis

2016-01-01

The emergence of Body Sensor Networks (BSNs) constitutes a new and fast growing trend for the development of daily routine applications. However, in the case of heterogeneous BSNs integration with Vehicular ad hoc Networks (VANETs) a large number of difficulties remain, that must be solved, especially when talking about the detection of human state factors that impair the driving of motor vehicles. The main contributions of this investigation are principally three: (1) an exhaustive review of the current mechanisms to detect four basic physiological behavior states (drowsy, drunk, driving under emotional state disorders and distracted driving) that may cause traffic accidents is presented; (2) A middleware architecture is proposed. This architecture can communicate with the car dashboard, emergency services, vehicles belonging to the VANET and road or street facilities. This architecture seeks on the one hand to improve the car driving experience of the driver and on the other hand to extend security mechanisms for the surrounding individuals; and (3) as a proof of concept, an Android real-time attention low level detection application that runs in a next-generation smartphone is developed. The application features mechanisms that allow one to measure the degree of attention of a driver on the base of her/his EEG signals, establish wireless communication links via various standard wireless means, GPRS, Bluetooth and WiFi and issue alarms of critical low driver attention levels. PMID:26784204

iLid: Low-power Sensing of Fatigue and Drowsiness Measures on a Computational Eyeglass

PubMed Central

ROSTAMINIA, SOHA; MAYBERRY, ADDISON; GANESAN, DEEPAK; MARLIN, BENJAMIN; GUMMESON, JEREMY

2018-01-01

The ability to monitor eye closures and blink patterns has long been known to enable accurate assessment of fatigue and drowsiness in individuals. Many measures of the eye are known to be correlated with fatigue including coarse-grained measures like the rate of blinks as well as fine-grained measures like the duration of blinks and the extent of eye closures. Despite a plethora of research validating these measures, we lack wearable devices that can continually and reliably monitor them in the natural environment. In this work, we present a low-power system, iLid, that can continually sense fine-grained measures such as blink duration and Percentage of Eye Closures (PERCLOS) at high frame rates of 100fps. We present a complete solution including design of the sensing, signal processing, and machine learning pipeline; implementation on a prototype computational eyeglass platform; and extensive evaluation under many conditions including illumination changes, eyeglass shifts, and mobility. Our results are very encouraging, showing that we can detect blinks, blink duration, eyelid location, and fatigue-related metrics such as PERCLOS with less than a few percent error. PMID:29417956

Real-time driver fatigue detection based on face alignment

NASA Astrophysics Data System (ADS)

Tao, Huanhuan; Zhang, Guiying; Zhao, Yong; Zhou, Yi

2017-07-01

The performance and robustness of fatigue detection largely decrease if the driver with glasses. To address this issue, this paper proposes a practical driver fatigue detection method based on face alignment at 3000 FPS algorithm. Firstly, the eye regions of the driver are localized by exploiting 6 landmarks surrounding each eye. Secondly, the HOG features of the extracted eye regions are calculated and put into SVM classifier to recognize the eye state. Finally, the value of PERCLOS is calculated to determine whether the driver is drowsy or not. An alarm will be generated if the eye is closed for a specified period of time. The accuracy and real-time on testing videos with different drivers demonstrate that the proposed algorithm is robust and obtain better accuracy for driver fatigue detection compared with some previous method.

Predictors of Responses to Corticosteroids for Cancer-Related Fatigue in Advanced Cancer Patients: A Multicenter, Prospective, Observational Study.

PubMed

Matsuo, Naoki; Morita, Tatsuya; Matsuda, Yoshinobu; Okamoto, Kenichiro; Matsumoto, Yoshihisa; Kaneishi, Keisuke; Odagiri, Takuya; Sakurai, Hiroki; Katayama, Hideki; Mori, Ichiro; Yamada, Hirohide; Watanabe, Hiroaki; Yokoyama, Taro; Yamaguchi, Takashi; Nishi, Tomohiro; Shirado, Akemi; Hiramoto, Shuji; Watanabe, Toshio; Kohara, Hiroyuki; Shimoyama, Satofumi; Aruga, Etsuko; Baba, Mika; Sumita, Koki; Iwase, Satoru

2016-07-01

Although corticosteroids are widely used to relieve cancer-related fatigue (CRF), information regarding the factors predicting responses to corticosteroids remains limited. The aim of this study was to identify potential factors predicting responses to corticosteroids for CRF in advanced cancer patients. Inclusion criteria for this multicenter, prospective, observational study were patients who had metastatic or locally advanced cancer and had a fatigue intensity score of 4 or more on a 0-10 Numerical Rating Scale (NRS). Univariate and multivariate analyses were conducted to identify the factors predicting two-point reduction or more in NRS on day 3. Among 179 patients who received corticosteroids, 86 (48%; 95% CI 41%-56%) had a response with two-point reduction or more. Factors that significantly predicted responses were performance status score of 3 or more, Palliative Performance Scale score more than 40, absence of ascites, absence of drowsiness, absence of depression, serum albumin level greater than 3 mg/dL, serum sodium level greater than 135 mEq/L, and baseline NRS score greater than 5. A multivariate analysis showed that the independent factors predicting responses were baseline NRS score greater than 5 (odds ratio [OR] 6.6, 95% CI 2.8-15.4), Palliative Performance Scale score more than 40 (OR 4.4, 95% CI 2.1-9.3), absence of drowsiness (OR 3.4, 95% CI 1.7-6.9), absence of ascites (OR 2.3, 95% CI 1.1-4.7), and absence of pleural effusion (OR 2.2, 95% CI 1.0-5.0). Treatment responses to corticosteroids for CRF may be predicted by baseline symptom intensity, performance status, drowsiness, and severity of fluid retention symptoms. Larger prospective studies are needed to confirm these results. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Sleep-related car crashes: risk perception and decision-making processes in young drivers.

PubMed

Lucidi, Fabio; Russo, Paolo Maria; Mallia, Luca; Devoto, Alessandra; Lauriola, Marco; Violani, Cristiano

2006-03-01

The aim of the present study is to analyse factors affecting worries, coping strategies and decisions of young drivers regarding the risk of sleep-related car crashes. Furthermore, the study also analyses whether framing the same information about sleepiness in two different linguistic forms influences: (1) the evaluation of the level of risk associated to a specific level of drowsiness (Attribute Framing problem); (2) the willingness to enact strategies to "prevent" sleepiness before night-time driving (Goal Framing problem); (3) the choice between two different ways, both of equal expected efficacy, of lowering drowsiness (Risky decision-making Framing problem). Six hundred and ninety-five young drivers [(57.6% females, 42.4% males); mean age 20.85 years (S.D.=1.2)] answered questions on drive risk perception and sleepiness, on nocturnal driving experience and on the strategies to deal with driver sleepiness, responding to one of the two different versions of the framed problems. A sub-sample of 130 participants completed the framed problems in both versions. The results show that experiences of sleep attacks and nocturnal driving frequency in the past 6 months affect both risk perception and the preventive strategies adopted. Furthermore, the manipulation on two out of the three problems (attribute and risky decision-making frames) significantly affected the respondents' evaluation.

Promethazine and its use as a treatment for space motion sickness

NASA Technical Reports Server (NTRS)

Bagian, James P.; Beck, Bradley G.

1993-01-01

Until Mar. 1989, no effective treatment--either prophylactic or symptomatic--for space motion sickness (SMS) had been discovered. Since Mar. 1989, intramuscular (IM) promethazine (PMZ) has been used in the treatment of SMS with extremely favorably results reported by the crew. A retrospective study was undertaken to quantify the efficacy of IM PMZ since its institution and the incidence of its major anticipated side-effect drowsiness and sedation. The results from a standardized crew medical debriefing conducted immediately after landing and follow-up interviews with the crews were used in establishing the efficacy and incidence of side effects from treatment. Only crews from the first 44 Shuttle flights on their first mission were considered. For a total of 132 crewmembers, 96 exhibited symptoms of SMS; and, of these, 20 were treated with IM PMZ. Ninety percent of those receiving IM PMZ 25-50mg received nearly immediate (less than 2 hours) relief of symptoms and 75 percent required no further treatment through the first 2 days of spaceflight. Those not receiving this treatment did not have any near-term resolution of their symptoms, and 50 percent were still ill through the second day of flight. This represents a significant difference at the p = 0.46 level. In stark contrast to the 60 percent to 73 percent incidence of sedation or drowsiness reported in individuals treated with PMZ in terrestrial environment at the doses used here, less than 5 percent reported these symptoms during spaceflight. IM PMZ is an effective therapy for SMS and is associated with minimal incidence of sedation or drowsiness. This combination of efficacy that is absent of significant side effects represents a substantial improvement in the operational situation of crewmembers afflicted with SMS. Studies to understand the mechanisms underlying these observations will be undertaken in the future.

Effects of exposure to lead among lead-acid battery factory workers in Sudan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mohamed, A.A.E.K.; Hamed, A.A.S.; Elhaimi, Y.A.A.

Health effects of occupational exposure to lead were investigated among 92 exposed workers in lead-acid battery factory and 40 nonexposed workers serving as a control group from an oil mill in Khartoum North industrial area. The two groups were closely similar in age, stature, body weight, and socioeconomic conditions. A highly significant increase (P<.01) was recorded in blood lead, urinary coproporphyrin, and basophilic stippled red blood cells of the exposed group in comparison to the control group. Central nervous system symptoms (insomnia, fatigue, weakness, and drowsiness) were reported by 50% and other symptoms such as abdominal colic and constipation weremore » reported by 41% of the exposed group. Blue line on the gum was detected only on 2% of the exposed group. Strong associations between exposure to lead and the prevalence of central nervous system symptoms, abdominal colic, and constipation were recorded. Exposure to exceedingly high levels of lead in the working environment causes adverse health effects.« less

Wireless sleep monitoring headband to identify sleep and track fatigue

NASA Astrophysics Data System (ADS)

Ramasamy, Mouli; Oh, Sechang; Varadan, Vijay K.

2014-04-01

Detection of sleepiness and drowsiness in human beings has been a daunting task for both engineering and medical technologies. Accuracy, precision and promptness of detection have always been an issue that has to be dealt by technologists. Commonly, the rudimentary bio potential signals - ECG, EOG, EEG and EMG are used to classify and discriminate sleep from being awake. However, the potential drawbacks may be high false detections, low precision, obtrusiveness, aftermath analysis, etc. To overcome the disadvantages, this paper proposes the design of a wireless and a real time monitoring system to track sleep and detect fatigue. This concept involves the use of EOG and EEG to measure the blink rate and asses the person's condition. In this user friendly and intuitive approach, EOG and EEG signals are obtained by the dry gold wire nano-sensors fabricated on the inner side of a flexible headband. The acquired signals are then electrically transmitted to the data processing and transmission unit, which transmits the processed data to the receiver/monitoring module through WCDMA/GSM communication. This module is equipped with a software program to process, feature extract, analyze, display and store the information. Thereby, immediate detection of a person falling asleep is made feasible and, tracking the sleep cycle continuously provides an insight about the experienced fatigue level. The novel approach of using a wireless, real time, dry sensor on a flexible substrate reduces the obtrusiveness, and techniques adopted in the electronics and software facilitates and substantial increase in efficiency, accuracy and precision.

Topographic distribution of EEG alpha attractor correlation dimension values in wake and drowsy states in humans.

PubMed

Kalauzi, Aleksandar; Vuckovic, Aleksandra; Bojić, Tijana

2015-03-01

Organization of resting state cortical networks is of fundamental importance for the phenomenon of awareness, which is altered in the first part of hypnagogic period (Hori stages 1-4). Our aim was to investigate the change in brain topography pattern of EEG alpha attractor correlation dimension (CD) in the period of transition from Hori stage 1 to 4. EEG of ten healthy adult individuals was recorded in the wake and drowsy states, using a 14 channel average reference montage, from which 91 bipolar channels were derived and filtered in the wider alpha (6-14 Hz) range. Sixty 1s long epochs of each state and individual were subjected to CD calculation according to the Grassberger-Procaccia method. For such a collection of signals, two embedding dimensions, d={5, 10}, and 22 time delays τ=2-23 samples were explored. Optimal values were d=10 and τ=18, where both saturation and second zero crossing of the autocorrelation function occurred. Bipolar channel CD underwent a significant decrease during the transition and showed a positive linear correlation with electrode distance, stronger in the wake individuals. Topographic distribution of bipolar channels with above median CD changed from longitudinal anterior-posterior pattern (awake) to a more diagonal pattern, with localization in posterior regions (drowsiness). Our data are in line with the literature reporting functional segregation of neuronal assemblies in anterior and posterior regions during this transition. Our results should contribute to understanding of complex reorganization of the cortical part of alpha generators during the wake/drowsy transition. Copyright © 2014 Elsevier B.V. All rights reserved.

Single-channel EEG-based mental fatigue detection based on deep belief network.

PubMed

Pinyi Li; Wenhui Jiang; Fei Su

2016-08-01

Mental fatigue has a pernicious influence on road and work place safety as well as a negative symptom of many acute and chronic illnesses, since the ability of concentrating, responding and judging quickly decreases during the fatigue or drowsiness stage. Electroencephalography (EEG) has been proven to be a robust physiological indicator of human cognitive state over the last few decades. But most existing EEG-based fatigue detection methods have poor performance in accuracy. This paper proposed a single-channel EEG-based mental fatigue detection method based on Deep Belief Network (DBN). The fused nonliear features from specified sub-bands and dynamic analysis, a total of 21 features are extracted as the input of the DBN to discriminate three classes of mental state including alert, slight fatigue and severe fatigue. Experimental results show the good performance of the proposed model comparing with those state-of-art methods.

Psychophysiological effects of self-regulation method: EEG frequency analysis and contingent negative variations.

PubMed

Ikemi, A

1988-01-01

Experiments were conducted to investigate the psychophysiological effects of self-regulation method (SRM), a newly developed method of self-control, using EEG frequency analysis and contingent negative variations (CNV). The results of the EEG frequency analysis showed that there is a significant increase in the percentage (power) of the theta-band and a significant decrease in the percentage (power) of the beta-band during SRM. Moreover, the results of an identical experiment conducted on subjects in a drowsy state showed that the changes in EEG frequencies during SRM can be differentiated from those of a drowsy state. Furthermore, experiments using CNV showed that there is a significant reduction of CNV amplitude during SRM. Despite the reduced amplitude during SRM, the number of errors in a task to evoke the CNV was reduced significantly without significant delay of reaction time. When an identical experiment was conducted in a drowsy state, CNV amplitude was reduced significantly, but reaction time and errors increased. From these experiments, the state of vigilance during SRM was discussed as a state of 'relaxed alertness'.

[Objective evaluation of driving fatigue by using variability of pupil diameter under spontaneous pupillary fluctuation conditions].

PubMed

Xiong, Xingliang; Zhang, Yan; Chen, Mengmeng; Chen, Longcong

2013-04-01

Objective evaluation of driver drowsiness is necessary toward suppression of fatigued driving and prevention of traffic accident. We have developed a new method in which we utilized pupillary diameter variability (PDV) under spontaneous pupillary fluctuation conditions. The method consists of three main steps. Firstly, we use a 90s long infrared video of pupillogram infrared-sensitive CCD camera. Secondly, we employed edge detection algorithm based on curvature characteristics of pupil boundary to extract a set of points of visible pupil boundary, and then we adopted these points to fit a circle to obtain the diameter of the pupil in current frame of video. Finally, the values of PDV in 90s long video is calculated. In an experimental pilot study, the values of PDV of two groups were measured. One group rated themselves as alert (12 men), the other group as sleepy (13 men). The results showed that significant differences could be found between the two groups, and the values were 0.06 +/- 0.005 and 0.141 +/- 0.042, respectively. Taking into account of the knowledge that spontaneous pupillary fluctuation is innervated by autonomic nervous system which activity is known to change in parallel with drowsiness and cannot be influenced by subjective motive of people. From the results of the experiments, we concluded that PDV could be used to evaluate driver fatigue objectively.

Development of wireless brain computer interface with embedded multitask scheduling and its application on real-time driver's drowsiness detection and warning.

PubMed

Lin, Chin-Teng; Chen, Yu-Chieh; Huang, Teng-Yi; Chiu, Tien-Ting; Ko, Li-Wei; Liang, Sheng-Fu; Hsieh, Hung-Yi; Hsu, Shang-Hwa; Duann, Jeng-Ren

2008-05-01

Biomedical signal monitoring systems have been rapidly advanced with electronic and information technologies in recent years. However, most of the existing physiological signal monitoring systems can only record the signals without the capability of automatic analysis. In this paper, we proposed a novel brain-computer interface (BCI) system that can acquire and analyze electroencephalogram (EEG) signals in real-time to monitor human physiological as well as cognitive states, and, in turn, provide warning signals to the users when needed. The BCI system consists of a four-channel biosignal acquisition/amplification module, a wireless transmission module, a dual-core signal processing unit, and a host system for display and storage. The embedded dual-core processing system with multitask scheduling capability was proposed to acquire and process the input EEG signals in real time. In addition, the wireless transmission module, which eliminates the inconvenience of wiring, can be switched between radio frequency (RF) and Bluetooth according to the transmission distance. Finally, the real-time EEG-based drowsiness monitoring and warning algorithms were implemented and integrated into the system to close the loop of the BCI system. The practical online testing demonstrates the feasibility of using the proposed system with the ability of real-time processing, automatic analysis, and online warning feedback in real-world operation and living environments.

Wearable sensor glove based on conducting fabric using electrodermal activity and pulse-wave sensors for e-health application.

PubMed

Lee, Youngbum; Lee, Byungwoo; Lee, Myoungho

2010-03-01

Improvement of the quality and efficiency of health in medicine, both at home and the hospital, calls for improved sensors that might be included in a common carrier such as a wearable sensor device to measure various biosignals and provide healthcare services that use e-health technology. Designed to be user-friendly, smart clothes and gloves respond well to the end users for health monitoring. This study describes a wearable sensor glove that is equipped with an electrodermal activity (EDA) sensor, pulse-wave sensor, conducting fabric, and an embedded system. The EDA sensor utilizes the relationship between drowsiness and the EDA signal. The EDA sensors were made using a conducting fabric instead of silver chloride electrodes, as a more practical and practically wearable device. The pulse-wave sensor measurement system, which is widely applied in oriental medicinal practices, is also a strong element in e-health monitoring systems. The EDA and pulse-wave signal acquisition module was constructed by connecting the sensor to the glove via a conductive fabric. The signal acquisition module is then connected to a personal computer that displays the results of the EDA and pulse-wave signal processing analysis and gives accurate feedback to the user. This system is designed for a number of applications for the e-health services, including drowsiness detection and oriental medicine.

On the efficiency of driver state monitoring systems

NASA Astrophysics Data System (ADS)

Dementienko, V. V.; Dorokhov, V. B.; Gerus, S. V.; Markov, A. G.; Shakhnarovich, V. M.

2007-06-01

Statistical data on road traffic and the results of laboratory studies are used to construct a mathematical model of a driver-driver state monitor-automobile-traffic system. In terms of the model, the probability of an accident resulting from the drowsy state of the driver is determined both in the absence and presence of a monitor. The model takes into account the efficiency and safety level provided by different monitoring systems, as well as psychological factors associated with the excessive reliance of drivers upon monitoring.

Sleep Disorders Associated With Mild Traumatic Brain Injury Using Sport Concussion Assessment Tool 3.

PubMed

Tkachenko, Nataliya; Singh, Kanwaljit; Hasanaj, Lisena; Serrano, Liliana; Kothare, Sanjeev V

2016-04-01

Sleep problems affect 30% to 80% of patients with mild traumatic brain injury. We assessed the prevalence of sleep disorders after mild traumatic brain injury and its correlation with other symptoms. Individuals with mild traumatic brain injury were assessed at the New York University Concussion Center during 2013-2014 with the Sports Concussion Assessment Tool, third edition, data following mild traumatic brain injury. The relationship between sleep problems (drowsiness, difficulty falling asleep, fatigue or low energy), psychiatric symptoms (sadness, nervousness or anxiousness), headache, and dizziness were analyzed by Spearman correlation and logistic regression using moderate to severe versus none to mild categorization. Ninety-three patients were retrospectively considered. The most common injury causes were falls (34.4%) and motor vehicle accidents (21.5%). There was a positive correlation between dizziness, headache, psychiatric problems (sadness, anxiety, irritability), and sleep problems (fatigue, drowsiness, and difficulty falling asleep) (P < 0.001). Logistic regression showed a significant association between moderate to severe psychiatric symptoms and moderate to severe sleep symptoms (P < 0.05). Sleep symptoms became more severe with increased time interval from mild traumatic brain injury to Sport Concussion Assessment Tool 3 administration (odds ratio = 1.005, 1.006, and 1.008, P < 0.05). There was significant correlation between motor vehicle accident and drowsiness and difficulty falling asleep (P < 0.05). Medications given in the emergency department had a positive correlation with drowsiness (P < 0.05). Individuals who report moderate to severe headache, dizziness, and psychiatric symptoms have a higher likelihood of reporting moderate to severe sleep disorders following mild traumatic brain injury and should be counseled and initiated with early interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of sleep profile in schizophrenia patients treated with extended-release paliperidone: an open-label prospective study in Southeast Asia.

PubMed

Kongsakon, Ronnachai; Thavichachart, Nuntika; Chung, Ka Fai; Lim, Leslie; Azucena, Beverly; Rondain, Elizabeth; Go, Benson; Costales, Fe; Nerapusee, Osot

2017-01-01

To evaluate the effect of 6 months of treatment with paliperidone extended-release (ER) tablets on the sleep profile of patients with schizophrenia. A total of 984 patients meeting the The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia who switched their antipsychotic to paliperidone ER were recruited from 61 sites in five countries in Southeast Asia. We recorded patient demographics and assessed sleep quality and daytime drowsiness using visual analog scales. Approximately 70% of patients completed the 6-month study. After the use of paliperidone ER, patients reported significantly better sleep quality (76.44 vs 65.48; p <0.001) and less daytime drowsiness compared with their baseline value (23.18 vs 34.22; p <0.001). Factors predicting sleep profile improvement were completion of the study and higher baseline Positive and Negative Syndrome Scale scores. Paliperidone ER can help schizophrenia patients to improve sleep quality and reduce daytime drowsiness; this was seen especially in the patients who completed the 6-month treatment period and had higher baseline Positive and Negative Syndrome Scale scores.

Evaluation of sleep profile in schizophrenia patients treated with extended-release paliperidone: an open-label prospective study in Southeast Asia

PubMed Central

Kongsakon, Ronnachai; Thavichachart, Nuntika; Chung, Ka Fai; Lim, Leslie; Azucena, Beverly; Rondain, Elizabeth; Go, Benson; Costales, Fe; Nerapusee, Osot

2017-01-01

Objective To evaluate the effect of 6 months of treatment with paliperidone extended-release (ER) tablets on the sleep profile of patients with schizophrenia. Methods A total of 984 patients meeting the The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia who switched their antipsychotic to paliperidone ER were recruited from 61 sites in five countries in Southeast Asia. We recorded patient demographics and assessed sleep quality and daytime drowsiness using visual analog scales. Results Approximately 70% of patients completed the 6-month study. After the use of paliperidone ER, patients reported significantly better sleep quality (76.44 vs 65.48; p<0.001) and less daytime drowsiness compared with their baseline value (23.18 vs 34.22; p<0.001). Factors predicting sleep profile improvement were completion of the study and higher baseline Positive and Negative Syndrome Scale scores. Conclusion Paliperidone ER can help schizophrenia patients to improve sleep quality and reduce daytime drowsiness; this was seen especially in the patients who completed the 6-month treatment period and had higher baseline Positive and Negative Syndrome Scale scores. PMID:29138607

Napping on the Night Shift: A Two-Hospital Implementation Project

PubMed Central

Brown, Jeanne Geiger; Sagherian, Knar; Zhu, Shijun; Wieroniey, Margaret; Blair, Lori; Warren, Joan; Hinds, Pamela; Szeles, Rose

2015-01-01

Some nurses who work the night shift experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries but has not had widespread acceptance in nursing. In this two-hospital implementation project, napping was offered to six nursing units where nurse executives had previously approved nap implementation for the night shift as a pilot project. Successful implementation occurred in only one of the six units with partial success in a second unit. Barriers primarily occurred at the point of seeking unit-based nursing leadership approval. On the successful unit, one hundred fifty three 30-minutes naps were taken during the 3-month pilot period. A Nap Experience Survey measured sleepiness prior to the nap, the nap duration and perceived sleep, sleep inertia after the nap, and the perceived helpfulness of the nap. A high level of sleepiness was present at the beginning of 44% of naps. For over half of naps, nurses reported sleeping slightly (43%) or deeply (14%). Sleep inertia was rare (very groggy or sluggish on arising, 1.3%). The average score of helpfulness of napping was high (7.3 on a 1–10 scale). Nurses who napped reported being less drowsy while driving home after their shift. These data suggest that when barriers to napping are overcome, napping on the nightshift is feasible and can reduce sleepiness and drowsy driving in nurses. PMID:27082421

Missing RRI interpolation for HRV analysis using locally-weighted partial least squares regression.

PubMed

Kamata, Keisuke; Fujiwara, Koichi; Yamakawa, Toshiki; Kano, Manabu

2016-08-01

The R-R interval (RRI) fluctuation in electrocardiogram (ECG) is called heart rate variability (HRV). Since HRV reflects autonomic nervous function, HRV-based health monitoring services, such as stress estimation, drowsy driving detection, and epileptic seizure prediction, have been proposed. In these HRV-based health monitoring services, precise R wave detection from ECG is required; however, R waves cannot always be detected due to ECG artifacts. Missing RRI data should be interpolated appropriately for HRV analysis. The present work proposes a missing RRI interpolation method by utilizing using just-in-time (JIT) modeling. The proposed method adopts locally weighted partial least squares (LW-PLS) for RRI interpolation, which is a well-known JIT modeling method used in the filed of process control. The usefulness of the proposed method was demonstrated through a case study of real RRI data collected from healthy persons. The proposed JIT-based interpolation method could improve the interpolation accuracy in comparison with a static interpolation method.

Safety of veralipride for the treatment of vasomotor symptoms of menopause.

PubMed

Valencia, Marcelino Hernández; Arias, María de Jesús Vega; González, Cuauhtémoc Celis; Marín, Imelda Hernández; González, Juan Humberto Martín; Campos, Enrique Rafael Morcate; Rodríguez, María Antonia Basavilvazo; Álvarez, Ignacio Morales; Vargas, María Antonia Valdés; Flores, José Braulio Everardo Otero; Haro, Samuel Santoyo; Bonilla, Manuel Cortes; Escudero, Roberto Bernardo; Campero, Rosalba Alonso

2014-05-01

Veralipride is a nonhormonal option for the treatment of vasomotor symptoms of menopause. Incidence of adverse events in a Mexican population and drug compliance according to correct use were evaluated. We carried out a longitudinal, prospective, and analytical study in Mexican women who received veralipride to treat symptoms of menopause from 2011 to 2012. There were 386 treatment cycles; 272 were assigned to dosing schedule 1, which included 20 days of treatment with 10 days of suspension, and 114 were assigned to dosing schedule 2, which included 5 days of treatment and 2 days of suspension. A total of 57 adverse events were registered during the 386-month treatment. For the 20 × 10 dosing schedule, the highest incidence was observed for anxiety (2.2%), drowsiness, and weakness (1.5%); for the 5 × 2 dosing schedule, the highest incidence was observed for drowsiness (5.3%) and headache (2.6%). The Hamilton Depression Rating Scale was used to assess the presence and severity of depression; improvement was noted. The Unified Parkinson's Disease Rating Scale was used to assess neurological movement disorders; no adverse neurological events were detected. Based on the assessments of both women and physicians, the highest frequency was observed for "very satisfied" (45.5% and 52.3%, respectively), followed by "satisfied" (23.9% and 27.3%, respectively). Both dosing schedules show acceptable safety profiles for up to 6 months of use when used according to the contraindications in the current prescribing information for standard use (2012) and recent medical literature.

Electrocardiographical case. A tale of tall T's. Hyperkalaemia.

PubMed

Chew, H C; Lim, S H

2005-08-01

A 63-year-old woman presented at the emergency department (ED) with a history of increasing lethargy and drowsiness. The electrocardiogram (ECG) showed tall peaked T waves with broadening of the QRS interval, suggestive of hyperkalaemia. This patient had an elevated serum potassium level due to diabetic ketoacidosis. She was treated with intravenous calcium chloride and insulin with 50% dextrose. The ECG changes associated with hyperkalaemia are discussed, with illustrations from a second 48-year-old male patient with renal failure who presented with malaise, lethargy and generalised weakness.

Quality of life assessment in advanced cancer patients treated at home, an inpatient unit, and a day care center

PubMed Central

Leppert, Wojciech; Majkowicz, Mikolaj; Forycka, Maria; Mess, Eleonora; Zdun-Ryzewska, Agata

2014-01-01

Aim of the study To assess quality of life (QoL) in cancer patients treated at home, at an in-patient palliative care unit (PCU), and at a day care center (DCC). Patients and methods QoL was assessed in advanced cancer patients at baseline and after 7 days of symptomatic treatment using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 15-Palliative Care (EORTC QLQ-C15-PAL), the Edmonton Symptom Assessment System (ESAS), and the Karnofsky Performance Status (KPS) scale. Results A total of 129 patients completed the study, with 51 patients treated at home, 51 patients treated at the PCU, and 27 patients at DCC. In the EORTC QLQ-C15-PAL, improvement in functional and symptom scales was observed except in physical functioning and fatigue levels; patients at DCC had a better physical functioning, global QoL, appetite, and fatigue levels. In the ESAS, improvement in all items was found except for drowsiness levels, which was stable in patients treated at DCC and deteriorated in home and PCU patients. Higher activity, better appetite and well-being, and less drowsiness were observed in patients treated at DCC. KPS was better in DCC patients compared to those treated at home and at the PCU; the latter group deteriorated. Conclusions QoL improved in all patient groups, with better results in DCC patients and similar scores in those staying at home and at the PCU. Along with clinical assessment, baseline age, KPS, physical and emotional functioning may be considered when assigning patients to care at a DCC, PCU, or at home. PMID:24855379

THE SLEEP OF LONG-HAUL TRUCK DRIVERS

PubMed Central

Mitler, Merrill M.; Miller, James C.; Lipsitz, Jeffrey J.; Walsh, James K.; Wylie, C. Dennis

2008-01-01

Background Fatigue and sleep deprivation are important safety issues for long-haul truck drivers. Methods We conducted round-the-clock electrophysiologic and performance monitoring of four groups of 20 male truck drivers who were carrying revenue-producing loads. We compared four driving schedules, two in the United States (five 10-hour trips of day driving beginning about the same time each day or of night driving beginning about 2 hours earlier each day) and two in Canada (four 13-hour trips of late-night-to-morning driving beginning at about the same time each evening or of afternoon-to-night driving beginning 1 hour later each day). Results Drivers averaged 5.18 hours in bed per day and 4.78 hours of electrophysiologically verified sleep per day over the five-day study (range, 3.83 hours of sleep for those on the steady 13-hour night schedule to 5.38 hours of sleep for those on the steady 10-hour day schedule). These values compared with a mean (±SD) self-reported ideal amount of sleep of 7.1±1 hours a day. For 35 drivers (44 percent), naps augmented the sleep obtained by an average of 0.45±0.31 hour. No crashes or other vehicle mishaps occurred. Two drivers had undiagnosed sleep apnea, as detected by polysomnography. Two other drivers had one episode each of stage 1 sleep while driving, as detected by electroencephalography. Forty-five drivers (56 percent) had at least 1 six-minute interval of drowsiness while driving, as judged by analysis of video recordings of their faces; 1067 of the 1989 six-minute segments (54 percent) showing drowsy drivers involved just eight drivers. Conclusions Long-haul truck drivers in this study obtained less sleep than is required for alertness on the job. The greatest vulnerability to sleep or sleep-like states is in the late night and early morning. PMID:9287232

Prediction of fatigue-related driver performance from EEG data by deep Riemannian model.

PubMed

Hajinoroozi, Mehdi; Jianqiu Zhang; Yufei Huang

2017-07-01

Prediction of the drivers' drowsy and alert states is important for safety purposes. The prediction of drivers' drowsy and alert states from electroencephalography (EEG) using shallow and deep Riemannian methods is presented. For shallow Riemannian methods, the minimum distance to Riemannian mean (mdm) and Log-Euclidian metric are investigated, where it is shown that Log-Euclidian metric outperforms the mdm algorithm. In addition the SPDNet, a deep Riemannian model, that takes the EEG covariance matrix as the input is investigated. It is shown that SPDNet outperforms all tested shallow and deep classification methods. Performance of SPDNet is 6.02% and 2.86% higher than the best performance by the conventional Euclidian classifiers and shallow Riemannian models, respectively.

The sopite syndrome revisited: Drowsiness and mood changes during real or apparent motion

NASA Astrophysics Data System (ADS)

Lawson, B. D.; Mead, A. M.

The sopite syndrome is a poorly understood response to motion. Drowsiness and mood changes are the primary characteristics of the syndrome. The sopite syndrome can exist in isolation from more apparent symptoms such as nausea, can last long; after nausea has subsided, and can debilitate some individuals. It is most likely a distinct syndrome from "regular" motion sickness or common fatigue, and is of potential concern in a variety of situations. The syndrome may be particularly hazardous in transportation settings where other performance challenges (e.g., sleep deprivation) are already present. It is also a potential concern in cases where illnesses such as sleep disorders or depression may interact with the syndrome and confuse diagnosis.

Drowsy Driving: Asleep at the Wheel

MedlinePlus

... Emergency Preparedness & Response Environmental Health Healthy Living Injury, Violence & Safety Life Stages & Populations Travelers’ Health Workplace Safety & Health Features Media Sign up for Features Get Email Updates To ...

Construction and validation of the EEG analogues of the Karolinska sleepiness scale based on the Karolinska drowsiness test.

PubMed

Putilov, Arcady A; Donskaya, Olga G

2013-07-01

Simple methods of sleepiness assessment are greatly needed for both fundamental research and practical applications. The Karolinska drowsiness test (KDT) was applied to construct physiological alertness scales and to validate them against such well-known instrument of subjective sleepiness assessment as the Karolinska sleepiness scale (KSS). Seven-min EEG recordings were obtained with 2-h interval from frontal and occipital derivations during the last 32-50 h of 44-61-h wakefulness of 15 healthy study participants. Occipital alpha-theta power difference and frontal and occipital scores on the 2nd principal component of the EEG spectrum were calculated for each one-min interval of 5-min eyes closed section of the record. To obtain scores (from 0 to 5) on alertness scales for each of these EEG indexes, all positive one-min values of the index were assigned to 1, and all remaining (negative) values were assigned to 0. Scores on any of the physiological alertness scales were found to be strongly associated with KSS scores. Physiological analogues of KSS were offered by utilising the EEG recordings on eyes closed interval of KDT. The constructed physiological scales can help in improving validity and user-friendliness of the field and laboratory methods of quantification of drowsy state. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Characteristics of social drinkers with and without a hangover after heavy alcohol consumption.

PubMed

Hogewoning, A; Van de Loo, Ajae; Mackus, M; Raasveld, S J; De Zeeuw, R; Bosma, E R; Bouwmeester, N H; Brookhuis, K A; Garssen, J; Verster, J C

2016-01-01

A number of social drinkers claim that they do not experience next-day hangovers despite consuming large quantities of alcohol. The aim of this study was to investigate the characteristics of drinkers who claim to be hangover immune and compare them with drinkers who do report having hangovers. A total of 36 social drinkers participated in a naturalistic study consisting of a hangover day (alcohol consumed) and a control day (no alcohol consumed). Data were collected on alcohol consumption, demographics, sleep, next-day adverse effects, and mood. Data from drinkers with a hangover (N=18) were compared with data from drinkers who claim to be hangover immune (N=18). Drinkers with a hangover reported drowsiness-related symptoms, symptoms related to reduced cognitive functioning, and classic hangover symptoms such as headache, nausea, dizziness, weakness, and stomach pain. Corresponding mood changes comprised increased feelings of depression, anger-hostility, fatigue, and reduced vigor-activity. In contrast, hangover-immune drinkers reported relatively few hangover symptoms, with only mild corresponding severity scores. The reported symptoms were limited to drowsiness-related symptoms such as sleepiness and being tired. The classic hangover symptoms were usually not reported by these drinkers. In contrast to drinkers with a hangover, for those who claim to be hangover immune, next-day adverse effects of alcohol consumption are limited to a mild increase in drowsiness-related symptoms.

Alcohol hangover symptoms and their contribution to the overall hangover severity.

PubMed

Penning, Renske; McKinney, Adele; Verster, Joris C

2012-01-01

Scientific literature suggests a large number of symptoms that may be present the day after excessive alcohol consumption. The purpose of this study was to explore the presence and severity of hangover symptoms, and determine their interrelationship. A survey was conducted among n = 1410 Dutch students examining their drinking behavior and latest alcohol hangover. The severity of 47 presumed hangover symptoms were scored on a 10-point scale ranging from 0 (absent) to 10 (maximal). Factor analysis was conducted to summarize the data into groups of associated symptoms that contribute significantly to the alcohol hangover and symptoms that do not. About half of the participants (56.1%, n = 791) reported having had a hangover during the past month. Most commonly reported and most severe hangover symptoms were fatigue (95.5%) and thirst (89.1%). Factor analysis revealed 11 factors that together account for 62% of variance. The most prominent factor 'drowsiness' (explained variance 28.8%) included symptoms such as drowsiness, fatigue, sleepiness and weakness. The second factor 'cognitive problems' (explained variance 5.9%) included symptoms such as reduced alertness, memory and concentration problems. Other factors, including the factor 'disturbed water balance' comprising frequently reported symptoms such as 'dry mouth' and 'thirst', contributed much less to the overall hangover (explained variance <5%). Drowsiness and impaired cognitive functioning are the two dominant features of alcohol hangover.

Pattern of eyelid motion predictive of decision errors during drowsiness: oculomotor indices of altered states.

PubMed

Lobb, M L; Stern, J A

1986-08-01

Sequential patterns of eye and eyelid motion were identified in seven subjects performing a modified serial probe recognition task under drowsy conditions. Using simultaneous EOG and video recordings, eyelid motion was divided into components above, within, and below the pupil and the durations in sequence were recorded. A serial probe recognition task was modified to allow for distinguishing decision errors from attention errors. Decision errors were found to be more frequent following a downward shift in the gaze angle which the eyelid closing sequence was reduced from a five element to a three element sequence. The velocity of the eyelid moving over the pupil during decision errors was slow in the closing and fast in the reopening phase, while on decision correct trials it was fast in closing and slower in reopening. Due to the high variability of eyelid motion under drowsy conditions these findings were only marginally significant. When a five element blink occurred, the velocity of the lid over pupil motion component of these endogenous eye blinks was significantly faster on decision correct than on decision error trials. Furthermore, the highly variable, long duration closings associated with the decision response produced slow eye movements in the horizontal plane (SEM) which were more frequent and significantly longer in duration on decision error versus decision correct responses.

Modafinil

MedlinePlus

... It works by changing the amounts of certain natural substances in the area of the brain that ... asleep or staying asleep drowsiness nausea diarrhea constipation gas heartburn loss of appetite unusual tastes dry mouth ...

Citalopram

MedlinePlus

... mood changes, irritability, agitation, dizziness, numbness, tingling or electric shock-like sensations in the hands or feet, ... may make you drowsy. Do not drive a car or operate machinery until you know how this ...

Midazolam

MedlinePlus

... to cause drowsiness, relieve anxiety, and prevent any memory of the event. Midazolam is in a class ... if your child is taking certain medications for human immunodeficiency virus (HIV) including amprenavir (Agenerase), atazanavir (Reyataz), ...

Medicines for back pain

MedlinePlus

... direct care, they can be effective in reducing pain. Examples of narcotics include: Codeine Fentanyl -- available as a patch Hydrocodone Hydromorphone Morphine Oxycodone Tramadol Possible side effects of these drugs include: Drowsiness ...

Anxiety Disorders

MedlinePlus

... side effects, including drowsiness, and can be habit forming at higher doses. People taking these medications should ... their pursuit of life goals, prevents them from forming relationships, pursuing career or school, being assertive, or ...

49 CFR 228.411 - Training.

Code of Federal Regulations, 2013 CFR

2013-10-01

... fatigue, including sleep disorders; (3) Alertness strategies, such as policies on napping, to address acute drowsiness and fatigue while an employee is on duty; (4) Opportunities to obtain restful sleep at...

49 CFR 228.411 - Training.

Code of Federal Regulations, 2012 CFR

2012-10-01

... fatigue, including sleep disorders; (3) Alertness strategies, such as policies on napping, to address acute drowsiness and fatigue while an employee is on duty; (4) Opportunities to obtain restful sleep at...

49 CFR 228.411 - Training.

Code of Federal Regulations, 2014 CFR

2014-10-01

... fatigue, including sleep disorders; (3) Alertness strategies, such as policies on napping, to address acute drowsiness and fatigue while an employee is on duty; (4) Opportunities to obtain restful sleep at...

Desipramine

MedlinePlus

... www.fda.gov/Drugs/DrugSafety/ucm085729.htm.No matter your age, before you take an antidepressant, you, ... seeing things that do not exist) widened pupils (dark circles in the middle of the eyes) drowsiness ...

Buprenorphine Transdermal Patch

MedlinePlus

... it to direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated ... may make you drowsy. Do not drive a car, operate machinery, or do other possibly dangerous activities ...

Selegiline Transdermal Patch

MedlinePlus

... patch from direct heat such as heating pads, electric blankets, heat lamps, saunas, hot tubs, and heated ... may make you drowsy. Do not drive a car or operate machinery until you know how this ...

Shock

MedlinePlus

... Restlessness, anxiety or agitation Drowsiness or fatigue Dizziness, light-headedness or faintness Profuse sweating, moist skin Irritability Thirst Rapid pulse Rapid, weak breathing Enlarged pupils Nausea or vomiting Blue tinge to lips or fingernails (or gray in ...

Delirium

MedlinePlus

... may be slow moving or hyperactive) Changes in sleep patterns, drowsiness Confusion (disorientation) about time or place Decrease in short-term memory and recall Disorganized thinking, such as talking in a way that doesn't make sense ...

Nortriptyline

MedlinePlus

... www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273.No matter what your age, before you take an antidepressant, ... seeing things that do not exist) widened pupils (dark circles in the middle of the eyes) drowsiness ...

Central Sleep Apnea - Mayo Clinic

MedlinePlus

... up Difficulty staying asleep (insomnia) Excessive daytime sleepiness (hypersomnia) Chest pain at night Difficulty concentrating Mood changes ... chronically fatigued, sleepy and irritable. Excessive daytime drowsiness (hypersomnia) may be due to other disorders, such as ...

CE: Original Research: Napping on the Night Shift: A Two-Hospital Implementation Project.

PubMed

Geiger-Brown, Jeanne; Sagherian, Knar; Zhu, Shijun; Wieroniey, Margaret Ann; Blair, Lori; Warren, Joan; Hinds, Pamela S; Szeles, Rose

2016-05-01

: Nurses who work the night shift often experience high levels of sleepiness. Napping has been adopted as an effective countermeasure to sleepiness and fatigue in other safety-sensitive industries, but has not had widespread acceptance in nursing. To assess the barriers to successful implementation of night-shift naps and to describe the nap experiences of night-shift nurses who took naps. In this two-hospital pilot implementation project, napping on the night shift was offered to six nursing units for which the executive nursing leadership had given approval. Unit nurse managers' approval was sought, and where granted, further explanation was given to the unit's staff nurses. A nap experience form, which included the Karolinska Sleepiness Scale, was used to assess pre-nap sleepiness level, nap duration and perceived sleep experience, post-nap sleep inertia, and the perceived helpfulness of the nap. Nurse managers and staff nurses were also interviewed at the end of the three-month study period. Successful implementation occurred on only one of the six units, with partial success seen on a second unit. Barriers primarily occurred at the point of seeking the unit nurse managers' approval. On the successful unit, 153 30-minutes naps were taken during the study period. A high level of sleepiness was present at the beginning of 44% of the naps. For more than half the naps, nurses reported achieving either light (43%) or deep (14%) sleep. Sleep inertia was rare. The average score of helpfulness of napping was high (7.3 on a 1-to-10 scale). Nurses who napped reported being less drowsy while driving home after their shift. These data suggest that when barriers to napping are overcome, napping on the night shift is feasible and can reduce nurses' workplace sleepiness and drowsy driving on the way home. Addressing nurse managers' perceptions of and concerns about napping may be essential to successful implementation.

Disopyramide

MedlinePlus

... operate machinery until you know how this medication affects you.remember that alcohol can add to the drowsiness caused by this medication.talk to your doctor about the use of cigarettes and caffeine-containing beverages. These products may increase the irritability ...

Mumps

MedlinePlus

... you or your child has mumps along with: Red eyes Constant drowsiness Constant vomiting or abdominal pain Severe headache Pain or a lump in testicle Call the local emergency number (such as 911) or visit the emergency room if convulsions occur.

Mirtazapine

MedlinePlus

... the orally disintegrating tablets contain aspartame that forms phenylalanine.you should know that mirtazapine may cause angle- ... Mirtazapine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: drowsiness dizziness anxiousness confusion ...

Periodic Limb Movement Disorder (PLMD) and Restless Legs Syndrome (RLS)

MedlinePlus

... Professional Version Sleep Disorders Overview of Sleep Snoring Insomnia and Excessive Daytime Sleepiness (EDS) Circadian Rhythm Sleep ... pressure when a person stands (orthostatic hypotension), and insomnia. Benzodiazepines: These drugs (such as clonazepam ) cause drowsiness, ...

Drowsiness and uncommon fever in a child after cannabis ingestion.

PubMed

Feliu, Catherine; Cazaubon, Yoann; Fouley, Aurélie; Guillemin, Hélène; Millart, Hervé; Gozalo, Claire; Djerada, Zoubir

2017-08-01

Trivialization of cannabis consumption goes hand in hand with a growing exposure of children and the number of cannabis poisoning cases is steadily increasing. As clinical presentation can be different from what is currently seen in adults, added to the fact that it is not always suspected, diagnosis of cannabis intoxication in children is often delayed or missed. A 16-month-old girl was admitted to the pediatric emergency unit for an important drowsiness combined to moderate fever. After elimination of infectious causes, a toxic origin was considered and biological analyses led to the diagnosis of involuntary acute cannabis intoxication. In conclusion, cannabis intoxication in child has uncommon presentations compared to that seen in adults. In this context, biological analyses have a great importance for a rapid diagnosis and also for the understanding intoxication circumstance. This is of paramount importance because it may lead to consider child protection measures.

A comparative descriptive study examining the perceptions of cancer patients, family caregivers, and nurses on patient symptom severity in Turkey.

PubMed

Akin, Semiha; Durna, Zehra

2013-02-01

Perform a comparative descriptive study that aims to describe the symptom severity of patients receiving chemotherapy and to compare patient self-reports of symptom severity with inferences made by nurses and family caregivers. The study was performed in the chemotherapy unit of a university hospital. The study was conducted on 119 patients undergoing chemotherapy that had a family caregiver and a nurse (n = 7) primarily responsible for their care. Symptom assessments were completed using the Edmonton Symptom Assessment System (ESAS). Symptoms were rated independently by the patient, caregiver and nurse. The patients reported severe tiredness, loss of well-being, anxiety, drowsiness, appetite changes, depression, pain and nausea. The patients and caregivers showed a strong agreement of the patients' symptoms (P < .001). Patients and nurses showed poor to fair agreement of the symptoms of pain, tiredness, nausea, depression, drowsiness, appetite, loss of well-being, skin and nail changes, mouth sores, and hand numbness (P < .05). The patients' mean scores of symptoms such as pain, depression, anxiety, drowsiness and loss of well-being were lower than those of the caregivers. The patients' mean scores of symptoms such as tiredness, shortness of breath, skin and nail changes and mouth sores were higher than scores of nurses (P < .05). Perceptions of formal or informal caregivers about symptoms in patients with cancer will help clinicians to develop strategies or approaches to improve the caregiver symptom assessment. Copyright © 2012 Elsevier Ltd. All rights reserved.

Sleep-deprived motor vehicle operators are unfit to drive: a multidisciplinary expert consensus statement on drowsy driving.

PubMed

Czeisler, Charles A; Wickwire, Emerson M; Barger, Laura K; Dement, William C; Gamble, Karen; Hartenbaum, Natalie; Ohayon, Maurice M; Pelayo, Rafael; Phillips, Barbara; Strohl, Kingman; Tefft, Brian; Rajaratnam, Shantha M W; Malhotra, Raman; Whiton, Kaitlyn; Hirshkowitz, Max

2016-06-01

This article presents the consensus findings of the National Sleep Foundation Drowsy Driving Consensus Working Group, which was an expert panel assembled to establish a consensus statement regarding sleep-related driving impairment. The National Sleep Foundation assembled a expert panel comprised of experts from the sleep community and experts appointed by stakeholder organizations. A systematic literature review identified 346 studies that were abstracted and provided to the panelists for review. A modified Delphi RAND/UCLA Appropriateness Method with 2 rounds of voting was used to reach consensus. A final consensus was reached that sleep deprivation renders motorists unfit to drive a motor vehicle. After reviewing growing evidence of impairment and increased crash risk among drivers who obtained less than optimal sleep duration in the preceding 24 hours, the panelists recognized the need for public policy guidance as to when it is certainly unsafe to drive. Toward this end, the panelists agreed upon the following expert consensus statement: "Drivers who have slept for two hours or less in the preceding 24 hours are not fit to operate a motor vehicle." Panelists further agreed that most healthy drivers would likely be impaired with only 3 to 5 hours of sleep during the prior 24 hours. There is consensus among experts that healthy individuals who have slept for 2 hours or less in the preceding 24 hours are too impaired to safely operate a motor vehicle. Prevention of drowsy driving will require sustained and collaborative effort from multiple stakeholders. Implications and limitations of the consensus recommendations are discussed. Copyright © 2016. Published by Elsevier Inc.

Predictors of responses to corticosteroids for anorexia in advanced cancer patients: a multicenter prospective observational study.

PubMed

Matsuo, Naoki; Morita, Tatsuya; Matsuda, Yoshinobu; Okamoto, Kenichiro; Matsumoto, Yoshihisa; Kaneishi, Keisuke; Odagiri, Takuya; Sakurai, Hiroki; Katayama, Hideki; Mori, Ichiro; Yamada, Hirohide; Watanabe, Hiroaki; Yokoyama, Taro; Yamaguchi, Takashi; Nishi, Tomohiro; Shirado, Akemi; Hiramoto, Shuji; Watanabe, Toshio; Kohara, Hiroyuki; Shimoyama, Satofumi; Aruga, Etsuko; Baba, Mika; Sumita, Koki; Iwase, Satoru

2017-01-01

Although corticosteroids are widely used to relieve anorexia, information regarding the factors predicting responses to corticosteroids remains limited. The purpose of the study is to identify potential factors predicting responses to corticosteroids for anorexia in advanced cancer patients. Inclusion criteria for this multicenter prospective observational study were patients who had metastatic or locally advanced cancer and had an anorexia intensity score of 4 or more on a 0-10 Numerical Rating Scale (NRS). Univariate and multivariate analyses were conducted to identify the factors predicting ≥2-point reduction in NRS on day 3. Among 180 patients who received corticosteroids, 99 (55 %; 95 % confidence interval [CI], 47-62 %) had a response with ≥2-point reduction. Factors that significantly predicted responses were Palliative Performance Scale (PPS) > 40 and absence of drowsiness. In addition, factors that tended to be associated with ≥2-point reduction in NRS included PS 0-3, absence of diabetes mellitus, absence of peripheral edema, presence of lung metastasis, absence of peritoneal metastasis, baseline anorexia NRS of >6, presence of pain, and presence of constipation. A multivariate analysis showed that the independent factors predicting responses were PPS of >40 (odds ratio = 2.7 [95 % CI = 1.4-5.2]), absence of drowsiness (2.6 [1.3-5.0]), and baseline NRS of >6 (2.4 [1.1-4.8]). Treatment responses to corticosteroids for anorexia may be predicted by PPS, drowsiness, and baseline symptom intensity. Larger prospective studies are needed to confirm these results.

Distraction and drowsiness in motorcoach drivers.

DOT National Transportation Integrated Search

2016-11-01

Despite the large number of motorcoaches in the United States, there has been limited research on motorcoach operations. With more than 15 billion miles traveled per year and the transport of millions of people, crashes, when they occur, can involve ...

IC Treatment: Antidepressants

MedlinePlus

... prescribes you a TCA, take it in the early evening to eliminate unwanted morning drowsiness. For constipation, increase the amount of fiber in your diet. Consider taking Metamucil or a stool softener such as Colace. Pregnancy & Warnings None of the antidepressants in any of ...

Study of high-tension cable barriers on Michigan roadways.

DOT National Transportation Integrated Search

2014-10-01

Median-crossover crashes present the highest risk of fatality and severe injury among all collision types on : freeways. These crashes are caused by : a variety of factors, including drowsiness, driver distraction, impaired : driving, and loss of con...

Emergency Contraception

MedlinePlus

... levonorgestrel ECP, but this medicine can make a person feel drowsy. Who Uses It? Emergency contraception is not recommended as a ... Editorial Policy Permissions Guidelines Privacy Policy & Terms of ... is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor. © ...

Quantitative analysis on electrooculography (EOG) for neurodegenerative disease

NASA Astrophysics Data System (ADS)

Liu, Chang-Chia; Chaovalitwongse, W. Art; Pardalos, Panos M.; Seref, Onur; Xanthopoulos, Petros; Sackellares, J. C.; Skidmore, Frank M.

2007-11-01

Many studies have documented abnormal horizontal and vertical eye movements in human neurodegenerative disease as well as during altered states of consciousness (including drowsiness and intoxication) in healthy adults. Eye movement measurement may play an important role measuring the progress of neurodegenerative diseases and state of alertness in healthy individuals. There are several techniques for measuring eye movement, Infrared detection technique (IR). Video-oculography (VOG), Scleral eye coil and EOG. Among those available recording techniques, EOG is a major source for monitoring the abnormal eye movement. In this real-time quantitative analysis study, the methods which can capture the characteristic of the eye movement were proposed to accurately categorize the state of neurodegenerative subjects. The EOG recordings were taken while 5 tested subjects were watching a short (>120 s) animation clip. In response to the animated clip the participants executed a number of eye movements, including vertical smooth pursued (SVP), horizontal smooth pursued (HVP) and random saccades (RS). Detection of abnormalities in ocular movement may improve our diagnosis and understanding a neurodegenerative disease and altered states of consciousness. A standard real-time quantitative analysis will improve detection and provide a better understanding of pathology in these disorders.

Directional templates for real-time detection of coronal axis rotated faces

NASA Astrophysics Data System (ADS)

Perez, Claudio A.; Estevez, Pablo A.; Garate, Patricio

2004-10-01

Real-time face and iris detection on video images has gained renewed attention because of multiple possible applications in studying eye function, drowsiness detection, virtual keyboard interfaces, face recognition, video processing and multimedia retrieval. In this paper, a study is presented on using directional templates in the detection of faces rotated in the coronal axis. The templates are built by extracting the directional image information from the regions of the eyes, nose and mouth. The face position is determined by computing a line integral using the templates over the face directional image. The line integral reaches a maximum when it coincides with the face position. It is shown an improvement in localization selectivity by the increased value in the line integral computed with the directional template. Besides, improvements in the line integral value for face size and face rotation angle was also found through the computation of the line integral using the directional template. Based on these results the new templates should improve selectivity and hence provide the means to restrict computations to a fewer number of templates and restrict the region of search during the face and eye tracking procedure. The proposed method is real time, completely non invasive and was applied with no background limitation and normal illumination conditions in an indoor environment.

An innovative nonintrusive driver assistance system for vital signal monitoring.

PubMed

Sun, Ye; Yu, Xiong Bill

2014-11-01

This paper describes an in-vehicle nonintrusive biopotential measurement system for driver health monitoring and fatigue detection. Previous research has found that the physiological signals including eye features, electrocardiography (ECG), electroencephalography (EEG) and their secondary parameters such as heart rate and HR variability are good indicators of health state as well as driver fatigue. A conventional biopotential measurement system requires the electrodes to be in contact with human body. This not only interferes with the driver operation, but also is not feasible for long-term monitoring purpose. The driver assistance system in this paper can remotely detect the biopotential signals with no physical contact with human skin. With delicate sensor and electronic design, ECG, EEG, and eye blinking can be measured. Experiments were conducted on a high fidelity driving simulator to validate the system performance. The system was found to be able to detect the ECG/EEG signals through cloth or hair with no contact with skin. Eye blinking activities can also be detected at a distance of 10 cm. Digital signal processing algorithms were developed to decimate the signal noise and extract the physiological features. The extracted features from the vital signals were further analyzed to assess the potential criterion for alertness and drowsiness determination.

Psychophysiological monitoring of operator's emotional stress in aviation and astronautics.

PubMed

Simonov, P V; Frolov, M V; Ivanov, E A

1980-01-01

The level of emotional stress depending on the power of motivation and the estimation by the subject of the probability (possibility) of goal achievement, largely influences the operator's skill performance (that of a pilot, controller, astronaut). A decrease in the emotional tonus leads to drowsiness, lack of vigilance, missing of significant signals, and to slower reactions. The extremely high stress level disorganizes the activity, complicates it with a trend toward untimely acts and reactions to the insignificant signals (false alarms). The best methods to monitor the degree of the operator's emotional state during his skill performance are the integral estimation of the changes in heart-rate and T-peak amplitude, as well as the analysis of spectral and intonational characteristics of the human voice during radio conversation. These methods were tested on paratroopers, pilots in civil aviation, and airport controllers.

Light Vehicle-Heavy Vehicle Interaction Data Collection and Countermeasure Research Project.

DOT National Transportation Integrated Search

2016-11-01

The Light Vehicle-Heavy Vehicle Interaction (LV-HV) Data Collection and Countermeasure Research Project : leveraged data from the Drowsy Driver Warning System Field Operational Test (DDWS FOT) to investigate a : set of research issues relating to dri...

Quality of life after whole brain radiotherapy compared with radiosurgery of the tumor bed: results from a randomized trial.

PubMed

Kepka, L; Tyc-Szczepaniak, D; Osowiecka, K; Sprawka, A; Trąbska-Kluch, B; Czeremszynska, B

2018-02-01

A recent randomized trial (NCT01535209) demonstrated no difference in neurocognitive function between stereotactic radiotherapy of the tumor bed (SRT-TB) and whole brain radiotherapy (WBRT) in patients with resected single brain metastasis. Patients treated with SRT-TB had lower overall survival compared with the WBRT arm. Here, we compared the health-related quality of life (HRQOL) in patients who received WBRT vs. SRT-TB. A self-reported questionnaire was used to assess HRQOL (EORTC QLQ-C30 with the QLQ-BN20 module) before RT, 2 months after RT, and every 3 months thereafter. HRQOL results are presented as mean scores and compared between groups. Of 59 randomized patients, 37 (64%) were eligible for HRQOL analysis, 15 received SRT-TB, and 22 had WBRT. There were no differences between groups in global health status and main function scales/symptoms (except for drowsiness and appetite loss, which were worse with WBRT 2 months after RT). Global health status decreased 2 and 5 months after RT, but significantly only for SRT-TB (p = 0.025). Physical function decreased significantly 5 months after SRT-TB (p = 0.008). Future uncertainty worsened after RT, but significantly only for SRT-TB after 2 months (p = 0.036). Patients treated with WBRT had significant worsening of appetite, hair loss, and drowsiness after treatment. Despite higher symptom burden after WBRT attributed to the side effects of RT (such as appetite loss, drowsiness, and hair loss), global health status, physical functioning, and future uncertainty favored WBRT compared with SRT-TB. This may be related to the compromised brain tumor control with omission of WBRT.

[Sleep deprivation and its effect on the ability to maintain wakefulness: implications on functioning and driving].

PubMed

Furman, Gabriela Dorfman; Cahan, Clement; Baharav, Armada

2009-05-01

During the last century, western society suffers from an increasing steep debt. A large number of accidents occur due to drowsy drivers. People are not aware of the influence of fatigue/drowsiness on their functioning and driving capacity. Our goal is to identify and characterize measurable physioLogicaL information capable of monitoring simple and reliable performance of driver vigilance. Eight healthy volunteers without sleep disorders were included in the study. They participated in two missions, on and off every two hours during 34-36 hours, in order to create an accumulative sleep debt. The tasks included the Maintenance of wakefulness test (MWT) and the driving simulator test. White tested, they remained connected to EEG, EMG, EOG, ECG and audio-video registration. These first results are related to 60 MWT tests. The first falling asleep events (FA) appeared around the early afternoon hours, in agreement to the physiological tendency to fall asleep, according to the biological clock. The night was characterized by FAs with a very short sleep Latency time at around 4 AM. On the second day of the experiment, the averaged sleep latency was larger than in the night before, despite the accumulation of sleep debt. The fluctuations of RRI increased after the first micro sleep. The autonomic nervous regulation displays an increase in the overall sympathetic activity as an indicator of increased stress. There is a correlation between parameters associated with instantaneous autonomic changes of heart rhythm (RRI) and the FA/almost-FA events observed on EEG. These attributes may provide a useful tool for monitoring drowsy drivers and preventing accidents.

Circadian timing, drowsy driving, and health risk behavior in adolescent drivers.

DOT National Transportation Integrated Search

2016-06-01

Both worldwide and in the UnitedStates, major contributors to adolescent and early adult mortality and morbidity arise from health risks characterized as behavioral misadventure. The large majority of deaths among 10-to 24-year-olds are due to risk-r...

The Role Of Driver Inattention In Crashes; New Statistics From The 1995 Crashworthiness Data System

DOT National Transportation Integrated Search

1996-08-08

INTELLIGENT VEHICLE INITIATIVE OR IVI : IN 1995, NHTSA BEGAN EMPLOYING THE CRASHWORTHINESS DATA SYSTEM (CDS) TO OBTAIN MORE IN-DEPTH INFORMATION ON DRIVER INATTENTION-RELATED CRASH CAUSES, INCLUDING DROWSINESS AND MANY FORMS OF DISTRACTION. CDS IS PO...

Temperature and behavioral responses of squirrel monkeys to 2Gz acceleration

NASA Technical Reports Server (NTRS)

Fuller, C. A.; Tremor, J.; Connolly, J. P.; Williams, B. A.

1982-01-01

This study examines the responses of squirrel monkeys to acute +2Gz exposure. Body temperature responses of loosely restrained animals were recorded via a thermistor in the colon. Behavioral responses were recorded by video monitoring. After baseline recording at 1G, monkeys were exposed to 2G for 60 min. The body temperature started to fall within 10 min of the onset of centrifugation and declined an average of 1.4 C in 60 min. This is in contrast to a stable body temperature during the control period. Further, after a few minutes at 2G, the animals became drowsy and appeared to fall asleep. During the control period, however, they were alert and continually shifting their gaze about the cage. Thus, primates are susceptible to hypergravic fields in the +Gz orientation. The depression in primate body temperature was consistent and significant. Further, the observed drowsiness in this study has significant ramifications regarding alertness and performance in man.

Acute organophosphorus poisoning complicated by acute coronary syndrome.

PubMed

Pankaj, Madhu; Krishna, Kavita

2014-07-01

We report a case of 30 year old alcoholic male admitted with vomiting, drowsiness, limb weakness and fasciculations after alleged history of consumption of 30 ml of chlorpyriphos insecticide. He had low serum cholinesterase levels. With standard treatment for organophosphorus poisoning (OPP), he improved gradually until day 5, when he developed neck and limb weakness and respiratory distress. This intermediate syndrome was treated with oximes, atropine and artificial ventilation. During treatment, his ECG showed fresh changes of ST elevation. High CPK & CPK-MB levels, septal hypokinesia on 2D echo suggested acute coronary syndrome. Coronary angiography was postponed due to his bedridden and obtunded status. The patient finally recovered fully by day 15 and was discharged. Acute coronary syndrome is a rare occurrence in OP poisoning. The present case thus emphasises the need for careful electrocardiographic and enzymatic monitoring of all patients of organophosphorus poisoning to prevent potential cardiac complication which can prove fatal.

Brainwave Monitoring Software Improves Distracted Minds

NASA Technical Reports Server (NTRS)

2014-01-01

Neurofeedback technology developed at Langley Research Center to monitor pilot awareness inspired Peter Freer to develop software for improving student performance. His company, Fletcher, North Carolina-based Unique Logic and Technology Inc., has gone on to develop technology for improving workplace and sports performance, monitoring drowsiness, and encouraging relaxation.

Factor Structure of a Sluggish Cognitive Tempo Scale in Clinically-Referred Children

ERIC Educational Resources Information Center

Jacobson, Lisa A.; Murphy-Bowman, Sarah C.; Pritchard, Alison E.; Tart-Zelvin, Ariana; Zabel, T. Andrew; Mahone, E. Mark

2012-01-01

"Sluggish cognitive tempo" (SCT) is a construct hypothesized to describe a constellation of behaviors that includes daydreaming, lethargy, drowsiness, difficulty sustaining attention, and underactivity. Although the construct has been inconsistently defined, measures of SCT have shown associations with symptoms of attention-deficit/hyperactivity…

Intermittent maple syrup urine disease: two case reports.

PubMed

Axler, Olof; Holmquist, Peter

2014-02-01

The presenting symptoms and clinical course of 2 cases of intermittent maple syrup urine disease (MSUD) are described. Intermittent MSUD is a potentially life-threatening metabolic disorder caused by a deficiency of branched-chain α-keto acid dehydrogenase, the enzyme complex that decarboxylates the 3 branched-chain amino acids. In contrast to classic MSUD, children with the intermittent form show normal development with normal intelligence and, when asymptomatic, normal levels of branched-chain amino acids. Symptoms usually appear between 5 months and 2 years of age, when a trivial infection such as otitis media or viral gastroenteritis triggers catabolism of muscle protein. Intermittent MSUD should be suspected in cases of common infections with a clinically atypical course, especially in children displaying ataxia or marked drowsiness.

Complex Cognitive Performance and Antihistamine Use

DTIC Science & Technology

1990-04-01

22 Antihistamine Use and Sedation ...........................................24 Antihistamine Use and Physiological Measures...Reactivity and Sedation in Healthy Volunteers after Administration of Hismanal, Alone or in Combination with Central Nervous System Depressants...cross the blood-brain barrier easily, resulting in central nervous system effects such as sedation , drowsiness, and altered psychomotor performance

In-vehicle evaluation of milled rumble strips at pre- and post-chip sealed maintenance periods : final report.

DOT National Transportation Integrated Search

2017-01-01

Driver fatigue and drowsiness can have a profound impact on safety. Centerline and shoulder rumble strips (RS) are popular countermeasures designed to produce audible and tactile warning when vehicles deviate from the travel lane onto the RS. This re...

In Search of a Safe Natural Sleep Aid.

PubMed

Rao, Theertham P; Ozeki, Motoko; Juneja, Lekh R

2015-01-01

Sleep deprivation is associated with an elevated risk of various diseases and leads to a poor quality of life and negative socioeconomic consequences. Sleep inducers such as drugs and herbal medicines may often lead to dependence and other side effects. L-Theanine (γ-glutamylethylamide), an amino acid naturally found abundant in tea leaves, has anxiolytic effects via the induction of α brain waves without additive and other side effects associated with conventional sleep inducers. Anxiolysis is required for the initiation of high-quality sleep. In this study, we review the mechanism(s), safety, and efficacy of L-theanine. Collectively, sleep studies based on an actigraph, the obstructive sleep apnea (OSA) sleep inventory questionnaire, wakeup after sleep onset (WASO) and automatic nervous system (ANS) assessment, sympathetic and parasympathetic nerve activities, and a pediatric sleep questionnaire (PSQ) suggest that the administration of 200 mg of L-theanine before bed may support improved sleep quality not by sedation but through anxiolysis. Because L-theanine does not induce daytime drowsiness, it may be useful at any time of the day. The no observable adverse effect level (NOAEL) for the oral administration of L-theanine was determined to be above 2000 mg/kg bw/day. KEY TEACHING POINTS: Sleep deprivation-associated morbidity is an increasing public health concern posing a substantial socioeconomic burden. Chronic sleep disorders may seriously affect quality of life and may be etiological factors in a number of chronic diseases such as depression, obesity, diabetes, and cardiovascular diseases. Most sleep inducers are sedatives and are often associated with addiction and other side effects. L-Theanine promotes relaxation without drowsiness. Unlike conventional sleep inducers, L-theanine is not a sedative but promotes good quality of sleep through anxiolysis. This review suggests that L-theanine is a safe natural sleep aid.

A non-contact capacitance based electrocardiograph and associated heart-rate detection using enhanced Fourier interpolation method.

PubMed

Kumar Thakur, Rupak; Anoop, C S

2015-08-01

Cardio-vascular health monitoring has gained considerable attention in the recent years. Principle of non-contact capacitive electrocardiograph (ECG) and its applicability as a valuable, low-cost, easy-to-use scheme for cardio-vascular health monitoring has been demonstrated in some recent research papers. In this paper, we develop a complete non-contact ECG system using a suitable front-end electronic circuit and a heart-rate (HR) measurement unit using enhanced Fourier interpolation technique. The front-end electronic circuit is realized using low-cost, readily available components and the proposed HR measurement unit is designed to achieve fairly accurate results. The entire system has been extensively tested to verify its efficacy and test results show that the developed system can estimate HR with an accuracy of ±2 beats. Detailed tests have been conducted to validate the performance of the system for different cloth thicknesses of the subject. Some basic tests which illustrate the application of the proposed system for heart-rate variability estimation has been conducted and results reported. The developed system can be used as a portable, reliable, long-term cardiac health monitoring device and can be extended to human drowsiness detection.

Effect of clebopride on lower esophageal sphincter pressure.

PubMed

Ribeiro, V; da Silva, A L; Castro, L de P

1981-01-01

In 12 individuals without gastrointestinal symptoms, the IV administration of metoclopramide and of clebopride produced both a significant increase on the lower esophageal sphincter pressure. The increase induced by clebopride was significantly higher than that induced by metoclopramide. The tolerability of clebopride was satisfactory with just mild drowsiness being noted in most cases.

49 CFR Appendix D to Part 228 - Guidance on Fatigue Management Plans

Code of Federal Regulations, 2012 CFR

2012-10-01

... treatment of any medical condition that may affect alertness or fatigue, including sleep disorders; (3... employee fatigue and cumulative sleep loss; (5) Methods to minimize accidents and incidents that occur as a... drowsiness and fatigue while an employee is on duty; (7) Opportunities to obtain restful sleep at lodging...

49 CFR Appendix D to Part 228 - Guidance on Fatigue Management Plans

Code of Federal Regulations, 2013 CFR

2013-10-01

... treatment of any medical condition that may affect alertness or fatigue, including sleep disorders; (3... employee fatigue and cumulative sleep loss; (5) Methods to minimize accidents and incidents that occur as a... drowsiness and fatigue while an employee is on duty; (7) Opportunities to obtain restful sleep at lodging...

49 CFR Appendix D to Part 228 - Guidance on Fatigue Management Plans

Code of Federal Regulations, 2014 CFR

2014-10-01

... treatment of any medical condition that may affect alertness or fatigue, including sleep disorders; (3... employee fatigue and cumulative sleep loss; (5) Methods to minimize accidents and incidents that occur as a... drowsiness and fatigue while an employee is on duty; (7) Opportunities to obtain restful sleep at lodging...

Positive emotion word use and longevity in famous deceased psychologists.

PubMed

Pressman, Sarah D; Cohen, Sheldon

2012-05-01

This study examined whether specific types of positive and negative emotional words used in the autobiographies of well-known deceased psychologists were associated with longevity. For each of the 88 psychologists, the percent of emotional words used in writing was calculated and categorized by valence (positive or negative) and arousal (activated [e.g., lively, anxious] or not activated [e.g., calm, drowsy]) based on existing emotion scales and models of emotion categorization. After controlling for sex, year of publication, health (based on disclosed illness in autobiography), native language, and year of birth, the use of more activated positive emotional words (e.g., lively, vigorous, attentive, humorous) was associated with increased longevity. Negative terms (e.g., angry, afraid, drowsy, sluggish) and unactivated positive terms (e.g., peaceful, calm) were not related to longevity. The association of activated positive emotions with longevity was also independent of words indicative of social integration, optimism, and the other affect/activation categories. Results indicate that in writing, not every type of emotion correlates with longevity and that there may be value to considering different categories beyond emotional valence in health relevant outcomes.

Sleep-Wake Disturbances in Sedentary Community-Dwelling Elders With Functional Limitations

PubMed Central

Vaz Fragoso, Carlos A.; Miller, Michael E.; Fielding, Roger A.; King, Abby C.; Kritchevsky, Stephen B.; McDermott, Mary M.; Myers, Valerie; Newman, Anne B.; Pahor, Marco; Gill, Thomas M.

2014-01-01

OBJECTIVES To evaluate sleep-wake disturbances in sedentary community-dwelling elders with functional limitations. DESIGN Cross-sectional. SETTING Lifestyle Interventions and Independence in Elder (LIFE) Study. PARTICIPANTS 1635 community-dwelling persons, mean age 78.9, who spent <20 minutes/week in the past month of regular physical activity and <125 minutes/week of moderate physical activity, and had a Short Physical Performance Battery (SPPB) score <10. MEASUREMENTS Mobility was evaluated by the 400-meter walk time (slow gait speed defined as <0.8 m/s) and SPPB score (≤7 defined moderate-to-severe mobility impairment). Physical inactivity was defined by sedentary time, as percent of accelerometry wear time with activity <100 counts/min); top quartile established high sedentary time. Sleep-wake disturbances were evaluated by the Insomnia Severity Index (ISI) (range 0–28; ≥8 defined insomnia), Epworth Sleepiness Scale (ESS) (range 0–24; ≥10 defined daytime drowsiness), Pittsburgh Sleep Quality Index (PSQI) (range 0–21; >5 defined poor sleep quality), and Berlin Questionnaire (high risk of sleep apnea). RESULTS Prevalence rates were 43.5% for slow gait speed and 44.7% for moderate-to-severe mobility impairment, with 77.0% of accelerometry wear time spent as sedentary time. Prevalence rates were 33.0% for insomnia, 18.1% for daytime drowsiness, 47.8% for poor sleep quality, and 32.9% for high risk of sleep apnea. Participants with insomnia, daytime drowsiness, and poor sleep quality had mean values of 12.1 for ISI, 12.5 for ESS, and 9.2 for PSQI, respectively. In adjusted models, measures of mobility and physical inactivity were generally not associated with sleep-wake disturbances, using continuous or categorical variables. CONCLUSION In a large sample of sedentary community-dwelling elders with functional limitations, sleep-wake disturbances were prevalent but only mildly severe, and were generally not associated with mobility impairment or physical inactivity. PMID:24889836

Patient-reported symptoms during radiotherapy : Clinically relevant symptom burden in patients treated with palliative and curative intent.

PubMed

Körner, Philipp; Ehrmann, Katja; Hartmannsgruber, Johann; Metz, Michaela; Steigerwald, Sabrina; Flentje, Michael; van Oorschot, Birgitt

2017-07-01

The benefits of patient-reported symptom assessment combined with integrated palliative care are well documented. This study assessed the symptom burden of palliative and curative-intent radiation oncology patients. Prior to first consultation and at the end of RT, all adult cancer patients planned to receive fractionated percutaneous radiotherapy (RT) were asked to answer the Edmonton Symptom Assessment Scale (ESAS; nine symptoms from 0 = no symptoms to 10 = worst possible symptoms). Mean values were used for curative vs. palliative and pre-post comparisons, and the clinical relevance was evaluated (symptom values ≥ 4). Of 163 participating patients, 151 patients (90.9%) completed both surveys (116 curative and 35 palliative patients). Before beginning RT, 88.6% of palliative and 72.3% of curative patients showed at least one clinically relevant symptom. Curative patients most frequently named decreased general wellbeing (38.6%), followed by tiredness (35.0%), anxiety (32.4%), depression (30.0%), pain (26.3%), lack of appetite (23.5%), dyspnea (17.8%), drowsiness (8.0%) and nausea (6.1%). Palliative patients most frequently named decreased general wellbeing (62.8%), followed by pain (62.8%), tiredness (60.0%), lack of appetite (40.0%), anxiety (38.0%), depression (33.3%), dyspnea (28.5%), drowsiness (25.7%) and nausea (14.2%). At the end of RT, the proportion of curative and palliative patients with a clinically relevant symptom had increased significantly to 79.8 and 91.4%, respectively; whereas the proportion of patients reporting clinically relevant pain had decreased significantly (42.8 vs. 62.8%, respectively). Palliative patients had significantly increased tiredness. Curative patients reported significant increases in pain, tiredness, nausea, drowsiness, lack of appetite and restrictions in general wellbeing. Assessment of patient-reported symptoms was successfully realized in radiation oncology routine. Overall, both groups showed a high symptom burden. The results prove the need of systematic symptom assessment and programs for early integrated supportive and palliative care in radiation oncology.

Ventilation is unstable during drowsiness before sleep onset.

PubMed

Thomson, Stuart; Morrell, Mary J; Cordingley, Jeremy J; Semple, Stephen J

2005-11-01

Ventilation is unstable during drowsiness before sleep onset. We have studied the effects of transitory changes in cerebral state during drowsiness on breath duration and lung volume in eight healthy subjects in the absence of changes in airway resistance and fluctuations of ventilation and CO2 tension, characteristic of the onset of non-rapid eye movement sleep. A volume-cycled ventilator in the assist control mode was used to maintain CO2 tension close to that when awake. Changes in cerebral state were determined by the EEG on a breath-by-breath basis and classified as alpha or theta breaths. Breath duration and the pause in gas flow between the end of expiratory airflow and the next breath were computed for two alpha breaths which preceded a theta breath and for the theta breath itself. The group mean (SD) results for this alpha-to-theta transition was associated with a prolongation in breath duration from 5.2 (SD 1.3) to 13.0 s (SD 2.1) and expiratory pause from 0.7 (SD 0.4) to 7.5 s (SD 2.2). Because the changes in arterial CO2 tension (PaCO2) are unknown during the theta breaths, we made in two subjects a continuous record of PaCO2 in the radial artery. PaCO2 remained constant from the alpha breaths through to the expiratory period of the theta breath by which time the duration of breath was already prolonged, representing an immediate and altered ventilatory response to the prevailing PaCO2. In the eight subjects, the CO2 tension awake was 39.6 Torr (SD 2.3) and on assisted ventilation 38.0 Torr (1.4). We conclude that the ventilatory instability recorded in the present experiments is due to the apneic threshold for CO2 being at or just below that when awake.

Physiologic adaptation to space - Space adaptation syndrome

NASA Technical Reports Server (NTRS)

Vanderploeg, J. M.

1985-01-01

The adaptive changes of the neurovestibular system to microgravity, which result in space motion sickness (SMS), are studied. A list of symptoms, which range from vomiting to drowsiness, is provided. The two patterns of symptom development, rapid and gradual, and the duration of the symptoms are described. The concept of sensory conflict and rearrangements to explain SMS is being investigated.

State as Variable, as Obstacle and as Mediator of Stimulation in Infant Research.

ERIC Educational Resources Information Center

Korner, Anneliese F.

This paper is a discussion of the different contexts in which the concept of the infant's state is used in infant research. The infant states discussed are: regular sleep, irregular sleep, drowsiness, alert inactivity, waking activity, and crying. Also included are hunger periods and indeterminate states, those instances in which an infant's state…

A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach

PubMed Central

Mancini, Fabrizio; Gladi, Maurizio; Scerrati, Massimo

2018-01-01

A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure. PMID:29713348

Informational need of emotional stress

NASA Astrophysics Data System (ADS)

Simonov, P. V.; Frolov, M. V.

According to the informational theory of emotions[1], emotions in humans depend on the power of some need (motivation) and the estimation by the subject of the probability (possibility) of the need staisfaction (the goal achievement). Low probability of need satisfaction leads to negative emotions, actively minimized by the subject. Increased probability of satisfaction, as compared to earlier forecast, generates positive emotions, which the subject tries to maximize, i.e. to enhance, to prolong, to repeat. The informational theory of emotions encompasses their reflective function, the laws of their appearance, the regulatory significance of emotions, and their role in organization of behavior. The level of emotional stress influences the operator's performance. A decrease in the emotional tonus leads to drowsiness, lack of vigilance, missing of significant signals and to slower reactions. An extremely high stress level disorganizes the activity, complicates it with a trend toward incorrect actions and reactions to insignificant signals (false alarms). The neurophysiological mechanisms of the influence of emotions on perceptual activity and operator performance as well as the significance of individuality are discussed.

Acute fish liver intoxication induced blisters formation and generalized skin peeling.

PubMed

Chang, Chih-Hao; Lu, Chun-Wei; Chung, Wen-Hung; Ho, Hsin-Chun

2018-02-01

Acute fish liver intoxication, including hypervitaminosis A and hypervitaminosis D, may result from the ingestion of certain fish livers. The typical symptoms of hypervitaminosis A include nausea, headache, blurred vision, and cutaneous manifestations, such as flushing, vesicles formation, and desquamation. Hypervitaminosis D may result in hypercalcemia. We report a case of acute fish liver intoxication with systemic and cutaneous manifestations. A 63-year-old male presented to the clinic with generalized desquamation and multiple clear-fluid filled flaccid vesicles after eating approximately two fist-sized portions (about 300-400 g) of cooked seerfish (Scomberomorus spp.) liver. Laboratory examination showed a high serum level of vitamin A and D, and hypercalcemia. Fish liver consumption from particular fish may result in acute hypervitaminosis A and D. In patients with skin detachment or blister formation, headache, drowsiness, and other symptoms and signs consistent with hypervitaminosis A and/or hypercalcemia, a history of fish intake should be sought, and a serum level of vitamin A and D should be measured.

A Case of Nongerminomatous Germ Cell Tumor of the Pineal Region: Risks and Advantages of Biopsy by Endoscopic Approach.

PubMed

Dobran, Mauro; Nasi, Davide; Mancini, Fabrizio; Gladi, Maurizio; Scerrati, Massimo

2018-01-01

A 21-year-old male was admitted to our department with headache and drowsiness. CT scan and MRI revealed acute obstructive hydrocephalus caused by a pineal region mass. The serum and CSF levels of beta-human chorionic gonadotropin (beta-hCG) were 215 IU/L and 447 IU/L, respectively, while levels of alpha-fetoprotein (AFP) were normal. A germ cell tumor (GCT) was suspected, and the patient underwent endoscopic third ventriculostomy (ETV) with biopsy. After four days from surgery, the tumor bled with mass expansion and ETV stoma occlusion; thus, a ventriculoperitoneal shunt was positioned. After ten months, the tumor metastasized to the thorax and abdomen with progression of intracerebral tumor mass. Despite the aggressive nature of this tumor, ETV remains a valid approach for a pineal region mass, but in case of GCT, the risk of bleeding should be taken into account, during and after the surgical procedure.

A Study of Deep CNN-Based Classification of Open and Closed Eyes Using a Visible Light Camera Sensor.

PubMed

Kim, Ki Wan; Hong, Hyung Gil; Nam, Gi Pyo; Park, Kang Ryoung

2017-06-30

The necessity for the classification of open and closed eyes is increasing in various fields, including analysis of eye fatigue in 3D TVs, analysis of the psychological states of test subjects, and eye status tracking-based driver drowsiness detection. Previous studies have used various methods to distinguish between open and closed eyes, such as classifiers based on the features obtained from image binarization, edge operators, or texture analysis. However, when it comes to eye images with different lighting conditions and resolutions, it can be difficult to find an optimal threshold for image binarization or optimal filters for edge and texture extraction. In order to address this issue, we propose a method to classify open and closed eye images with different conditions, acquired by a visible light camera, using a deep residual convolutional neural network. After conducting performance analysis on both self-collected and open databases, we have determined that the classification accuracy of the proposed method is superior to that of existing methods.

Symptom recovery after thoracic surgery: Measuring patient-reported outcomes with the MD Anderson Symptom Inventory.

PubMed

Fagundes, Christopher P; Shi, Qiuling; Vaporciyan, Ara A; Rice, David C; Popat, Keyuri U; Cleeland, Charles S; Wang, Xin Shelley

2015-09-01

Measuring patient-reported outcomes (PROs) has become increasingly important for assessing quality of care and guiding patient management. However, PROs have yet to be integrated with traditional clinical outcomes (such as length of hospital stay), to evaluate perioperative care. This study aimed to use longitudinal PRO assessments to define the postoperative symptom recovery trajectory in patients undergoing thoracic surgery for lung cancer. Newly diagnosed patients (N = 60) with stage I or II non-small cell lung cancer who underwent either standard open thoracotomy or video-assisted thoracoscopic surgery lobectomy reported multiple symptoms from before surgery to 3 months after surgery, using the MD Anderson Symptom Inventory. We conducted Kaplan-Meier analyses to determine when symptoms returned to presurgical levels and to mild-severity levels during recovery. The most-severe postoperative symptoms were fatigue, pain, shortness of breath, disturbed sleep, and drowsiness. The median time to return to mild symptom severity for these 5 symptoms was shorter than the time to return to baseline severity, with fatigue taking longer. Recovery from pain occurred more quickly for patients who underwent lobectomy versus thoracotomy (8 vs 18 days, respectively; P = .022). Patients who had poor preoperative performance status or comorbidities reported higher postoperative pain (all P < .05). Assessing symptoms from the patient's perspective throughout the postoperative recovery period is an effective strategy for evaluating perioperative care. This study demonstrates that the MD Anderson Symptom Inventory is a sensitive tool for detecting symptomatic recovery, with an expected relationship among surgery type, preoperative performance status, and comorbid conditions. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Grave's disease with transverse and sigmoid sinus thrombosis needing surgical intervention.

PubMed

Srikant, Banumathy; Balasubramaniam, Srikant

2013-07-01

Thrombosis of venous sinuses associated with thyrotoxicosis is rare, and isolated transverse and sigmoid sinus thrombosis is rarer and reported only once previously. We present a case of Graves disease, who suffered unilateral sigmoid and transverse sinus thrombosis with intracranial hemorrhage. A 42-year-old female, a diagnosed case of Graves disease, presented to us with headache, drowsiness, and hemiparesis. Computed Tomography revealed a large right temporo-parieto-occipital venous infarct. The patient needed surgical intervention in the form of decompressive craniotomy following which she improved, and on follow-up is having no deficits. Thrombophilia profile showed a low Protein S and Anti thrombin III (AT III) levels. Deranged thrombophilia profile in combination with the hypercoagulable state in thyrotoxicosis, most likely precipitated the thrombotic event. Timely surgical intervention can be offered in selective cases with a good clinical outcome.

A New Perspective on Neonatal Smiling: Differences between the Judgments of Expert Coders and Naive Observers

ERIC Educational Resources Information Center

Dondi, Marco; Messinger, Daniel; Colle, Marta; Tabasso, Alessia; Simion, Francesca; Barba, Beatrice Dalla; Fogel, Alan

2007-01-01

To better understand the form and recognizability of neonatal smiling, 32 newborns (14 girls; M = 25.6 hr) were videorecorded in the behavioral states of alertness, drowsiness, active sleep, and quiet sleep. Baby Facial Action Coding System coding of both lip corner raising (simple or non-Duchenne) and lip corner raising with cheek raising…

An Evaluation of the Frequency and Severity of Motion Sickness Incidences in Personnel Within the Command and Control Vehicle (C2V)

NASA Technical Reports Server (NTRS)

Cowings, Patricia S.; Toscano, William B.; DeRoshia, Charles

1998-01-01

The purpose of this study was to assess the frequency and severity of motion sickness in personnel during a field exercise in the Command and Control Vehicle (C2V). This vehicle contains four workstations where military personnel are expected to perform command decisions in the field during combat conditions. Eight active duty military men (U.S. Army) at the Yuma Proving Grounds in Arizona participated in this study. All subjects were given baseline performance tests while their physiological responses were monitored on the first day. On the second day of their participation, subjects rode in the C2V while their physiological responses and performance measures were recorded. Self-reports of motion sickness were also recorded. Results showed that only one subject experienced two incidences of emesis. However, seven out of the eight subjects reported other motion sickness symptoms; most predominant was the report of drowsiness, which occurred a total of 19 times. Changes in physiological responses were observed relative to motion sickness symptoms reported and the different environmental conditions (i.e., level, hills, gravel) during the field exercise. Performance data showed an overall decrement during the C2V exercise. These findings suggest that malaise and severe drowsiness can potentially impact the operational efficiency of the C2V crew. It was concluded that conflicting sensory information from the subject's visual displays and movements of the vehicle during the field exercise significantly contributed to motion sickness symptoms. It was recommended that a second study be conducted to further evaluate the impact of seat position or orientation and C2V experience on motion sickness susceptibility. Further, it was recommended that an investigation be performed on behavioral methods for improving crew alertness, motivation, and performance and for reducing malaise.

Review of Fatigue Management Technologies for Enhanced Military Vehicle Safety and Performance

DTIC Science & Technology

2013-09-01

Tung University, Taiwan), Quasar DSI 10/20 ( Quantum Science and Applied Research, Inc.; San Diego, CA), and the B-Alert systems (Advanced Brain...apnea; Drowsiness; Deception; Emotional response; Fall; Heart rate; Muscle tension; Motility; Relaxation; Sleep stages; Stales of consciousness ...Quasar EEG Dry Sensor Interface 10120 (05110120) Quantum Applied Science and Research Inc. (Quasar USA) \\YMv.quasarusa.com Readiband"’ Fatigue

The Analgesic Efficacy of Nonsteroidal Anti-inflammatory Agents (NSAIDs) in Patients Undergoing Cesarean Deliveries: A Meta-Analysis.

PubMed

Zeng, Angela M; Nami, Nina F; Wu, Christopher L; Murphy, Jamie D

Postoperative pain after cesarean delivery, which accounts for approximately 1 in 3 live births in the United States, can be severe in many patients. Nonsteroidal anti-inflammatory agents (NSAIDs) are potent analgesics that are effective in the treatment of postoperative pain. In this meta-analysis, we assessed the analgesic efficacy of NSAIDs in postoperative cesarean delivery patients. An electronic literature search of the Library of Medicine's PubMed, Cochrane CENTRAL, Scopus, and EMBASE databases was conducted in May 2013 and updated in January 2015 (Appendix, Supplemental Digital Content 1, http://links.lww.com/AAP/A174). Searches were limited to randomized controlled trials. The primary outcome variable was visual analog scale or numerical rating scale pain scores. Secondary outcomes included cumulative postoperative opioid consumption and opioid-related adverse effects (drowsiness/sedation, nausea, and vomiting). Data extraction was performed independently by 2 reviewers. Extracted data were input into Review Manager. Twenty-two randomized controlled trials compared a NSAID (n = 639) to a control (n = 674). Patients in the NSAID group versus control reported lower pain scores at 12 hours (P = 0.003) and at 24 hours (P < 0.001). Subgroup analysis showed a significant difference in pain scores at 24 hours, with patients receiving NSAIDs via intravenous/intramuscular (P < 0.001) route, but not the oral (P = 0.39) or rectal routes (P = 0.99). Significantly lower average pain scores were reported for pain with movement at 24 hours in the NSAID group (P = 0.001). Patients in the NSAID group versus controls consumed significantly less opioids (P < 0.001) and had significantly less drowsiness/sedation (P = 0.03), but there was no significant difference between the groups with regard to nausea or vomiting (P = 0.48 and P = 0.17, respectively). The perioperative use of NSAIDs in cesarean delivery patients will result in a significantly lower pain scores, less opioid consumption, and less drowsiness/sedation but no difference in nausea or vomiting compared to those who did not receive NSAIDs. Further research should address the optimal NSAID regimen and examine the effect of improved analgesia on patient-centered outcomes such as patient satisfaction and quality of breastfeeding.

Delirium diagnosis methodology used in research: a survey-based study.

PubMed

Neufeld, Karin J; Nelliot, Archana; Inouye, Sharon K; Ely, E Wesley; Bienvenu, O Joseph; Lee, Hochang Benjamin; Needham, Dale M

2014-12-01

To describe methodology used to diagnose delirium in research studies evaluating delirium detection tools. The authors used a survey to address reference rater methodology for delirium diagnosis, including rater characteristics, sources of patient information, and diagnostic process, completed via web or telephone interview according to respondent preference. Participants were authors of 39 studies included in three recent systematic reviews of delirium detection instruments in hospitalized patients. Authors from 85% (N = 33) of the 39 eligible studies responded to the survey. The median number of raters per study was 2.5 (interquartile range: 2-3); 79% were physicians. The raters' median duration of clinical experience with delirium diagnosis was 7 years (interquartile range: 4-10), with 5% having no prior clinical experience. Inter-rater reliability was evaluated in 70% of studies. Cognitive tests and delirium detection tools were used in the delirium reference rating process in 61% (N = 21) and 45% (N = 15) of studies, respectively, with 33% (N = 11) using both and 27% (N = 9) using neither. When patients were too drowsy or declined to participate in delirium evaluation, 70% of studies (N = 23) used all available information for delirium diagnosis, whereas 15% excluded such patients. Significant variability exists in reference standard methods for delirium diagnosis in published research. Increasing standardization by documenting inter-rater reliability, using standardized cognitive and delirium detection tools, incorporating diagnostic expert consensus panels, and using all available information in patients declining or unable to participate with formal testing may help advance delirium research by increasing consistency of case detection and improving generalizability of research results. Copyright © 2014 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Homeostasis in Primates in the Hyperdynamic Environment. [circadian timekeeping and effects of lower body positive pressure on sleep

NASA Technical Reports Server (NTRS)

Fuller, C. A.

1985-01-01

The influence of chronic centrifugation upon the homestatic regulation of the circadian timekeeping system was examined. The interactions of body temperature regulation and the behavioral state of arousal were studied by evaluating the influence of cephalic fluid shifts induced by lower body positive air pressure (LBPP), upon these systems. The small diurnal squirrel monkey (Saimiri sciureus) was used as the non-human primate model. Results show that the circadian timekeeping system of these primates is functional in the hyperdynamic environment, however, some of its components appear to be regulated at different homeostatic levels. The LBPP resulted in an approximate 0.7 C decrease in DBT (p 0.01). However, although on video some animals appeared drowsy during LBPP, sleep recording revealed no significant changes in state of arousal. Thus, the physiological mechanisms underlying this lowering of body temperature can be independent of the arousal state.

The NHTSA & NCSDR program to combat drowsy driving : a report to the House and Senate Appropriations Committees describing collaboration between National Highway Traffic Safety Administration and National Center on Sleep Disorders Research, National Heart, Lung and Blood Institute, National Institutes of Health

DOT National Transportation Integrated Search

1999-03-15

In 1996, the National Highway Traffic Safety Administration (NHTSA) embarked on a congressionally mandated effort to develop educational countermeasures to the effects of fatigue, sleep disorders, and inattention on highway safety. In collaboration w...

The Effect of Mild Motion Sickness and Sopite Syndrome on Multitasking Cognitive Performance

DTIC Science & Technology

2013-03-01

Ledin, & Falkmer, 2009), in command and control tasks ( Cowings , Toscano, DeRoshia, & Tauson, 2001), or in visual search (Golding & Kerguelen, 1992...common and frequent. Research has shown that drowsiness is among the most frequent symptoms associated with motion sickness ( Cowings et al., 2001...sickness ( Cowings , Naifeh, & Toscano, 1990; J. C. Miller, Sharkey, Graham, & McCauley, 1993). The following paragraphs will focus on the

Brain Dynamics in Predicting Driving Fatigue Using a Recurrent Self-Evolving Fuzzy Neural Network.

PubMed

Liu, Yu-Ting; Lin, Yang-Yin; Wu, Shang-Lin; Chuang, Chun-Hsiang; Lin, Chin-Teng

2016-02-01

This paper proposes a generalized prediction system called a recurrent self-evolving fuzzy neural network (RSEFNN) that employs an on-line gradient descent learning rule to address the electroencephalography (EEG) regression problem in brain dynamics for driving fatigue. The cognitive states of drivers significantly affect driving safety; in particular, fatigue driving, or drowsy driving, endangers both the individual and the public. For this reason, the development of brain-computer interfaces (BCIs) that can identify drowsy driving states is a crucial and urgent topic of study. Many EEG-based BCIs have been developed as artificial auxiliary systems for use in various practical applications because of the benefits of measuring EEG signals. In the literature, the efficacy of EEG-based BCIs in recognition tasks has been limited by low resolutions. The system proposed in this paper represents the first attempt to use the recurrent fuzzy neural network (RFNN) architecture to increase adaptability in realistic EEG applications to overcome this bottleneck. This paper further analyzes brain dynamics in a simulated car driving task in a virtual-reality environment. The proposed RSEFNN model is evaluated using the generalized cross-subject approach, and the results indicate that the RSEFNN is superior to competing models regardless of the use of recurrent or nonrecurrent structures.

Massive naproxen overdose with serial serum levels.

PubMed

Al-Abri, Suad A; Anderson, Ilene B; Pedram, Fatehi; Colby, Jennifer M; Olson, Kent R

2015-03-01

Massive naproxen overdose is not commonly reported. Severe metabolic acidosis and seizure have been described, but the use of renal replacement therapy has not been studied in the context of overdose. A 28-year-old man ingested 70 g of naproxen along with an unknown amount of alcohol in a suicidal attempt. On examination in the emergency department 90 min later, he was drowsy but had normal vital signs apart from sinus tachycardia. Serum naproxen level 90 min after ingestion was 1,580 mg/L (therapeutic range 25-75 mg/L). He developed metabolic acidosis requiring renal replacement therapy using sustained low efficiency dialysis (SLED) and continuous venovenous hemofiltration (CVVH) and had recurrent seizure activity requiring intubation within 4 h from ingestion. He recovered after 48 h. Massive naproxen overdose can present with serious toxicity including seizures, altered mental status, and metabolic acidosis. Hemodialysis and renal replacement therapy may correct the acid base disturbance and provide support in cases of renal impairment in context of naproxen overdose, but further studies are needed to determine the extraction of naproxen.

A multicentre study of vigabarin for drug-resistant epilepsy

PubMed Central

Browne, T. R.; Mattson, R. H.; Penry, J. K.; Smith, D. B.; Treiman, D. M.; Wilder, B. J.; Ben-Menachem, E.; Miketta, R. M.; Sherry, K. M.; Szabo, G. K.

1989-01-01

1 Vigabatrin (GVG) was given in a single-blind fashion to 89 patients with complex partial seizures (CPS) refractory to conventional drugs. 2 The median number of CPS per month decreased from 11.0 to 5.0 after addition of GVG, and 51% of patients had a 50% or greater decrease in CPS frequency (P < 0.001). 3 Side effects (principally drowsiness, ataxia, headache) occurred mainly during the initiation of therapy and decreased during therapy. After 12 weeks on GVG side effects significantly interfered with functioning in only 13% of patients, and the efficacy: toxicity ratio warranted continued administration in 74% of patients. 4 Co-administration of GVG resulted in a mean decrease of 20% in phenytoin serum concentration (P < 0.001). 5 Sixty-six patients having a favourable response to GVG during the single-blind study have been followed for 6-54 (median 33) months on GVG. Only 17 patients have dropped out of long-term follow-up due to break through seizures and/or side effects. No serious systemic or neurological toxicity has been detected. PMID:2667606

A Study of Deep CNN-Based Classification of Open and Closed Eyes Using a Visible Light Camera Sensor

PubMed Central

Kim, Ki Wan; Hong, Hyung Gil; Nam, Gi Pyo; Park, Kang Ryoung

2017-01-01

The necessity for the classification of open and closed eyes is increasing in various fields, including analysis of eye fatigue in 3D TVs, analysis of the psychological states of test subjects, and eye status tracking-based driver drowsiness detection. Previous studies have used various methods to distinguish between open and closed eyes, such as classifiers based on the features obtained from image binarization, edge operators, or texture analysis. However, when it comes to eye images with different lighting conditions and resolutions, it can be difficult to find an optimal threshold for image binarization or optimal filters for edge and texture extraction. In order to address this issue, we propose a method to classify open and closed eye images with different conditions, acquired by a visible light camera, using a deep residual convolutional neural network. After conducting performance analysis on both self-collected and open databases, we have determined that the classification accuracy of the proposed method is superior to that of existing methods. PMID:28665361

Characterization of "Yaa Chud" Medicine on the Thailand-Myanmar border: selecting for drug-resistant malaria and threatening public health.

PubMed

Newton, Paul N; Hampton, Christina Y; Alter-Hall, Krystyn; Teerwarakulpana, Thanongsak; Prakongpan, Sompol; Ruangveerayuth, Ronnatrai; White, Nicholas J; Day, Nicholas P J; Tudino, Mabel B; Mancuso, Natalia; Fernández, Facundo M

2008-11-01

Multidrug-resistant Plasmodium falciparum malaria is a severe public health problem on the Thailand-Myanmar border. Many villagers buy packets of 4-5 mixed medicines ("yaa chud") from shops without medical assessment as their first-line malaria treatment. In 2000-2001 a local researcher purchased 50 yaa chud from 44 shops around Mae Sot, Thailand and Myawaddy, Myanmar (Burma), for his wife who was said to be pregnant with fever and drowsiness. The tablets/capsules were provisionally identified by appearance and active ingredients determined in a subset by using mass and atomic spectrometry. The most frequently detected active ingredients were acetaminophen (22%), chlorpheniramine (13.4%), chloroquine (12.6%), tetracycline/doxycycline (11.4%), and quinine (5.1%). Only seven bags contained potentially curative medicine for malaria. A total of 82% of the bags contained medicines contraindicated in pregnancy. Inappropriate, ineffective antimalarial drugs on the Thailand-Myanmar border are likely to increase malaria morbidity, mortality and health costs and engender the emergence and spread of antimalarial drug resistance.

Quadriplegia caused by an epidural abscess occurring at the same level of cervical destructive spondyloarthropathy: a case report.

PubMed

Lee, Jun-Seok; Ryu, Ji-Hyun; Park, Jong-Tae; Kim, Ki-Won

2017-01-10

Destructive spondyloarthropathy (DSA) is one of the major complications in patients undergoing long-term hemodialysis. To the best of our knowledge, an epidural abscess occurring at the level of preexisting cervical DSA has not been well described in the literature. We report a unique case of quadriplegia caused by an epidural abscess occurring at the same level of preexisting cervical DSA. A 49-year-old woman was transferred to our emergency department with 5 days of sepsis, drowsy mental status, and quadriplegia below the C5 level. The patient had a medical history of hemodialysis for 10 years. Magnetic resonance imaging showed spinal cord compression by an epidural abscess at the level of preexisting cervical DSA. Blood culture revealed methicillin-sensitive Staphylococcus aureus. Infection of the arteriovenous (AV) shunt was considered as the primary focus of sepsis and pyogenic spondylitis. We performed an emergent open door laminoplasty and the vascular team debrided the infected AV shunt site. Approximately 8 months after surgery, the patient was able to perform activities of daily living somewhat independently. Emergent surgical decompression and intensive medical care led to successful recovery from a septic and quadriplegic state in this patient. When diagnosing a patient who has undergone long-term hemodialysis presenting with neurologic deficits, the possibility of infectious spondylitis at the same level as DSA should be considered.

Developing an EEG-based on-line closed-loop lapse detection and mitigation system

PubMed Central

Wang, Yu-Te; Huang, Kuan-Chih; Wei, Chun-Shu; Huang, Teng-Yi; Ko, Li-Wei; Lin, Chin-Teng; Cheng, Chung-Kuan; Jung, Tzyy-Ping

2014-01-01

In America, 60% of adults reported that they have driven a motor vehicle while feeling drowsy, and at least 15–20% of fatal car accidents are fatigue-related. This study translates previous laboratory-oriented neurophysiological research to design, develop, and test an On-line Closed-loop Lapse Detection and Mitigation (OCLDM) System featuring a mobile wireless dry-sensor EEG headgear and a cell-phone based real-time EEG processing platform. Eleven subjects participated in an event-related lane-keeping task, in which they were instructed to manipulate a randomly deviated, fixed-speed cruising car on a 4-lane highway. This was simulated in a 1st person view with an 8-screen and 8-projector immersive virtual-reality environment. When the subjects experienced lapses or failed to respond to events during the experiment, auditory warning was delivered to rectify the performance decrements. However, the arousing auditory signals were not always effective. The EEG spectra exhibited statistically significant differences between effective and ineffective arousing signals, suggesting that EEG spectra could be used as a countermeasure of the efficacy of arousing signals. In this on-line pilot study, the proposed OCLDM System was able to continuously detect EEG signatures of fatigue, deliver arousing warning to subjects suffering momentary cognitive lapses, and assess the efficacy of the warning in near real-time to rectify cognitive lapses. The on-line testing results of the OCLDM System validated the efficacy of the arousing signals in improving subjects' response times to the subsequent lane-departure events. This study may lead to a practical on-line lapse detection and mitigation system in real-world environments. PMID:25352773

Mobile Healthcare for Automatic Driving Sleep-Onset Detection Using Wavelet-Based EEG and Respiration Signals

PubMed Central

Lee, Boon-Giin; Lee, Boon-Leng; Chung, Wan-Young

2014-01-01

Driving drowsiness is a major cause of traffic accidents worldwide and has drawn the attention of researchers in recent decades. This paper presents an application for in-vehicle non-intrusive mobile-device-based automatic detection of driver sleep-onset in real time. The proposed application classifies the driving mental fatigue condition by analyzing the electroencephalogram (EEG) and respiration signals of a driver in the time and frequency domains. Our concept is heavily reliant on mobile technology, particularly remote physiological monitoring using Bluetooth. Respiratory events are gathered, and eight-channel EEG readings are captured from the frontal, central, and parietal (Fpz-Cz, Pz-Oz) regions. EEGs are preprocessed with a Butterworth bandpass filter, and features are subsequently extracted from the filtered EEG signals by employing the wavelet-packet-transform (WPT) method to categorize the signals into four frequency bands: α, β, θ, and δ. A mutual information (MI) technique selects the most descriptive features for further classification. The reduction in the number of prominent features improves the sleep-onset classification speed in the support vector machine (SVM) and results in a high sleep-onset recognition rate. Test results reveal that the combined use of the EEG and respiration signals results in 98.6% recognition accuracy. Our proposed application explores the possibility of processing long-term multi-channel signals. PMID:25264954

Evaluation of blue light exposure to beta brainwaves on simulated night driving

NASA Astrophysics Data System (ADS)

Purawijaya, Dandri Aly; Fitri, Lulu Lusianti; Suprijanto

2015-09-01

Numbers of night driving accident in Indonesia since 2010 are exponentially rising each year with total of loss more than 50 billion rupiah. One of the causes that contribute to night driving accident is drowsiness. Drowsiness is affected by circadian rhythm resulted from the difference of blue light quality and quantity between night and day. Blue light may effect on human physiology through non-visual pathway by suppressing melatonin hormone suppression that influence drowsiness. Meanwhile, the production of hormones and other activities in brain generate bioelectrical activity such as brainwaves and can be recorded using Electroencephalograph (EEG). Therefore, this research objective is to evaluate the effect of blue light exposure to beta brainwave emergence during night driving simulation to a driver. This research was conducted to 4 male subjects who are able to drive and have a legitimate car driving license. The driving simulator was done using SCANIA Truck Driving Simulator on freeform driving mode in dark environment. Subjects drove for total 32 minutes. The data collections were taken in 2 days with 16 minutes for each day. The 16 minutes were divided again into 8 minutes adaptation in dark and 8 minutes for driving either in blue light exposure or in total darkness. While driving the simulation, subjects' brainwaves were recorded using EEG EMOTIV 14 Channels, exposed by LED monochromatic blue light with 160 Lux from source and angle 45o and sat 1 m in front of the screen. Channels used on this research were for visual (O1; O2), cognition (F3; F4; P7; P8), and motor (FC5; FC6). EEG brainwave result was filtered with EEGLab to obtain beta waves at 13 - 30 Hz frequencies. Results showed that beta waves response to blue light varied for each subject. Blue light exposure either increased or decreased beta waves in 2 minutes pattern and maintaining beta waves on cognition and motor area in 3 out of 4 subjects. Meanwhile, blue light exposure did not maintain and induce beta waves fluctuation on visual area of another 2 subjects. The conclusion of this research is that blue light exposure affected the pattern of beta waves on frontal, parietal, premotor cortex and visual lobes.

Human Factors Research Under Ground-Based and Space Conditions. Part 2

NASA Technical Reports Server (NTRS)

1997-01-01

In this session, Session WP2, the discussion focuses on the following topics: Training Astronauts Using Three-Dimensional Visualizations of the International Space Station; Measurement and Validation of Bidirectional Reflectance of Shuttle and Space Station Materials for Computerized Lighting Models; Effects of Environmental Color on Mood and Performance of Astronauts in ISS; Psychophysical Measures of Motion and Orientation, Implications for Human Interface Design; and the Sopite Syndrome Revisited, Drowsiness and Mood Changes in Student Aviators.

Operational Risk Management of Fatigue Effects II

DTIC Science & Technology

2008-08-01

to their low point in the pre-dawn hours. Additionally, the state of wakefulness, itself, unavoidably induces the state of sleepiness. If sleep...malaise 5b. Reduced aerobic capacity 5c. Drowsiness 5d. Sleep debt and need for recovery sleep 5e. Falling asleep on the job 5f. Dizziness 5g ...rhythm in metabolic rate and body temperature. This rhythm reaches its low point at about 04:00 in a person without jet lag or shift lag. 8

GHB: Forensic examination of a dangerous recreational drug by FTIR spectroscopy

NASA Astrophysics Data System (ADS)

Kindig, J. P.; Ellis, L. E.; Brueggemeyer, T. W.; Satzger, R. D.

1998-06-01

Gamma-hydroxybutyric acid (GHB) is an illegal drug that has been abused for its intoxicating effects. However, GHB can also produce harmful physiological effects ranging from mild (nausea, drowsiness) to severe (coma, death). Because GHB is often produced by clandestine manufacture, its concentration, purity, and final form can be variable. Therefore, the analysis of suspected GHB samples using FTIR spectroscopy requires a variety of sample preparations and accessories, based on the sample matrix.

Profound bradycardia associated with NIV removal.

PubMed

Echevarria, C; Bourke, S C; Gibson, G J

2012-01-01

A patient with lower-limb onset ALS presented with a one-month history of vasovagal episodes and a one-week history of cough productive of green sputum and lethargy. She was drowsy and in acute on chronic type-two respiratory failure. She responded to non-invasive ventilation, however she suffered recurrent episodes of profound bradycardia on removal of the mask, which gradually resolved over ten days. We have reviewed the literature and offer a potential explanation for these events.

Risk factors for automobile accidents caused by falling asleep while driving in obstructive sleep apnea syndrome.

PubMed

Arita, Aki; Sasanabe, Ryujiro; Hasegawa, Rika; Nomura, Atsuhiko; Hori, Reiko; Mano, Mamiko; Konishi, Noriyuki; Shiomi, Toshiaki

2015-12-01

We examined the risk factors for automobile accidents caused by falling asleep while driving in subjects with obstructive sleep apnea syndrome (OSAS). We asked licensed drivers with history of snoring and excessive daytime sleepiness who had undergone polysomnography (PSG) at the Department of Sleep Medicine/Sleep Disorders Center at Aichi Medical University Hospital to complete the questionnaires on accidents caused by falling asleep while driving. As a subjective measure of sleepiness, we used the Epworth sleepiness scale (ESS). Based on PSG results, 2387 subjects diagnosed with OSAS were divided into three groups according to apnea-hypopnea index (AHI): mild-to-moderate (5 ≤ AHI < 30), severe (30 ≤ AHI < 60), and very severe (AHI ≥ 60). We performed univariate and multivariate logistic regression on variables that might explain falling asleep at the wheel. We compared results between each group and simple snorers (394 subjects with AHI < 5) and found the group with very severe OSAS reported significantly higher rates of driving when drowsy and having accidents in the past 5 years due to falling asleep. Our multivariate analysis suggests that scores on the ESS and patient-reported frequency of feeling drowsy while regular driving and working are related to automobile accidents caused by falling asleep while driving.

Safety of Acupuncture Practice in Japan: Patient Reactions, Therapist Negligence and Error Reduction Strategies

PubMed Central

Tsukayama, Hiroshi

2008-01-01

Evidence-based approach on the safety of acupuncture had been lagging behind both in the West and the East, but reliable data based on some prospective surveys were published after the late 1990s. In the present article, we, focusing on ‘Japanese acupuncture’, review relevant case reports and prospective surveys on adverse events in Japan, assess the safety of acupuncture practice in this country, and suggest a strategy for reducing the therapists’ error. Based on the prospective surveys, it seems reasonable to suppose that serious adverse events are rare in standard practice by adequately trained acupuncturists, regardless of countries or modes of practice. Almost all of adverse reactions commonly seen in acupuncture practice—such as fatigue, drowsiness, aggravation, minor bleeding, pain on insertion and subcutaneous hemorrhage—are mild and transient, although we should be cautious of secondary injury following drowsiness and needle fainting. After demonstrating that acupuncture is inherently safe, we have been focusing on how to reduce the risk of negligence in Japan, as well as educating acupuncturists more about safe depth of insertion and infection control. Incident reporting and feedback system is a useful strategy for reducing therapist errors such as forgotten needles. For the benefit of acupuncture patients in Japan, it is important to establish mandatory postgraduate clinical training and continued education system. PMID:18955234

Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting.

PubMed

Wodlin, Ninnie Borendal; Nilsson, Lena; Arestedt, Kristofer; Kjølhede, Preben

2011-04-01

To determine whether postoperative symptoms differ between women who undergo abdominal benign hysterectomy in a fast-track model under general anesthesia or spinal anesthesia with intrathecal morphine. Secondary analysis from a randomized, open, multicenter study. Five hospitals in south-east Sweden. One-hundred and eighty women scheduled for benign hysterectomy were randomized; 162 completed the study; 82 were allocated to spinal and 80 to general anesthesia. The Swedish Postoperative Symptoms Questionnaire, completed daily for 1 week and thereafter once a week until 5 weeks postoperatively. Occurrence, intensity and duration of postoperative symptoms. Women who had hysterectomy under spinal anesthesia with intrathecal morphine experienced significantly less discomfort postoperatively compared with those who had the operation under general anesthesia. Spinal anesthesia reduced the need for opioids postoperatively. The most common symptoms were pain, nausea and vomiting, itching, drowsiness and fatigue. Abdominal pain, drowsiness and fatigue occurred significantly less often and with lower intensity among the spinal anesthesia group. Although postoperative nausea and vomiting was reported equally in the two groups, vomiting episodes were reported significantly more often during the first day after surgery in the spinal anesthesia group. Spinal anesthesia was associated with a higher prevalence of postoperative itching. Spinal anesthesia with intrathecal morphine carries advantages regarding postoperative symptoms and recovery following fast-track abdominal hysterectomy. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

Can arousing feedback rectify lapses in driving? Prediction from EEG power spectra.

PubMed

Lin, Chin-Teng; Huang, Kuan-Chih; Chuang, Chun-Hsiang; Ko, Li-Wei; Jung, Tzyy-Ping

2013-10-01

This study explores the neurophysiological changes, measured using an electroencephalogram (EEG), in response to an arousing warning signal delivered to drowsy drivers, and predicts the efficacy of the feedback based on changes in the EEG. Eleven healthy subjects participated in sustained-attention driving experiments. The driving task required participants to maintain their cruising position and compensate for randomly induced lane deviations using the steering wheel, while their EEG and driving performance were continuously monitored. The arousing warning signal was delivered to participants who experienced momentary behavioral lapses, failing to respond rapidly to lane-departure events (specifically the reaction time exceeded three times the alert reaction time). The results of our previous studies revealed that arousing feedback immediately reversed deteriorating driving performance, which was accompanied by concurrent EEG theta- and alpha-power suppression in the bilateral occipital areas. This study further proposes a feedback efficacy assessment system to accurately estimate the efficacy of arousing warning signals delivered to drowsy participants by monitoring the changes in their EEG power spectra immediately thereafter. The classification accuracy was up 77.8% for determining the need for triggering additional warning signals. The findings of this study, in conjunction with previous studies on EEG correlates of behavioral lapses, might lead to a practical closed-loop system to predict, monitor and rectify behavioral lapses of human operators in attention-critical settings.

SLEEP COMPLAINTS IN COMMUNITY-LIVING OLDER PERSONS: A MULTIFACTORIAL GERIATRIC SYNDROME

PubMed Central

Vaz Fragoso, Carlos A.; Gill, Thomas M.

2009-01-01

Among older persons, sleep complaints in the form of insomnia and daytime drowsiness are highly prevalent and associated with adverse outcomes. The underlying mechanisms are linked to age-related declines in physiology, i.e., normal aging, and age-related increases in disease prevalence, i.e., usual aging. In this monograph, we describe how normal aging leads to less restorative sleep, characterized by reductions in homeostatic and circadian sleep, and to phase advancement of the sleep-wake cycle, characterized by older persons being more alert in the early morning but drowsier in the early evening. We also describe how usual aging leads to sleep complaints through reductions in health status, loss of physical function, and primary sleep disorders. Psychosocial influences are likewise described and their relevance to sleep complaints is discussed. We subsequently incorporate these aging-related changes into a conceptual model that describes sleep complaints as a consequence of multiple and interdependent predisposing, precipitating, and perpetuating factors, akin to a geriatric syndrome. We conclude our discussion by applying our conceptual model to the sleep-related care of an older person with insomnia and daytime drowsiness, and suggest that the diagnostic assessment consider, in addition to primary sleep disorders, multiple domains including medical, physical, cognitive, psychological, and social issues with the intent of developing an overall therapeutic plan and establishing long-term follow-up. PMID:17916123

Characterization of edible marijuana product exposures reported to United States poison centers.

PubMed

Cao, Dazhe; Srisuma, Sahaphume; Bronstein, Alvin C; Hoyte, Christopher O

2016-11-01

Edible marijuana products are sold as brownies, cookies, and candies, which may be indistinguishable from counterparts without marijuana and are palatable to children and adults. The consumption of an entire product containing multiple dose-units may result in overdose. To characterize edible marijuana exposures reported to US poison centers with subgroup analysis by age. We analyzed single substance, human exposure calls coded to marijuana brownies, candies, cookies, beverages, or other foods reported to the National Poison Data System from January 2013 to December 2015. Calls were analyzed by state, age, gender, exposure route, clinical effect, therapies, and level of healthcare facility utilization. Four-hundred and thirty calls were reported: Colorado (N = 166, 1.05/100,000 population/year) and Washington (96, 0.46) yielded the highest number of exposures. Three hundred and eighty-one (91%) calls occurred in states with decriminalized medical/recreational marijuana. The number of calls increased every year of the study. The most common age groups were: ≤5 years (N = 109, 0.15/100,000 population/year) and 13-19 (78, 0.09). The most frequent clinical effects were drowsiness/lethargy (N = 118, percentage = 43%), tachycardia (84, 31%), agitated/irritable (37, 14%), and confusion (37, 14%). Children ≤5 years have more drowsiness/lethargy, ataxia, and red eye/conjunctivitis. No deaths were reported. The most common therapies administered were intravenous fluids (85, 20%), dilute/irrigate/wash (48, 11 %), and benzodiazepines (47, 11%). Three patients (ages 4, 10, and 57 years) received intubation. 97 (23%), 217 (50%), and 12 (3%) calls were managed at home, treated/released, admitted to a critical care unit, respectively. Although most clinical effects are minor, ventilatory support may be necessary for children and adults. We speculate the increasing exposures may be related to a combination of delayed absorption kinetics of Δ9-tetrahydrocannablnol, lagging packaging regulations, increased accessibility in decriminalized states, and increased familiarity of poison center specialists with edible product codes. Edible marijuana exposures are increasing and may lead to severe respiratory depression.

Monitoring of Crew Activity with FAMOS

NASA Astrophysics Data System (ADS)

Wolf, L.; Cajochen, C.; Bromundt, V.

2007-10-01

The success of long duration space missions, such as manned missions to Mars, depends on high and sustained levels of vigilance and performance of astronauts and operators working in the technology rich environment of a spacecraft. Experiment 'Monitoring of Crew Activity with FAMOS' was set up to obtain operational experience with complimentary methods / technologies to assess the alertness / sleepiness status of selected AustroMars crewmembers on a daily basis. We applied a neurobehavioral test battery consisting of 1) Karolinska Sleepiness Scale KSS, 2) Karolinska Drowsiness Test KDT, 3) Psychomotor Vigilance Task PVT, combined with 4) left eye video recordings with an early prototype of the FAMOS Fatigue Monitoring System headset currently being developed by Sowoon Technologies (CH), and 5) Actiwatches that were worn continuously. A test battery required approximately 15 minutes and was repeated up to 4 times daily by 2 to 4 subjects. Here we present the data analysis of methods 1, 2, 3, and 5, while data analysis of method 4 is still in progress.

Sleep and errors in a group of Australian hospital nurses at work and during the commute.

PubMed

Dorrian, Jillian; Tolley, Carolyn; Lamond, Nicole; van den Heuvel, Cameron; Pincombe, Jan; Rogers, Ann E; Drew, Dawson

2008-09-01

There is a paucity of information regarding Australian nurses' sleep and fatigue levels, and whether they result in impairment. Forty-one Australian hospital nurses completed daily logbooks for one month recording work hours, sleep, sleepiness, stress, errors, near errors and observed errors (made by others). Nurses reported exhaustion, stress and struggling to remain (STR) awake at work during one in three shifts. Sleep was significantly reduced on workdays in general, and workdays when an error was reported relative to days off. The primary predictor of error was STR, followed by stress. The primary predictor of extreme drowsiness during the commute was also STR awake, followed by exhaustion, and consecutive shifts. In turn, STR awake was predicted by exhaustion, prior sleep and shift length. Findings highlight the need for further attention to these issues to optimise the safety of nurses and patients in our hospitals, and the community at large on our roads.

Antihistamines in drivers, aircrew and occupations of risk.

PubMed

Jáuregui, I; Ferrer, M; Montoro, J; Dávila, I; Bartra, J; del Cuvillo, A; Mullol, J; Sastre, J; Valero, A

2013-01-01

The most commonly occurring allergic diseases can involve a daytime drowsiness associated with the condition itself. The antihistamines used in their treatment can also have central effects and affect certain occupations concerned with risk, road safety and maritime and air navigation. Cognitive tests, experimental studies and epidemiological data recommend avoiding 1st generation antihistamines for people who must drive regularly and/or professions concerned with safety. Although there are no comparative studies on real driving between 1st and 2nd generation antihistamines, in this type of patients there should be a preference for prescribing those with least possible central effect, especially those which are a good substrate for transmembrane transporter pumps such as P-glycoprotein and therefore have a low capacity for crossing the hematoencephalic barrier, thus allowing a broader window for therapy. In this sense, bilastine is a good P-glycoprotein substrate and shows good tolerance at CNS level, in both psychometric trials and real driving test protocols, even at double the dose recommended in the technical file.

Sensitivity and validity of psychometric tests for assessing driving impairment: effects of sleep deprivation.

PubMed

Jongen, Stefan; Perrier, Joy; Vuurman, Eric F; Ramaekers, Johannes G; Vermeeren, Annemiek

2015-01-01

To assess drug induced driving impairment, initial screening is needed. However, no consensus has been reached about which initial screening tools have to be used. The present study aims to determine the ability of a battery of psychometric tests to detect performance impairing effects of clinically relevant levels of drowsiness as induced by one night of sleep deprivation. Twenty four healthy volunteers participated in a 2-period crossover study in which the highway driving test was conducted twice: once after normal sleep and once after one night of sleep deprivation. The psychometric tests were conducted on 4 occasions: once after normal sleep (at 11 am) and three times during a single night of sleep deprivation (at 1 am, 5 am, and 11 am). On-the-road driving performance was significantly impaired after sleep deprivation, as measured by an increase in Standard Deviation of Lateral Position (SDLP) of 3.1 cm compared to performance after a normal night of sleep. At 5 am, performance in most psychometric tests showed significant impairment. As expected, largest effect sizes were found on performance in the Psychomotor Vigilance Test (PVT). Large effects sizes were also found in the Divided Attention Test (DAT), the Attention Network Test (ANT), and the test for Useful Field of View (UFOV) at 5 and 11 am during sleep deprivation. Effects of sleep deprivation on SDLP correlated significantly with performance changes in the PVT and the DAT, but not with performance changes in the UFOV. From the psychometric tests used in this study, the PVT and DAT seem most promising for initial evaluation of drug impairment based on sensitivity and correlations with driving impairment. Further studies are needed to assess the sensitivity and validity of these psychometric tests after benchmark sedative drug use.

Clinical pharmacology of sibutramine hydrochloride (BTS 54524), a new antidepressant, in healthy volunteers.

PubMed Central

King, D J; Devaney, N

1988-01-01

The cardiovascular, anticholinergic and central effects of single doses of 30, 45 and 60 mg of sibutramine hydrochloride (BTS 54524), a new potential antidepressant, were compared with amitriptyline (50 mg) and placebo given at weekly intervals in a randomised design to six healthy male volunteers. Sibutramine was associated with increases in both supine heart rate and systolic blood pressure at 1, 2 and 6 h after 60 mg (P less than 0.05). Amitriptyline caused a significant 50-60% decrease in salivation compared with placebo at 2 and 6 h but there were no changes with sibutramine. No significant changes in pupil size were detected with either drug. Visual analogue rating scales (VARS) revealed significant drowsiness with amitriptyline but neither sedative nor stimulant effects with sibutramine. Impairments of simple auditory and visual reaction times, visual two-choice reaction time, finger tapping and trail making, measured using an automated test battery, occurred with amitriptyline compared with sibutramine. If sibutramine proves to be an effective antidepressant it should be devoid of anticholinergic or central depressant effects. Chronic dosage studies are indicated to evaluate the clinical significance of its cardiovascular effects. PMID:3207566

Phenoxyethanol as a nontoxic substitute for formaldehyde in long-term preservation of human anatomical specimens for dissection and demonstration purposes.

PubMed

Frølich, K W; Andersen, L M; Knutsen, A; Flood, P R

1984-02-01

Formaldehyde has recently been declared a potential carcinogen. Occupational health authorities throughout the world are therefore likely to put stricter regulations to its use also within anatomical disciplines. We have been able to reduce the atmospheric concentration of formaldehyde in our dissection rooms to below the detection limit of a conventional Dräger tube multigas analyzer (i.e., below 0.5 ppm or 0.6 mg formaldehyde/m3 air), by extracting previously formaldehyde-fixed material for more than 3 months in 1% phenoxyethanol in tap water. In this fluid our material has remained soft and flexible with a consistency and color retention suitable for dissection and demonstration purposes for up to 10 years. Fungal attacks are rare and we have been unable to raise bacteria from such specimens. Even the microscopical structure of most tissues remains satisfactory after 5 years in 1% phenoxyethanol. The unpleasant and irritating smell traditionally felt in dissection rooms is almost absent in our facilities, but some of our students still mention slight odor, headache, drowsiness, and mild eye, nose, and throat irritation during their dissection practice periods.

Neural basis for eye velocity generation in the vestibular nuclei of alert monkeys during off-vertical axis rotation

NASA Technical Reports Server (NTRS)

Reisine, H.; Raphan, T.; Cohen, B. (Principal Investigator)

1992-01-01

Activity of "vestibular only" (VO) and "vestibular plus saccade" (VPS) units was recorded in the rostral part of the medial vestibular nucleus and caudal part of the superior vestibular nucleus of alert rhesus monkeys. By estimating the "null axes" of recorded units (n = 79), the optimal plane of activation was approximately the mean plane of reciprocal semicircular canals, i.e., lateral canals, left anterior-right posterior (LARP) canals or right anterior-left posterior (RALP) canals. All units were excited by rotation in a direction that excited a corresponding ipsilateral semicircular canal. Thus, they all displayed a "type I" response. With the animal upright, there were rapid changes in firing rates of both VO and VPS units in response to steps of angular velocity about a vertical axis. The units were bidirectionally activated during vestibular nystagmus (VN), horizontal optokinetic nystagmus (OKN), optokinetic after-nystagmus (OKAN) and off-vertical axis rotation (OVAR). The rising and falling time constants of the responses to rotation indicated that they were closely linked to velocity storage. There were differences between VPS and VO neurons in that activity of VO units followed the expected time course in response to a stimulus even during periods of drowsiness, when eye velocity was reduced. Firing rates of VPS units, on the other hand, were significantly reduced in the drowsy state. Lateral canal-related units had average firing rates that were linearly related to the bias or steady state level of horizontal eye velocity during OVAR over a range of +/- 60 deg/s. These units could be further divided into two classes according to whether they were modulated during OVAR. Non-modulated units (n = 5) were VO types and all modulated units (n = 5) were VPS types. There was no significant difference between the bias level sensitivities relative to eye velocity of the units with and without modulation (P > 0.05). The modulated units had no sustained change in firing rate in response to static head tilts and their phases relative to head position varied from unit to unit. The phase did not appear to be linked to the modulation of horizontal eye velocity during OVAR. The sensitivities of unit activity to eye velocity were similar during all stimulus modalities despite the different gains of eye velocity vs stimulus velocity during VN, OKN and OVAR. Therefore, VO and VPS units are likely to carry an eye velocity signal related to velocity storage.(ABSTRACT TRUNCATED AT 400 WORDS).

Sleepiness and Safety: Where Biology Needs Technology.

PubMed

Abe, Takashi; Mollicone, Daniel; Basner, Mathias; Dinges, David F

2014-04-01

Maintaining human alertness and behavioral capability under conditions of sleep loss and circadian misalignment requires fatigue management technologies due to: (1) dynamic nonlinear modulation of performance capability by the interaction of sleep homeostatic drive and circadian regulation; (2) large differences among people in neurobehavioral vulnerability to sleep loss; (3) error in subjective estimates of fatigue on performance; and (4) to inform people of the need for recovery sleep. Two promising areas of technology have emerged for managing fatigue risk in safety-sensitive occupations. The first involves preventing fatigue by optimizing work schedules using biomathematical models of performance changes associated with sleep homeostatic and circadian dynamics. Increasingly these mathematical models account for individual differences to achieve a more accurate estimate of the timing and magnitude of fatigue effects on individuals. The second area involves technologies for detecting transient fatigue from drowsiness. The Psychomotor Vigilance Test (PVT), which has been extensively validated to be sensitive to deficits in attention from sleep loss and circadian misalignment, is an example in this category. Two shorter-duration versions of the PVT recently have been developed for evaluating whether operators have sufficient behavioral alertness prior to or during work. Another example is online tracking the percent of slow eyelid closures (PERCLOS), which has been shown to reflect momentary fluctuations of vigilance. Technologies for predicting and detecting sleepiness/fatigue have the potential to predict and prevent operator errors and accidents in safety-sensitive occupations, as well as physiological and mental diseases due to inadequate sleep and circadian misalignment.

Parental cannabis abuse and accidental intoxications in children: prevention by detecting neglectful situations and at-risk families.

PubMed

Pélissier, Fanny; Claudet, Isabelle; Pélissier-Alicot, Anne-Laure; Franchitto, Nicolas

2014-12-01

Cannabis intoxication in toddlers is rare and mostly accidental. Our objectives were to focus on the characteristics and management of children under the age of 6 years who were admitted to our emergency department with cannabis poisoning reported as accidental by parents, and to point out the need to consider accidental cannabis ingestions as an indicator of neglect. The medical records of children hospitalized for cannabis poisoning in a pediatric emergency department from January 2007 to November 2012 were retrospectively evaluated. Data collected included age, sex, drug ingested, source of drug, intentional versus accidental ingestion, pediatric intensive care unit or hospital admission, treatment and length of hospital stay, toxicology results, and rate of child protectives services referral. Twelve toddlers (4 boys and 8 girls; mean age, 16.6 months) were included. All had ingested cannabis. Their parents reported the ingestion. Seven children experienced drowsiness or hypotonia. Three children were given activated charcoal. Blood screening for cannabinoids, performed in 2 cases, was negative in both, and urine samples were positive in 7 children (70%). All children had favorable outcomes after being hospitalized from 2 to 48 hours. Nine children were referred to social services for further assessment before discharge. Cannabis intoxication in children should be reported to child protection services with the aim of prevention, to detect situations of neglect and at-risk families. Legal action against the parents may be considered. Accidental intoxication and caring parents should be no exception to this rule.

Clinical and financial implications of emergency department visits for synthetic marijuana.

PubMed

Rowley, Eric; Benson, David; Tiffee, Aaron; Hockensmith, Adam; Zeng, Henry; Jones, Glenn N; Musso, Mandi W

2017-10-01

Many users believe that synthetic cannabinoids offer a safe and legal means of getting high. However, spikes in emergency department visits have been associated with use of synthetic cannabinoids. The purpose of the current study was to document emergency department visits from three large hospitals in one metropolitan area over a two month period. This was a retrospective chart review examining 218 patients presenting to three inner city emergency departments between March and April 2014. Data collected included demographic information, information regarding ED diagnosis and treatment, signs and symptoms, ancillary testing, ED disposition, and cost of the medical treatment. The majority of patients (75.7%) were discharged after ED workup, but 12.4% were admitted for medical treatment and 11.5% were admitted for psychiatric treatment. Ten patients (4.6%) were admitted to the ICU. Symptoms experienced most frequently include: hypertension, tachycardia, agitation, drowsiness, nausea, and confusion. Cluster analysis revealed four symptom clusters of individuals presenting after using synthetic cannabinoids: 1) confusion, hostility, agitation, 2) nausea, vomiting, abdominal pain, 3) drowsiness, and 4) the absence of these symptoms. This study has three important findings. First, significant ED resources are being used to treat individuals presenting due to effects of synthetic cannabis. Second, synthetic cannabis is not a benign substance. Third, while the hostile and agitated user is generally presented in the media, this study finds significant heterogeneity in presentation. Further research is needed to fully understand the implications of synthetic cannabinoid use. Copyright © 2017 Elsevier Inc. All rights reserved.

[Dietary factors associated with daytime somnolence in healthy elderly of Chile].

PubMed

Durán Agüero, Samuel; Sánchez Reyes, Hugo; Díaz Narváez, Víctor; Araya Pérez, Mónica

2015-01-01

To determine the prevalence of mild and excessive somnolence and the associated factors with the presence of daytime sleepiness in the elderly. A total of 1780 independent individuals 60 years and older of both sexes (70.9±7.9 years old; females 62%), were included, of which 1704 of them completed all the information. All of them were assessed using an Epworth sleepiness scale (ESE), an Pittsburgh sleep quality index, plus information of cigarettes smoking, dinner time, and an anthropometric evaluation. An ESE score>10 was considered drowsiness and scores>15 excessive or severe drowsiness. Among the population under 80 years, 5.3% showed ESE score>15 and 26.2% an ESE score>10. For over 80 years, the prevalence of sleepiness was 6.3% for an ESE score>15 and 32.5% for an ESE score>10. In the adjusted model, the factors associated with increased risk of sleepiness (ESE>10) were age older than 80 years (OR=1.58; 95% CI=1.14 to 2.19) and dinner after 21 hours (OR=1.3; 95% CI=1.01 to 1.68). By contrast, only age older than 80 years was independently associated with severe sleepiness (OR=1.81; 95% CI=1.01 to 3.29). Meals after 21 hours and age above 80 years are associated with increased likelihood of daytime sleepiness. Instead, only older than 80 years is associated with severe daytime sleepiness. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

The Effect of Aromatherapy on Insomnia and Other Common Symptoms Among Patients With Acute Leukemia

PubMed

Blackburn, Lisa; Achor, Sara; Allen, Betty; Bauchmire, Nicole; Dunnington, Danielle; Klisovic, Rebecca; Naber, Steven; Roblee, Kirsten; Samczak, Angela; Tomlinson-Pinkham, Kelly; Chipps, Esther

2017-07-01

To determine if the use of aromatherapy improves insomnia and other common symptoms in hospitalized patients with newly diagnosed acute leukemia. A randomized, crossover, washout trial. An inpatient acute leukemia unit at the Arthur G. James Cancer Hospital and Richard L. Solove Research Institute of the Wexner Medical Center at Ohio State University in Columbus. 50 patients who were newly diagnosed with acute leukemia and hospitalized to receive their initial four weeks of intensive induction chemotherapy. Patients were offered a choice of three scents to be used during the trial: lavender, peppermint, or chamomile. Each patient was randomized to receive either the chosen aromatherapy intervention or a placebo intervention during alternate weeks, with a washout period in between. Sleep quality and other common symptoms were measured. Aromatherapy, sleep, insomnia, pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and well-being. Most patients reported poor quality sleep at baseline, but aromatherapy had a statistically significant positive impact. Improvements were noted in tiredness, drowsiness, lack of appetite, depression, anxiety, and well-being because of aromatherapy. Aromatherapy is a viable intervention for improving insomnia and other symptoms commonly experienced by patients with acute leukemia. Oncology nurses can employ aromatherapy safely and inexpensively, and with minimal training, as an effective tool in decreasing many symptoms that plague patients with leukemia. Patients can exercise a greater sense of control over their treatment environments through the use of aromatherapy.

Memantine induces manic episode in a 73-year-old patient with vascular neurocognitive disorder: a case report.

PubMed

Duan, Jinfeng; Lao, Chengming; Chen, Jingkai; Pan, Fen; Zhang, Chenlin; Xu, Weijuan; Zhou, Weihua; Hu, Jianbo; Shang, Desheng; Huang, Manli; Xu, Yi

2018-01-01

Memantine, an N -methyl-d-aspartate receptor antagonist, is a well-established treatment option for moderate-to-severe cognitive impairment related to Alzheimer disease. Recently, growing evidence has indicated memantine might also be effective in treatment of affective disorders. The common drug-induced adverse events of memantine include confusion, dizziness, drowsiness, headache, insomnia, and agitation. Herein, we presented a case of a 73-year-old female patient with vascular neurocognitive disorder, who developed a manic episode after taking memantine.

Memantine induces manic episode in a 73-year-old patient with vascular neurocognitive disorder: a case report

PubMed Central

Duan, Jinfeng; Lao, Chengming; Chen, Jingkai; Pan, Fen; Zhang, Chenlin; Xu, Weijuan; Zhou, Weihua; Hu, Jianbo; Shang, Desheng; Huang, Manli; Xu, Yi

2018-01-01

Memantine, an N-methyl-d-aspartate receptor antagonist, is a well-established treatment option for moderate-to-severe cognitive impairment related to Alzheimer disease. Recently, growing evidence has indicated memantine might also be effective in treatment of affective disorders. The common drug-induced adverse events of memantine include confusion, dizziness, drowsiness, headache, insomnia, and agitation. Herein, we presented a case of a 73-year-old female patient with vascular neurocognitive disorder, who developed a manic episode after taking memantine. PMID:29881276

Drowsy cheetah hunting antelopes: a diffusing predator seeking fleeing prey

NASA Astrophysics Data System (ADS)

Winkler, Karen; Bray, Alan J.

2005-02-01

We consider a system of three random walkers (a 'cheetah' surrounded by two 'antelopes') diffusing in one dimension. The cheetah and the antelopes diffuse, but the antelopes experience in addition a deterministic relative drift velocity, away from the cheetah, proportional to their distance from the cheetah, such that they tend to move away from the cheetah with increasing time. Using the backward Fokker-Planck equation we calculate, as a function of their initial separations, the probability that the cheetah has caught neither antelope after infinite time.

Pharmacokinetics of Scopolamine Intranasal Gel Formulation (INSCOP) During Antiorthostatic Bedrest

NASA Technical Reports Server (NTRS)

Putcha, Lakshmi; Boyd, J. L.; Du, B.; Daniels, V.; Crady, C.

2011-01-01

Space Motion sickness (SMS) is an age old problem for space travelers on short and long duration space flight Oral antiemetics are not very effective in space due to poor bioavailability. Scopolamine (SCOP) is the most frequently used drug by recreational travelers V patch, tablets available on the market. Common side effects of antiemetics, in general, include drowsiness, sedation, dry mouth and reduced psychomotor performance. Severity and persistence of side effects are often dose related Side effects can be detrimental in high performance demanding settings, e.g. space flight, military.

Practice Safe Driving.

PubMed

2017-07-01

More than 30,000 people die in motor vehicle collisions each year in the United States. Distracted, drowsy, and drunk driving cause most motor vehicle collision injuries and deaths. An editorial published in the October 2016 issue of JOSPT identified the global need for effective strategies to reduce, if not eliminate, preventable injuries, including whiplash-associated disorders and deaths from distracted driving. This is a call to action for everyone who gets behind the wheel of a car. J Orthop Sports Phys Ther 2017;47(7):449. doi:10.2519/jospt.2017.0506.

Correlation between driving errors and vigilance level: influence of the driver's age.

PubMed

Campagne, Aurelie; Pebayle, Thierry; Muzet, Alain

2004-01-01

During long and monotonous driving at night, most drivers progressively show signs of visual fatigue and loss of vigilance. Their capacity to maintain adequate driving performance usually is affected and varies with the age of the driver. The main question is to know, on one hand, if occurrence of fatigue and drowsiness is accompanied by a modification in the driving performance of the driver and, on the other hand, if this relationship partially depends on the driver's age. Forty-six male drivers, divided into three age categories: 20-30, 40-50, and 60-70 years, performed a 350-km motorway driving session at night on a driving simulator. Driving errors were measured in terms of number of running-off-the-road incidents (RORI) and large speed deviations. The evolution of physiological vigilance level was evaluated using electroencephalography (EEG) recording. In older drivers, in comparison with young and middle-aged drivers, the degradation of driving performance was correlated to the evolution of lower frequency waking EEG (i.e., theta). Contrary to young and middle-aged drivers, the deterioration of the vigilance level attested by EEG correlated with the increase in gravity of all studied driving errors in older drivers. Thus, depending on the age category considered, only part of the driving errors would constitute a relevant indication as for the occurrence of a state of low arousal.

Upper Limb Muscle and Brain Activity in Light Assembly Task on Different Load Levels

NASA Astrophysics Data System (ADS)

Zadry, Hilma Raimona; Dawal, Siti Zawiah Md.; Taha, Zahari

2010-10-01

A study was conducted to investigate the effect of load on upper limb muscles and brain activities in light assembly task. The task was conducted at two levels of load (Low and high). Surface electromyography (EMG) was used to measure upper limb muscle activities of twenty subjects. Electroencephalography (EEG) was simultaneously recorded with EMG to record brain activities from Fz, Pz, O1 and O2 channels. The EMG Mean Power Frequency (MPF) of the right brachioradialis and the left upper trapezius activities were higher on the high-load task compared to low-load task. The EMG MPF values also decrease as time increases, that reflects muscle fatigue. Mean power of the EEG alpha bands for the Fz-Pz channels were found to be higher on the high-load task compared to low-load task, while for the O1-O2 channels, they were higher on the low-load task than on the high-load task. These results indicated that the load levels effect the upper limb muscle and brain activities. The high-load task will increase muscle activities on the right brachioradialis and the left upper tapezius muscles, and will increase the awareness and motivation of the subjects. Whilst the low-load task can generate drowsiness earlier. It signified that the longer the time and the more heavy of the task, the subjects will be more fatigue physically and mentally.

Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care.

PubMed

Mercadante, Sebastiano; Masedu, Francesco; Balzani, Isabella; De Giovanni, Daniela; Montanari, Luigi; Pittureri, Cristina; Bertè, Raffaella; Russo, Domenico; Ursini, Laura; Marinangeli, Franco; Aielli, Federica

2018-03-01

The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care. A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected. Possible causes or factors associated with delirium were looked for. The Edmonton Symptom Assessment Scale was used to assess physical and psychological symptoms and the Memorial Delirium Assessment Scale (MDAS) to assess the cognitive status of patients, at admission (T0) and 1 week after palliative care (T7). Of 848 patients screened, 263 patients were evaluated. Sixty-six patients had only the initial evaluation. The mean Karnofsky status was 34.1 (SD = 6.69); the mean PaP score at admission was 6.9 (SD = 3.97). The mean duration of palliative care assistance, equivalent to survival, was 38.4 days (SD = 48, range 2-220). The mean MDAS values at admission and after 1 week of palliative care were 6.9 (SD = 6.71) and 8.8 (SD = 8.26), respectively. One hundred ten patients (41.8%) and 167 patients (67.3%) had MDAS values ≥ 7 at admission and after 1 week of palliative care, respectively. Age, dehydration, cachexia, chemotherapy in the last three months, and intensity of drowsiness and dyspnea were independently associated with a MDAS > 7. A worsening of drowsiness, the use of opioids, and the use of corticosteroids were independently associated with changes of MDAS from T0 to T7. Although the prevalence of delirium seems to be similar to that reported in other acute settings, delirium tended to worsen or poorly responded to a palliative care treatment. Some clinical factors were independently associated with delirium. This information is relevant for decision-making when delirium does not change despite a traditional intervention. Continuous assessment of delirium should be performed in these settings to detect deterioration of cognitive function. Further studies should elucidate whether an earlier approach to palliative care would decrease the prevalence of delirium at a late stage of disease.

Efficacy and tolerability of high-dose phenobarbital in children with focal seizures.

PubMed

Okumura, Akihisa; Nakahara, Eri; Ikeno, Mitsuru; Abe, Shinpei; Igarashi, Ayuko; Nakazawa, Mika; Takasu, Michihiko; Shimizu, Toshiaki

2016-04-01

We retrospectively reviewed the outcomes of children with focal epilepsy treated with oral high-dose phenobarbital. We reviewed data on children (aged<15 years) with focal seizures treated with high-dose phenobarbital (>5 mg/kg/day to maintain a target serum level >40 μg/mL) for at least 6 months. Seizure frequency was evaluated after phenobarbital titration, and 1 and 2 years after high-dose phenobarbital treatment commenced. Treatment was judged effective when seizure frequencies fell by ⩾75%. Seven boys and eight girls were treated. The median age at commencement of high-dose phenobarbital therapy was 30 months. The maximal serum phenobarbital level ranged from 36.5 to 62.9 μg/mL. High-dose PB was effective in seven. In two patients, treatment was transiently effective, but seizure frequency later returned to the baseline. High-dose PB was ineffective in six. No significant association between effectiveness and any clinical variable was evident. Drowsiness was recorded in nine patients, but no patient developed a behavioral problem or hypersensitivity. Oral high-dose phenobarbital was effective in 7 of 15 patients with focal epilepsy and well tolerated. High-dose PB may be useful when surgical treatment is difficult. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Sleep quality and functional gastrointestinal disorders. A psychological issue.

PubMed

Bouchoucha, Michel; Mary, Florence; Bon, Cyriaque; Bejou, Bakhtiar; Airinei, Gheorghe; Benamouzig, Robert

2018-02-01

Sleep disorders are often associated with functional gastrointestinal disorders (FGIDs). This study aims to evaluate the association of sleep disorders with specific FGIDs and to assess the related importance of psychological disorders. We included 1009 consecutive patients with FGIDs (70.9% females). The patients completed a Rome III questionnaire and after a psychological evaluation on anxiety and depression they were classified according to their sleep disorders using a 7-point grading scale: Groups 1-3, drowsiness (severe, moderate, mild); Group 4, no change; Groups 5-7, insomnia (mild, moderate, severe). Multinomial logistic regression using sleep group as a dependent variable with no sleep change as reference and body mass index, FGIDs, anxiety and depression as independent variables were used for statistical analysis. Altogether 667 (66.1%) patients reported changes in sleep disorders, of whom 487 (48.3%) had decreased sleep and 180 (17.8%) had increased sleep while 342 (33.9%) reported no change. Depression was lower in patients with no change in sleep pattern and increased with the severity of their sleep disorder (P < 0.001). State-anxiety is associated with moderate drowsiness (P = 0.024), while trait anxiety is associated with mild insomnia (P = 0.048). FGIDs associated with sleep disorders included chest pain, epigastric pain syndrome, irritable bowel syndrome with constipation, diarrhea, bloating, fecal incontinence and proctalgia fugax. Sleep disorders are associated with FGIDs, especially in the presence of depressive symptoms. © 2018 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Performance following a sudden awakening from daytime nap induced by zaleplon.

PubMed

Whitmore, Jeffrey N; Fischer, Joseph R; Barton, Emily C; Storm, William F

2004-01-01

Zaleplon appears to be a prime candidate for assisting individuals in obtaining sleep in situations not conducive to rest (i.e., a short period during the day). However, should an early unexpected awakening and return to duty be required, the effect on performance is not known. Zaleplon (10 mg) would negatively affect human performance for some duration, compared with placebo, after a sudden awakening from a short period (1 h) of daytime sleep. There were 16 participants, 8 men and 8 women, who volunteered to participate in this study. The study was conducted using a counterbalanced, double-blind, repeated measures design. At 1 h prior to drug administration, and at each of 7 h postdrug, performance measures (cognition, memory, balance, and strength) and subjective symptom reports were recorded. Zaleplon had a statistically significant (p < 0.05) negative impact on balance through the first 2 h postdose when compared with placebo. In addition, symptoms related to "drowsiness" were statistically more prevalent under zaleplon than under placebo through the first 3 h postdrug. Of the eight measures of cognitive performance, six were significantly negatively impacted in the zaleplon condition through 2 h postdose when compared with placebo, with one remaining significantly degraded through 3 h postdose. Zaleplon also had a significantly negative impact on memory at 1 h and 4 h postdose. Zaleplon (10 mg), when used as a daytime sleep aid, causes drowsiness (and related symptoms) up to 3 h postdose, and may impact task performance, especially more complex tasks, for at least 2-3 h postdose.

Losing the struggle to stay awake: divergent thalamic and cortical activity during microsleeps.

PubMed

Poudel, Govinda R; Innes, Carrie R H; Bones, Philip J; Watts, Richard; Jones, Richard D

2014-01-01

Maintaining alertness is critical for safe and successful performance of most human activities. Consequently, microsleeps during continuous visuomotor tasks, such as driving, can be very serious, not only disrupting performance but sometimes leading to injury or death due to accidents. We have investigated the neural activity underlying behavioral microsleeps--brief (0.5-15 s) episodes of complete failure to respond accompanied by slow eye-closures--and EEG theta activity during drowsiness in a continuous task. Twenty healthy normally-rested participants performed a 50-min continuous tracking task while fMRI, EEG, eye-video, and responses were simultaneously recorded. Visual rating of performance and eye-video revealed that 70% of the participants had frequent microsleeps. fMRI analysis revealed a transient decrease in thalamic, posterior cingulate, and occipital cortex activity and an increase in frontal, posterior parietal, and parahippocampal activity during microsleeps. The transient activity was modulated by the duration of the microsleep. In subjects with frequent microsleeps, power in the post-central EEG theta was positively correlated with the BOLD signal in the thalamus, basal forebrain, and visual, posterior parietal, and prefrontal cortices. These results provide evidence for distinct neural changes associated with microsleeps and with EEG theta activity during drowsiness in a continuous task. They also suggest that the occurrence of microsleeps during an active task is not a global deactivation process but involves localized activation of fronto-parietal cortex, which, despite a transient loss of arousal, may constitute a mechanism by which these regions try to restore responsiveness. Copyright © 2012 Wiley Periodicals, Inc.

Insulinoma presenting as idiopathic hypersomnia.

PubMed

Maestri, Michelangelo; Monzani, Fabio; Bonanni, Enrica; Di Coscio, Elisa; Cignoni, Fabio; Dardano, Angela; Iudice, Alfonso; Murri, Luigi

2010-06-01

We report the case of a 32-year-old woman with a history of increased sleep need and difficulty waking up; the diagnosis of idiopathic hypersomnia was hypothesized. During ambulatory polysomnography (PSG), the patient presented an episode characterized by loss of consciousness and jerking of the four limbs. A video-PSG monitoring was performed and the patient showed unresponsiveness and drowsiness at 7 a.m. During the episode, EEG showed theta-delta diffuse activity, and blood glucose level was 32 mg dl(-1). The diagnosis of insulinoma was then assumed; CT scan showed a hypodense mass into the pancreatic tail, and a partial pancreasectomy was performed. The described symptoms disappeared, and 5 years later the findings of a complete clinical and neurophysiological examination were negative. The clinical picture of insulinoma presenting with paroxysmal disorders has been previously described; however, whereas hypersomnia is uncommon, in the current case it represents the main symptom. Clinicians should keep in mind that neuroglycopenia should be considered in the differential diagnosis of patients with hypersomnia, particularly if the clinical scenario does not conform to standard criteria.

Myasthenia gravis imitating pituitary apoplexy in macroprolactinoma.

PubMed

Zoli, Matteo; Guaraldi, Federica; Faustini, Marco; Mazzatenta, Diego

2018-06-02

Myasthenia gravis (MG) is an autoimmune disease affecting neuromuscular transmission that manifests with muscle weakness and typically involves the eye muscles, often producing diplopia and ptosis. Recent studies suggest that hyperprolactinaemia may have a role in the development of MG, although its association with prolactinoma is extremely rare. We report the unusual case of a 71-year-old male affected with macroprolactinoma, who presented at our Center 2 weeks after starting cabergoline treatment because of acute onset of headache, diplopia, and ptosis. On admission, he presented with drowsiness, dropped head, swallowing impairment and bilateral ptosis, which rapidly worsened. Based on clinical manifestation and history, emergency surgery was performed on suspicion of pituitary apoplexy (PA), the typical complication occurring in patients with macroadenomas who present these symptoms. No pituitary haemorrhage was found. The symptoms initially resolved after surgery, but soon returned and worsened day by day, especially in the evening, despite the increase of cortisone replacement doses. MG was thus suspected and confirmed by the detection of antibodies to the acetylcholine receptor. Pyridostigmine was started with prompt improvement of neurological symptoms. In conclusion, although very rare, MG should be considered in the differential diagnosis of patients with macroprolactinomas and suggestive neurological symptoms in order to provide early and appropriate treatment. The role of hyperprolactinaemia in MG onset and evolution is also discussed.

Salivary Pharmacodynamics and Bioavailability of Promethazine in Human Subjects

NASA Technical Reports Server (NTRS)

Putcha, Lakshmi; Harm, Deborah L.; Nimmagudda, Ram; Berens, Kurt L.; Bourne, David W. A.

1999-01-01

The acute effects of exposure to microgravity include the development of space motion sickness which usually requires therapeutic intervention. The current drug of choice, promethazine (PMZ), has side effects which include nausea, drowsiness, dizziness, sedation and impaired psychomotor performance. In a ground-based study with commercial airline pilots and shuttle simulator trainers, we measured sleep and psychomotor performance variables, and physiological variables such as blood pressure and heart rate, as a function of circulating drug concentrations in the body. We evaluated a non-invasive sampling method (saliva) as a means of assessing pharmacodynamics following a single intramuscular (IM) dose of PMZ.

A multicenter study of sleep-wake rhythm disorders: therapeutic effects of vitamin B12, bright light therapy, chronotherapy and hypnotics.

PubMed

Yamadera, H; Takahashi, K; Okawa, M

1996-08-01

One hundred and six subjects with primary sleep-wake rhythm disorders [13 non-24 hour sleep-wake syndrome (non-24), 76 delayed sleep phase syndrome (DSPS), 11 irregular sleep-wake pattern (irregular) and six long sleepers] were treated with vitamin B12, bright light, chronotherapy and/or hypnotics. These therapies caused moderate or remarkable improvement in 32% of the non-24, 42% of DSPS, 45% of irregular and 67% of long sleepers. A lack of adequate sleep, unpleasant feelings at waking and daytime drowsiness were also improved in DSPS.

Treatment of epilepsy with clonazepam and its effect on other anticonvulsants.

PubMed Central

Nanda, R N; Johnson, R H; Keogh, H J; Lambie, D G; Melville, I D

1977-01-01

Clonazepam was added to the treatment of patients with poorly controlled epilepsy in a double-blind trial and an open trial. Considerable improvement occurred with patients with myoclonic jerks and tonic-clonic convulsions, and with photosensitive epilepsy. Patients with atypical petit mal and focal epilepsies also improved. Drowsiness was initially common but lasted only a short time. No evidence was found for an action of clonazepam on the metabolism of other drugs, but treatment with phenobarbitone lowered serum concentrations of clonazepam. We conclude that clonazepam is particularly valuable in epilepsy with associated myoclonsu and in photosensitive epilepsy. PMID:409803

Orthorexia Nervosa with Hyponatremia, Subcutaneous Emphysema, Pneumomediastimum, Pneumothorax, and Pancytopenia

PubMed Central

Park, Sang Won; Kim, Jeong Yup; Go, Gang Ji; Jeon, Eun Sil; Pyo, Heui Jung

2011-01-01

30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients. PMID:21998605

Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia.

PubMed

Park, Sang Won; Kim, Jeong Yup; Go, Gang Ji; Jeon, Eun Sil; Pyo, Heui Jung; Kwon, Young Joo

2011-06-01

30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients.

[Chemical pneumonia following ingestion of lamp oil].

PubMed

Lewiszong-Rutjens, C A W; Réchards, M; Schipper, J A

2007-08-18

A 20-months-old girl developed a cough and became drowsy after drinking lamp oil. In the Emergency Ward, her oxygen saturation was 85%. The day after admission to hospital she showed a clinical and radiological picture of chemical pneumonia. After 3 days the patient could be discharged in good condition. The most important symptoms after the ingestion of hydrocarbon compounds such as lamp oil are respiratory problems due to aspiration and effects on the central nervous system following gastrointestinal absorption. Severe symptoms can develop in a short period of time. The treatment is supportive. The prognosis is favourable.

Development of the caffeine withdrawal symptom questionnaire: caffeine withdrawal symptoms cluster into 7 factors.

PubMed

Juliano, Laura M; Huntley, Edward D; Harrell, Paul T; Westerman, Ashley T

2012-08-01

Habitual caffeine consumers who abstain from caffeine experience withdrawal symptoms such as headache, fatigue, difficulty concentrating, mood disturbances, and flu-like symptoms (Juliano and Griffiths, 2004). The caffeine withdrawal syndrome has been documented across many experimental studies; however, little is known about how withdrawal symptoms co-vary during a discrete episode. Furthermore, a validated measure of caffeine withdrawal is lacking. To develop, evaluate, and reduce a 23-item measure of caffeine withdrawal symptoms; the Caffeine Withdrawal Symptom Questionnaire (CWSQ), to a set of composite variables. Caffeine consumers (N=213) completed the CWSQ after 16h of caffeine abstinence. A subset of participants also completed the CWSQ during a preceding baseline period and/or after double-blind consumption of caffeinated coffee. Principal components analysis resulted in a solution comprised of 7-factors: (1) Fatigue/drowsiness; (2) Low alertness/difficulty concentrating; (3) Mood disturbances; (4) Low sociability/motivation to work; (5) Nausea/upset stomach; (6) Flu-like feelings; and (7) Headache. With the exception of nausea/upset stomach, the CWSQ total score and individual composite scores were significantly greater during caffeine abstinence relative to both baseline and double-blind consumption of caffeinated coffee, thereby demonstrating sensitivity of the measure. Compared to non-daily coffee consumers, daily consumers had greater increases in total withdrawal, fatigue/drowsiness, low alertness/difficulty concentrating, mood disturbances, and headache. Future directions include replication, assessment on a clinical population, and further examination of psychometric properties of the CWSQ. The CWSQ should facilitate the assessment and diagnosis of caffeine withdrawal and increase our knowledge of the caffeine withdrawal syndrome. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Influences of twilight on diurnal variation of core temperature, its nadir, and urinary 6-hydroxymelatonin sulfate during nocturnal sleep and morning drowsiness.

PubMed

Kondo, Masayuki; Tokura, Hiromi; Wakamura, Tomoko; Hyun, Ki-Ja; Tamotsu, Satoshi; Morita, Takeshi; Oishi, Tadashi

2009-03-01

This study aimed at elucidating the physiological significance of dusk and dawn in the circadian rhythm of core temperature (T(core)) and urinary 6-hydroxymelatonin sulfate in humans during sleep and the waking sensation just after rising. Seven female and four male students served as participants. Participants retired at 2300 h and rose at 0700 h. They were requested to sit on a chair and spend time as quietly as possible during wakefulness, reading a book or listening to recorded light music. Two lighting conditions were provided for each participant: 1) Light-Dark (LD)-rectangular light change with abrupt decrease from 3,000 lx to 100 lx at 1800 h, abrupt increase from 0 lx to 3,000 lx at 0700 h. 2) LD-twilight light change with gradual decrease from 3,000 lx to 100 lx starting at 1700 h (twilight period about 2 h), with gradual increase from 0 lx to 3,000 lx starting at 0500 h (twilight period about 2 h). The periods of 0 lx at night were from 2300 h to 0700 h on the first day and from 2300 to 0500 h on the second day. Nadir time advanced significantly under the influence of the LD-twilight condition. The amount of 6-hydroxymelatonin sulfate in urine collected at 0200 h was significantly higher under LD-twilight in comparison with LD-rectangular light. Morning drowsiness tended to be lower under LD-twilight. Our results suggest that in architectural design of indoor illumination it is important to provide LD-twilight in the evening and early morning for sleep promotion in healthy normal people and/or light treatment in elderly patients with advanced dementia.

Sleepiness at the wheel across Europe: a survey of 19 countries.

PubMed

Gonçalves, Marta; Amici, Roberto; Lucas, Raquel; Åkerstedt, Torbjörn; Cirignotta, Fabio; Horne, Jim; Léger, Damien; McNicholas, Walter T; Partinen, Markku; Téran-Santos, Joaquín; Peigneux, Philippe; Grote, Ludger

2015-06-01

The European Sleep Research Society aimed to estimate the prevalence, determinants and consequences of falling asleep at the wheel. In total, 12 434 questionnaires were obtained from 19 countries using an anonymous online questionnaire that collected demographic and sleep-related data, driving behaviour, history of drowsy driving and accidents. Associations were quantified using multivariate logistic regression. The average prevalence of falling asleep at the wheel in the previous 2 years was 17%. Among respondents who fell asleep, the median prevalence of sleep-related accidents was 7.0% (13.2% involved hospital care and 3.6% caused fatalities). The most frequently perceived reasons for falling asleep at the wheel were poor sleep in the previous night (42.5%) and poor sleeping habits in general (34.1%). Falling asleep was more frequent in the Netherlands [odds ratio = 3.55 (95% confidence interval: 1.97; 6.39)] and Austria [2.34 (1.75; 3.13)], followed by Belgium [1.52 (1.28; 1.81)], Portugal [1.34 (1.13, 1.58)], Poland [1.22 (1.06; 1.40)] and France [1.20 (1.05; 1.38)]. Lower odds were found in Croatia [0.36 (0.21; 0.61)], Slovenia [0.62 (0.43; 0.89)] and Italy [0.65 (0.53; 0.79)]. Individual determinants of falling asleep were younger age; male gender [1.79 (1.61; 2.00)]; driving ≥20 000 km year [2.02 (1.74; 2.35)]; higher daytime sleepiness [7.49 (6.26; 8.95)] and high risk of obstructive sleep apnea syndrome [3.48 (2.78; 4.36) in men]. This Pan European survey demonstrates that drowsy driving is a major safety hazard throughout Europe. It emphasizes the importance of joint research and policy efforts to reduce the burden of sleepiness at the wheel for European drivers.

Comparison of toxicity of acute overdoses with citalopram and escitalopram.

PubMed

Hayes, Bryan D; Klein-Schwartz, Wendy; Clark, Richard F; Muller, Allison A; Miloradovich, Jane E

2010-07-01

Seizures and QTc prolongation are associated with citalopram poisoning; however, overdose experience with escitalopram is more limited. The goals of this study were to compare citalopram's vs. escitalopram's clinical effects in overdose, including the incidence of seizures. A retrospective review was conducted for single-substance acute overdoses with citalopram and escitalopram, managed in hospitals, that were reported to six U.S. poison centers from 2002-2005. There were 374 citalopram and 421 escitalopram overdose cases. Gender and ages were similar between the two, with 68-70% females and a median age of 20 years for citalopram and 18 years for escitalopram. Median dose by history was 310 mg for citalopram and 130 mg for escitalopram. More serious outcomes were associated with citalopram overdoses (p < 0.001). Most frequently reported clinical effects with citalopram and escitalopram were tachycardia, drowsiness, hypertension, and vomiting. Seizures (30 vs. 1, respectively, p < 0.001) and tremor (32 vs. 13, respectively, p = 0.001) were more common with citalopram. QTc prolongation occurred in 14 citalopram cases and 7 escitalopram cases (p = 0.109). There was an association between increasing dose and severity of outcome for citalopram (p < 0.001) and escitalopram (p = 0.011). In children < 6 years old, 12 of 66 citalopram and 5 of 57 escitalopram cases experienced toxicity, such as drowsiness, nausea/vomiting, and tachycardia. There were no seizures in this age group. Escitalopram seems to be less toxic than citalopram after an acute overdose; seizures and tremors were more common with citalopram. Initial management of overdoses should include seizure precautions for citalopram and cardiac monitoring for both drugs. Copyright 2010 Elsevier Inc. All rights reserved.

The influence of daily sleep patterns of commercial truck drivers on driving performance

PubMed Central

Chen, Guang Xiang; Fang, Youjia; Guo, Feng; Hanowski, Richard J.

2016-01-01

Fatigued and drowsy driving has been found to be a major cause of truck crashes. Lack of sleep is the number one cause of fatigue and drowsiness. However, there are limited data on the sleep patterns (sleep duration, sleep percentage in the duration of non-work period, and the time when sleep occurred) of truck drivers in non-work periods and the impact on driving performance. This paper examined sleep patterns of 96 commercial truck drivers during non-work periods and evaluated the influence these sleep patterns had on truck driving performance. Data were from the Naturalistic Truck Driving Study. Each driver participated in the study for approximately four weeks. A shift was defined as a non-work period followed by a work period. A total of 1397 shifts were identified. Four distinct sleep patterns were identified based on sleep duration, sleep start/end point in a non-work period, and the percentage of sleep with reference to the duration of non-work period. Driving performance was measured by safety-critical events, which included crashes, near-crashes, crash-relevant conflicts, and unintentional lane deviations. Negative binomial regression was used to evaluate the association between the sleep patterns and driving performance, adjusted for driver demographic information. The results showed that the sleep pattern with the highest safety-critical event rate was associated with shorter sleep, sleep in the early stage of a non-work period, and less sleep between 1 a.m. and 5 a.m. This study also found that male drivers, with fewer years of commercial vehicle driving experience and higher body mass index, were associated with deteriorated driving performance and increased driving risk. The results of this study could inform hours-of-service policy-making and benefit safety management in the trucking industry. PMID:26954762

Severe metabolic alkalosis, hypokalemia, and respiratory acidosis induced by the Chinese herbal medicine yokukansan in an elderly patient with muscle weakness and drowsiness.

PubMed

Yamada, Shunsuke; Tokumoto, Masanori; Kansui, Yasuo; Wakisaka, Yoshinobu; Uchizono, Yuji; Tsuruya, Kazuhiko; Ooboshi, Hiroaki

2013-05-01

Yokukansan is a Chinese herbal medicine containing licorice that has been shown to alleviate the behavioral and psychological symptoms of Alzheimer's disease, with few adverse effects. Increasing numbers of patients with Alzheimer's disease in Japan are now being treated with this drug. However, yokukansan should be used with caution because of its potential to induce pseudoaldosteronism through the inhibition of 11-beta-hydroxysteroid dehydrogenase type 2, which metabolizes cortisol into cortisone. We present the case of an 88-year-old woman with a history of Alzheimer's disease who was transferred to our emergency department because of drowsiness, anorexia, and muscle weakness. Her blood pressure was 168/90 mmHg. Laboratory data showed serum potassium of 1.9 mmol/l, metabolic alkalosis (pH 7.54; HCO 3 - , 50.5 mmol/l; chloride, 81 mmol/l; sodium, 140 mmol/l), and respiratory disorders (pCO 2 , 60.5 mmHg; pO 2 , 63.8 mmHg). Plasma renin activity and aldosterone concentration were suppressed, and urinary potassium excretion was 22 mmol/l (calculated transtubular potassium gradient 12.9). An electrocardiogram showed flat T-waves and U-waves with ventricular premature contractions. Echocardiography denied volume depletion. Medical interview disclosed that she had been treated with a Chinese herbal medicine (yokukansan) containing licorice. The final diagnosis was pseudoaldosteronism and respiratory acidosis induced by licorice. Hypokalemia, metabolic alkalosis, and respiratory acidosis all subsided shortly after the discontinuation of yokukansan and initiation of intravenous potassium replacement. This case highlights the need for nephrologists to consider the possible involvement of Chinese herbal medicines, including yokukansan, when they encounter hypokalemia in elderly patients.

Symptom burden among young adults with breast or colorectal cancer.

PubMed

Sanford, Stacy D; Zhao, Fengmin; Salsman, John M; Chang, Victor T; Wagner, Lynne I; Fisch, Michael J

2014-08-01

Cancer incidence has increased among young adults (YAs) and survival rates have not improved compared with other age groups. Patient-reported outcomes may enhance our understanding of this vulnerable population. In a multisite prospective study, patients completed a cancer symptom inventory at the time of enrollment (T1) and 4 weeks to 5 weeks later (T2). YAs (those aged ≤ 39 years) with breast or colorectal cancer were compared with older adults (those aged ≥ 40 years) with breast or colorectal cancer with regard to symptom severity, symptom interference, changes over time, and medical care. Participants included 1544 patients with breast cancer (96 of whom were YAs) and 718 patients with colorectal cancer (37 of whom were YAs). Compared with older adults, YAs with breast cancer were more likely to report moderate/severe drowsiness, hair loss, and symptom interference with relationships at T1. YAs with colorectal cancer were more likely to report moderate/severe pain, fatigue, nausea, distress, drowsiness, shortness of breath, and rash plus interference in general activity, mood, work, relationships, and life enjoyment compared with older adults. Compared with older adults, shortness of breath, appetite, and sore mouth were more likely to improve in YAs with breast cancer; vomiting was less likely to improve in YAs with colorectal cancer. Referrals for supportive care were few, especially among patients with colorectal cancer. YAs with breast cancer were somewhat more likely to be referred to nutrition and psychiatry services than older patients. YAs reported symptom severity, symptom interference, and variations over time that were distinct from older patients. Distinctions were found to differ by diagnostic group. These findings enhance the understanding of symptom burden in YAs and inform the development of targeted interventions and future research. © 2014 American Cancer Society.

Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects Across Multiple Symptom Clusters.

PubMed

Reich, Richard R; Lengacher, Cecile A; Alinat, Carissa B; Kip, Kevin E; Paterson, Carly; Ramesar, Sophia; Han, Heather S; Ismail-Khan, Roohi; Johnson-Mallard, Versie; Moscoso, Manolete; Budhrani-Shani, Pinky; Shivers, Steve; Cox, Charles E; Goodman, Matthew; Park, Jong

2017-01-01

Breast cancer survivors (BCS) face adverse physical and psychological symptoms, often co-occurring. Biologic and psychological factors may link symptoms within clusters, distinguishable by prevalence and/or severity. Few studies have examined the effects of behavioral interventions or treatment of symptom clusters. The aim of this study was to identify symptom clusters among post-treatment BCS and determine symptom cluster improvement following the Mindfulness-Based Stress Reduction for Breast Cancer (MBSR(BC)) program. Three hundred twenty-two Stage 0-III post-treatment BCS were randomly assigned to either a six-week MBSR(BC) program or usual care. Psychological (depression, anxiety, stress, and fear of recurrence), physical (fatigue, pain, sleep, and drowsiness), and cognitive symptoms and quality of life were assessed at baseline, six, and 12 weeks, along with demographic and clinical history data at baseline. A three-step analytic process included the error-accounting models of factor analysis and structural equation modeling. Four symptom clusters emerged at baseline: pain, psychological, fatigue, and cognitive. From baseline to six weeks, the model demonstrated evidence of MBSR(BC) effectiveness in both the psychological (anxiety, depression, perceived stress and QOL, emotional well-being) (P = 0.007) and fatigue (fatigue, sleep, and drowsiness) (P < 0.001) clusters. Results between six and 12 weeks showed sustained effects, but further improvement was not observed. Our results provide clinical effectiveness evidence that MBSR(BC) works to improve symptom clusters, particularly for psychological and fatigue symptom clusters, with the greatest improvement occurring during the six-week program with sustained effects for several weeks after MBSR(BC) training. Name and URL of Registry: ClinicalTrials.gov. Registration number: NCT01177124. Copyright © 2016. Published by Elsevier Inc.

Sensitivity and Validity of Psychometric Tests for Assessing Driving Impairment: Effects of Sleep Deprivation

PubMed Central

Jongen, Stefan; Perrier, Joy; Vuurman, Eric F.; Ramaekers, Johannes G.; Vermeeren, Annemiek

2015-01-01

Objective To assess drug induced driving impairment, initial screening is needed. However, no consensus has been reached about which initial screening tools have to be used. The present study aims to determine the ability of a battery of psychometric tests to detect performance impairing effects of clinically relevant levels of drowsiness as induced by one night of sleep deprivation. Methods Twenty four healthy volunteers participated in a 2-period crossover study in which the highway driving test was conducted twice: once after normal sleep and once after one night of sleep deprivation. The psychometric tests were conducted on 4 occasions: once after normal sleep (at 11 am) and three times during a single night of sleep deprivation (at 1 am, 5 am, and 11 am). Results On-the-road driving performance was significantly impaired after sleep deprivation, as measured by an increase in Standard Deviation of Lateral Position (SDLP) of 3.1 cm compared to performance after a normal night of sleep. At 5 am, performance in most psychometric tests showed significant impairment. As expected, largest effect sizes were found on performance in the Psychomotor Vigilance Test (PVT). Large effects sizes were also found in the Divided Attention Test (DAT), the Attention Network Test (ANT), and the test for Useful Field of View (UFOV) at 5 and 11 am during sleep deprivation. Effects of sleep deprivation on SDLP correlated significantly with performance changes in the PVT and the DAT, but not with performance changes in the UFOV. Conclusion From the psychometric tests used in this study, the PVT and DAT seem most promising for initial evaluation of drug impairment based on sensitivity and correlations with driving impairment. Further studies are needed to assess the sensitivity and validity of these psychometric tests after benchmark sedative drug use. PMID:25668292

Alcohol and the young child.

PubMed

Bradford, D E

1984-01-01

With the increasing availability of alcohol in modern times, the child neglect and abuse portrayed in Hogarth's engraving Gin Lane may once again be witnessed. Reports occur occasionally of alcohol being given deliberately to infants to quieten them, but alcohol poisoning in the slightly older child is not uncommon. The introduction of child-proof containers has altered poisoning figures recently. However, alcohol poisoning tends to occur at ages 3 and 4, that is, about 2 years after the peak of all poisonings in children. This difference may be an indication that alcohol is taken in imitation of parents' drinking, a suggestion which has some support from reported cases of mouthwash poisoning. Holidays and high days where children and alcohol mix, are potentially dangerous periods. Since alcohol poisoning can be fatal, yet if recognised is relatively easily managed, every child with the slightest degree of drowsiness should be suspect until proven or not by blood alcohol. The prevention of alcohol poisoning in the young child consists in protecting the alcohol by lock and key, not setting an example by drinking or gargling in front of children. Many substances such as mouthwash and perfume should also be under supervision. Once actual poisoning has occurred blood sugar is probably more important than the level of blood ethanol and blood sugar levels should be monitored frequently and the child treated with glucose, preferably intravenously.

[Adverse effects of oxcarbazepine].

PubMed

Fang, Shu; Gong, Zhi-Cheng

2015-04-01

Oxcarbazepine is a new antiepileptic drug. The results of clinical trials suggest that oxcarbazepine is well tolerated and has less drug interactions. It is being used more and more widely in clinical practice, but its adverse effects should not be ignored. The most common adverse effects of oxcarbazepine are usually related to the central nervous system and digestive system, including fatigue, drowsiness, diplopia, dizziness, nausea and vomit. The common skin adverse reaction is rash. Long-term use of oxcarbazepine may also cause hyponatremia. This article reviews the literature from China and overseas about the adverse effets of oxcarbazepine over the last 10 years in order to find information about rational clinical use of oxcarbazepine.

The effect of optokinetic stimulation on daytime sleepiness

NASA Technical Reports Server (NTRS)

Leslie, K. R.; Stickgold, R.; Dizio, P.; Lackner, J. R.; Hobson, J. A.

1997-01-01

This study examined the effect of optokinetic stimulation on objective sleepiness, as measured by the Multiple Sleep Latency Test (MSLT). The Nightcap, a portable sleep monitor, was used in a novel way to perform MSLTs, as well as record sleep in the home. Subjects wore the Nightcap for seven consecutive nights. On days 3 and 5 of the protocol, subjects came into the lab for an MSLT. On the experimental day, subjects underwent 10 minutes optokinetic stimulation (OKS), resulting in moderate motion sickness prior to each MSLT trial. Although subjects in the OKS condition reported significantly more drowsiness than controls, this did not result in significantly reduced sleep latencies.

Symptomatic Cerebral Vasospasm and Delayed Cerebral Ischemia Following Transsphenoidal Resection of a Craniopharyngioma.

PubMed

Ricarte, Irapuá Ferreira; Funchal, Bruno F; Miranda Alves, Maramélia A; Gomes, Daniela L; Valiente, Raul A; Carvalho, Flávio A; Silva, Gisele S

2015-09-01

Vasospasm has been rarely described as a complication associated with craniopharyngioma surgery. Herein we describe a patient who developed symptomatic vasospasm and delayed cerebral ischemia after transsphenoidal surgery for a craniopharyngioma. A 67-year-old woman became drowsy 2 weeks after a transsphenoidal resection of a craniopharyngioma. A head computed tomography (CT) was unremarkable except for postoperative findings. Electroencephalogram and laboratory studies were within the normal limits. A repeated CT scan 48 hours after the initial symptoms showed bilateral infarcts in the territory of the anterior cerebral arteries (ACA). Transcranial Doppler (TCD) showed increased blood flow velocities in both anterior cerebral arteries (169 cm/second in the left ACA and 145 cm/second in the right ACA) and right middle cerebral artery (164 cm/second) compatible with vasospasm. A CT angiography confirmed the findings. She was treated with induced hypertension and her level of consciousness improved. TCD velocities normalized after 2 weeks. Cerebral vasospasm should be considered in the differential diagnosis of patients with altered neurologic status in the postoperative period following a craniopharyngioma resection. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Primate body temperature and sleep responses to lower body positive pressure

NASA Technical Reports Server (NTRS)

Edgar, D. M.; Fuller, C. A.

1984-01-01

Cephalic fluid shifts, induced by lower body positive pressure (LBPP) are known to influence various physiological systems (i.e., cardiovascular and renal). In earlier experiments, an apparent change in the arousal state of primates in such LBPP conditions was observed. This study was designed to examine the effects of LBPP on arousal state and body temperature level which is normally correlated with sleep. Chair-restrained male squirrel monkeys were exposed to 40 mmHg LBPP for 90-100 minutes between the daytime hours of 13:00-15:00. Each monkey was placed in a specially modified restraint chair to which they were highly trained. Deep body temperature (DBT) was collected from 10 animals. Sleep parameters were obtained from six animals chronically implanted for sleep recording. A video camera was used to observe each animal's apparent state of arousal. LBPP resulted in an approximate 0.9 C decrease in DBT. During video observation, some animals appeared drowsy during LBPP; however, sleep recording revealed no significant changes in the state of arousal. Thus, LBPP is capable of inducing a mild hyperthermia. Further, the mechanisms underlying the observed lowering of body temperature appear to be independent of arousal state.

Ammonia encephalopathy and awake craniotomy for brain language mapping: cause of failed awake craniotomy.

PubMed

Villalba Martínez, G; Fernández-Candil, J L; Vivanco-Hidalgo, R M; Pacreu Terradas, S; León Jorba, A; Arroyo Pérez, R

2015-05-01

We report the case of an aborted awake craniotomy for a left frontotemporoinsular glioma due to ammonia encephalopathy on a patient taking Levetiracetam, valproic acid and clobazam. This awake mapping surgery was scheduled as a second-stage procedure following partial resection eight days earlier under general anesthesia. We planned to perform the surgery with local anesthesia and sedation with remifentanil and propofol. After removal of the bone flap all sedation was stopped and we noticed slow mentation and excessive drowsiness prompting us to stop and control the airway and proceed with general anesthesia. There were no post-operative complications but the patient continued to exhibit bradypsychia and hand tremor. His ammonia level was found to be elevated and was treated with an infusion of l-carnitine after discontinuation of the valproic acid with vast improvement. Ammonia encephalopathy should be considered in patients treated with valproic acid and mental status changes who require an awake craniotomy with patient collaboration. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Knowledge of hypoglycemia and its associated factors among type 2 diabetes mellitus patients in a Tertiary Care Hospital in South India.

PubMed

Shriraam, Vanishree; Mahadevan, Shriraam; Anitharani, M; Jagadeesh, Nalini Sirala; Kurup, Sreelekha Bhaskara; Vidya, T A; Seshadri, Krishna G

2015-01-01

Hypoglycemia being the rate limiting complication in the attainment of strict glycemic control in diabetes management, in this study, we intended to study the knowledge of its symptoms, target blood levels during treatment and ways of prevention among type 2 diabetes patients attending Outpatient Department (OPD) of a medical college hospital. Every fifth patient attending the OPD during the 4 months between March and June 2013 was interviewed using a questionnaire. The study included 366 type 2 diabetic patients, of which 76.5% were females. The target fasting and postprandial blood glucose levels while on treatment was known to 135 (36.9%) and 126 (34.4%) patients, respectively. The common symptoms of hypoglycemia known to the study subjects were dizziness (81.4%), weakness (73.8%), and drowsiness (72.1%). Overall, 242 (66.1%) diabetic patients had good knowledge on hypoglycemia (knowledge of at least three symptoms of hypoglycemia together with at least one precipitating factor and at least one remedial measure). Higher age, illiteracy, low socioeconomic status were associated with poor knowledge whereas treatment with insulin along with oral hypoglycemic agents was associated with good knowledge on hypoglycemia. Sex and duration of disease were not associated with knowledge on hypoglycemia. Although the knowledge on symptoms of hypoglycemia, precipitating factors, remedial measures are high in this study, the target blood levels, complications were known to just a third of them. There is a knowledge gap on important aspects of hypoglycemia among type 2 diabetic patients.

Lead Toxicity Risks in Gunshot Victims

PubMed Central

de Araújo, Gabriel Costa Serrão; Mourão, Natália Teixeira; Pinheiro, Igor Natário; Xavier, Analúcia Rampazzo; Gameiro, Vinicius Schott

2015-01-01

Background Gunshot wounds require surgeons to decide whether to remove or leave bullet fragments in the body. Surgeons also decide how to follow up with patients who have lead fragments retained in their body. Current literature recommends to remove only intra-articular fragments without the need for a follow-up for patients with the metal retained. Therefore, this study investigates chronic lead toxicity for gunshot wounds. Methods The study was performed in the metropolitan area of Rio de Janeiro/Brazil, between 2013 and 2015. It was a case-control study that included 45 victims of gunshot lesions with metallic fragments retained for more than 6 months. The 45 controls were matched for gender, age, and race. We compared the lead blood levels and frequency of symptoms. Results The control group had average blood lead levels of 2.17 μg/dL (95% Confidence Interval [CI]; 1.71–2.63) and median 2.1 μg/dL. The case group had average values of 9.01 μg/dL (CI; 6.07–11.96) and median values of 6.5 μg/dL with p-values < = 0.001. The case group reported the following more frequently: irritancy, bad mood, headache, memory losses, daylight drowsiness, myalgia, weakness, abdominal pain, joint pain, trembling, tingling limbs. There was statistical significance for the differences of symptoms frequencies and for odds ratio between groups. Conclusions Although the mean lead levels found were lower than the current laboratory references, low levels have been associated with both rising morbidity and mortality. The WHO stated: “There is no known level of lead exposure that is considered safe”. In conclusion, this work showed that bullets retained in the body are not innocuous. There are impacts in the blood lead levels and symptoms related to it, even with few fragments, extra-articular located or existing with low blood lead levels. PMID:26509498

Side effects of antimotion sickness drugs

NASA Technical Reports Server (NTRS)

Wood, C. D.; Manno, J. E.; Manno, B. R.; Redetzki, H. M.; Wood, M. D.; Vekovius, W. A.

1984-01-01

The effects on operational proficiency of the antimotion sickness drugs scopolamine, promethazine and d-amphetamine are tested using a computerized pursuit meter. Proficiency is not significantly affected by oral doses of 0.25 mg or 0.50 mg scopolamine but is descreased by oral or I.M. doses of 25 mg promethazine. The performance decrement associated with 25 mg oral promethazine is prevented when combined with 10 mg oral d-amphetamine. The combination of 25 mg I.M. promethazine, 25 mg oral promethazine and 10 mg d-amphetamine produces less performance decrement than oral or I.M. doses of promethazine alone, though more performance decrement than a placebo. I.M. promethazine is adsorbed slowly and consequently may provoke drowsiness.

Congenital intrahepatic portosystemic venous shunt presenting with paraparesis as the initial symptom.

PubMed

Torigoe, Masataka; Maeshima, Keisuke; Takeshita, Yasushi

2013-01-01

An 85-year-old woman was hospitalized with rapidly progressive paraparesis without altered consciousness, although she was not definitively diagnosed. She developed acute drowsiness and disorientation several days later. An intrahepatic portosystemic venous shunt (IPSVS) was observed on enhanced computed tomography, and hyperammonemia suggested leakage of neurotoxins from the shunt as the etiology of the patient's symptoms. Her neurological symptoms and hyperammonemia improved following transcatheter shunt embolization. We diagnosed her with hepatic myelopathy, which is a rare complication of liver cirrhosis and portosystemic venous shunts. Hepatic myelopathy resulting from a congenital IPSVS has not been previously reported. A diagnosis of hepatic myelopathy should be ruled out in diagnostically difficult cases of paraparesis.

Rhythmic movement disorder (head banging) in an adult during rapid eye movement sleep.

PubMed

Anderson, Kirstie N; Smith, Ian E; Shneerson, John M

2006-06-01

Sleep-related rhythmic movements (head banging or body rocking) are extremely common in normal infants and young children, but less than 5% of children over the age of 5 years old exhibit these stereotyped motor behaviors. They characteristically occur during drowsiness or sleep onset rather than in deep sleep or rapid eye movement (REM) sleep. We present a 27-year-old man with typical rhythmic movement disorder that had persisted into adult life and was restricted to REM sleep. This man is the oldest subject with this presentation reported to date and highlights the importance of recognizing this nocturnal movement disorder when it does occur in adults.

L-Arginine in the treatment of valproate overdose - five clinical cases.

PubMed

Schrettl, Verena; Felgenhauer, Norbert; Rabe, Christian; Fernando, Malkanthi; Eyer, Florian

2017-04-01

Valproic acid and its metabolites - particularly valproyl-CoA - are inhibitors of the enzyme N-acetylglutamate synthetase. The amino acid l-arginine can stimulate N-acetylglutamate synthetase activity and could be potentially used therapeutically to correct hyperammonemia caused by valproate therapy or overdose. Severely valproic-acid-poisoned patients are usually treated with l-carnitine or hemodialysis in order to decrease hyperammonemia. We herein report of five cases, in which l-arginine was administered. Observational study on five cases. Patients with hyperammonemia (i.e., ammonia 80 > μg/dL) and symptoms consistent with valproate overdose (i.e., drowsiness, coma) were selected for treatment with l-arginine. Data was collected retrospectively. l-Arginine decreased ammonia levels in a close temporal relation (case I ammonia in EDTA-plasma [μg/dL] decreased from 381 to 39; case II from 281 to 50; case III from 669 to 74; case IV from 447 to 56; case V from 202 to 60). In cases I and II, hemodialysis was performed and l-carnitine was given before the administration of l-arginine. In case III, hemodialysis was performed after the administration of l-arginine was already started. In cases IV and V, treatment with l-arginine was the sole measure to decrease ammonia levels in plasma. The results suggest that l-arginine may be beneficial in selected cases of valproate overdose complicated by hyperammonemia. l-Arginine could extend our conventional treatment options for valproic acid overdose.

Driver education: Enhancing knowledge of sleep, fatigue and risky behaviour to improve decision making in young drivers.

PubMed

Alvaro, Pasquale K; Burnett, Nicole M; Kennedy, Gerard A; Min, William Yu Xun; McMahon, Marcus; Barnes, Maree; Jackson, Melinda; Howard, Mark E

2018-03-01

This study assessed the impact of an education program on knowledge of sleepiness and driving behaviour in young adult drivers and their performance and behaviour during simulated night driving. Thirty-four participants (18-26 years old) were randomized to receive either a four-week education program about sleep and driving or a control condition. A series of questionnaires were administered to assess knowledge of factors affecting sleep and driving before and after the four-week education program. Participants also completed a two hour driving simulator task at 1am after 17 h of extended wakefulness to assess the impact on driving behaviour. There was an increase in circadian rhythm knowledge in the intervention group following the education program. Self-reported risky behaviour increased in the control group with no changes in other aspects of sleep knowledge. There were no significant differences in proportion of intervention and control participants who had microsleeps (p ≤ .096), stopped driving due to sleepiness (p = .107), recorded objective episodes of drowsiness (p = .455), and crashed (p = .761), although there was a trend towards more control participants having microsleeps and stopping driving. Those in the intervention group reported higher subjective sleepiness at the end of the drive [M = 6.25, SD = 3.83, t(31) = 2.15, p = .05] and were more likely to indicate that they would stop driving [M = 3.08, SD = 1.16, t(31) = 2.24, p = .04]. The education program improved some aspects of driver knowledge about sleep and safety. The results also suggested that the education program lead to an increased awareness of sleepiness. Education about sleep and driving could reduce the risk of drowsy driving and associated road trauma in young drivers, but requires evaluation in a broader sample with assessment of real world driving outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Enhanced Recovery After Surgery: The Plastic Surgery Paradigm Shift.

PubMed

Bartlett, Erica L; Zavlin, Dmitry; Friedman, Jeffrey D; Abdollahi, Aariane; Rappaport, Norman H

2017-12-14

With a focus on providing high quality care and reducing facility based expenses there has been an evolution in perioperative care by way of enhanced recovery after surgery (ERAS). ERAS allows for a multidisciplinary and multimodal approach to perioperative care which not only expedites recovery but maximizes patient outcomes. This paradigm shift has been generally accepted by most surgical specialties, including plastic surgery. The goal of this study was to evaluate the impact of ERAS on outcomes in cosmetic plastic surgery. A prospective study consisting of phone call questionnaires was designed where patients from two senior plastic surgeons (N.H.R. and J.D.F.) were followed. The treatment group (n = 10) followed an ERAS protocol while the control group (n = 12) followed the traditional recovery after surgery which included narcotic usage. Patients were contacted on postoperative days (POD) 0 through 7+ and surveyed about a number of outcomes measures. The ERAS group demonstrated a significant reduction in postoperative pain on POD 0, 1, 2, and 3 (all P < 0.01). There was also statistically less nausea/vomiting, fatigue/drowsiness, constipation, and hindrance on ambulation compared to the control group (all P < 0.05). Significance was achieved for reduction in fatigue/drowsiness on POD 0 and 1 (P < 0.01), as well as ability to ambulate on POD 0 and 3 (P = 0.044). Lastly, opioid use (P < 0.001) and constipation (P = 0.003) were decreased. ERAS protocols have demonstrated their importance within multiple surgical fields, including cosmetic plastic surgery. The utility lies in the ability to expedite patient's recovery while still providing quality care. This study showed a reduction in postoperative complaints by avoiding narcotics without an increase in complications. Our findings signify the importance of ERAS protocols within cosmetic plastic surgery. 4. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Amitraz poisoning: A case report of an unusual pesticide poisoning in Sri Lanka and literature review.

PubMed

Herath, H M M T B; Pahalagamage, S P; Yogendranathan, Nilukshana; Wijayabandara, M D M S; Kulatunga, Aruna

2017-01-23

Amitraz is a pesticide used worldwide on animals and in agriculture. It contains triazapentadiene, which is a centrally acting alpha-2 adrenergic agonist. Amitraz poisoning is fairly uncommon in humans and occurs via oral, dermal or inhalational routes. Only a limited number of case reports of human intoxication have been published and most of them are of accidental ingestion by children. A twenty-year-old Sri Lankan female presented following self-ingestion of 20 ml of amitraz resulting in 37.8 mg/ kg of amitraz poisoning. She lost consciousness after 20 min of ingestion, developed bradycardia and hypotension, which needed intravenous fluid resuscitation and dobutamine. Gastric lavage was performed. Her bradycardia persisted for 36 h and she was drowsy for 48 h. She did not develop respiratory depression, convulsions or hypothermia and the urine output was normal. Arterial blood gas revealed mild respiratory alkalosis. She recovered fully within 48 h and was discharged on day 3. The clinical manifestations of amitraz (impaired consciousness, drowsiness, vomiting, disorientation, miosis, mydriasis, hypotension, bradycardia, respiratory depression, hypothermia, generalized seizures, hyperglycemia and glycosuria) can be explained by the agonist action of amitraz on α1 and α2 receptors. Management of amitraz poisoning is still considered to be supportive and symptomatic with monitoring of nervous system, cardiovascular and respiratory systems. Activated charcoal may still be considered for treatment and the place for gastric lavage is controversial. Atropine is effective for symptomatic bradycardia and inotropic support is needed for hypotension that does not respond to fluid resuscitation. Diazepam or Lorazepam is used for convulsions and some patients may require intubation and ICU care. Several α2 adrenergic antagonists like yohimbine have been tried on animals, which have successfully reversed the effects of amitraz. Since the majority of amitraz poisoning cases are due to accidental ingestion, manufactures, regulatory authorities and national poisons control centers have a significant role to play in minimizing its occurrence.

Prevalence and correlates of dizziness in community-dwelling older people: a cross sectional population based study.

PubMed

de Moraes, Suzana Albuquerque; Soares, Wuber Jefferson de Souza; Ferriolli, Eduardo; Perracini, Monica Rodrigues

2013-01-04

Dizziness is a common complaint among older adults and has been linked to a wide range of health conditions, psychological and social characteristics in this population. However a profile of dizziness is still uncertain which hampers clinical decision-making. We therefore sought to explore the relationship between dizziness and a comprehensive range of demographic data, diseases, health and geriatric conditions, and geriatric syndromes in a representative sample of community-dwelling older people. This is a cross-sectional, population-based study derived from FIBRA (Network for the Study of Frailty in Brazilian Elderly Adults), with 391 elderly adults, both men and women, aged 65 years and older. Elderly participants living at home in an urban area were enrolled through a process of random cluster sampling of census regions. The outcome variable was the self-report of dizziness in the last year. Several feelings of dizziness were investigated including vertigo, spinning, light or heavy headedness, floating, fuzziness, giddiness and instability. A multivariate logistic regression analysis was conducted to estimate the adjusted odds ratios and build the probability model for dizziness. The complaint of dizziness was reported by 45% of elderly adults, from which 71.6% were women (p=0.004). The multivariate regression analysis revealed that dizziness is associated with depressive symptoms (OR = 2.08; 95% CI 1.29-3.35), perceived fatigue (OR = 1.93; 95% CI 1.21-3.10), recurring falls (OR = 2.01; 95% CI 1.11-3.62) and excessive drowsiness (OR = 1.91; 95% CI 1.11-3.29). The discrimination of the final model was AUC = 0.673 (95% CI 0.619-0.727) (p< 0.001). The prevalence of dizziness in community-dwelling elderly adults is substantial. It is associated with other common geriatric conditions usually neglected in elderly adults, such as fatigue and drowsiness, supporting its possible multifactorial manifestation. Our findings demonstrate the need to expand the design in future studies, aiming to estimate risk and identify possible causal relations.

Bioavailability and Pharmacodynamics of Promethazine in Human Subjects

NASA Technical Reports Server (NTRS)

Putcha, Lakshmi; Flynn, Chris; Paloski, W. H. (Technical Monitor)

2000-01-01

Space Motion Sickness (SMS) is often treated in space with promethazine (PMZ). Anecdotal reports indicate that the common side effects of drowsiness and decrements in cognitive performance that are associated with PMZ administration (50 mg IM on the ground, are absent or less pronounced in space suggesting I that-the bioavailability and/or pharmacodynamic behavior of PMZ may be altered during space flight. There are limited flight opportunities available for clinical research in space, the NRA-99, therefore, solicits research required to improve, or answer specific questions about in-flight diagnosis, therapy, and post-flight rehabilitation. We propose here, to establish a noninvasive method for pharmacodynamic and therapeutic assessment of PMZ. The specific objectives of the proposed research are to, 1. Establish a saliva to plasma ratio of PMZ after administration, 2. Estimate the relative bioavailability of the three flight-specific dosage forms of PMZ, and 3. Establish the dose-response relationship of PMZ. We will estimate the bioavailability of intramuscular injection (IM), oral tablets and rectal suppositories in normal subjects during ambulatory and antiorthostatic; bed rest (ABR) conditions using novel stable isotope techniques. Drowsiness, cognitive performance and salivary flow rate will be measured as a function of circulating drug concentrations after administration of three IM doses of PMZ. We will compare and contrast the bioavailability of PMZ during normal and ABR conditions to examine whether or not ABR can simulate changes in drug, absorption and availability similar to those anticipated in a microgravity environment. Results of this study will validate methods for an approved study with this medication awaiting a flight opportunity for manifestation. These data will also provide the much needed information on the dynamics and therapeutic index. of this medication and their implications on crew fatigue and performance in space. Key words: Promethazine, stable isotopes, bioavailability, pharmacodynamics, cognitive performance, antiorthostatic bed rest.

Abuse and Intentional Misuse of Promethazine Reported to US Poison Centers: 2002 to 2012.

PubMed

Tsay, M Ellen; Procopio, Gabrielle; Anderson, Bruce D; Klein-Schwartz, Wendy

2015-01-01

Promethazine abuse has been reported. The objective was to investigate promethazine abuse/misuse in the United States. An 11-year retrospective review was conducted of promethazine abuse and intentional misuse cases without co-ingestants in persons 10 years and older reported to the National Poison Data System. Data were stratified by product (promethazine-alone [PA] or co-formulation [PC]) and evaluated for demographics, toxicity, management sites, and outcomes. There were 354 single product abuse or misuse exposures-95 PA and 259 PC. Over the 11-year timeframe, the annual exposure rate per 100,000 population doubled. Exposures were most prevalent among 10 to 19 years old and young adults (20s), accounting for 69.5% of PA and 57.5% of PC cases. Clinical effects due to PA included drowsiness (43.2%), tachycardia (7.4%), agitation (13.7%), confusion (13.7%), slurred speech (12.6%), hallucinations (7.4%), dizziness (7.4%), and hypertension (5.3%). Drowsiness (53.4%) and tachycardia (20.8%) were more frequent with PC. There were significant differences between PA and PC in management site (P = 0.0078). Management sites for PA and PC, respectively, were emergency department (37.9%, 55.6%), non-health care facility (33.7%, 14.7%), critical care unit (8.4%, 11.2%), non-critical care unit (7.4%, 7.3%), psychiatry (2.1%, 4.2%), and other/unknown (10.5%, 7.0%). Outcomes for PA and PC, respectively, were no effect (21.0%, 12.4%), minor (58.9%, 53.7%), moderate (17.9%, 32.0%), and major effects (2.1%, 1.9%). Promethazine-alone abuse/misuse most frequently resulted in minor outcomes, and less than 20% required medical admission. Abuse/misuse of PC resulted in a higher frequency of health care facility treatment and a trend toward more moderate outcomes. These differences are most likely attributed to the co-formulate.

The influence of daily sleep patterns of commercial truck drivers on driving performance.

PubMed

Chen, Guang Xiang; Fang, Youjia; Guo, Feng; Hanowski, Richard J

2016-06-01

Fatigued and drowsy driving has been found to be a major cause of truck crashes. Lack of sleep is the number one cause of fatigue and drowsiness. However, there are limited data on the sleep patterns (sleep duration, sleep percentage in the duration of non-work period, and the time when sleep occurred) of truck drivers in non-work periods and the impact on driving performance. This paper examined sleep patterns of 96 commercial truck drivers during non-work periods and evaluated the influence these sleep patterns had on truck driving performance. Data were from the Naturalistic Truck Driving Study. Each driver participated in the study for approximately four weeks. A shift was defined as a non-work period followed by a work period. A total of 1397 shifts were identified. Four distinct sleep patterns were identified based on sleep duration, sleep start/end point in a non-work period, and the percentage of sleep with reference to the duration of non-work period. Driving performance was measured by safety-critical events, which included crashes, near-crashes, crash-relevant conflicts, and unintentional lane deviations. Negative binomial regression was used to evaluate the association between the sleep patterns and driving performance, adjusted for driver demographic information. The results showed that the sleep pattern with the highest safety-critical event rate was associated with shorter sleep, sleep in the early stage of a non-work period, and less sleep between 1 a.m. and 5 a.m. This study also found that male drivers, with fewer years of commercial vehicle driving experience and higher body mass index, were associated with deteriorated driving performance and increased driving risk. The results of this study could inform hours-of-service policy-making and benefit safety management in the trucking industry. Published by Elsevier Ltd.

The impact of multiple care giving roles on fatigue, stress, and work performance among hospital staff nurses.

PubMed

Scott, Linda D; Hwang, Wei-Ting; Rogers, Ann E

2006-02-01

This study describes fatigue and stress among a random sample of full-time hospital staff nurses (n=393) who provide care for aging family members, compares the results to nurses with and without children younger than 18 years living at home, examines differences in sleep duration, and explores the effects on work performance by care giving status during a 4-week period. Little attention has been given to the effects of care giver well-being when individuals assume dual roles as family and professional care givers. Hospital staff nurses recorded daily information concerning their work hours, errors, sleep/wake patterns, perceptions of fatigue, alertness, and stress and periods of drowsiness and sleep episodes while on duty for 28 days. Fatigue and stress levels were significantly higher among nurses caring for both children and elders. However, nurses providing elder care at home were more fatigued, sleep-deprived, and likely to make errors at work. These findings underscore the importance of restorative sleep interventions and fatigue countermeasures for hospital staff nurses involved in dual care giving roles. Limiting overtime and applying circadian principles to hospital scheduling processes would ensure a more alert workforce, minimize health risks for nurses, and maximize the safety of those in their care.

School start times for adolescents.

PubMed

2014-09-01

The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation's middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students' ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 am) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5-9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life. Copyright © 2014 by the American Academy of Pediatrics.

Postnatal development of EEG patterns, catecholamine contents and myelination, and effect of hyperthyroidism in Suncus brain.

PubMed

Takeuchi, T; Sitizyo, K; Harada, E

1998-03-01

The postnatal development of the central nervous system (CNS) in house musk shrew in the early stage of maturation was studied. The electroencephalogram (EEG) and visual evoked potential (VEP) in association with catecholamine contents and myelin basic protein (MBP) immunoreactivity were carried out from the 1st to the 20th day of postnatal age. Different EEG patterns which were specific to behavioral states (awake and drowsy) were first recorded on the 5th day, and the total power which was obtained by power spectrum analysis increased after this stage. The latencies of all peaks in VEP markedly shortened between the 5th and the 7th day. Noradrenalin (NA) content of the brain showed a slight increase after the 3rd day, and reached maximum levels on the 7th day, which was delayed a few days compared to dopamine (DA). In hyperthyroidism, the peak latency of VEP was shortened and biosynthesis of NA in cerebral cortex and DA in hippocampus was accelerated. The most obvious change in MBP-immunoreactivity of the telencephalon occurred from the 7th to the 10th day. These morphological changes in the brain advanced at the identical time-course to those in the electrophysiological development and increment of DA and NA contents.

Carboxyatractyloside poisoning in humans.

PubMed

Turgut, Mehmet; Alhan, Cafer Cumhur; Gürgöze, Metin; Kurt, Abdullah; Doğan, Yaşar; Tekatli, Muhittin; Akpolat, Nusret; Aygün, A Denizmen

2005-06-01

Cocklebur (Xanthium strumarium) is an herbaceous annual plant with worldwide distribution. The seeds contain the glycoside carboxyatractyloside, which is highly toxic to animals. We describe nine cases of carboxyatractyloside poisoning in humans which, to our knowledge, has not previously been reported. The clinical, laboratory and histopathological findings and our therapeutic approach are also discussed. The patients presented with acute onset abdominal pain, nausea and vomiting, drowsiness, palpitations, sweating and dyspnoea. Three of them developed convulsions followed by loss of consciousness and death. Laboratory findings showed raised liver enzymes, indicating severe hepatocellular damage. BUN and creatinine levels were raised, especially in the fatal cases who also displayed findings of consumption coagulopathy. CPK-MB values indicative of myocardial injury were also raised, especially in the fatal cases. Three of the patients died within 48 hours of ingesting carboxyatractyloside. Post-mortem histopathology of the liver confirmed centrilobular hepatic necrosis and renal proximal tubular necrosis, secondary changes owing to increased permeability and microvascular haemorrhage in the cerebrum and cerebellum, and leucocytic infiltrates in the muscles and various organs including pancreas, lungs and myocardium. Carboxyatractyloside poisoning causes multiple organ dysfunction and can be fatal. Coagulation abnormalities, hyponatraemia, marked hypoglycaemia, icterus and hepatic and renal failure are signs of a poor prognosis. No antidote is available and supportive therapy is the mainstay of treatment.

A Family Clustered Nitrite Intoxication Investigation in Gaoxin District, Suzhou, China, 2013.

PubMed

Wang, Ruiping; Teng, Chengang; Zhang, Ning; Zhang, Jun; Conway, George

2013-12-01

In April, 2013, a Suzhou Hospital reported a nitrite intoxication patient in coma as well as 2 family members with the similar symptom 5 days ahead. We investigated the event to identify the cause, source and possible pollution ways of the contamination. We defined case as any person living in YSHY community who has cyanosis and with at least one of the following symptoms: dizziness, headache, fatigue, tachycardia, drowsiness, nausea, vomiting, abdominal pain or diar-rhea during April 15 to April 25, 2013. We searched for case by interviewing community residents and reviewing clinics' medical records; information was then retrospectively collected on the patient's food history, cooking procedures and food sources. We identified 3 nitrite intoxication cases, 1 male and 2 female from a family. The interval time between dinner and onset was < 1 hour. Retrospective survey showed 'sugar stir and mix asparagus' on April 17 and 'scrambled asparagus' on April 21 were suspected foods. Both suspected dishes had 'sugar' added, sourced from a clean-up of a neighboring rental house. Nitrite was detected in a vomitus sample, the 'sugar' and two leftover food samples. This family clustered nitrite intoxication was induced by using unidentified nitrite as sugar to cook dishes. We recommend sodium nitrite should be dyed with bright colors to avoid mistaking it for plain salt or sugar, health departments strengthen food hygiene propaganda to improve people's recognition of food safety, and to alert them the dangerous of eating unidentified or unknown source food.

Age-related changes in sleep-wake rhythm in dog.

PubMed

Takeuchi, Takashi; Harada, Etsumori

2002-10-17

To investigate a sleep-wake rhythm in aged dogs, a radio-telemetry monitoring was carried out for 24 h. Electrodes and telemetry device were surgically implanted in four aged dogs (16-18 years old) and four young dogs (3-4 years old). Electroencephalogram (EEG), electromyogram (EMG) and electrocardiogram (ECG) were recorded simultaneously as parameters to determine vigilance states and an autonomic nervous function. Wakefulness, slow wave sleep (SWS) and paradoxical sleep (PS) were identified according to the EEG and EMG pattern. We also examined whether absolute powers and the low frequency-to-high frequency ratio (LF/HF) derived from the heart rate variability power spectrum could detect shifts in autonomic balance correlated with aging. The aged dogs showed a marked reduction of PS and a fragmentation of wakefulness in the daytime and a sleep disruption in the night. The pattern of 24 h sleep and waking was dramatically altered in the aged dog. It was characterized by an increase in the total amount of time spent in SWS during the daytime followed by an increasing of time spent in wakefulness during the night. Furthermore, LF/HF ratio showed a very low amplitude of variance throughout the day in the aged dog. These results suggest that the aged dog is a useful model to investigate sleep disorders in human such as daytime drowsiness, difficulties in sleep maintenance. The abnormality in sleep-wake cycle might be reflected by the altered autonomic balance in the aged dogs.

Reversal of Progressive Conscious Disturbance with Epidural Blood Patch for Cerebrospinal Fluid Leakage at C2 Level.

PubMed

Lai, Yi-Chen; Chia, Yuan-Yi; Lien, Wei-Hung

2017-03-01

Intracranial hypotension syndrome (IHS) is generally caused by cerebrospinal fluid (CSF) leakage. Complications include bilateral subdural hygroma or haematoma and herniation of the cerebellar tonsils. Epidural blood patch (EBP) therapy is indicated if conservative treatment is ineffective. We reported the case of a 46-year-old man with a history of postural headache and dizziness. The patient was treated with bed rest and daily hydration with 2000 mL of fluid for 2 weeks. However, dizziness and headache did not resolve, and he became drowsy and disoriented with incomprehensible speech. Magnetic resonance imaging demonstrated diffuse dural enhancement on the postcontrast study, sagging of the midbrain, and CSF leakage over right lateral posterior thecal sac at C2 level. We performed EBP at the level of T10-T11. We injected 14 mL of autologous blood slowly in the Trendelenburg position. Within 30 minutes, he became alert and oriented to people, place, and time. We chose thoracic EBP as first line treatment in consideration of the risk of cervical EBP such as spinal cord and nerve root compression or puncture, chemical meningitis. Also we put our patient in Trendelenburg position to make blood travel towards the site of the leak. Untreated IHS may delay the course of resolution and affect the patient's consciousness. Delivery of EBP via an epidural catheter inserted from the thoracic spine is familiar with most of anesthesiologists. It can be a safe and effective treatment for patients with IHS caused by CSF leak even at C2.Key words: Anaesthetic techniques, regional, thoracic; cerebrospinal fluid leakage; epidural blood patch; heavily T2-weighted magnetic resonance myelography; intracranial hypotension syndrome; Trendelenburg position.

Rifampicin-induced adrenal crisis in a patient with tuberculosis: a therapeutic challenge.

PubMed

Denny, Nicholas; Raghunath, Sarika; Bhatia, Praveen; Abdelaziz, Muntasir

2016-11-29

A 55-year-old Indian man presented with productive cough and a large left pleural effusion. Pleural fluid culture grew Mycobacterium tuberculosis, and he was started on antituberculosis therapy. One week later, the patient presented to hospital with drowsiness, dehydration and hypotension. He was transferred to critical care and only improved after starting hydrocortisone and stopping rifampicin. His short synACTHen test subsequently confirmed primary adrenal insufficiency, and a CT of the abdomen showed bilateral adrenal enlargement. Rifampicin is known to accelerate cortisol metabolism. We report the rare case of a rifampicin-induced adrenal crisis as a first presentation of Addison's disease in a patient with tuberculous infiltration of the adrenal glands. 2016 BMJ Publishing Group Ltd.

Hypoglycaemic haemiparesis

PubMed Central

Kirresh, Othman; Kamara, Achmed; Samadian, Samad

2013-01-01

Hypoglycaemic haemiparesis (HH) is an uncommon but important presentation to the emergency department, and it often mimics stroke and is therefore frequently misdiagnosed by clinicians. The mechanism of haemiparesis is not fully understood. This case outlines a diabetic elderly woman, who had been having frequent hypoglycaemic episodes and presented to paramedics with hypoglycaemia associated with a right-sided haemiparesis. She was immediately transferred to the local stroke centre after presenting to the emergency department. CT and MRI did not fit in with her presenting neurology. Her weakness resolved, after normoglycaemia was achieved with dextrose infusion; however, she was reported to be more sleepy and drowsy than usual. After extensive and costly investigations during her prolonged inpatient stay, her unifying diagnosis was an HH which triggered of a hypoactive delirium. PMID:24130203

Accidental poisoning with "Chinese chalk".

PubMed

Martínez-Navarrete, Juan; Loria-Castellanos, Jorge; Nava-Ocampo, Alejandro A

2008-04-01

We present a 1.5-year old, 11 kg, female infant with a history of bronchial hyper-responsiveness who accidentally ingested half of a "Chinese chalk". A day later, the infant showed vomiting, cough, fever, drowsiness, and irritability and her clinical conditions progressively worsened. She was admitted to the emergency department with cough, respiratory distress, and hepatomegaly. It has been reported that the chalk may contain deltamethrin and cypermethrin. The patient was successfully treated with supportive therapy. This report identifies "Chinese chalk" as a potential source of accidental poisoning in children and should be considered as part of the differential diagnoses in the emergency rooms since poisoning with these compounds may be misdiagnosed as organophosphate poisoning due to the presentation of similar symptoms.

Dementia with Lewy bodies in an elderly Greek male due to alpha-synuclein gene mutation.

PubMed

Morfis, Litsa; Cordato, Dennis John

2006-11-01

We report the case of an elderly man of Greek background who presented with progressive cognitive decline and motor parkinsonism on a background of a strong family history of Parkinson's disease. Associated symptoms included visual hallucinations, excessive daytime drowsiness, recurrent falls, orthostatic hypotension and urinary incontinence. His major clinical symptoms and signs fulfilled consensus criteria for a clinical diagnosis of dementia with Lewy bodies. An alpha-synuclein gene mutation analysis for the G209A substitution was positive. We conclude that the alpha-synuclein (G209A) gene mutation genotype should be considered in the differential diagnosis of dementia with Lewy bodies, particularly in patients with European ancestry and a family history of Parkinson's disease.

Mercury Toxicity Following Unauthorized Siddha Medicine Intake – A Mimicker of Acquired Neuromyotonia - Report of 32 Cases

PubMed Central

Gnanashanmugam, G.; Balakrishnan, R.; Somasundaram, S. P.; Parimalam, N.; Rajmohan, P.; Pranesh, M. B.

2018-01-01

Context: Mercury is used extensively in the preparation of Siddha medicines, after purification. In this study, we present 32 patients of mercury toxicity following unauthorized Siddha medicine intake who mimicked neuromyotonia clinically. We analyzed the clinical features of these patients, the role of autoimmunity in etiopathology, and compared it with acquired neuromyotonia. Subjects and Methods: This is a retrospective study to analyze inpatients in a tertiary care center, admitted with mercury toxicity following Siddha medicine intake from August 2012 to October 2016. We analyzed the clinical features, laboratory data including mercury, arsenic and lead levels in blood, and serum voltage-gated potassium channels (VGKC)-CASPR2 Ab in selected patients. Results: Thirty-two patients who had high blood mercury levels following Siddha medicine intake were included in the study. All patients (100%) had severe intractable neuropathic pain predominantly involving lower limbs. Twenty-six (81.25%) patients had fasciculations and myokymia. Fifteen patients (46.86%) had autonomic dysfunction (postural hypotension and resting tachycardia). Nine (28.12%) patients had encephalopathic features such as dullness, apathy, drowsiness, or delirium. Anti-VGKC Ab was positive in 12 patients with myokymia. All the patients in the study consumed Siddha medicines obtained from unauthorized dealers. Conclusions: Mercury toxicity following Siddha medicine intake closely mimics acquired neuromyotonia; severe intolerable neuropathic pain is the hallmark feature; Positive VGKC-CASPR2 antibody in some patients must be due to triggered autoimmunity secondary to mercury toxicity due to Siddha medicine intake. The government should establish licensing system to prevent distribution of unauthorized Siddha medicines. PMID:29720798

Mercury Toxicity Following Unauthorized Siddha Medicine Intake - A Mimicker of Acquired Neuromyotonia - Report of 32 Cases.

PubMed

Gnanashanmugam, G; Balakrishnan, R; Somasundaram, S P; Parimalam, N; Rajmohan, P; Pranesh, M B

2018-01-01

Mercury is used extensively in the preparation of Siddha medicines, after purification. In this study, we present 32 patients of mercury toxicity following unauthorized Siddha medicine intake who mimicked neuromyotonia clinically. We analyzed the clinical features of these patients, the role of autoimmunity in etiopathology, and compared it with acquired neuromyotonia. This is a retrospective study to analyze inpatients in a tertiary care center, admitted with mercury toxicity following Siddha medicine intake from August 2012 to October 2016. We analyzed the clinical features, laboratory data including mercury, arsenic and lead levels in blood, and serum voltage-gated potassium channels (VGKC)-CASPR2 Ab in selected patients. Thirty-two patients who had high blood mercury levels following Siddha medicine intake were included in the study. All patients (100%) had severe intractable neuropathic pain predominantly involving lower limbs. Twenty-six (81.25%) patients had fasciculations and myokymia. Fifteen patients (46.86%) had autonomic dysfunction (postural hypotension and resting tachycardia). Nine (28.12%) patients had encephalopathic features such as dullness, apathy, drowsiness, or delirium. Anti-VGKC Ab was positive in 12 patients with myokymia. All the patients in the study consumed Siddha medicines obtained from unauthorized dealers. Mercury toxicity following Siddha medicine intake closely mimics acquired neuromyotonia; severe intolerable neuropathic pain is the hallmark feature; Positive VGKC-CASPR2 antibody in some patients must be due to triggered autoimmunity secondary to mercury toxicity due to Siddha medicine intake. The government should establish licensing system to prevent distribution of unauthorized Siddha medicines.

Cortical venous thrombosis following exogenous androgen use for bodybuilding.

PubMed

Sveinsson, Olafur; Herrman, Lars

2013-02-05

There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic-clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully.

Using Latent Sleepiness to Evaluate an Important Effect of Promethazine

NASA Technical Reports Server (NTRS)

Feiveson, Alan H.; Hayat, Matthew; Vksman, Zalman; Putcha, Laksmi

2007-01-01

Astronauts often use promethazine (PMZ) to counteract space motion sickness; however PMZ may cause drowsiness, which might impair cognitive function. In a NASA ground study, subjects received PMZ and their cognitive performance was then monitored over time. Subjects also reported sleepiness using the Karolinska Sleepiness Score (KSS), which ranges from 1 - 9. A problem arises when using KSS to establish an association between true sleepiness and performance because KSS scores tend to overly concentrate on the values 3 (fairly awake) and 7 (moderately tired). Therefore, we defined a latent sleepiness measure as a continuous random variable describing a subject s actual, but unobserved true state of sleepiness through time. The latent sleepiness and observed KSS are associated through a conditional probability model, which when coupled with demographic factors, predicts performance.

Adolescent Sleepiness: Causes and Consequences.

PubMed

Hansen, Shana L; Capener, Dale; Daly, Christopher

2017-09-01

Insufficient sleep duration and poor sleep quality are common among adolescents. The multidimensional causes of insufficient sleep duration and poor sleep quality include biological, health-related, environmental, and lifestyle factors. The most common direct consequence of insufficient and/or poor sleep quality is excessive daytime sleepiness, which may contribute to poor academic performance, behavioral health problems, substance use, and drowsy driving. Evaluation of sleepiness includes a detailed sleep history and sleep diary, with polysomnography only required for the assessment of specific sleep disorders. Management involves encouraging healthy sleep practices such as having consistent bed and wake times, limiting caffeine and electronics at night before bed, and eliminating napping, in addition to treating any existing sleep or medical disorders. [Pediatr Ann. 2017;46(9):e340-e344.]. Copyright 2017, SLACK Incorporated.

Sleep dysfunctions influence decision making in undemented Parkinson's disease patients: a study in a virtual supermarket.

PubMed

Albani, Giovanni; Raspelli, Simona; Carelli, Laura; Priano, Lorenzo; Pignatti, Riccardo; Morganti, Francesca; Gaggioli, Andrea; Weiss, Patrice L; Kizony, Rachel; Katz, Noomi; Mauro, Alessandro; Riva, Giuseppe

2011-01-01

In the early-middle stages of Parkinson's disease (PD), polysomnographic studies show early alterations of the structure of the sleep, which may explain frequent symptoms reported by patients, such as daytime drowsiness, loss of attention and concentration, feeling of tiredness. The aim of this study was to verify if there is a correlation between the sleep dysfunction and decision making ability. We used a Virtual Reality version of the Multiple Errand Test (VMET), developed using the NeuroVR free software (http://www.neurovr2.org), to evaluate decision-making ability in 12 PD not-demented patients and 14 controls. Five of our not-demented 12 PD patients showed abnormalities in the polysomnographic recordings associated to significant differences in the VMET performance.

Pancytopenia associated with levetiracetam in an epileptic woman.

PubMed

García Carretero, Rafael; Romero Brugera, Marta; Olid-Velilla, Monica; Salamanca-Ramirez, Inmaculada

2016-12-07

Haematological toxicity due to antiepileptic drugs is uncommon, but the increased risk of aplastic anaemia has been reported. Few case reports have been published regarding pancytopenia associated with levetiracetam treatment, and its intrinsic pathogenesis is still unknown. We describe the case of a woman aged 77 years who presented with abdominal pain and loss of appetite. She had been taking valproic acid, due to a previous episode of epileptic seizures, and presented with drowsiness and dizziness. Valproate was discontinued and therapy with levetiracetam was initiated. 2 days later, we observed severe anaemia, leucopenia and thrombocytopenia, which were attributed to levetiracetam. Although she recovered soon after the treatment was discontinued, it took 2 weeks for cell counts to return to normal. 2016 BMJ Publishing Group Ltd.

Long-term retention of a divided attention psycho-motor test combining choice reaction test and postural balance test: A preliminary study.

PubMed

Rossi, R; Pascolo, P B

2015-09-01

Driving in degraded psychophysical conditions, such as under the influence of alcohol or drugs but also in a state of fatigue or drowsiness, is a growing problem. The current roadside tests used for detecting drugs from drivers suffer various limitations, while impairment is subjective and does not necessarily correlate with drug metabolite concentration found in body fluids. This work is a validation step towards the study of feasibility of a novel test conceived to assess psychophysical conditions of individuals performing at-risk activities. Motor gestures, long-term retention and learning phase related to the protocol are analysed in unimpaired subjects. The protocol is a divided attention test, which combines a critical tracking test achieved with postural movements and a visual choice reaction test. Ten healthy subjects participated in a first set of trials and in a second set after about six months. Each session required the carrying out of the test for ten times in order to investigate learning effect and performance over repetitions. In the first set the subjects showed a learning trend up to the third trial, whilst in the second set of trials they showed motor retention. Nevertheless, the overall performance did not significantly improve. Gestures are probably retained due to the type of tasks and the way in which the instructions are conveyed to the subjects. Moreover, motor retention after a short training suggests that the protocol is easy to learn and understand. Implications for roadside test usage and comparison with current tests are also discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Acute confusional syndrome associated with obstructive sleep apnea aggravated by acidosis secondary to oral acetazolamide treatment].

PubMed

Miguel, E; Güell, R; Antón, A; Montiel, J A; Mayos, M

2004-06-01

Acute confusional syndrome, or delirium, is a transitory mental state characterized by the fluctuating alteration of awareness and attention levels. We present the case of a patient with acute confusional syndrome associated with obstructive sleep apnea syndrome (OSAS) aggravated by metabolic acidosis induced by oral acetazolamide treatment.A 70-year-old man with no history of neurological disease was referred with a clinical picture consistent with acute confusional syndrome presenting between midnight and dawn. During the admission examination infectious, toxic, and neurologic causes, or those related to metabolic or heart disease were ruled out. Arterial blood gases measured during one of the nighttime episodes of acute confusional syndrome showed mild hypoxia and hypercapnia with mixed acidosis. Signs and symptoms suggestive of OSAS had been developing over the months prior to admission, with snoring, sleep apnea, and moderate daytime drowsiness. Polysomnography demonstrated severe OSAS with an apnea-hypopnea index of 38. Mean arterial oxygen saturation was 83%; time oxygen saturation remained below 90% was 44%. The attending physician ordered the withdrawal of oral acetazolamide, which was considered the cause of the metabolic component of acidosis. Treatment with continuous positive airway pressure was initiated at 9 cm H2O, after a titration polysomnographic study. The patient continued to improve.OSAS, for which very effective treatment is available, should be included among diseases that may trigger acute confusional syndrome.

Effectiveness and acceptability of intravenous sedation in child and adolescent dental patients: report of a case series at King's College Hospital, London.

PubMed

Lourenço-Matharu, L; Roberts, G J

2011-06-24

Conscious sedation for young patients continues to be challenging. Few studies have shown positive results using intravenous midazolam when sedating young patients. This case series reports an investigation of conscious sedation using intravenous midazolam for young patients receiving dental treatment. To determine acceptance, safety and efficacy of intravenous midazolam for conscious sedation in children and adolescent patients undergoing dental treatment.Patients and methods Patients from seven to 16 years of age, ASA I, II and III, opted to have extractions, minor oral surgery and/or conservative treatment with IV midazolam and local anaesthesia. A pulse oximeter was used to monitor vital signs and the Houpt scale to assess overall behaviour. A total of 552 patients, 234 boys and 318 girls with mean ages of 13.3 years and 13.5 years respectively, were included. Three hundred and sixty-five patients (66%) claimed to be anxious or very anxious before treatment. The average dose given was 5.7 mg and dosage ranged from 2 to 10 mg. Four hundred and fifty-seven patients (83%) scored 'very good' and 'excellent' for overall behaviour. Side-effects included crying, drowsiness and amnesia. Intravenous midazolam is accepted by patients and is a safe and effective method of sedation for use in children and adolescents, producing some level of tearfulness.

Perception of the quality of care, work environment and sleep characteristics of nurses working in the National Health System.

PubMed

Moreno-Casbas, María Teresa; Alonso-Poncelas, Emma; Gómez-García, Teresa; Martínez-Madrid, María José; Escobar-Aguilar, Gema

2018-03-19

To describe nurses' perception in relation to the quality of care and their work environment, as well as to describe their quality of sleep. To analyze the relationship between ward and work shift with nurses' perception of their work environment, sleep quality and day time drowsiness. A multicentre, observational and descriptive study carried out between 2012-2014 in seven hospitals of the Spanish National Health System. Work environment, work satisfaction, sleep quality and quality of patient care were evaluated through validated tools. 635 registered nurses participated in the study. Eighty-three point seven percent perceived the quality of cares as good/excellent, and 55.1% rated the work environment of their hospital as good/excellent. PES-NWI classified 39% of hospitals as unfavourable and 20% as favourable. Fifteen point four percent of the nurses had a high level of burnout and 58.3% had low burnout. Sleep quality was 6.38 for nurses working on day shifts, 6.78 for the rotational shifts and 7.93 for night shifts. Significant differences were found between subjective sleep quality score, sleep duration, sleep disturbances and daytime dysfunction. In the provision of quality care services, there is a multitude of related factors such as shift, ward, satisfaction, and nurses' perceptions of patient safety and sleep quality. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Promethazine affects autonomic cardiovascular mechanisms minimally

NASA Technical Reports Server (NTRS)

Brown, T. E.; Eckberg, D. L.

1997-01-01

Promethazine hydrochloride, Phenergan, is a phenothiazine derivative with antihistaminic (H1), sedative, antiemetic, anticholinergic, and antimotion sickness properties. These properties have made promethazine a candidate for use in environments such as microgravity, which provoke emesis and motion sickness. Recently, we evaluated carotid baroreceptor-cardiac reflex responses during two Space Shuttle missions 18 to 20 hr after the 50 mg intramuscular administration of promethazine. Because the effects of promethazine on autonomic cardiovascular mechanisms in general and baroreflex function in particular were not known, we were unable to exclude a possible influence of promethazine on our results. Our purpose was to determine the ground-based effects of promethazine on autonomic cardiovascular control. Because of promethazine's antihistaminic and anticholinergic properties, we expected that a 50-mg intramuscular injection of promethazine would affect sympathetically and vagally mediated cardiovascular mechanisms. Eight healthy young subjects, five men and three women, were studied at rest in recumbency. All reported drowsiness as a result of the promethazine injection; most also reported nervous excitation, dry mouth, and fatigue. Three subjects had significant reactions: two reported excessive anxiety and one reported dizziness. Measurements were performed immediately prior to injection and 3.1 +/- 0.1 and 19.5 +/- 0.4 hr postinjection. We found no significant effect of promethazine on resting mean R-R interval, arterial pressure, R-R interval power spectra, carotid baroreflex function, and venous plasma catecholamine levels.

Comparison of Motor Activity and Sleep in Patients with Complex Partial Seizures on Levetiracetam Treatment and a Group of Healthy Subjects

PubMed Central

Yilmaz, Hikmet

2007-01-01

Purpose: Levetiracetam-treated patients commonly report daytime drowsiness, fatique, asthenia and decreasing of motor activity. However the origin of these reported side effects are still debated, we aimed to clarify effect of levetiracetam on sleep. Therefore this prospective study was conducted to evaluate the effects of levetiracetam on motor activity, amount and continuity of sleep and napping. Methods: Various tests were performed on twenty two patients treated with levetiracetam (10 monotherapy, 12 add-on therapy) at least three days before the initiation of treatment, and consecutively for five to eight days at the third week of treatment. These tests included sleep logs, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Modified Maintenance of Wakefulness Test and actimetric measurements. In order to evaluate the sleep behavior of these patients the following sleep parameters were estimated: bedtime, wake-up time, sleep-onset time, sleep-offset time, sleep latency, total sleep time, wake time after sleep onset, fragmentation index, total activity score, nap episodes, total nap duration and sleep efficiency. Twenty members of staff from our hospital (Doctor, nurse, secretary, civil servant etc.) were evaluated as control subjects in the study. Results: After three-week treatment with levetiracetam (in particular with add-on therapy), Epworth Sleepiness Scale scores, napping episodes and total nap durations increased and sleep latencies decreased. While durations of Modified Maintenance of Wakefulness Test and total activity scores decreased. However the total sleep time and the sleep efficiency did not show any difference from the pre-treatment values. Conclusions: Our results suggest that levetiracetam leads to drowsiness by decreasing the daily motor activity and increasing the naps; however this agent does not have any major effects on total sleep time and sleep efficiency during night. Actimetric analyses give information about continuity of sleep and sleep/wake states however does not give satisfactory information about architecture of sleep. In order to determine the effects of levetiracetam on the sleep architecture we need similiar protocol studies by full night polysomnography. PMID:17726245

Cortical venous thrombosis following exogenous androgen use for bodybuilding

PubMed Central

Sveinsson, Olafur; Herrman, Lars

2013-01-01

There are only a few reports of patients developing cerebral venous sinus thrombosis (CVST) after androgen therapy. We present a young man who developed cortical venous thrombosis after using androgens to increase muscle mass. He was hospitalised for parasthesia and dyspraxia in the left hand followed by a generalised tonic–clonic seizure. At admission, he was drowsy, not fully orientated, had sensory inattention, pronation drift and a positive extensor response, all on the left side. The patient had been using anabolic steroids (dainabol 20 mg/day) for the last month for bodybuilding. CT angiography showed a right cortical venous thrombosis. Anticoagulation therapy was started with intravenous heparin for 11 days and oral anticoagulation (warfarin) thereafter. A control CT angiography 4 months later showed resolution of the thrombosis. He recovered fully. PMID:23389726

Nanoliposome encapsulated anesthetics for local anesthesia application.

PubMed

Vahabi, Sepideh; Eatemadi, Ali

2017-02-01

The systemic administration of opioids leads to potentially severe and undesirable and side effects like sedation and drowsiness, vomiting and nausea, allergies, respiratory depression, and neutrophil dysfunction. The application of nanotechnology in medical field has drawn a great attention in recent times. Several treatments available are tedious and expensive. Application of nanotechnology brings about faster cure and cost effectiveness. Nanoliposomes are one of the widely used names for nanoparticles used in medicine. Recently, nanoliposomes are used as a crucial novel drug delivery systems. The use of nanoliposomal formulation brings about a good results to pain control, rapid patient recovery, increased patient comfort, treatment costs reduction, and shortens length of hospitalization. This review presents a brief description about the achievements in the field of nanoscience and nanotechnology related to the application of nanoliposomes in anesthesia. Copyright © 2016. Published by Elsevier Masson SAS.

Acupuncture in the treatment of renal colic.

PubMed

Lee, Y H; Lee, W C; Chen, M T; Huang, J K; Chung, C; Chang, L S

1992-01-01

A prospective randomized study was performed to compare the effect of acupuncture and intramuscular Avafortan injection in the treatment of renal colic. Our results showed that acupuncture is as effective in relieving renal colic as Avafortan but it had a more rapid analgesic onset (3.14 +/- 2.88 minutes versus 15.44 +/- 7.55 minutes, p less than 0.05). Of the patients in the Avafortan group 7 (43.8%) had side effects, including skin rash in 3, tachycardia in 2, drowsiness in 1 and facial flush in 1. No side effects were noted in the acupuncture group. During 2 hours of observation acupuncture and Avafortan seemed to be ineffective in promoting stone passage. However, patients receiving Avafortan treatment were more likely to have paralytic ileus. In summary, acupuncture can be a good alternative for the treatment of renal colic.

The efficacy of diazepam in enhancing motor function in children with spastic cerebral palsy.

PubMed

Mathew, Anna; Mathew, M C; Thomas, Molly; Antonisamy, B

2005-04-01

Muscle spasm and hypertonia limit mobility in children with spastic cerebral palsy. This double-blind, placebo-controlled, randomized controlled clinical trial studies the clinical efficacy of a low dose of diazepam in enhancing movement in children with spastic cerebral palsy. One hundred and eighty children fulfilled the criteria and were randomly allocated to receive one of two doses of diazepam or placebo at bedtime; 173 completed the study. There was a significant reduction of hypertonia, improvement in the range of passive movement, and an increase in spontaneous movement in the children who received diazepam. There was no report of daytime drowsiness. In developing countries, where cost factors often determine choice of drug, diazepam is a cheap and effective way of relieving spasm and stiffness, optimizing physical therapy and facilitating movement in children with spasticity.

[Dieffenbachia poisoning in an infant].

PubMed

Mocking, Roel J T; Schene, Kiry M; Maingay-Visser, Dianne A P G F

2015-01-01

Plant poisoning is becoming an increasingly common reason to consult a doctor. A 7-month-old infant was sent to the emergency room by her general practitioner with a suspected apparent life-threatening event (ALTE). Her parents reported the sudden development of fluctuating restlessness and listlessness, superficial breathing, vomiting, drowsiness and episodes of loss of consciousness. On physical examination we saw a pale, listless and variably responsive girl. During admission for observation, she improved within a few hours, although she had one episode of blood admixture with the stool. After discharge from hospital, the infant's grandmother suggested that the symptoms could be due to poisoning from a Dieffenbachia plant. The literature supports this explanation. Young parents and doctors appear to know little about plant toxicity in general and Dieffenbachia in particular. In small children with poorly-understood symptoms, the possibility plant poisoning should be considered.

Caffeine and exercise.

PubMed

Paluska, Scott A

2003-08-01

Caffeine is the most commonly consumed drug in the world, and athletes frequently use it as an ergogenic aid. It improves performance and endurance during prolonged, exhaustive exercise. To a lesser degree it also enhances short-term, high-intensity athletic performance. Caffeine improves concentration, reduces fatigue, and enhances alertness. Habitual intake does not diminish caffeine's ergogenic properties. Several mechanisms have been proposed to explain the physiologic effects of caffeine, but adenosine receptor antagonism most likely accounts for the primary mode of action. It is relatively safe and has no known negative performance effects, nor does it cause significant dehydration or electrolyte imbalance during exercise. Routine caffeine consumption may cause tolerance or dependence, and abrupt discontinuation produces irritability, mood shifts, headache, drowsiness, or fatigue. Major sport governing bodies ban excessive use of caffeine, but current monitoring techniques are inadequate, and ethical dilemmas persist regarding caffeine intake by athletes.

A preliminary observation of the adverse effects of phenobarbital among patients with convulsive epilepsy in rural West China.

PubMed

Si, Yang; Liu, Ling; Tian, Linyu; Mu, Jie; Chen, Deng; Chen, Tao; Deng, Ying; He, Jun; Li, You; He, Li; Zhou, Dong

2016-01-01

This study explored the adverse effect (AE) profile of phenobarbital (PB) among patients with active convulsive epilepsy (ACE) from resource-poor areas. Patients with ACE were enrolled into an epilepsy management project in rural West China. Information was obtained from monthly follow-up questionnaires. The demographic and clinical features of the patients with AE were firstly described. After that, the occurrence rate was estimated for each subtype of AE at three different severity levels (mild, moderate, and serious). Survival analysis was used to determine the potential risk factors of AEs. A total of 7231 patients (3780 men) were included in the present cohort. During the follow-up time period (average 33.4months), the most common AEs were drowsiness (moderate: 4.4%, serious: 0.68%), dizziness (moderate: 3.7%, serious: 0.5%), and headache (moderate: 2.9%, serious: 0.41%). In the confirmed AE groups (moderate and serious severity levels), the symptoms tended to be transient, with durations of less than 3months. Polytherapy was an independent risk factor for AEs and had an increasing risk when the severity of the AE increased (Hazard Ratio 1.12, 1.55, and 2.52 for mild AE, moderate AE, and serious AE, respectively). Receiving a high dosage of PB (>180mg/day) indicated a slightly elevated risk (Hazard Ratio 1.22 and 1.27 for mild AE and moderate AE, respectively). Phenobarbital demonstrates overall tolerability, and serious AEs were not common. Patients receiving a high dose of PB or polytherapy are at increased risk of developing AEs. Copyright © 2015 Elsevier Inc. All rights reserved.

Symptom Cluster Trajectories During Chemotherapy in Breast Cancer Outpatients.

PubMed

Hsu, Hsin-Tien; Lin, Kuan-Chia; Wu, Li-Min; Juan, Chiung-Hui; Hou, Ming-Feng; Hwang, Shiow-Li; Liu, Yi; Dodd, Marylin J

2017-06-01

Breast cancer patients often experience multiple symptoms and substantial discomfort. Some symptoms may occur simultaneously and throughout the duration of chemotherapy treatment. The aim of this study was to investigate symptom severity and symptom cluster trajectories during chemotherapy in outpatients with breast cancer in Taiwan. This prospective, longitudinal, repeated measures study administered a standardized questionnaire (M. D. Anderson Symptom Inventory Taiwan version) to 103 breast cancer patients during each day of the third 21-day cycle of chemotherapy. Latent class growth analysis was performed to examine symptom cluster trajectories. Three symptom clusters were identified within the first 14 days of the 21-day chemotherapy cycle: the neurocognition cluster (pain, shortness of breath, vomiting, memory problems, and numbness/tingling) with a trajectory of Y = 2.09 - 0.11 (days), the emotion-nausea cluster (nausea, disturbed sleep, distress/upset, drowsiness, and sadness) with a trajectory ofY = 3.57 - 0.20 (days), and the fatigue-anorexia cluster (fatigue, lack of appetite, and dry mouth) with a trajectory of Y = 4.22 - 0.21 (days). The "fatigue-anorexia cluster" and "emotion-nausea cluster" peaked at moderate levels on chemotherapy days 3-5, and then gradually decreased to mild levels within the first 14 days of the 21-day chemotherapy cycle. Distinct symptom clusters were observed during the third cycle of chemotherapy. Systematic and ongoing evaluation of symptom cluster trajectories during cancer treatment is essential. Healthcare providers can use these findings to enhance communication with their breast cancer patients and to prioritize symptoms that require attention and intervention. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Prevalence, Awareness and Reporting of Symptoms of Obstructive Sleep Apnoea among Hospitalized Adult Patients in Nigeria: A Multicenter Study.

PubMed

Desalu, Olufemi; Onyedum, Cajetan; Sanya, Emmanuel; Fadare, Joseph; Adeoti, Adekunle; Salawu, Fatai; Oluyombo, Rotimi; Olamoyegun, Micheal; Fawale, Micheal; Gbadegesin, Babajide; Bello, Hamzat

2016-07-01

Obstructive sleep apnoea is the most common form of sleep-disordered breathing in adults and children. It is associated with many adverse health consequences. The objectives this study were to determine the prevalence, awareness and reporting of symptoms of obstructive sleep apnoea among hospitalized adult patients in Nigeria. This was a multicenter cross-sectional study involving 1420 adult patients admitted to general medical and surgical wards of selected hospitals from March to April 2013. A questionnaire embedded with Berlin questionnaire, Epworth sleepiness scale and questions on level of awareness and reporting of symptoms of sleep apnoea was used for data collection. One-third of the patients (33.4%) reported snoring, 16.3% had excessive daytime sleepiness, 10.0% experienced daytime fatigue, and 8.0% experienced drowsy driving. Approximately 5% reported witnessed apnoea and 18.0% had high risks for obstructive sleep apnoea. The frequency of high risk for sleep apnoea increased with age and declined after 65 years and also increased with the body mass index. Snoring, excessive daytime sleepiness and high risk for obstructive sleep apnoea were more common in patients with chronic medical conditions and who were admitted to the urban hospitals. The majority were not aware that snoring (77.3%) and excessive daytime sleepiness (65.8%) constitute a medical problem, and only 4.5% reported these symptoms to their doctors. The level of awareness and under-reporting of sleep apnoea symptoms are poor. The high prevalence of obstructive sleep apnoea symptoms from this study should form the basis for screening hospitalized patients with chronic medical condition across the country.

Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players

PubMed Central

Greenhill, Dustin A.; Navo, Paul; Zhao, Huaqing; Torg, Joseph; Comstock, R. Dawn; Boden, Barry P.

2016-01-01

Background: There is limited information on the relationship between football helmet fit and concussion severity. Hypothesis: Poor helmet fit may predispose football players to a more severe concussion. Study Design: Descriptive epidemiology study. Level of Evidence: Level 3. Methods: Data from concussion injury reports were obtained from the National High School Sports-Related Injury Surveillance System over a 9-year period. Symptoms, duration, and helmet parameters (fit, interior padding) were analyzed for all first-time concussions. Results: Data from 4580 concussions were analyzed. Patients who suffered concussions with a helmet that did not fit properly (3.22%), as determined by an athletic trainer, had higher rates of drowsiness (RR, 1.46; P = 0.005), hyperexcitability (RR, 2.38; P = 0.047), and sensitivity to noise (RR, 1.88; P < 0.001); had more symptoms (5.34 vs 4.54, P = 0.004); and had longer symptom duration (P = 0.04). Athletes with helmets lined with an air bladder had greater rates of sensitivity to light (RR, 1.13; P = 0.02), sensitivity to noise (RR, 1.25; P = 0.009), and longer symptom duration (P = 0.004) compared with foam or gel liners. Conclusion: An improperly fitted football helmet is a risk factor for a concussion with more symptoms and of longer duration. Concussions of longer duration are also more common in players with an air bladder–lined helmet. Current high school football rules should mandate supervision and maintenance of helmet fit throughout the season, prior to impact. Clinical Relevance: Team physicians, athletic trainers, coaches, and high school officials should ensure proper oversight of helmet fit in high school athletes to decrease concussion severity and duration. PMID:27005467

Comprehensibility of selected USP pictograms by illiterate and literate Farsi speakers: The first experience in Iran - Part I.

PubMed

Zargarzadeh, Amir H; Ahamdi, Sahar

2017-01-01

Good understanding of medication instructions is paramount to a good pharmaceutical care. The aim of our study was to examine the understandability of the selected three most applicable pictograms by participants and their recall after educational mini sessions. First, nine experienced pharmacists selected the three most potentially applicable pictograms. Pictograms A to C were determined, respectively, "A-take medication with food," "B-medication may cause drowsiness," and "C-take medication before sleep." In the second phase, we measured the comprehensibility of pictograms by three groups of participants (sample of 358): highly educated participants of two major universities of Isfahan (Groups 1 and 2), low-literate and illiterate individuals (Groups 3 and 4), and the rest were participants interviewed in three teaching pharmacies affiliated to the Isfahan School of Pharmacy (Group 5). The American National Standards Institute (ANSI) and International Organization for Standardization (ISO) were used to compare the comprehensibility of pictograms. Furthermore, five qualitative questions were asked about the impact of pictograms on several parameters. In the pre-follow-up period, only Group 1 (75%) understood pictogram A while pictogram B did not pass the ANSI and ISO thresholds for acceptability in none of the groups. In the pre-follow-up period, Groups 1 and 2 surpassed the ANSI threshold and Group 5 passed the ISO limit for C. In the post-follow-up period, C passed the ISO limit in Group 3. Regarding the qualitative questions, 84.1% believed that pictograms had positive impact on the correct use of medications and timing of administration. The groups with high level of literacy interpreted the pictograms better than those with lower levels of literacy.

Comprehensibility of selected USP pictograms by illiterate and literate Farsi speakers: The first experience in Iran - Part I

PubMed Central

Zargarzadeh, Amir H; Ahamdi, Sahar

2017-01-01

Background: Good understanding of medication instructions is paramount to a good pharmaceutical care. The aim of our study was to examine the understandability of the selected three most applicable pictograms by participants and their recall after educational mini sessions. Materials and Methods: First, nine experienced pharmacists selected the three most potentially applicable pictograms. Pictograms A to C were determined, respectively, “A-take medication with food,” “B-medication may cause drowsiness,” and “C-take medication before sleep.” In the second phase, we measured the comprehensibility of pictograms by three groups of participants (sample of 358): highly educated participants of two major universities of Isfahan (Groups 1 and 2), low-literate and illiterate individuals (Groups 3 and 4), and the rest were participants interviewed in three teaching pharmacies affiliated to the Isfahan School of Pharmacy (Group 5). The American National Standards Institute (ANSI) and International Organization for Standardization (ISO) were used to compare the comprehensibility of pictograms. Furthermore, five qualitative questions were asked about the impact of pictograms on several parameters. Results: In the pre-follow-up period, only Group 1 (75%) understood pictogram A while pictogram B did not pass the ANSI and ISO thresholds for acceptability in none of the groups. In the pre-follow-up period, Groups 1 and 2 surpassed the ANSI threshold and Group 5 passed the ISO limit for C. In the post-follow-up period, C passed the ISO limit in Group 3. Regarding the qualitative questions, 84.1% believed that pictograms had positive impact on the correct use of medications and timing of administration. Conclusion: The groups with high level of literacy interpreted the pictograms better than those with lower levels of literacy. PMID:28919911

Severe Hyponatremia Due to Valproic Acid Toxicity.

PubMed

Gupta, Ena; Kunjal, Ryan; Cury, James D

2015-09-01

Hyponatremia is a very commonly encountered clinical entity with potentially dangerous effects and for which many precipitating factors have been identified. We present a case of valproic acid (VPA) overdose causing profound hyponatremia, with one of the lowest serum sodium levels ever documented in literature. A 54-year-old woman with hypothyroidism, hypertension and bipolar disorder presented with somnolence after intentionally ingesting 7,500 mg VPA. She was drowsy but easily arousable with no hemodynamic compromise and an unremarkable physical exam. There was no clinical suspicion for organic neurological or pulmonary disease, adrenal insufficiency or volume depletion. She was found to have a serum sodium of 99 mEq/L, low plasma osmolality (211 mOsm/kg H2O), and high urine osmolality (115 mOsm/kg H2O). Her urine sodium was 18 mEq/L. She was euthyroid (TSH: 3.06 mIU/L) and compliant with thyroxine replacement. She was admitted to the intensive care unit for close monitoring and VPA was withheld. Over 36 hours her VPA level fell from 59.3 mg/L to 22.8 mg/L, serum sodium steadily rose to 125 mEq/L and there was concomitant improvement in her mental status. At 72 hours, she was transferred for an inpatient psychiatric evaluation and her sodium level was 135 mEq/L. She luckily did not experience any seizures or decline in neurological function. The clinical presentation in this patient is consistent with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) leading to a dramatic fall in sodium to a level of 99 mEq/L. Chronic VPA use has been associated with SIADH and chronic hyponatremia. Review of records in this patient from 1 year prior revealed that her last measured sodium level was 127 mEq/L. It is therefore most likely that our case is one of acute on chronic hyponatremia provoked by VPA overdose in the setting of chronic VPA use. Whilst our patient's course was relatively benign, this case illustrates a rare consequence of VPA toxicity, which if unnoticed in another patient may be tragic.

When elephants fall asleep: A literature review on elephant rest with case studies on elephant falling bouts, and practical solutions for zoo elephants.

PubMed

Schiffmann, Christian; Hoby, Stefan; Wenker, Christian; Hård, Therese; Scholz, Robert; Clauss, Marcus; Hatt, Jean-Michel

2018-05-01

Little attention has been paid to the resting and sleeping behavior of zoo elephants so far. An important concern is when elephants avoid lying down, due to degenerative joint and foot disease, social structure, or stressful environmental changes. Inability or unwillingness to lie down for resting is an important welfare issue, as it may impair sleep. We emphasize the importance of satisfying rest in elephants by reviewing the literature on resting behavior in elephants (Loxodonta africana and Elephas maximus) as well as the documentation of four cases from European zoos and our own direct observations in a zoo group of four female African elephants during 12 entire days. The common denominator in the case reports is the occurrence of a falling bout out of a standing position subsequently to a cessation of lying rest for different periods of time. Although well-known in horses as "episodic collapse" or "excessive drowsiness," this syndrome has not been described in elephants before. To enable its detection, we recommend nocturnal video monitoring for elephant-keeping institutions. The literature evaluation as well as own observational data suggest an inverse relationship between lying rest and standing rest. Preventative measures consist of enclosure modifications that facilitate lying rest (e.g., sand hills) or standing rest in a leaning position as a substitute. Anecdotal observations suggest that the provision of appropriate horizontal environmental structures may encourage safe, sleep-conducive standing rest. We provide drawings on how to install such structures. Effects of providing such structures should be evaluated in the future. © 2018 Wiley Periodicals, Inc.

Segmentation method of eye region based on fuzzy logic system for classifying open and closed eyes

NASA Astrophysics Data System (ADS)

Kim, Ki Wan; Lee, Won Oh; Kim, Yeong Gon; Hong, Hyung Gil; Lee, Eui Chul; Park, Kang Ryoung

2015-03-01

The classification of eye openness and closure has been researched in various fields, e.g., driver drowsiness detection, physiological status analysis, and eye fatigue measurement. For a classification with high accuracy, accurate segmentation of the eye region is required. Most previous research used the segmentation method by image binarization on the basis that the eyeball is darker than skin, but the performance of this approach is frequently affected by thick eyelashes or shadows around the eye. Thus, we propose a fuzzy-based method for classifying eye openness and closure. First, the proposed method uses I and K color information from the HSI and CMYK color spaces, respectively, for eye segmentation. Second, the eye region is binarized using the fuzzy logic system based on I and K inputs, which is less affected by eyelashes and shadows around the eye. The combined image of I and K pixels is obtained through the fuzzy logic system. Third, in order to reflect the effect by all the inference values on calculating the output score of the fuzzy system, we use the revised weighted average method, where all the rectangular regions by all the inference values are considered for calculating the output score. Fourth, the classification of eye openness or closure is successfully made by the proposed fuzzy-based method with eye images of low resolution which are captured in the environment of people watching TV at a distance. By using the fuzzy logic system, our method does not require the additional procedure of training irrespective of the chosen database. Experimental results with two databases of eye images show that our method is superior to previous approaches.

Sleep Management Strategy and Performance in an Extreme Mountain Ultra-marathon.

PubMed

Poussel, Mathias; Laroppe, Julien; Hurdiel, Rémy; Girard, Julien; Poletti, Laurence; Thil, Catherine; Didelot, Antoine; Chenuel, Bruno

2015-01-01

We intended to assess the relationship between sleep strategies and performance during the North-Face Ultra-Trail du Mont-Blanc 2013, to test the hypothesis that sleep management can influence athletic performance. Almost all runners specifically adopted sleep management strategies before the race. Among the finishers 72% didn't sleep at all during the race and 28% took a least one break for sleep. Non-sleepers completed the race faster than the sleepers (P = 0.0008). Race time was positively correlated with drowsiness (P < 0.0001) and negatively correlated with the number participations in this race (P = 0.0039). Runners who adopted a sleep management strategy based on increased sleep time before the race completed the race faster (P = 0.0258). Most finishers seemed to be aware of the importance of developing sleep management strategies and increasing sleep time some nights before the race appeared to be the most relevant strategy to improve performance.

Yawning and its physiological significance

PubMed Central

Gupta, Sharat; Mittal, Shallu

2013-01-01

Although yawning is a commonly witnessed human behavior, yet it has not been taught in much detail in medical schools because, until the date, no particular physiological significance has been associated with it. It is characterized by opening up of mouth which is accompanied by a long inspiration, with a brief interruption of ventilation and followed by a short expiration. Since time immemorial, yawning has been associated with drowsiness and boredom. However, this age old belief is all set to change as the results of some newer studies have pointed out that yawning might be a way by which our body is trying to accomplish some more meaningful goals. In this review, we have tried to put together some of the important functions that have been proposed by a few authors, with the hope that this article will stimulate the interest of newer researchers in this hitherto unexplored field. PMID:23776833

Bupropion (Zyban) toxicity.

PubMed

Tracey, J A; Cassidy, N; Casey, P B; Ali, I

2002-01-01

Bupropion is a monocyclic antidepressant structurally related to amphetamine. Zyban, a sustained-release formulation of bupropion hydrochloride, was recently released in Ireland, as a smoking cessation aid. In the initial 6 months since it's introduction, 12 overdose cases have been reported to The National Poisons Information Centre. 8 patients developed symptoms of toxicity. Common features included tachycardia, drowsiness, hallucinations and convulsions. Two patients developed severe cardiac arrhythmias, including one patient who was resuscitated following a cardiac arrest. All patients recovered without sequelae. We report a case of a 31 year old female who required admission to the Intensive Care Unit for ventilation and full supportive therapy, following ingestion of 13.5g bupropion. Recurrent seizures were treated with diazepam and broad complex tachycardia was successfully treated with adenosine. Zyban caused significant neurological and cardiovascular toxicity in overdose. The potential toxic effects should be considered when prescribing it as a smoking cessation aid.

Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review

PubMed Central

Garbarino, Sergio; Lanteri, Paola; Durando, Paolo; Magnavita, Nicola; Sannita, Walter G.

2016-01-01

Sleep disorders are frequent (18%–23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders. PMID:27548196

Nocturnal sleep and daytime alertness of aircrew after transmeridian flights

NASA Technical Reports Server (NTRS)

Nicholson, Anthony N.; Pascoe, Peta A.; Spencer, Michael B.; Stone, Barbara M.; Green, Roger L.

1986-01-01

The nocturnal sleep and daytime alertness of aircrew were studied by electroencephalography and the multiple sleep latency test. After a transmeridian flight from London To San Francisco, sleep onset was faster and, although there was increased wakefulness during the second half of the night, sleep duration and efficiency over the whole night were not changed. The progressive decrease in sleep latencies observed normally in the multiple sleep latency test during the morning continued throughout the day after arrival. Of the 13 subjects, 12 took a nap of around 1-h duration in the afternoon preceding the return flight. These naps would have been encouraged by the drowsiness at this time and facilitated by the departure of the aircraft being scheduled during the early evening. An early evening departure had the further advantage that the circadian increase in vigilance expected during the early part of the day would occur during the latter part of the return flight.

Scedosporium apiospermum causing brain abscess in a renal allograft recipient.

PubMed

Sharma, Amit; Singh, Divya

2015-11-01

Scedosporium apiospermum is the asexual form of a rare fungus Pseudallescheria boydii that is usually present in the soil, sewage and dirty water. In immunocompromised patients, it is a rare infection involving multiple organs. We present a case of renal allograft recipient who developed fever two weeks post renal transplant. He was initially found to have dengue fever. After five days, he became drowsy and developed right-sided hemiparesis. Magnetic resonance imaging of the brain revealed multiple irregular masses with associated edema consistent with fungal brain abscesses. Left parietal abscess was drained and he was started on voriconazole. His cyclosporine was stopped. Drained pus revealed fungal hyphae on potassium hydroxide stain and Scedosporium apiospermum on culture. Unfortunately, the patient died after five days. Scedosporium infections should be kept as a possibility in transplant recipients with disseminated infections, especially with a brain abscess. Despite antifungal therapy and surgical drainage, mortality rates are high.

Sleepiness and health in midlife women: results of the National Sleep Foundation's 2007 Sleep in America poll.

PubMed

Chasens, Eileen R; Twerski, Sarah R; Yang, Kyeongra; Umlauf, Mary Grace

2010-01-01

The 2007 Sleep in America poll, a random-sample telephone survey, provided data for this study of sleep in community-dwelling women aged 40 to 60 years. The majority of the respondents were post- or perimenopausal, overweight, married or living with someone, and reported good health. A subsample (20%) reported sleepiness that consistently interfered with daily life; the sleepy subsample reported more symptoms of insomnia, restless legs syndrome, obstructive sleep apnea, depression and anxiety, as well as more problems with health-promoting behaviors, drowsy driving, job performance, household duties, and personal relationships. Hierarchical regression showed that sleepiness along with depressive symptoms, medical comorbidities, obesity, and lower education were associated with poor self-rated health, whereas menopause status (pre-, peri- or post-) was not. These results suggest that sleep disruptions and daytime sleepiness negatively affect the daily life of midlife women.

[Child poisoning after ingestion of a wild apiaceae: a case report].

PubMed

Durand, M-F; Pommier, P; Chazalette, A; de Haro, L

2008-02-01

Apiaceae family (formerly Umbelliferae) contains several highly toxic species, including Poison Hemlock (Conium maculatum), Water Hemlock (Cicuta virosa) and Hemlock Water Dropwort (Oenanthe crocata) which are the three main poisonous Apiaceae species growing in France. Thinking he was identifying wild carrots, an 11-year-old boy without previous history ingested the root from a wild Apiaceae. One hour later, he was confused, had drowsiness, headache as well as abdominal pain, vomiting and diarrhoea. Upon hospital admission, myosis, ophtalmoplegia and a moderate rhabdomyolysis were noted. The patient recovered after 24 h of symptomatic treatments. In this case, the description of the ingested plant allowed to identify the Apiaceae family but not the species involved. The geographical location (Southern France in a humid area), the clinical features and the aspect of the ingested root, with an orange secretion led to implicate Oenanthe crocata as the origin of this unusual poisoning.

Chronic pretrigeminal and cerveau isolé cats.

PubMed

Slósarska, M; Zernicki, B

1973-01-01

Ten pretrigeminal and ten cerveau isole cats were observed chronically. During 24-36 h sessions EEG activity was continuously recorded and the EEG and ocular responses to visual and olfactory stimuli were studied. In the pretrigeminal cat acute and chronic stages were distinguished, and in the cerveau isole, acute, "early chronic" and "late chronic" stages. During the acute stage, the pretrigeminal cat is continuously awake, whereas the cerveau isole is comatose. During the "early chronic stage", which lasted at least about 3 weeks, the cerveau isole is semicomatose. During the chronic stage in the pretrigeminal cat and the "late chronic stage" in the cerveau isole, the sleep-waking cycle is present. In both preparations alert wakefulness, drowsiness, light .synchronized sleep and deep synchronized sleep occupy, respectively, about 30 percent, 45 percent, 15 percent and 10 percent of the time. Thus, synchronized sleep is strikingly reduced in comparison with an intact cat, while desynchronized sleep is absent.

Effects of Listening to Music on the Comfort of Chemotherapy Patients.

PubMed

Bilgiç, Şebnem; Acaroğlu, Rengin

2017-06-01

The symptoms of an illness that requires chemotherapy and the corresponding effects of such treatment exacerbate the pain and discomfort that patients typically experience. Listening to music may help patients cope with chemotherapy symptoms, thereby contributing to their physical ease and well-being. Seventy patients who were receiving treatment at the outpatient chemotherapy unit were invited to participate in this work. During chemotherapy sessions and the week after the sessions, the patients listened to music with headphones. The occurrence of chemotherapy symptoms such as pain, tiredness, nausea, depression, anxiety, drowsiness, lack of appetite, not feeling well, and shortness of breath in the intervention group was statistically significant after listening to music ( p < .05). Improvements in total general comfort, as well as physical, psychospiritual, and sociocultural comfort, were also statistically significant ( p < .05). These findings indicate that listening to music effectively reduces the severity of chemotherapy symptoms and enhances the comfort of patients receiving the treatment.

Clinical efficacy and safety of cisapride and clebopride in the management of chronic functional dyspepsia: a double-blind, randomized study.

PubMed

Sabbatini, F; Minieri, M; Manzi, G; Piai, G; D'Angelo, V; Mazzacca, G

1991-01-01

The clinical efficacy and the safety of chronic oral administration of cisapride, a new gastrointestinal prokinetic agent, (10 mg tid) and clebopride (0.5 mg tid) was assayed in 48 outpatients affected with functional dyspepsia, in a randomized double-blind study. Each of the drugs induced a significant reduction in dyspeptic symptoms after 2 and 4 weeks (p less than 0.001). Two patients, given clebopride, dropped out of the study because of severe side effects during the first week of treatment. Mild adverse reactions were reported in 6 out of 23 cisapride-treated patients and in 10 out of 20 clebopride-treated patients who completed the study. The most common side effect of cisapride was diarrhoea and that of clebopride was drowsiness. Cisapride appears to be as effective as clebopride in reducing dyspeptic symptoms and seems to induce less severe side effects.

Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts.

PubMed

Hammersley, Daniel; Arora, Ankur; Dissanayake, Madhava; Sengupta, Nabarun

2017-01-02

An 81-year-old man underwent cardiac catheterisation to investigate breathlessness and left ventricular impairment of unknown cause. He had unobstructed coronary arteries. Immediately following the procedure, he became suddenly unresponsive with vertical gaze palsy, anisocoria and bilateral upgoing plantar responses. He made a rapid recovery to his premorbid state 25 min later with no residual focal neurological signs. He then had multiple unresponsive episodes, interspaced with complete resolution of symptoms and neurological signs. MRI of the brain identified bilateral medial thalamic infarcts and midbrain infarcts, consistent with an artery of Percheron territory infarction. By the time the diagnosis was reached, the thrombolysis window had elapsed. The unresponsive episodes diminished with time and the patient was discharged to inpatient rehabilitation. At 6-month review after the episode, the patient has a degree of progressive cognitive impairment. 2017 BMJ Publishing Group Ltd.

Insufficient sleep in adolescents and young adults: an update on causes and consequences.

PubMed

Owens, Judith

2014-09-01

Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness. Copyright © 2014 by the American Academy of Pediatrics.

Co-Morbidity, Mortality, Quality of Life and the Healthcare/Welfare/Social Costs of Disordered Sleep: A Rapid Review.

PubMed

Garbarino, Sergio; Lanteri, Paola; Durando, Paolo; Magnavita, Nicola; Sannita, Walter G

2016-08-18

Sleep disorders are frequent (18%-23%) and constitute a major risk factor for psychiatric, cardiovascular, metabolic or hormonal co-morbidity and mortality. Low social status or income, unemployment, life events such as divorce, negative lifestyle habits, and professional requirements (e.g., shift work) are often associated with sleep problems. Sleep disorders affect the quality of life and impair both professional and non-professional activities. Excessive daytime drowsiness resulting from sleep disorders impairs efficiency and safety at work or on the road, and increases the risk of accidents. Poor sleep (either professional or voluntary) has detrimental effects comparable to those of major sleep disorders, but is often neglected. The high incidence and direct/indirect healthcare and welfare costs of sleep disorders and poor sleep currently constitute a major medical problem. Investigation, monitoring and strategies are needed in order to prevent/reduce the effects of these disorders.

Prolonged exclusive breast-feeding from vegan mother causing an acute onset of isolated methylmalonic aciduria due to a mild mutase deficiency.

PubMed

Ciani, F; Poggi, G M; Pasquini, E; Donati, M A; Zammarchi, E

2000-04-01

We describe a case of methylmalonic aciduria (MMA) occurred in a 22-month-old boy whose diet was exclusively based upon breast-feeding from a mother following a long-lasting strict vegetarian diet. Clinical picture showed a dramatic onset, with a profound drowsiness associated with a severe metabolic acidosis, hyperammonemia, macrocytic anemia, ketonuria, and massive methylmalonic aciduria without homocystinuria. Both symptoms and biochemical findings quickly improved thanks to prompt vitamin B(12)parenteral therapy. Biochemical and enzymatic findings allowed a diagnosis of mild mutase deficiency, which only and inadequate dietary B(12)contribution might have revealed. Our case highlights the risk of a prolonged strictly vegetarian diet of lactating mother for providing inadequate amounts of some nutrients to the breast-fed baby. Moreover, such a dietary behaviour could dramatically unmask otherwise clinically unapparent metabolic defects in the baby. Copyright 2000 Harcourt Publishers Ltd.

Acute effect of glucose on cerebral blood flow, blood oxygenation, and oxidative metabolism.

PubMed

Xu, Feng; Liu, Peiying; Pascual, Juan M; Xiao, Guanghua; Huang, Hao; Lu, Hanzhang

2015-02-01

While it is known that specific nuclei of the brain, for example hypothalamus, contain glucose-sensing neurons thus their activity is affected by blood glucose level, the effect of glucose modulation on whole-brain metabolism is not completely understood. Several recent reports have elucidated the long-term impact of caloric restriction on the brain, showing that animals under caloric restriction had enhanced rate of tricarboxylic acid cycle (TCA) cycle flux accompanied by extended life span. However, acute effect of postprandial blood glucose increase has not been addressed in detail, partly due to a scarcity and complexity of measurement techniques. In this study, using a recently developed noninvasive MR technique, we measured dynamic changes in global cerebral metabolic rate of O2 (CMRO2 ) following a 50 g glucose ingestion (N = 10). A time dependent decrease in CMRO2 was observed, which was accompanied by a reduction in oxygen extraction fraction (OEF) with unaltered cerebral blood flow (CBF). At 40 min post-ingestion, the amount of CMRO2 reduction was 7.8 ± 1.6%. A control study without glucose ingestion was performed (N = 10), which revealed no changes in CMRO2 , CBF, or OEF, suggesting that the observations in the glucose study was not due to subject drowsiness or fatigue after staying inside the scanner. These findings suggest that ingestion of glucose may alter the rate of cerebral metabolism of oxygen in an acute setting. © 2014 Wiley Periodicals, Inc.

Safety and efficacy of intrathecal ziconotide in the management of severe chronic pain

PubMed Central

Smith, Howard S; Deer, Timothy R

2009-01-01

Ziconotide is a conopeptide intrathecal (IT) analgesic which is approved by the US Food and Drug Administration (FDA) for the management of severe chronic pain. It is a synthetic equivalent of a naturally occurring conopeptide found in the venom of the fish-eating marine cone snail and provides analgesia via binding to N-type voltage-sensitive calcium channels in the spinal cord. As ziconotide is a peptide, it is expected to be completely degraded by endopeptidases and exopeptidases (Phase I hydrolytic enzymes) widely located throughout the body, and not by other Phase I biotransformation processes (including the cytochrome P450 system) or by Phase II conjugation reactions. Thus, IT administration, low plasma ziconotide concentrations, and metabolism by ubiquitous peptidases make metabolic interactions of other drugs with ziconotide unlikely. Side effects of ziconotide which tend to occur more commonly at higher doses may include: nausea, vomiting, confusion, postural hypotension, abnormal gait, urinary retention, nystagmus/amblyopia, drowsiness/somnolence (reduced level of consciousness), dizziness or lightheadedness, weakness, visual problems (eg, double vision), elevation of serum creatine kinase, or vestibular side effects. Initially, when ziconotide was first administered to human subjects, titration schedules were overly aggressive and led to an abundance of adverse effects. Subsequently, clinicians have gained appreciation for ziconotide’s relatively narrow therapeutic window. With appropriate usage multiple studies have shown ziconotide to be a safe and effective intrathecal analgesic alone or in combination with other intrathecal analgesics. PMID:19707262

Eye movements and abducens motoneuron behavior after cholinergic activation of the nucleus reticularis pontis caudalis.

PubMed

Márquez-Ruiz, Javier; Escudero, Miguel

2010-11-01

the aim of this work was to characterize eye movements and abducens (ABD) motoneuron behavior after cholinergic activation of the nucleus reticularis pontis caudalis (NRPC). six female adult cats were prepared for chronic recording of eye movements (using the scleral search-coil technique), electroencephalography, electromyography, ponto-geniculo-occipital (PGO) waves in the lateral geniculate nucleus, and ABD motoneuron activities after microinjections of the cholinergic agonist carbachol into the NRPC. unilateral microinjections of carbachol in the NRPC induced tonic and phasic phenomena in the oculomotor system. Tonic effects consisted of ipsiversive rotation to the injected side, convergence, and downward rotation of the eyes. Phasic effects consisted of bursts of rhythmic rapid eye movements directed contralaterally to the injected side along with PGO-like waves in the lateral geniculate and ABD nuclei. Although tonic effects were dependent on the level of drowsiness, phasic effects were always present and appeared along with normal saccades when the animal was vigilant. ABD motoneurons showed phasic activities associated with ABD PGO-like waves during bursts of rapid eye movements, and tonic and phasic activities related to eye position and velocity during alertness. the cholinergic activation of the NRPC induces oculomotor phenomena that are somewhat similar to those described during REM sleep. A precise comparison of the dynamics and timing of the eye movements further suggests that a temporal organization of both NRPCs is needed to reproduce the complexity of the oculomotor behavior during REM sleep.

The cholinergic forebrain arousal system acts directly on the circadian pacemaker

PubMed Central

Yamakawa, Glenn R.; Basu, Priyoneel; Cortese, Filomeno; MacDonnell, Johanna; Whalley, Danica; Smith, Victoria M.

2016-01-01

Sleep and wake states are regulated by a variety of mechanisms. One such important system is the circadian clock, which provides temporal structure to sleep and wake. Conversely, changes in behavioral state, such as sleep deprivation (SD) or arousal, can phase shift the circadian clock. Here we demonstrate that the level of wakefulness is critical for this arousal resetting of the circadian clock. Specifically, drowsy animals with significant power in the 7- to 9-Hz band of their EEGs do not exhibit phase shifts in response to a mild SD procedure. We then show that treatments that both produce arousal and reset the phase of circadian clock activate (i.e., induce Fos expression in) the basal forebrain. Many of the activated cells are cholinergic. Using retrograde tract tracing, we demonstrate that cholinergic cells activated by these arousal procedures project to the circadian clock in the suprachiasmatic nuclei (SCN). We then demonstrate that arousal-induced phase shifts are blocked when animals are pretreated with atropine injections to the SCN, demonstrating that cholinergic activity at the SCN is necessary for arousal-induced phase shifting. Finally, we demonstrate that electrical stimulation of the substantia innominata of the basal forebrain phase shifts the circadian clock in a manner similar to that of our arousal procedures and that these shifts are also blocked by infusions of atropine to the SCN. These results establish a functional link between the major forebrain arousal center and the circadian system. PMID:27821764

The impact of Australian legislative changes on synthetic cannabinoid exposures reported to the New South Wales Poisons Information Centre.

PubMed

Cairns, Rose; Brown, Jared A; Gunja, Naren; Buckley, Nicholas A

2017-05-01

The emergence of new psychoactive substances (NPS), including synthetic cannabinoid receptor agonists (SCRAs) poses novel challenges for drug regulation and public health. Misconceptions of safety and legality, coupled with the fact that NPS are undetectable on routine drugs screens contributes to their popularity. Concerns over the unpredictable toxicity and abuse potential of NPS has led to a variety of legislative responses worldwide. We wish to describe Australian trends in SCRA use, examining the effects of legislative changes on calls to Australia's largest poisons centre. A retrospective review of calls to the New South Wales Poisons Information Centre (NSWPIC). Cases occurring between 1 January 2010 and 30 June 2015 with documented use of SCRAs were included. There were 146 exposures to SCRAs recorded in the NSWPIC database. Federal bans of specific SCRA compounds in 2011/2012 had little impact on call volumes. State-based legislation introduced in 2013 banning specific brand names of SCRA products was followed by a dramatic, sustained decrease in exposures. The most common symptoms reported with SCRA use were tachycardia, vomiting, drowsiness, anxiety/panic, decreased level of consciousness, chest pain, agitation, hallucinations, confusion, seizures and hypertension. Banning of specific brand names of SCRA (timed with raids and social media campaigns) appears effective at reducing SCRA exposures. We postulate that this raised awareness within the community of the illegality of these substances while also reducing supply through bricks-and-mortar shops. These results could help inform future legislative responses. Copyright © 2017 Elsevier B.V. All rights reserved.

A randomized double-blind crossover comparison of continuous and intermittent subcutaneous administration of opioid for cancer pain.

PubMed

Watanabe, Sharon; Pereira, Jose; Tarumi, Yoko; Hanson, John; Bruera, Eduardo

2008-05-01

ABSTRACT Although the preferred route of opioid administration is oral, patients with cancer often require an alternative route. Options include continuous subcutaneous infusion (CSCI) or regularly scheduled intermittent subcutaneous injections (ISCI). CSCI maintains steady drug levels, theoretically avoiding the "bolus effect" of nausea and sedation immediately post-dose, and breakthrough pain prior to the next dose. However, portable infusion pumps can be costly to use. The Edmonton Injector is an inexpensive portable device for ISCI. CSCI and ISCI have not been directly compared. The objective of this trial was to compare CSCI and ISCI of opioid for treatment of cancer pain. Patients were recruited from two tertiary palliative care units. Eligibility criteria included stable cancer pain requiring opioid therapy, need for parenteral route, and normal cognition. Patients were randomly assigned to receive opioid by CSCI by portable pump or ISCI by Edmonton Injector for 48 hours, followed by crossover to the alternative modality for 48 hours. During each phase, placebo was administered by the alternative modality. The study was closed after 12 patients were entered, due to slow accrual. Eleven patients completed the study. There were no differences between CSCI and ISCI in mean visual analogue score (VAS) for pain, nausea or drowsiness; categorical rating score of pain; number of breakthrough opioid doses per day; global rating of treatment effectiveness; or adverse effects. In all cases, patients and investigators expressed no preference for one modality over another. Further research is required to confirm that opioid administration by CSCI and ISCI provide similar analgesic and adverse effects.

A profile of concurrent alcohol and alcohol-interactive prescription drug use in the US population.

PubMed

Jalbert, Jessica J; Quilliam, Brian J; Lapane, Kate L

2008-09-01

The risk of adverse events among alcohol-interactive medication users can occur with one standard alcoholic drink. Research on the extent to which this occurs is scant. To examine the prevalence and correlates of concurrent alcohol and alcohol-interactive (AI) medication use across different levels of risk for an alcohol-related adverse event in a nationally representative sample of American adults. Cross-sectional analysis of past year, self-reported drinking history as well as past month, self-reported and visually inspected prescription drug use data from the 1999-2000 and 2001-2002 NHANES questionnaire section (n = 8,246). Medications were considered AI if concurrent use of alcohol and the prescription drug could intensify the effects of alcohol, resulting in increased sedation, drowsiness, or dizziness. Weighted prevalence estimates and polytomous logistic regression accounted for the complex survey design. Overall, 13.5% took prescription AI medications, of which 5.6% reported alcohol consumption of three or more drinks on each drinking occasion. Correlates of such use were being a man [adjusted odds ratio (AOR): 4.37; 95% confidence interval (CI): 1.84-10.35], between the ages of 20 and 54 (AOR=12.28; 95% CI: 3.12-48.25), and currently smoking (AOR: 2.61; 95% CI: 1.28-5.29), with alcohol-abstaining AI users as the referent group. Combining alcohol and AI medications is a common phenomenon, and the risk of alcohol-related adverse drug events may be nontrivial. Screening for alcohol use before prescribing AI medications would be prudent. Better communication regarding the dangers of mixing alcohol with AI medications is warranted.

Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin.

PubMed

Ordia, Joe I; Fischer, Edward; Adamski, Ellen; Chagnon, Kimberly G; Spatz, Edward L

2002-01-01

We began this study to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the treatment of severe spasticity of spinal cord origin. One hundred fifty two patients with severe spasticity of spinal origin, refractory to oral baclofen, or who experienced intolerable side-effects were given a test dose of ITB. Only those who had a satisfactory response were considered to be appropriate for pump implantation. All but one of the 152 patients had a satisfactory response, and the pump was implanted in 131 patients. Pre- and postoperative spasticity scores were compared and analyzed. The mean Ashworth score for rigidity decreased from 4.2 preoperatively to 1.3 (p < 0.0005) on ITB. The spasm score decreased from a mean of 3.4 to 0.6 (p < 0.0005). Reduction of spasticity resulted in improved levels of physical activity, decreased pain, and augmentation of sleep. Drug-related complications included constipation, muscular hypotonia, urinary retention, erectile dysfunction, nausea, dizziness, drowsiness, hypotension and bradycardia as well as tolerance to baclofen. Some patients experienced post-spinal puncture headaches. Catheter-related problems included occlusions, breaks, punctures, and dislodgments. Superficial pump pocket infection, pocket erosion, cerebrospinal fluid (CSF) leak, post-spinal puncture headache, and meningitis were some of the procedure-related complications. Two pumps flipped and another pump valve was stuck. We conclude that long-term intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe intractable spinal spasticity.

Grouped factors of the 'SSADE: signs and symptoms accompanying dementia while eating' and nutritional status-An analysis of older people receiving nutritional care in long-term care facilities in Japan.

PubMed

Takada, Kento; Tanaka, Kazumi; Hasegawa, Mihoko; Sugiyama, Michiko; Yoshiike, Nobuo

2017-09-01

Behavioural and psychological symptoms of dementia (BPSD) are very common among older people, and previous studies showed that BPSD affects eating behaviour negatively, possibly resulting in undernutrition. In a previous study, we constructed a set of 11 items based on direct observations of older people with dementia during mealtime and named them 'SSADE: signs and symptoms accompanying dementia while eating'. This study aimed to conduct a factor analysis to clarify the structure of the set of 11 SSADE items and to analyse the relationship of the SSADE with nutritional status. We sampled 259 older people from 14 institutional facilities in Japan. To assess the status of the SSADE, we quantified each item according to its frequency and severity, using a 5-point scale. We also collected information regarding characteristics and nutritional status (body mass index [BMI], dietary intakes, body weight change, serum albumin level). We performed an exploratory factor analysis on the SSADE. In addition, associations between grouped factor scores and nutritional status were analysed. Exploratory factor analysis indicated four factors. 'Hypoactivity' including 'dietary agnosia' and 'drowsiness' correlated negatively with BMI and serum albumin levels. 'Hyperactivity' including 'agitation', 'delusion', 'wandering' and 'eating too rapidly' correlated negatively with BMI. 'Obsessiveness' including 'food refusal' and 'fad eating' correlated negatively with BMI, dietary intake and body weight change. 'Aberrant behaviours' including 'eating apraxia', 'pica' and 'stealing food' correlated positively with dietary intake. The identified factors of the SSADE were related to nutritional status, which may suggest acceptable factorial validity. We expected the SSADE to contribute to the prevention and improvement of undernutrition, through the development of a concrete strategy for nutritional care planning by professional teams including dietitians in long-term care facilities. © 2017 John Wiley & Sons Ltd.

Ocular Measures of Sleepiness Are Increased in Night Shift Workers Undergoing a Simulated Night Shift Near the Peak Time of the 6-Sulfatoxymelatonin Rhythm

PubMed Central

Ftouni, Suzanne; Sletten, Tracey L.; Nicholas, Christian L.; Kennaway, David J.; Lockley, Steven W.; Rajaratnam, Shantha M.W.

2015-01-01

Study Objectives: The study examined the relationship between the circadian rhythm of 6-sulphatoxymelatonin (aMT6s) and ocular measures of sleepiness and neurobehavioral performance in shift workers undergoing a simulated night shift. Methods: Twenty-two shift workers (mean age 33.4, SD 11.8 years) were tested at approximately the beginning (20:00) and the end (05:55) of a simulated night shift in the laboratory. At the time point corresponding to the end of the simulated shift, 14 participants were classified as being within range of 6-sulphatoxymelatonin (aMT6s) acrophase— defined as 3 hours before or after aMT6s peak—and 8 were classified as outside aMT6s acrophase range. Participants completed the Karolinska Sleepiness Scale (KSS) and the auditory psychomotor vigilance task (aPVT). Waking electroencephalography (EEG) was recorded and infrared reflectance oculography was used to collect ocular measures of sleepiness: positive and negative amplitude/velocity ratio (PosAVR, NegAVR), mean blink total duration (BTD), the percentage of eye closure (%TEC), and a composite score of sleepiness levels (Johns Drowsiness Scale; JDS). Results: Participants who were tested within aMT6s acrophase range displayed higher levels of sleepiness on ocular measures (%TEC, BTD, PosAVR, JDS), objective sleepiness (EEG delta power frequency band), subjective ratings of sleepiness, and neurobehavioral performance, compared to those who were outside aMT6s acrophase range. Conclusions: The study demonstrated that objective ocular measures of sleepiness are sensitive to circadian rhythm misalignment in shift workers. Citation: Ftouni S, Sletten TL, Nicholas CL, Kennaway DJ, Lockley SW, Rajaratnam SM. Ocular measures of sleepiness are increased in night shift workers undergoing a simulated night shift near the peak time of the 6-sulfatoxymelatonin rhythm. J Clin Sleep Med 2015;11(10):1131–1141. PMID:26094925

Thalidomide treatment in cutaneous lesions of systemic lupus erythematosus: a multicenter study in China.

PubMed

Wang, Dandan; Chen, Haifeng; Wang, Shiying; Zou, Yaohong; Li, Jing; Pan, Jieping; Wang, Xiangdang; Ren, Tianli; Zhang, Yu; Chen, Zhiwei; Feng, Xuebing; Sun, Lingyun

2016-06-01

Thalidomide is effective for treating severe cutaneous lupus patients. The aim of this study was to observe the optimum effective and maintenance doses of thalidomide to maximize clinical benefit and minimize side effects for patients with cutaneous lupus in China. Sixty-nine patients with lupus rash from eight hospitals in China were enrolled and treated with different doses of thalidomide. We started the dose of thalidomide at 25 mg daily and gradually increased administration dose once a week until erythema was markedly improved. The effective and maintenance doses were documented. The size of skin lesions was noted once a week. Systemic lupus erythematosus disease activity index (SLEDAI) score, levels of erythrocyte sedimentation rate (ESR), and serum TNF-α were measured before and after treatment. The remission rates were evaluated weekly until 8 weeks. Sixty-eight percent of patients showed an effective dose of 50 mg daily; another 13, 10, and 9 % of patients had an effective dose of 100, 75, and 25 mg daily, respectively. The maintenance dose was 50 mg daily for 71 % of the patients, and 100, 75, and 25 mg daily for 9, 14, and 6 % of the patients. SLEDAI score and serum ESR levels significantly decreased 4 weeks after thalidomide treatment. At the end of the fourth week, the rates of complete remission, partial remission, and no response were 56 % (n = 39), 41 % (n = 28), and 3 % (n = 2). At the eighth week, the rate of total remission rose up to 100 %. The most common side effects were drowsiness and constipation. No peripheral neuropathy was observed in these patients. Thalidomide at a dose of 50 mg daily may offer a better benefit to risk ratio in the treatment of Chinese cutaneous lupus patients.

Defining reasonable patient standard and preference for shared decision making among patients undergoing anaesthesia in Singapore.

PubMed

Yek, J L J; Lee, A K Y; Tan, J A D; Lin, G Y; Thamotharampillai, T; Abdullah, H R

2017-02-02

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients' perception of material risks, by trained interviewers. Patients' demographics were obtained. Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education (p < 0.007), being employed (p < 0.046) and younger age group (p < 0.003) are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea (64.8%), Drowsiness (62.4%) and Surgical Wound Pain (58.8%). Patients ranked Heart Attack (59.3%), Death (53.8%) and Stroke (52.7%) as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist (52.2%), instead of letting the doctor decide (37.1%) or deciding for themselves (10.7%). Discussion with the anaesthetist (61.3%) is the preferred medium of communication compared to reading a pamphlet (23.4%) or watching a video (15.4%). Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship.

Comparisons of Traffic Collisions between Expressways and Rural Roads in Truck Drivers.

PubMed

Lee, Sangbok; Jeong, Byung Yong

2016-03-01

Truck driving is known as one of the occupations with the highest accident rate. This study investigates the characteristics of traffic collisions according to road types (expressway and rural road). Classifying 267 accidents into expressway and rural road, we analyzed them based on driver characteristics (age, working experience, size of employment), time characteristics (day of accident, time, weather), and accident characteristics (accident causes, accident locations, accident types, driving conditions). When we compared the accidents by road conditions, no differences were found between the driver characteristics. However, from the accident characteristics, the injured person distributions were different by the road conditions. In particular, driving while drowsy is shown to be highly related with the accident characteristics. This study can be used as a guideline and a base line to develop a plan of action to prevent traffic accidents. It can also help to prepare formal regulations about a truck driver's vehicle maintenance and driving attitude for a precaution on road accidents.

Validation of the Karolinska sleepiness scale against performance and EEG variables.

PubMed

Kaida, Kosuke; Takahashi, Masaya; Akerstedt, Torbjörn; Nakata, Akinori; Otsuka, Yasumasa; Haratani, Takashi; Fukasawa, Kenji

2006-07-01

The Karolinska sleepiness scale (KSS) is frequently used for evaluating subjective sleepiness. The main aim of the present study was to investigate the validity and reliability of the KSS with electroencephalographic, behavioral and other subjective indicators of sleepiness. Participants were 16 healthy females aged 33-43 (38.1+/-2.68) years. The experiment involved 8 measurement sessions per day for 3 consecutive days. Each session contained the psychomotor vigilance task (PVT), the Karolinska drowsiness test (KDT-EEG alpha & theta power), the alpha attenuation test (AAT-alpha power ratio open/closed eyes) and the KSS. Median reaction time, number of lapses, alpha and theta power density and the alpha attenuation coefficients (AAC) showed highly significant increase with increasing KSS. The same variables were also significantly correlated with KSS, with a mean value for lapses (r=0.56). The KSS was closely related to EEG and behavioral variables, indicating a high validity in measuring sleepiness. KSS ratings may be a useful proxy for EEG or behavioral indicators of sleepiness.

Blue light aids in coping with the post-lunch dip: an EEG study.

PubMed

Baek, Hongchae; Min, Byoung-Kyong

2015-01-01

The 'post-lunch dip' is a commonly experienced period of drowsiness in the afternoon hours. If this inevitable period can be disrupted by an environmental cue, the result will be enhanced workplace performance. Because blue light is known to be a critical cue for entraining biological rhythms, we investigated whether blue light illumination can be a practical strategy for coping with the post-lunch dip. Twenty healthy participants underwent a continuous performance test, during which the electroencephalogram (EEG) was recorded under four different illumination conditions: dark ( < 0.3 lx), 33% blue-enriched light, 66% blue-enriched light and white polychromatic light. As a result, exposure to blue-enriched light during the post-lunch dip period significantly reduced the EEG alpha activity, and increased task performance. Since desynchronisation of alpha activity reflects enhancement of vigilance, our findings imply that blue light might disrupt the post-lunch dip. Subsequent exploration of illumination parameters will be beneficial for possible chronobiological and ergonomic applications.

The Case for Addressing Operator Fatigue

PubMed Central

Duffy, Jeanne F.; Zitting, Kirsi-Marja; Czeisler, Charles A.

2015-01-01

Sleep deficiency, which can be caused by acute sleep deprivation, chronic insufficient sleep, untreated sleep disorders, disruption of circadian timing, and other factors, is endemic in the U.S., including among professional and non-professional drivers and operators. Vigilance and attention are critical for safe transportation operations, but fatigue and sleepiness compromise vigilance and attention by slowing reaction times and impairing judgment and decision-making abilities. Research studies, polls, and accident investigations indicate that many Americans drive a motor vehicle or operate an aircraft, train or marine vessel while drowsy, putting themselves and others at risk for error and accident. In this chapter, we will outline some of the factors that contribute to sleepiness, present evidence from laboratory and field studies demonstrating how sleepiness impacts transportation safety, review how sleepiness is measured in laboratory and field settings, describe what is known about interventions for sleepiness in transportation settings, and summarize what we believe are important gaps in our knowledge of sleepiness and transportation safety. PMID:26056516

Crew factors in flight operations. Part 4: Sleep and wakefulness in international aircrews

NASA Technical Reports Server (NTRS)

Graeber, R. C.

1986-01-01

Physiological recordings of sleep and wakefulness in operating international (B-747) flight crews were obtained. Crews spent their first layover (48 h) of a trip in a sleep laboratory where standardized EEG, electro-oculograph (EOC), and electromyograph (EMG) sleep recordings were carried out whenever volunteers chose to sleep. During periods of wakefulness they underwent multiple sleep latency tests every 2 h in order to assess daytime drowsiness. The same standardized recordings were carried out at a home-based laboratory before departure. Approximately four crews each participated in flights over 7 to 9 time zones on five routes. All participants were encouraged to use whatever sleep-wake strategies they thought would provide them with the most satisfactory crew rest. Overall, layover sleep quality was not seriously disturbed, but eastward flights produced greater sleep disruption. The contributors of individual factors and the usefulness of various sleep strategies are discussed in the individual laboratory reports and in an operational summary.

Sleep-Wake Cycle and Daytime Sleepiness in the Myotonic Dystrophies

PubMed Central

Romigi, A.; Albanese, M.; Liguori, C.; Placidi, F.; Marciani, M. G.; Massa, R.

2013-01-01

Myotonic dystrophy is the most common type of muscular dystrophy in adults and is characterized by progressive myopathy, myotonia, and multiorgan involvement. Two genetically distinct entities have been identified, myotonic dystrophy type 1 (DM1 or Steinert's Disease) and myotonic dystrophy type 2 (DM2). Myotonic dystrophies are strongly associated with sleep dysfunction. Sleep disturbances in DM1 are common and include sleep-disordered breathing (SDB), periodic limb movements (PLMS), central hypersomnia, and REM sleep dysregulation (high REM density and narcoleptic-like phenotype). Interestingly, drowsiness in DM1 seems to be due to a central dysfunction of sleep-wake regulation more than SDB. To date, little is known regarding the occurrence of sleep disorders in DM2. SDB (obstructive and central apnoea), REM sleep without atonia, and restless legs syndrome have been described. Further polysomnographic, controlled studies are strongly needed, particularly in DM2, in order to clarify the role of sleep disorders in the myotonic dystrophies. PMID:26316996

Thalamic reticular nucleus induces fast and local modulation of arousal state

PubMed Central

Lewis, Laura D; Voigts, Jakob; Flores, Francisco J; Schmitt, L Ian; Wilson, Matthew A

2015-01-01

During low arousal states such as drowsiness and sleep, cortical neurons exhibit rhythmic slow wave activity associated with periods of neuronal silence. Slow waves are locally regulated, and local slow wave dynamics are important for memory, cognition, and behaviour. While several brainstem structures for controlling global sleep states have now been well characterized, a mechanism underlying fast and local modulation of cortical slow waves has not been identified. Here, using optogenetics and whole cortex electrophysiology, we show that local tonic activation of thalamic reticular nucleus (TRN) rapidly induces slow wave activity in a spatially restricted region of cortex. These slow waves resemble those seen in sleep, as cortical units undergo periods of silence phase-locked to the slow wave. Furthermore, animals exhibit behavioural changes consistent with a decrease in arousal state during TRN stimulation. We conclude that TRN can induce rapid modulation of local cortical state. DOI: http://dx.doi.org/10.7554/eLife.08760.001 PMID:26460547

Profound Bradycardia After Intrathecal Baclofen Injection in a Patient With Hydranencephaly.

PubMed

Sechrist, Catherine; Kinsman, Stephen; Cain, Nicole

2015-12-01

Intrathecal baclofen is often used to treat medically intractable spasticity of cerebral or spinal origin. Complications are rare but close monitoring is routinely performed with intrathecal test doses and before pump implantation. We describe a 6 year-old girl with hydranencephaly who underwent an intrathecal baclofen test dose and developed severe bradycardia. A 6 year-old girl with hydranencephaly, quadriplegic cerebral palsy, and severe spasticiityn was a candidate for an intrathecal baclofen pump. She underwent an intrathecal baclofen test dose and within 4 hours developed a heart rate between 30-40 beats per minute and mild hypotension without neurological side effects. Vital signs subsequently normalized, and she was discharged home within 48 hours of admission. Although neurological side effects such as drowsiness and weakness are commonly associated with intrathecal baclofen test doses, attention should also be focused on possible hemodynamic complications including significant bradycardia, especially in vulnerable patients such as those with possible or known hypothalamic dysfunction. Copyright © 2015 Elsevier Inc. All rights reserved.

A Case of Fisher-Bickerstaff Syndrome Overlapped by Guillain-Barré Syndrome

PubMed Central

Fujii, Daiki; Manabe, Yasuhiro; Takahasi, Yosiaki; Narai, Hisashi; Omori, Nobuhiko; Kusunoki, Susumu; Abe, Koji

2012-01-01

We report a 72-year-old woman with overlapping Miller Fisher syndrome (MFS), Guillain-Barré syndrome (GBS) and Bickerstaff's brainstem encephalitis (BBE). She developed diplopia and unsteady gait a week after an upper respiratory infection on day 1. She had weakness of both upper limbs on day 3 and became drowsy, and her respiratory status worsened on day 5. Neurologic examination revealed ophthalmoplegia, ataxia, symmetrical weakness, areflexia, and consciousness disturbance. We diagnosed her with MFS on day 1, GBS on day 3 and overlapping BBE on day 5. She underwent immunoadsorption therapy and two courses of intravenous immunoglobulin therapy. Ten months after onset, her symptoms had fully recovered. Anti-GM1 IgG, GD1a IgG, GQ1b IgG, and GT1a IgG antibodies were positive. Our case supports the notion that MFS, GBS, and BBE are all part of a continuous clinical spectrum, which is an antibody-mediated process. PMID:23275783

Symptom communication during critical illness: the impact of age, delirium, and delirium presentation.

PubMed

Tate, Judith A; Sereika, Susan; Divirgilio, Dana; Nilsen, Marci; Demerci, Jill; Campbell, Grace; Happ, Mary Beth

2013-08-01

Symptom communication is integral to quality patient care. Communication between patients and nurses in the intensive care unit (ICU) is complicated by oral or endotracheal intubation and fluctuating neurocognitive status or delirium. We report the (a) prevalence of delirium and its subtypes in non-vocal, mechanically ventilated, critically ill patients; (b) impact of age on delirium; and (c) influence of delirium and age on symptom communication. Videorecorded interactions between patients (N = 89) and nurses (N = 30) were analyzed for evidence of patient symptom communication at four time points across 2 consecutive days. Delirium was measured at enrollment and following sessions. Delirium prevalence was 23.6% at enrollment and 28.7% across sessions. Participants age >60 were more likely to be delirious on enrollment and during observational sessions. Delirium was associated with self-report of pain, drowsiness, and feeling cold. Patients were significantly less likely to initiate symptom communication when delirious. Symptom identification should be carefully undertaken in older adults with or without delirium. Copyright 2013, SLACK Incorporated.

Cholestyramine induced hyperchloremic metabolic acidosis.

PubMed

Eaves, E R; Korman, M G

1984-10-01

The first reported case, in an adult, of cholestyramine induced hyperchloremic metabolic acidosis is a 70 year old female with a two year history of primary biliary cirrhosis confirmed by histologic and immunologic criteria. After taking cholestyramine II sachets twice daily for two months she presented with lethargy, confusion and drowsiness. Examination revealed confusion, jaundice, signs of chronic liver disease, portal hypertension and hepatic encephalopathy. Laboratory investigations confirmed a metabolic acidosis (pH 7.15) and hyperchloremia. Multiple cultures failed to reveal sepsis and a urinary pH of 4.85 together with tests of renal acidification, excluded renal tubular acidosis. She received 600 mEq of sodium bicarbonate intravenously over 36 hours by which time her mentation, electrolytes and pH were normal. It is presumed that her hyperchloremic metabolic acidosis was secondary to cholestyramine because of the similarity to pediatric reports; the rapid and lasting response to intravenous sodium bicarbonate; the absence of another etiology; normal serum potassium, chloride and bicarbonate despite continued spironolactone therapy after recovery.

Ventilation and Heart Rate Monitoring in Drivers using a Contactless Electrical Bioimpedance System

NASA Astrophysics Data System (ADS)

Macías, R.; García, M. A.; Ramos, J.; Bragós, R.; Fernández, M.

2013-04-01

Nowadays, the road safety is one of the most important priorities in the automotive industry. Many times, this safety is jeopardized because of driving under inappropriate states, e.g. drowsiness, drugs and/or alcohol. Therefore several systems for monitoring the behavior of subjects during driving are researched. In this paper, a device based on a contactless electrical bioimpedance system is shown. Using the four-wire technique, this system is capable of obtaining the heart rate and the ventilation of the driver through multiple textile electrodes. These textile electrodes are placed on the car seat and the steering wheel. Moreover, it is also reported several measurements done in a controlled environment, i.e. a test room where there are no artifacts due to the car vibrations or the road state. In the mentioned measurements, the system response can be observed depending on several parameters such as the placement of the electrodes or the number of clothing layers worn by the driver.

Comparisons of Traffic Collisions between Expressways and Rural Roads in Truck Drivers

PubMed Central

Lee, Sangbok; Jeong, Byung Yong

2015-01-01

Background Truck driving is known as one of the occupations with the highest accident rate. This study investigates the characteristics of traffic collisions according to road types (expressway and rural road). Methods Classifying 267 accidents into expressway and rural road, we analyzed them based on driver characteristics (age, working experience, size of employment), time characteristics (day of accident, time, weather), and accident characteristics (accident causes, accident locations, accident types, driving conditions). Results When we compared the accidents by road conditions, no differences were found between the driver characteristics. However, from the accident characteristics, the injured person distributions were different by the road conditions. In particular, driving while drowsy is shown to be highly related with the accident characteristics. Conclusion This study can be used as a guideline and a base line to develop a plan of action to prevent traffic accidents. It can also help to prepare formal regulations about a truck driver's vehicle maintenance and driving attitude for a precaution on road accidents. PMID:27014489

The role of midazolam-induced sedation in bone marrow aspiration/trephine biopsies.

PubMed

Mainwaring, C J; Wong, C; Lush, R J; Smith, J G; Singer, C R

1996-12-01

This study was undertaken in 102 adult patients to evaluate the safety and efficacy of intravenous (i.v.) midazolam in the setting of bone marrow aspiration and trephine biopsy (BMAT). Combined local anaesthetic (LA) and sedation was used in 87% of patients and 13% received LA alone. Amnesia occurred in all sedated patients with only 9% experiencing a mild degree of post-procedure pain. This contrasted sharply with the non-sedated group, in whom 85% had intense pain during the biopsy followed by protracted local discomfort in approximately 54%. Drowsiness and some psychomotor impairment were the only notable sedation-related side-effects in approximately 20%. None required assisted ventilation. There was a resounding patient preference for BMAT with sedation. Considering the ease of use, safety and efficacy of i.v. midazolam, the availability of flumazenil as a reversal agent and the undoubted positive effects on quality of life, we would advocate using it in BMAT provided that there were no contraindications.

Inhaled peppermint oil for postop nausea in patients undergoing cardiac surgery.

PubMed

Briggs, Patricia; Hawrylack, Helen; Mooney, Ruth

2016-07-01

Postoperative nausea is a common occurrence that is very uncomfortable for patients and may result in complications including pain, strain at the surgical site, aspiration, and possible dehiscence. Antiemetics used to manage the nausea cause many adverse reactions, such as dysrhythmias and/or drowsiness resulting in an unwillingness to ambulate or perform deep-breathing exercises. Previous studies have reported a decrease in nausea following the use of peppermint oil. Researchers obtained informed consent from 123 patients for this study; 34 (28%) of them experienced nausea and were offered a nasal inhaler that contained peppermint oil. The average nausea rating before the use of peppermint oil was 3.29 (SD, 1.0) on a scale of 0 to 5, with 5 being the greatest nausea. Two minutes later, the average nausea rating was 1.44 (SD, 1.3). Using paired t-tests, these differences were found to be statistically significant (P = 0.000). The researchers concluded that peppermint oil inhalation is a viable first-line treatment for nausea in postoperative cardiac surgery patients.

Sleep complaints: Whenever possible, avoid the use of sleeping pills.

PubMed

2008-10-01

(1) Most sleep complaints involve difficulties in getting to sleep or staying asleep, or not feeling refreshed on awakening. Misconceptions and worrying over the lack of sleep and its consequences can contribute to reinforcing these disorders; (2) How can patients who complain of poor-quality sleep be helped, without resorting to treatments that can have adverse effects? To answer this question, we conducted a systematic review of the literature based on the standard Prescrire procedure; (3) One effective approach is to explain the basic physiology of sleep, to discuss misconceptions, and to adopt a strategy of "stimulus control". This method has a similar efficacy to prescribing a benzodiazepine. and the effect is longer lasting; (4) Moderate, regular physical exercise, especially in the morning, seems to help some patients, but the evidence is weak; (5) Some clinical trials of phytotherapy have shown a positive risk-benefit balance of weak aqueous or hydroalcoholic valerian extracts. Efficacy is limited, however; (6) A meta-analysis of placebo-controlled trials showed that benzodiazepines and related drugs increase the duration of sleep and help patients to fall asleep sooner. However, none of these trials provides comparative data spanning periods of more than two weeks. Efficacy is uncertain in the longer term, as patients quickly develop a tolerance to the hypnotic effects of benzodiazepines; (7) The adverse effects of benzodiazepines include frequent memory disorders, daytime drowsiness, falls, fractures and road accidents, and a withdrawal syndrome after treatment cessation. Related drugs such as zolpidem and zopiclone provoke similar adverse effects; (8) Sedative antihistamines have not been as well-evaluated as benzodiazepines in this setting. Small comparative trials of doxylamine and diphenhydramine showed no major difference in efficacy versus benzodiazepines and related drugs. The main adverse effects of sedative antihistamines are daytime drowsiness and altered vigilance, and atropinic effects; (9) Case-control studies showed a statistical link between benzodiazepine use in early pregnancy and birth defects such as cleft lip. In contrast, data on the use of doxylamine during pregnancy are reassuring; (10) Other sedative psychotropics have not been adequately tested in this setting or have been shown to have a negative risk-benefit balance; (11) In practice, patients who complain of poor-quality sleep should be given appropriate information on the mechanisms of normal sleep and related misconceptions, on the best methods for getting to sleep, and on the dangers of sedative psychotropics (dependence, withdrawal syndrome). When prescribing or dispensing a benzodiazepine to a woman of child-bearing age, the risk of birth defects, although not clearly demonstrated, must be mentioned.

An 11-year review of levetiracetam ingestions in children less than 6 years of age.

PubMed

Lewis, J C; Albertson, T E; Walsh, M J

2014-11-01

Levetiracetam is a new anticonvulsant, which works to block high-voltage-activated Ca(++) channels in children, for partial-onset seizures. Reports of clinical experience with pediatric ingestions are minimal. The purpose of this study was to characterize the toxicity of accidental levetiracetam exposures in children less than 6 years of age. This was an 11-year retrospective observational case series of pediatric (< 6 years old) levetiracetam ingestions reported to a Poison Control System from 2002 to 2013. Case narratives were individually reviewed to collect desired information on exposure and clinical course. Inclusion criteria were levetiracetam as a single ingested medication, age less than 6 years, treatment in a health care facility, and followed to a known outcome. Eighty-two cases met inclusion criteria with 55% female patients and overall median age of 2.0 years (range: 1-60 months). The levetiracetam dose ingested was reported in 69 (84.1%) cases, with exact dose (median dose, 45.0 mg/kg; range, 10.5-1429 mg/kg) reported in 33 cases (40.2%). Of these, twenty-nine cases (88%) involved the oral solution formulation and 28 cases (85%) had unintentional therapeutic error as the cause of the exposure. No dose-response relationship was demonstrated; however, the odds of a levetiracetam-naive patient, (median dose, 26.9 mg/kg; N = 15) with an unintentional exposure, developing drowsiness or ataxia was 6 times that of a patient who was not naïve to levetiracetam (median dose, 70.1 mg/kg; N = 20) (Odds ratio [OR], 6.0; 95% confidence interval [CI], 1.03-35.91).Of the 82 cases, 17 (20.7%) developed untoward clinical effects of drowsiness and/or ataxia. Eighty patients (97.6%) were treated and discharged from the emergency department, and two patients (2.4%) were admitted. The two patients admitted included a two-month old who was accidentally given a dose 10 times that of her usual dose and a 3-year old who was lethargic on arrival to the hospital after ingestion of an unknown dose. Of all patients, 66 patients (80.5%) had no effect from the drug exposure. The medical outcome was considered to be minor in 15 cases (18.3%), and moderate in 1 case (1.2%). There were no cases with major outcomes and no deaths. Pediatric levetiracetam exposures were associated with few transient clinical effects. Poison Control Centers may wish to consider acuity of ingestion when developing send-in protocols.

School start times and teenage driver motor vehicle crashes.

PubMed

Foss, Robert D; Smith, Richard L; O'Brien, Natalie P

2018-04-26

Shifting school start times to 8:30 am or later has been found to improve academic performance and reduce behavior problems. Limited research suggests this may also reduce adolescent driver motor vehicle crashes. A change in the school start time from 7:30 am to 8:45 am for all public high schools in one North Carolina county presented the opportunity to address this question with greater methodologic rigor. We conducted ARIMA interrupted time-series analyses to examine motor vehicle crash rates of high school age drivers in the intervention county and 3 similar comparison counties with comparable urban-rural population distribution. To focus on crashes most likely to be affected, we limited analysis to crashes involving 16- & 17-year-old drivers occurring on days when school was in session. In the intervention county, there was a 14% downward shift in the time-series following the 75 min delay in school start times (p = .076). There was no change approaching statistical significance in any of the other three counties. Further analysis indicated marked, statistically significant shifts in hourly crash rates in the intervention county, reflecting effects of the change in school start time on young driver exposure. Crashes from 7 to 7:59 am decreased sharply (-25%, p = .008), but increased similarly from 8 to 8:59 am (21%, p = .004). Crashes from 2 to 2:59 pm declined dramatically (-48%, p = .000), then increased to a lesser degree from 3 to 3:59 pm (32%, p = .024) and non-significantly from 4 to 4:59 (19%, p = .102). There was no meaningful change in early morning or nighttime crashes, when drowsiness-induced crashes might have been expected to be most common. The small decrease in crashes among high school age drivers following the shift in school start time is consistent with the findings of other studies of teen driver crashes and school start times. All these studies, including the present one, have limitations, but the similar findings suggest that crashes and school start times are indeed related, with earlier start times equating to more crashes. Later high school start times (>8:30 am) appear to be associated with lower adolescent driver crash rates, but additional research is needed to confirm this and to identify the mechanism by which this occurs (reduced drowsiness or reduced exposure). Copyright © 2018 Elsevier Ltd. All rights reserved.

[Clinical and laboratory studies on 28 patients with glutaric aciduria type 1].

PubMed

Wang, Qiao; Ding, Yuan; Liu, Yupeng; Li, Xiyuan; Wu, Tongfei; Song, Jinqing; Wang, Yujie; Yang, Yanling

2014-06-01

To investigate the clinical, biochemical and genetic profiles of 28 Chinese patients with glutaric aciduria type 1. Twenty-eight patients with glutaric aciduria type 1 seen in the Department of Pediatrics, Peking University First Hospital from July 2003 to October 2013 were studied. The data of clinical course, laboratory examinations, cranial MRI and GCDH gene mutations of the patients were analyzed. (1) Three cases were detected by newborn screening, and the other patients were diagnosed at the age of 2 months to 17 years. (2) 22 patients (79%) were infant onset cases with psychomotor retardation, dystonia, seizures, athetosis, recurrent vomiting, drowsiness or feeding difficulty. Only two of the 22 patients with infant onset got normal intelligence and movement after treatment. Twenty of them were improved slowly with delayed development, dystonia and other neurological problems. Three patients (11%) had late onset. They had motor regression, headache and seizure at the age of 8, 9 and 17 years, respectively. Rapid improvement was observed after treatment. (3) Cranial MRI has been checked in 23 patients; 22 of them showed characteristic widening of the Sylvian fissure, abnormalities of the basal ganglia, leukoencephalopathy and brain atrophy. Thirty-five mutations in GCDH gene of the patients were identified; c.148T>C (p.W50R) was the most common mutation with the frequency of 7.7%; 6 mutations (c.628A>G, c.700C>T, c.731G>T, c.963G>C, c.1031C>T and c.1109T>C) were novel. Glutaric aciduria type 1 usually induced neurological deterioration resulting in severe psychomotor retardation and dystonia. Most of our patients were clinically diagnosed. Patients with early onset usually remained having neurological damage. Phenotype and genotype correlation has not been found in the patients. Neonatal screening for organic acidurias should be expanded in China.

Altered sleep patterns in patients with non-functional GHRH receptor.

PubMed

Oliveira, Francielle T; Salvatori, Roberto; Marcondes, José; Macena, Larissa B; Oliveira-Santos, Alecia A; Faro, Augusto C N; Campos, Viviane C; Oliveira, Carla R P; Costa, Ursula M M; Aguiar-Oliveira, Manuel H

2017-07-01

GH-releasing hormone (GHRH) exerts hypnotic actions increasing the non-rapid eye movement (NREM) sleep. Conversely, GH stimulates the REM sleep. GH deficiency (GHD) often leads to sleep problems, daytime fatigue and reduced quality of life (QoL). GHD may be due to lack of hypothalamic GHRH or destruction of somatotroph cells. We have described a cohort with isolated GHD (IGHD) due to GHRH resistance caused by a homozygous null mutation (c.57 + 1G > A) in the GHRH receptor gene. They have normal QoL and no obvious complaints of chronic tiredness. The aim of this study was to determine the sleep quality in these subjects. A cross-sectional study was carried out in 21 adult IGHD subjects, and 21 age- and gender-matched controls. Objective sleep assessment included polygraphic records of the awake, stages NREM [N1 (drowsiness), N2 and N3 (already sleeping)] and REM (R). Subjective evaluation included the Pittsburgh Sleep Quality Index, the Insomnia Severity Index and the Epworth Sleepiness Scale. IGHD subjects showed a reduction in sleep efficiency ( P  = 0.007), total sleep time ( P  = 0.028), duration of N2 and R in minutes ( P  = 0.026 and P =  0.046 respectively), but had increased duration and percentage of N1 stage ( P  = 0.029 and P =  0.022 respectively), wake ( P  = 0.007) and wake-time after sleep onset ( P  = 0.017). There was no difference in N3 or in sleep quality questionnaire scores. Patients with IGHD due to GHRH resistance exhibit objective reduction in the sleep quality, with changes in NREM and REM sleep, with no detectable subjective consequences. GHRH resistance seems to have a preponderant role over GHD in the sleep quality of these subjects. © 2017 European Society of Endocrinology.

Bilateral cerebellar and brain stem infarction resulting from vertebral artery injury following cervical trauma without radiographic damage of the spinal column: a case report.

PubMed

Mimata, Yoshikuni; Murakami, Hideki; Sato, Kotaro; Suzuki, Yoshiaki

2014-01-01

Vertebral artery injury can be a complication of cervical spine injury. Although most cases are asymptomatic, the rare case progresses to severe neurological impairment and fatal outcomes. We experienced a case of bilateral cerebellar and brain stem infarction with fatal outcome resulting from vertebral artery injury associated with cervical spine trauma. A 69-year-old male was admitted to our hospital because of tetraplegia after falling down the stairs and hitting his head on the floor. Marked bony damage of the cervical spine was not apparent on radiographs and CT scans, so the injury was initially considered to be a cervical cord injury without bony damage. However, an intensity change in the intervertebral disc at C5/C6, and a ventral epidural hematoma were observed on MRI. A CT angiogram of the neck showed the right vertebral artery was completely occluded at the C4 level of the spine. Forty-eight hours after injury, the patient lapsed into drowsy consciousness. The cranial CT scan showed a massive low-density area in the bilateral cerebellar hemispheres and brain stem. Anticoagulation was initiated after a diagnosis of the right vertebral artery injury, but the patient developed bilateral cerebellar and brain stem infarction. The patient's brain herniation progressed and the patient died 52 h after injury. We considered that not only anticoagulation but also treatment for thrombosis would have been needed to prevent cranial embolism. We fully realize that early and appropriate treatment are essential to improve the treatment results, and constructing a medical system with a team of orthopedists, radiologists, and neurosurgeons is also very important.

Low-resolution brain electromagnetic tomography (LORETA) identifies brain regions linked to psychometric performance under modafinil in narcolepsy.

PubMed

Saletu, Michael; Anderer, Peter; Semlitsch, Heribert V; Saletu-Zyhlarz, Gerda Maria; Mandl, Magdalena; Zeitlhofer, Josef; Saletu, Bernd

2007-01-15

Low-resolution brain electromagnetic tomography (LORETA) showed a functional deterioration of the fronto-temporo-parietal network of the right hemispheric vigilance system in narcolepsy and a therapeutic effect of modafinil. The aim of this study was to determine the effects of modafinil on cognitive and thymopsychic variables in patients with narcolepsy and investigate whether neurophysiological vigilance changes correlate with cognitive and subjective vigilance alterations at the behavioral level. In a double-blind, placebo-controlled crossover design, EEG-LORETA and psychometric data were obtained during midmorning hours in 15 narcoleptics before and after 3 weeks of placebo or 400 mg modafinil. Cognitive investigations included the Pauli Test and complex reaction time. Thymopsychic/psychophysiological evaluation comprised drive, mood, affectivity, wakefulness, depression, anxiety, the Symptom Checklist 90 and critical flicker frequency. The Multiple Sleep Latency Test (MSLT) and the Epworth Sleepiness Scale (ESS) were performed too. Cognitive performance (Pauli Test) was significantly better after modafinil than after placebo. Concerning reaction time and thymopsychic variables, no significant differences were observed. Correlation analyses revealed that a decrease in prefrontal delta, theta and alpha-1 power correlated with an improvement in cognitive performance. Moreover, drowsiness was positively correlated with theta power in parietal and medial prefrontal regions and beta-1 and beta-2 power in occipital regions. A less significant correlation was observed between midmorning EEG LORETA and the MSLT; between EEG LORETA and the ESS, the correlation was even weaker. In conclusion, modafinil did not influence thymopsychic variables in narcolepsy, but it significantly improved cognitive performance, which may be related to medial prefrontal activity processes identified by LORETA.

Multivitamin and Protein Supplement Use Is Associated With Positive Mood States and Health Behaviors in US Military and Coast Guard Personnel

PubMed Central

Austin, Krista G.; McGraw, Susan M.; Lieberman, Harris R.

2014-01-01

Abstract Approximately 60% of Armed Forces personnel regularly consume dietary supplements (DSs). We investigated the association of mood and health behaviors with multiple classes of DSs in military and Coast Guard personnel (N = 5536). Participants completed a survey of DS use and the Quick Mood Scale to assess mood domains of wakeful-drowsiness, relaxed-anxious, cheerful-depressed, friendly-aggression, clearheaded-confused, and well coordinated–clumsy. Supplements were categorized as multivitamin/minerals (MVM), individual vitamin/minerals, protein/amino acid supplements (PS), combination products (C), herbals (H), purported steroid analogs, (S) and other (O). One-way analyses of covariance assessed associations of DSs and perceived health behavior with mood controlling for age. Logistic regression determined associations between DS use and health behavior. Users of MVM and PS reported feeling significantly (P < 0.05) more awake, relaxed, cheerful, clearheaded, and coordinated. Participants using PS and S reported feeling less friendly (more aggressive, P < 0.02). Users of MVM and PS were more likely to report their general health, eating habits, and fitness level as excellent/good (P < 0.05). Participants reporting health behaviors as excellent/good were more (P < 0.01) awake, relaxed, cheerful, friendly, clearheaded, and coordinated. As no known biological mechanisms can explain such diverse effects of MVM and PS use on multiple mood states, health, eating habits, and fitness, we hypothesize these associations are not causal, and DS intake does not alter these parameters per se. Preexisting differences in mood and other health-related behaviors and outcomes between users versus nonusers of DSs could be a confounding factor in studies of DSs. PMID:25122181

Palliative sedation, not slow euthanasia: a prospective, longitudinal study of sedation in Flemish palliative care units.

PubMed

Claessens, Patricia; Menten, Johan; Schotsmans, Paul; Broeckaert, Bert

2011-01-01

Palliative sedation remains a much debated and controversial issue. The limited literature on the topic often fails to answer ethical questions concerning this practice. The aim of this study was to describe the characteristics of patients who are being sedated for refractory symptoms in palliative care units (PCUs) from the time of admission until the day of death. A prospective, longitudinal, descriptive design was used to assess data in eight PCUs. The total sample consisted of 266 patients. Information on demographics, medication, food and fluid intake, decision making, level of consciousness, and symptom experience were gathered by nurses and researchers three times a week. If patients received palliative sedation, extra information was gathered. Of all included patients (n=266), 7.5% received palliative sedation. Sedation started, on average, 2.5 days before death and for half of these patients, the form of sedation changed over time. At the start of sedation, patients were in the end stage of their illness and needed total care. Patients were fully conscious and had very limited oral food or fluid intake. Only three patients received artificial fluids at the start of sedation. Patients reported, on average, two refractory symptoms, the most important ones being pain, fatigue, depression, drowsiness, and loss of feeling of well-being. In all cases, the patient gave consent to start palliative sedation because of increased suffering. This study revealed that palliative sedation is only administered in exceptional cases where refractory suffering is evident and for those patients who are close to the ends of their lives. Moreover, this study supports the argument that palliative sedation has no life-shortening effect. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Inadequate Helmet Fit Increases Concussion Severity in American High School Football Players.

PubMed

Greenhill, Dustin A; Navo, Paul; Zhao, Huaqing; Torg, Joseph; Comstock, R Dawn; Boden, Barry P

2016-05-01

There is limited information on the relationship between football helmet fit and concussion severity. Poor helmet fit may predispose football players to a more severe concussion. Descriptive epidemiology study. Level 3. Data from concussion injury reports were obtained from the National High School Sports-Related Injury Surveillance System over a 9-year period. Symptoms, duration, and helmet parameters (fit, interior padding) were analyzed for all first-time concussions. Data from 4580 concussions were analyzed. Patients who suffered concussions with a helmet that did not fit properly (3.22%), as determined by an athletic trainer, had higher rates of drowsiness (RR, 1.46; P = 0.005), hyperexcitability (RR, 2.38; P = 0.047), and sensitivity to noise (RR, 1.88; P < 0.001); had more symptoms (5.34 vs 4.54, P = 0.004); and had longer symptom duration (P = 0.04). Athletes with helmets lined with an air bladder had greater rates of sensitivity to light (RR, 1.13; P = 0.02), sensitivity to noise (RR, 1.25; P = 0.009), and longer symptom duration (P = 0.004) compared with foam or gel liners. An improperly fitted football helmet is a risk factor for a concussion with more symptoms and of longer duration. Concussions of longer duration are also more common in players with an air bladder-lined helmet. Current high school football rules should mandate supervision and maintenance of helmet fit throughout the season, prior to impact. Team physicians, athletic trainers, coaches, and high school officials should ensure proper oversight of helmet fit in high school athletes to decrease concussion severity and duration. © 2016 The Author(s).

Efficacy and Tolerability of High-Dose Escitalopram in Posttraumatic Stress Disorder.

PubMed

Qi, Wei; Gevonden, Martin; Shalev, Arieh

2017-02-01

Open-label trials suggest that escitalopram (up to 20 mg/d) is an effective treatment for some, but not all posttraumatic stress disorder (PTSD) patients. Higher doses of escitalopram effectively reduced major depression symptoms in patients who had not responded to regular doses. The current study examines the efficacy, tolerability, and adherence to high-dose escitalopram in PTSD. Forty-five PTSD patients received 12 weeks of gradually increasing doses of escitalopram reaching 40 mg daily at 4 weeks. Among those, 12 participants received regular doses of antidepressants at study onset including escitalopram (n = 7). The Clinician-Administered PTSD Scale (CAPS) evaluated PTSD symptoms severity before treatment, at 3 months (upon treatment termination), and at 6 months (maintenance effect). A 20% reduction in CAPS scores was deemed clinically significant. Adverse events and medication adherence were monitored at each clinical session. Linear mixed-models analysis showed a significant reduction of mean CAPS scores (11.5 ± 18.1 points) at 3 months and maintenance of gains by 6 months (F2,34.56 = 8.15, P = 0.001). Eleven participants (34.3%) showed clinically significant improvement at 3 months. Only 9 participants (20%) left the study. There were no serious adverse events and few mild ones with only 2 adverse events (diarrhea, 11.1%; drowsiness, 11.1%) reported by more than 10% of participants. High doses of escitalopram are tolerable and well adhered to in PTSD. Their beneficial effect at a group level is due to a particularly good response in a subset of patients.Variability in prior pharmacological treatment precludes a definite attribution of the results to high doses of escitalopram.

Multivitamin and protein supplement use is associated with positive mood states and health behaviors in US Military and Coast Guard personnel.

PubMed

Austin, Krista G; McGraw, Susan M; Lieberman, Harris R

2014-10-01

Approximately 60% of Armed Forces personnel regularly consume dietary supplements (DSs). We investigated the association of mood and health behaviors with multiple classes of DSs in military and Coast Guard personnel (N = 5536). Participants completed a survey of DS use and the Quick Mood Scale to assess mood domains of wakeful-drowsiness, relaxed-anxious, cheerful-depressed, friendly-aggression, clearheaded-confused, and well coordinated-clumsy. Supplements were categorized as multivitamin/minerals (MVM), individual vitamin/minerals, protein/amino acid supplements (PS), combination products (C), herbals (H), purported steroid analogs, (S) and other (O). One-way analyses of covariance assessed associations of DSs and perceived health behavior with mood controlling for age. Logistic regression determined associations between DS use and health behavior. Users of MVM and PS reported feeling significantly (P < 0.05) more awake, relaxed, cheerful, clearheaded, and coordinated. Participants using PS and S reported feeling less friendly (more aggressive, P < 0.02). Users of MVM and PS were more likely to report their general health, eating habits, and fitness level as excellent/good (P < 0.05). Participants reporting health behaviors as excellent/good were more (P < 0.01) awake, relaxed, cheerful, friendly, clearheaded, and coordinated. As no known biological mechanisms can explain such diverse effects of MVM and PS use on multiple mood states, health, eating habits, and fitness, we hypothesize these associations are not causal, and DS intake does not alter these parameters per se. Preexisting differences in mood and other health-related behaviors and outcomes between users versus nonusers of DSs could be a confounding factor in studies of DSs.

Thirteen years of oxcarbazepine exposures reported to US poison centers: 2000 to 2012.

PubMed

Spiller, H A; Strauch, J; Essing-Spiller, S J; Burns, G

2016-10-01

Oxcarbazepine (OXC) is a 10-keto analogue of carbamazepine used in patients with partial and secondary generalized seizures. We evaluated ingestions of OXC reported to US poison centers for adverse effects from supratherapeutic doses and/or overdose. Retrospective analysis of data reported to National Poison Data System from single-substance OXC ingestions between January 2000 and December 2012. There were 18,867cases with a mean of 1451 exposures/year. The patients were predominantly adults with 5464 exposures in children <6 years (29%). The most commonly reported clinical effects were drowsiness (n = 4703, 25%), vomiting (n = 1559, 8%), tachycardia (n = 590, 3%), agitated (n = 342, 1.8%), hypotension (n = 178, 0.9%), electrolyte disturbance (n = 153, 0.8%), coma (n = 156, 0.8%), and seizures (n = 121, 0.6%). There were 176 patients with a major effect of which 31 involved were children and 1728 (9%) patients with moderate effects of which 300 involved were children. Five deaths were reported in adults. Intentional exposure (e.g. suicide) was the reason for exposure in 68% of patients with major effects and in all fatalities. Fifty-three percent of adults and 38% of children were managed in a health-care facility (HCF). HCF utilization levels remained consistent. Severe outcomes appear to be infrequent (<1%). Unlike other anticonvulsants OXC does not appear to be proconvulsant in overdose. Serious outcomes for OXC overdoses are unlikely in the pediatric patient. With only mild symptoms likely, observation at home may be appropriate for the majority of cases. In the adult population there appears to be few neurologic and cardiovascular complications even in the intentional exposure. © The Author(s) 2015.

Sleep-waking cycle in the cerveau isolé cat.

PubMed

Slósarska, M; Zernicki, B

1973-06-01

The experiments were performed on ten chronic low cerveau isolé cats: in eight cats the brain stem transection was prepontine and in two cats, intercollicular. The preparations survived from 24 to 3 days. During 24-36 hr sessions the ECoG activity was continuously recorded, and the ocular and ECoG components of the orienting reflexes to visual and olfactory stimuli were studied. 2. Three periods can be recognized in the recovery process of the low cerveau isolé cat. They are called acute, early chronic and late chronic stages. The acute stage lasts 1 day and the early chronic stage seems to last 3 weeks at least. During the acute stage the ability to desynchronize the EEG, either spontaneously or in response to sensory stimulations, is dramatically impaired and the pupils are fissurated. Thus the cat is comatous. 4. During the early chronic stage, although the ECoG synchronization-desynchronization cycle and the associated fissurated myosis-myosis cycle already exist, the episodes of ECoG desynchronization occupy only a small percentage of time and usually develop slowly. Visual and olfactory stimuli are often ineffective. Thus the cat is semicomatous. In the late chronic stage the sleep-waking cycle is present. The animal can be easily awakened by visual and olfactory stimuli. The intensity of the ECoG arousal to visual stimuli and the distribution of time between alert wakefulness, drowsiness, light synchronized sleep and deep synchronized sleep are similar to those in the chronic pretrigeminal cat. The recovery of the cerveau isolé seems to reach a steady level when the sleep-waking cycle becomes similar to that present in the chronic pretrigeminal cat. During the whole survival period the vertical following reflex is abortive.

Extrapyramidal symptoms following accidental ingestion of risperidone in a child.

PubMed

Cheslik, T A; Erramouspe, J

1996-04-01

To describe the development of extrapyramidal symptoms (EPS) precipitated by an accidental overdose of risperidone in a 3.5-year-old boy. The boy presented to the emergency department with bilateral upward eye gaze, jerky movements of his extremities, and motor restlessness following an accidental ingestion of a single 4-mg risperidone tablet. Decontamination with NaCl 0.9% lavage and activated charcoal with sorbitol was performed. His symptoms responded immediately to intravenous diphenhydramine (on 3 different occasions) during his first 9.5 hours of hospitalization. He experienced no additional EPS, and was discharged home approximately 33 hours following initial presentation. At home, he received three oral doses of diphenhydramine in the 24 hours following hospital discharge because of hand tremor, total body shivering, and eye wandering. These signs resolved without further complications. Although the incidence of EPS associated with therapeutic risperidone use is low, its occurrence following overdose is less clearly defined. This represents the first published case, to our knowledge, of risperidone overdose in a child and highlights the potential for dystonic reactions at low doses in this population. Seven intentional overdoses of risperidone in adults (aged 21-68 y) have been reported in the literature and are reviewed. Amounts ingested ranged from 5 to 270 mg. All adult patients appeared to have a relatively benign course. Reported symptoms included drowsiness, slurred speech, altered levels of consciousness, hypertension, tachycardia, electrocardiogram abnormalities, atypical motor behavior, tremors, and other EPS (not specified). Accidental ingestion of low doses of risperidone can cause EPS in children that may respond well to an anticholinergic agent. Overdose management includes gastrointestinal lavage, activated charcoal with cathartic, cardiovascular monitoring, and supportive therapy.

Bioavailability and Pharmacodynamics of Promethazine on Long Duration Missions to the International Space Station

NASA Technical Reports Server (NTRS)

Putcha, Lakshmi; Boyd, Jason L.; Cintron, Nitza; Berens, Kurt L.

2004-01-01

Space motion sickness (SMS) is often treated in space with promethazine (PMZ). Common side effects of PMZ administration (50 mg intramuscular) on the ground are drowsiness and impaired cognitive performance. Anecdotal reports indicate that these effects are absent or less pronounced in space. This suggests that the availability of PMZ to the body (bioavailability) and/or the response of the body to PMZ (pharmacodynamics) may change during space flight. Opportunities for clinical research in space are limited. The study described here is our response to a NASA Research Announcement for proposals for flight-based research needed to improve, or answer specific questions about, diagnosis and therapy during space flight, and post-flight rehabilitation. We propose here to evaluate noninvasive methods for determining the bioavailability and pharmacodynamics of PMZ. The specific objectives of the proposed research are to 1) compare pharmacokinetic and pharmacodynamic parameters of PMZ, estimated from saliva and plasma levels after administration of PMZ, 2) estimate the relative bioavailability of the three dosage forms of PMZ that are often administered to control motion sickness symptoms in space, and 3) establish the dose-response relationship of PMZ. We will estimate the bioavailability of an intramuscular injection (IM), oral tablet, and rectal suppository of PMZ in noma1 subjects during ambulatory and antiorthostatic bed rest (ABR) conditions using novel stable isotope techniques. We will compare and contrast the bioavailability of PMZ during normal and microgravity conditions to examine changes in drug absorption and bioavailability during microgravit. Results of this study will validate methods for an approved in-flight investigation with this medication awaiting an opportunity for manifestation..

Transcutaneous electrical nerve stimulation for pain relief after liposuction: a randomized controlled trial.

PubMed

da Silva, Milla Pompilio; Liebano, Richard Eloin; Rodrigues, Victor Ales; Abla, Luiz Eduardo Felipe; Ferreira, Lydia Masako

2015-04-01

Liposuction is a common cosmetic surgical procedure, which requires analgesia for postoperative pain. Transcutaneous electrical nerve stimulation (TENS) has been used for postoperative pain relief; however, there is no evidence of its effectiveness in liposuction patients and this is the focus of this paper. A prospective, randomized, double-blind, controlled trial was conducted with 42 adult patients who underwent liposuction. Patients were randomly allocated to either the TENS group (active TENS) or control group (sham TENS). All patients received morphine (0.1 mg/kg) and dipyrone 1 g immediately after surgery; TENS was delivered 2 h later. The primary outcome was pain intensity. Secondary outcomes were analgesic requirement, number and types of adverse effects of TENS, quality of pain, treatment success, and patient satisfaction. Postoperative pain was measured using a visual analog scale (VAS) and the Brazilian version of the McGill Pain Questionnaire (Br-MPQ). Patients in the TENS group reported significantly lower pain intensity (P < 0.001, effect size = 0.92) compared with those in the control group. TENS significantly decreased the consumption of analgesics in the postoperative period (P < 0.001). No withdrawals or adverse effects were observed in the TENS group, but 33.3% of patients in the control group reported drowsiness and nausea. About 95 and 38% of patients in the TENS and control groups, respectively, were satisfied with the analgesic treatment. The results indicate that TENS is effective as an adjunct to analgesics for pain relief after liposuction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Changes in prevalence of subjective fatigue during 14-day 6° head-down bed rest

NASA Astrophysics Data System (ADS)

Hirayanagi, Kaname; Natsuno, Toyoki; Shiozawa, Tomoki; Yamaguchi, Nobuhisa; Watanabe, Yoriko; Suzuki, Satomi; Iwase, Satoshi; Mano, Tadaaki; Yajima, Kazuyoshi

2009-06-01

The present study examines the prevalence of subjective fatigue in young healthy males during 14 days of 6° head-down bed rest (HDBR) by using a multidimensional questionnaire. Forty-one subjects completed the Subjective Fatigue Scale questionnaire to assess the fatigue-related complaints and symptoms. The questionnaire is composed of three sections, with 10 items each. The sections measured drowsiness and dullness (Section 1), difficulty in concentration (Section 2), and the projection of physical disintegration (Section 3). The subjects answered simple questions between 1400 and 1700 on 6 measurement days before and during the HDBR period. The prevalence rate of low back pain was markedly high (80.5%) on the second day and more than 50% in the first half of the HDBR period, and any complaints related to either a lack of sleep or a deterioration in the quality of sleep continued until the end of the HDBR period. Our findings may be useful in developing preventive strategies against physical and mental fatigue associated with prolonged HDBR, horizontal bed rest, and microgravity environments.

Symptom Frequencies and Intensities in Hospitalized Patients With Advanced Cancer Having Depressive Disorder.

PubMed

Liu, Yong; Liu, Fei; Yu, Yang; Li, Qing; Jin, Xin; Li, Jin

2017-06-01

To explore the frequencies and intensities of depressive symptoms associated with hospitalized patients with advanced cancer. A total of 196 hospitalized patients with advanced cancer were surveyed with the Edmonton Symptom Assessment System and Self-Rating Depression Scale (SDS). The χ 2 test and Wilcoxon rank-sum test were used to compare the frequency and intensity of symptoms between patients with and without depressive disorders. Spearman rank correlation was used to test the correlation between depression and symptoms. Of the 196 enrolled patients, 115 (59%) were males. The median age of the patients was 58 (19-80) years. Seventy-six (39%) patients were diagnosed with depression (SDS ≥ 53). Patients with depressive disorders exhibited pain, drowsiness, and nausea along with a higher frequency and intensity of poor self-perception, appetite loss, anxiety, dyspnea, and fatigue. Depressive symptoms were positively correlated with the symptoms. Depressive disorders are very common and severe in hospitalized patients with advanced cancer. Identifying the frequencies and intensities of the symptoms enables early intervention to improve patients' quality of life.

Placebo-controlled trial of mianserin and maprotiline in primary depressive illness

PubMed Central

Edwards, J. Guy; Goldie, Ann

1983-01-01

1 Preliminary results of a double-blind placebo-controlled trial of mianserin and maprotiline carried out in 58 outpatients with primary depressive illness are reported. 2 Patients received six weeks' treatment with 30 to 90 mg mianserin, 75 to 225 mg maprotiline or one to three capsules of placebo, all medication being taken at night. 3 There were statistically significant improvements in each treatment group and a better response to mianserin than to placebo or maprotiline on the Hamilton Rating Scale for Depression, after one week's treatment. 4 Neither mianserin nor maprotiline was superior to placebo after two or four weeks' treatment and relatively few patients completed six weeks' treatment because of a generally unsatisfactory response. 5 Unwanted effects were not particularly troublesome, though mianserin and maprotiline caused more drowsiness and blurred vision than did placebo, while maptrotiline produced more constipation than either of the other two treatments. 6 The importance of placebo-controlled trials of antidepressants is emphasized and the precautions that should be taken when they are carried out in outpatients are described. PMID:6337611

Pharmacology of Antihistamines

PubMed Central

Church, Martin K; Church, Diana S

2013-01-01

H1-antihistamines, the mainstay of treatment for urticaria, were developed from anticholinergic drugs more than 70 years ago. They act as inverse agonists rather than antagonists of histamine H1-receptors which are members of the G-protein family. The older first generation H1-antihistamines penetrate readily into the brain to cause sedation, drowsiness, fatigue and impaired concentration and memory causing detrimental effects on learning and examination performance in children and on impairment of the ability of adults to work and drive. Their use should be discouraged. The newer second-generation H1-antihistamines are safer, cause less sedation and are more efficacious. Three drugs widely used for symptomatic relief in urticaria, desloratadine, levocetirizine and fexofenadine are highlighted in this review. Of these levocetirizine and fexofenadine are the most potent in humans in vivo. However, levocetirizine may cause somnolence in susceptible individuals, whereas fexofenadine has a relatively short duration of action and may be required to be given twice daily for all round daily protection. Although desloratadine is less potent, it has the advantages of rarely causing somnolence and having a long duration of action. PMID:23723474

Alpha1-adrenergic blockers: current usage considerations.

PubMed

Sica, Domenic A

2005-12-01

Alpha1-adrenergic-blocking drugs are effective in reducing blood pressure and do so in a fashion comparable to most other antihypertensive drug classes. These compounds are most effective in patients in the upright position, reducing systolic and diastolic pressures by 8%-10%. Alpha1-adrenergic-blocking drugs incrementally reduce blood pressure when combined with most drug classes and are the only antihypertensive drug class to improve plasma lipid profiles. Alpha1-adrenergic-blocking drugs are also accepted as important elements of the treatment plan for symptomatic benign prostatic hypertrophy. Dose escalation of an alpha1-adrenergic-blocking drug can trigger renal Na+ retention, and the ensuing volume expansion can attenuate its blood pressure-lowering effect. Orthostatic hypotension can occur with these compounds, particularly when a patient is volume-contracted. Dizziness, headache, and drowsiness are common side effects with alpha1-adrenergic blockers. A modest decline in the use of doxazosin and other alpha1-adrenergic-blocking drugs has occurred coincident to the early termination of the doxazosin treatment arm in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

Association of sleep habits with accidents and near misses in United States transportation operators.

PubMed

Johnson, Kevin D; Patel, Sanjay R; Baur, Dorothee M; Edens, Edward; Sherry, Patrick; Malhotra, Atul; Kales, Stefanos N

2014-05-01

To explore sleep risk factors and their association with adverse events in transportation operators. Self-reported sleep-related behaviors were analyzed in transportation operators (drivers, pilots, and rail operators) aged 26 to 78 years who completed the National Sleep Foundation's 2012 "Planes, Trains, Automobiles, and Sleep" survey. Regression analyses were used to assess the associations of various sleep-related variables with the combined outcome of self-reported accidents and near misses. Age- and body mass-adjusted predictors of accidents/near misses included an accident while commuting (odds ratio [OR] = 4.6; confidence interval [CI], 2.1 to 9.8), driving drowsy (OR = 4.1; CI, 2.5 to 6.7), and Sheehan Disability Scale score greater than 15 (OR = 3.5; CI, 2.2 to 5.5). Sleeping more than 7 hours nightly was protective for accident/near misses (OR = 0.6; CI, 0.4 to 0.9). Recognized risk factors for poor sleep or excessive daytime sleepiness were significantly associated with self-reported near misses and/or accidents in transportation operators.

An unusual case of central diabetes insipidus & hyperglycemic hyperosmolar state following cardiorespiratory arrest

PubMed Central

2013-01-01

Background We are describing an unusual case of severe hyperglycemia and hypernatremia, resistant to treatment. Case presentation A thirty year old female with adenocarcinoma of rectum was admitted with increasing lethargy, headache and drowsiness. She deteriorated rapidly and had cardiac arrest, following which she remained comatose. Her initial serum glucose and sodium were normal, but after receiving dexamethasone and mannitol, the serum glucose progressively increased to 54.7 mmol/L and sodium to 175 mmol/L, despite receiving very high dose of intravenous (IV) insulin infusion. She was evaluated for diabetes insipidus because of continued polyuria even after correction of hyperglycemia. Her serum osmolality was 337 mmol/kg, and urine osmolality was 141 mmol/kg which rose to 382 mmol/kg, after receiving 4 mcg of IV Desmopressin. Conclusion Our patient developed central diabetes insipidus post cardiac arrest and severe dehydration because of diabetes insipidus. Stress of critical illness, dehydration, dexamethasone and IV dextrose infusion were likely responsible for this degree of severe and resistant to treatment hyperglycemia. PMID:23947429

Strontium 89 in the treatment of pain due to diffuse osseous metastases: a university hospital experience.

PubMed Central

Ashayeri, Ebrahim; Omogbehin, Adedamola; Sridhar, Rajagopalan; Shankar, Ravi A.

2002-01-01

More than two-thirds of the patients with osseous metastases experience debilitating bone pain, requiring some form of pain relief. Analgesics are limited in their efficacy. Palliative application of hemi-body external beam radiation therapy in the treatment of multiple osseous metastases also is limited due to toxicity associated with large treatment ports. Intravenous injections of bone seeking radioisotopes are effective in the palliation of pain with fewer side effects. Forty-one patients with multiple osseous metastases due to prostate and breast cancer were treated with strontium chloride 89 (89Sr) at the department of radiation oncology, in a university hospital. A retrospective analysis of these patients indicated that all subjects had severe pain that diminished their quality of life. Most of these patients had multiple co-morbid factors. Many were on opioids leading to adverse effects such as nausea, constipation, and drowsiness that required additional medication. Objective findings and evaluation of the responses were not always available for all patients. Following treatmentwith 89Sr, over two-thirds of the patients responded favorably and required lower doses of opioids. PMID:12152927

Severe visual loss and cerebral infarction after injection of hyaluronic acid gel.

PubMed

Kim, Eung Gyu; Eom, Tae Kyung; Kang, Seok Joo

2014-01-01

We report a case of a 23-year-old man with cerebral infarction and permanent visual loss after injection of a hyaluronic acid gel filler for augmentation rhinoplasty. The patient was admitted to the hospital with complaints of loss of vision in the right eye, facial paralysis on the right side, and paralysis of the left limbs with severe pain during augmentation rhinoplasty with filler injection. Brain magnetic resonance imaging and computed tomography showed ophthalmic artery obstruction and right middle cerebral artery infarction. Acute thrombolysis was performed to treat the infarction; however, the patient's condition did not improve. Intracerebral hemorrhage in the right temporal/frontal/occipital/parietal lobe, subarachnoid hemorrhage, and midline shifting were observed on brain computed tomography after 24 hours after thrombolysis. Emergency decompressive craniectomy was performed. After the surgery, the patient continued to experience drowsiness, with no improvement in visual loss and motor weakness. Three months later, he could walk with cane. This case indicates that surgeons who administer filler injections should be familiar with the possibility of accidental intravascular injection and should explain the adverse effects of fillers to patients before surgery.

Effect of bilastine upon the ocular symptoms of allergic rhinoconjunctivitis.

PubMed

Bartra, J; Mullol, J; Montoro, J; Jáuregui, I; del Cuvillos, A; Dávila, I; Ferrer, M; Sastre, J; Valero, A

2011-01-01

Ocular symptoms often accompany allergic rhinitis and can be as or even more bothersome for the patient than the actual nasal symptoms. Ocular manifestations of allergic rhinoconjunctivitis may result from both direct allergen-mediated mast cell stimulation on the surface of the eye and naso-ocular reflexes--histamine being one of the mediators of symptoms onset. An H1 antihistamine would be the first line treatment for allergic conjunctivitis. Since allergic conjunctivitis is always (or almost always) accompanied by nasal symptoms, a second-generation H1 antihistamine administered via oral route is the drug of choice for jointly managing both the nasal and the ocular symptoms--minimizing the impact of the effects inherent to first-generation H, antihistamine, including particularly drowsiness. Bilastine is a new H1 antihistamine with an excellent safety profile, developed for the treatment of allergic rhinoconjunctivitis and urticaria, with potency similar to that of cetirizine and desloratadine, and superior to that of fexofenadine. This new drug has been shown to be effective in controlling the ocular symptoms of allergic rhinoconjunctivitis.

Awakening is not a metaphor: the effects of Buddhist meditation practices on basic wakefulness

PubMed Central

Britton, Willoughby B.; Lindahl, Jared R.; Cahn, B. Rael; Davis, Jake H.; Goldman, Roberta E.

2014-01-01

Buddhist meditation practices have become a topic of widespread interest in both science and medicine. Traditional Buddhist formulations describe meditation as a state of relaxed alertness that must guard against both excessive hyperarousal (restlessness) and excessive hypoarousal (drowsiness, sleep). Modern applications of meditation have emphasized the hypoarousing and relaxing effects without as much emphasis on the arousing or alertness-promoting effects. In an attempt to counterbalance the plethora of data demonstrating the relaxing and hypoarousing effects of Buddhist meditation, this interdisciplinary review aims to provide evidence of meditation’s arousing or wake-promoting effects by drawing both from Buddhist textual sources and from scientific studies, including subjective, behavioral, and neuroimaging studies during wakefulness, meditation, and sleep. Factors that may influence whether meditation increases or decreases arousal are discussed, with particular emphasis on dose, expertise, and contemplative trajectory. The course of meditative progress suggests a nonlinear multiphasic trajectory such that early phases that are more effortful may produce more fatigue and sleep propensity, while later stages produce greater wakefulness as a result of neuroplastic changes and more efficient processing. PMID:24372471

The exploding head syndrome: polysomnographic recordings and therapeutic suggestions.

PubMed

Sachs, C; Svanborg, E

1991-06-01

Attention has recently been drawn to a condition termed the exploding head syndrome, which is characterized by unpleasant, even terrifying sensations of flashing lights and/or sounds during reported sleep. Nine patients complaining of sensations of explosions in the head during sleep or drowsiness were investigated with polysomnographic recordings. None of them had any neurological disorder. Five patients reported explosions during the recording sessions. According to the recordings, the attacks always took place when the patients were awake and relaxed. In two cases abrupt electroencephalographic (EEG) and electromyographic changes indicating increasing alertness were recorded at the time of the reported attacks. In the remaining three cases no EEG changes were seen. Thus, there were no indications of an epileptic etiology to the condition. In all patients the symptoms ameliorated spontaneously with time. The severity of the symptoms was reduced by reassurance of the harmlessness of the condition. Clomipramine was prescribed to three patients who all reported immediate relief of symptoms. It is concluded that symptoms of this type are probably not true hypnagogic phenomena but may be an expression of emotional stress in the awake state.

A double-blind, placebo-controlled, multicenter study with alprazolam and extended-release alprazolam in the treatment of panic disorder.

PubMed

Pecknold, J; Luthe, L; Munjack, D; Alexander, P

1994-10-01

This is a double-blind, placebo-controlled, flexible-dose, multicenter, 6-week study comparing regular alprazolam (compressed tablet, CT), given four times per day, and extended release alprazolam (XR), given once in the morning. The aim of the XR preparation is to offer less frequent dosing and to reduce interdose anxiety. Of the intent-to-treat group of 209 patients, 184 completed 3 weeks of medication and were evaluated according to protocol. There was a completer rate for the 6 weeks of 94% (CT), 97% (XR), and 87% (placebo). On global measures, Hamilton Rating Scale for Anxiety, phobia rating, and work disability measures, both active treatment groups were equally effective and significantly more efficacious than the placebo cell on endpoint MANOVA analysis. On analysis of the panic factor with endpoint data, both active treatment groups were equally effective throughout the 6-week trial and significantly more efficacious than the placebo group. Drowsiness occurred more frequently with CT alprazolam (86% of patients) than with the XR preparation (79%) or placebo (49%).

Automated Driving System Architecture to Ensure Safe Delegation of Driving Authority

NASA Astrophysics Data System (ADS)

YUN, Sunkil; NISHIMURA, Hidekazu

2016-09-01

In this paper, the architecture of an automated driving system (ADS) is proposed to ensure safe delegation of driving authority between the ADS and a driver. Limitations of the ADS functions may activate delegation of driving authority to a driver. However, it leads to severe consequences in emergency situations where a driver may be drowsy or distracted. To address these issues, first, the concept model for the ADS in the situation for delegation of driving authority is described taking the driver's behaviour and state into account. Second, the behaviour / state of a driver and functional flow / state of ADS and the interactions between them are modelled to understand the context where the ADS requests to delegate the driving authority to a driver. Finally, the proposed architecture of the ADS is verified under the simulations based on the emergency braking scenarios. In the verification process using simulation, we have derived the necessary condition for safe delegation of driving authority is that the ADS should assist s driver even after delegating driving authority to a driver who has not enough capability to regain control of the driving task.

Monotony of road environment and driver fatigue: a simulator study.

PubMed

Thiffault, Pierre; Bergeron, Jacques

2003-05-01

Studies have shown that drowsiness and hypovigilance frequently occur during highway driving and that they may have serious implications in terms of accident causation. This paper focuses on the task induced factors that are involved in the development of these phenomena. A driving simulator study was conducted in order to evaluate the impact of the monotony of roadside visual stimulation using a steering wheel movement (SWM) analysis procedure. Fifty-six male subjects each drove during two different 40-min periods. In one case, roadside visual stimuli were essentially repetitive and monotonous, while in the other one, the environment contained disparate visual elements aiming to disrupt monotony without changing road geometry. Subject's driving performance was compared across these conditions in order to determine whether disruptions of monotony can have a positive effect and help alleviate driver fatigue. Results reveal an early time-on-task effect on driving performance for both driving periods and more frequent large SWM when driving in the more monotonous road environment, which implies greater fatigue and vigilance decrements. Implications in terms of environmental countermeasures for driver fatigue are discussed.

Association of Sleep Habits With Accidents and Near Misses in United States Transportation Operators

PubMed Central

Johnson, Kevin D.; Patel, Sanjay R.; Baur, Dorothee M.; Edens, Edward; Sherry, Patrick; Malhotra, Atul; Kales, Stefanos N.

2015-01-01

Objective To explore sleep risk factors and their association with adverse events in transportation operators. Methods Self-reported sleep-related behaviors were analyzed in transportation operators (drivers, pilots, and rail operators) aged 26 to 78 years who completed the National Sleep Foundation’s 2012 “Planes, Trains, Automobiles, and Sleep” survey. Regression analyses were used to assess the associations of various sleep-related variables with the combined outcome of self-reported accidents and near misses. Results Age- and body mass–adjusted predictors of accidents/near misses included an accident while commuting (odds ratio [OR] = 4.6; confidence interval [CI], 2.1 to 9.8), driving drowsy (OR = 4.1; CI, 2.5 to 6.7), and Sheehan Disability Scale score greater than 15 (OR = 3.5; CI, 2.2 to 5.5). Sleeping more than 7 hours nightly was protective for accident/near misses (OR = 0.6; CI, 0.4 to 0.9). Conclusion Recognized risk factors for poor sleep or excessive daytime sleepiness were significantly associated with self-reported near misses and/or accidents in transportation operators. PMID:24806564

Bilateral adrenal hemorrhage in the background of Escherichia coli sepsis: a case report.

PubMed

Khwaja, Jahanzaib

2017-03-17

Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host response to infection. It can have devastating consequences, including bilateral adrenal hemorrhage, particularly in patients at high thrombotic risk, such as those with antiphospholipid syndrome and those on long-term anticoagulation. A 49-year-old white woman re-presented to hospital with a history suggestive of sepsis. She had a medical background of primary antiphospholipid syndrome on lifelong warfarin. Ten days prior to this presentation, she had been hospitalized following Escherichia coli bacteremia, commenced on intravenous antibiotics, and discharged 2 days later with a prescribed 5-day course of oral amoxicillin. On readmission, she had ongoing fever, myalgia, malaise, and hypotension. Investigations revealed anemia with thrombocytopenia, hyponatremia, and acute-on-chronic kidney injury. Despite treatment for urosepsis, she became tachypneic, clammy, light-headed, drowsy, and hypothermic. Computed tomography revealed bilateral adrenal hemorrhage, and biochemical examination confirmed hypoadrenalism. Following discharge, she had persistent renal and hepatic injury lasting 3 months. Early identification, intensive monitoring, and aggressive support may reduce the acquired thrombotic risk and avoid potentially life-threatening outcomes of sepsis.

[Electroencephalographic effects of chlorphenesin carbamate, a new central muscle relaxant, in rabbits (author's transl)].

PubMed

Watanabe, S; Araki, H; Kawasaki, H; Ueki, S

1977-05-01

Electroencephalographic (EEG) effects of chlorphenesin carbamate were investigated in rabbits with chronic electrode implants, and compared with those of chlormezanone and methocarbamol. Chlorphenesin carbamate (50 mg/kg i.v., 100 mg/kg i.d.) induced a drowsy pattern of spontaneous EEG consisting of high voltage slow waves in the cortex and amygdala, and desynchronization of hippocampal theta waves. Chlormezanone also elicited similar EEG changes but such were much more potent than chlorphenesin carbamate. Methocarbamol showed no effect on spontaneous EEG. Chlorphenesin carbamate caused sedation in this period and muscle relaxation was more potent than that of chlormezanone. The EEG arousal response to auditory stimulation and to electric stimulation of the posterior hypothalamus, centromedian thalamus and mesencephalic reticular formation was slightly depressed by chlorphenesin carbamate. Chlorphenesin carbamate, as with chlormezanone, markedly depressed the limbic afterdischarges elicited by hippocampal stimulation. These EEG effects of chlorphenesin carbamate were qualitatively similar to but much weaker than those of chlormezanone, whereas the muscle relaxant effect of chlorphenesin carbamate was more potent than that of chlormezanone.

A Temporal Model of Level-Invariant, Tone-in-Noise Detection

ERIC Educational Resources Information Center

Berg, Bruce G.

2004-01-01

Level-invariant detection refers to findings that thresholds in tone-in-noise detection are unaffected by roving-level procedures that degrade energy cues. Such data are inconsistent with ideas that detection is based on the energy passed by an auditory filter. A hypothesis that detection is based on a level-invariant temporal cue is advanced.…

New reporting procedures based on long-term method detection levels and some considerations for interpretations of water-quality data provided by the U.S. Geological Survey National Water Quality Laboratory

USGS Publications Warehouse

Childress, Carolyn J. Oblinger; Foreman, William T.; Connor, Brooke F.; Maloney, Thomas J.

1999-01-01

This report describes the U.S. Geological Survey National Water Quality Laboratory?s approach for determining long-term method detection levels and establishing reporting levels, details relevant new reporting conventions, and provides preliminary guidance on interpreting data reported with the new conventions. At the long-term method detection level concentration, the risk of a false positive detection (analyte reported present at the long-term method detection level when not in sample) is no more than 1 percent. However, at the long-term method detection level, the risk of a false negative occurrence (analyte reported not present when present at the long-term method detection level concentration) is up to 50 percent. Because this false negative rate is too high for use as a default 'less than' reporting level, a more reliable laboratory reporting level is set at twice the determined long-term method detection level. For all methods, concentrations measured between the laboratory reporting level and the long-term method detection level will be reported as estimated concentrations. Non-detections will be censored to the laboratory reporting level. Adoption of the new reporting conventions requires a full understanding of how low-concentration data can be used and interpreted and places responsibility for using and presenting final data with the user rather than with the laboratory. Users must consider that (1) new laboratory reporting levels may differ from previously established minimum reporting levels, (2) long-term method detection levels and laboratory reporting levels may change over time, and (3) estimated concentrations are less certain than concentrations reported above the laboratory reporting level. The availability of uncensored but qualified low-concentration data for interpretation and statistical analysis is a substantial benefit to the user. A decision to censor data after they are reported from the laboratory may still be made by the user, if merited, on the basis of the intended use of the data.

Frequency of reporting and predictive factors for anxiety and depression in patients with advanced cancer.

PubMed

Salvo, N; Zeng, L; Zhang, L; Leung, M; Khan, L; Presutti, R; Nguyen, J; Holden, L; Culleton, S; Chow, E

2012-03-01

The prevalence of anxiety and depression in patients with advanced cancer has been reported to be on average 25% and to significantly affect patients' quality of life. Despite high prevalence rates, these disorders remain underdiagnosed and undertreated. The purpose of our study was to examine the self-report rates of anxiety and depression with the Edmonton Symptom Assessment System (ESAS) and to assess the predictive factors for these reports in cancer patients with metastatic disease. Consecutive patients who attended the Rapid Response Radiotherapy Program (RRRP) completed the ESAS as well as baseline demographic information. Ordinal logistic regression analysis was used to determine factors that significantly predicted anxiety and/or depression. Pearson χ(2) was used to test goodness-of-fit for categorical variables and established whether or not an observed frequency distribution differed from a predicted frequency distribution. A univariate analysis was conducted first and those variables with a P value<0.100 were included in a multivariate analysis. A score test was used to test the proportional odds assumption. In total, 1439 patients seen in the RRRP between January 1999 and October 2009 completed ESAS questionnaires. Fifty-five per cent of patients reported at least mild symptoms of depression and 65% reported at least mild anxiety. In the univariate analysis, patients who were female, who had a lower performance status score, or primary lung cancer were more likely to report depressed and anxious feelings. Primary prostate cancer patients were significantly less likely to report depression and anxiety. Patients referred for spinal cord compression were significantly less depressed. The multivariate models showed that younger patients were significantly more anxious than older patients and females reported more anxiety than males. Patients who reported higher feelings of nausea, tiredness, drowsiness, dyspnoea, and worse appetite and overall well-being on the ESAS tool were more likely to report feelings of depression. Patients who reported higher nausea, drowsiness, dyspnoea and worse overall well-being more often reported higher feelings of anxiety. The self-report rates of anxiety and depression were consistent with published prevalence rates. However, the explained variance based on factors included in the model remains low. Additional predictive factors should be examined in future studies in this population. The ESAS tool seems to be an efficient screening tool for anxiety and depression; however, future studies should examine its correlative properties with other known screening tools in the advanced cancer population. A prospective study should be conducted to assess the severity cut-off point in which the ESAS scores most frequently lead to a further diagnosis of an anxiety or depressive disorder in the advance cancer population. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic.

PubMed

Delgado-Guay, Marvin Omar; Chisholm, Gary; Williams, Janet; Frisbee-Hume, Susan; Ferguson, Andrea O; Bruera, Eduardo

2016-08-01

Regular assessments of spiritual distress/spiritual pain among patients in a supportive/palliative care clinic (SCPC) are limited or unavailable. We modified the Edmonton Symptom Assessment Scale (ESAS) by adding spiritual pain (SP) to the scale (0 = best, 10 = worst) to determine the frequency, intensity, and correlates of self-reported SP (≥1/10) (pain deep in your soul/being that is not physical) among these advanced cancer patients. We reviewed 292 consecutive consults of advanced cancer patients (ACPs) who were evaluated at our SCPC between October of 2012 and January of 2013. Symptoms were assessed using the new instrument (termed the ESAS-FS). The median age of patients was 61 (range = 22-92). Some 53% were male; 189 (65%) were white, 45 (15%) African American, and 34 (12%) Hispanic. Some 123 of 282 (44%) of ACPs had SP (mean (95% CI) = 4(3.5-4.4). Advanced cancer patients with SP had worse pain [mean (95% CI) = 5.3(4.8, 5.8) vs. 4.5(4.0, 5.0)] (p = 0.02); depression [4.2(3.7, 4.7) vs. 2.1(1.7, 2.6), p < 0.0001]; anxiety [4.2(3.6, 4.7) vs. 2.5(2.0, 3.0), p < 0.0001]; drowsiness [4.2(3.7, 4.7) vs. 2.8(2.3, 3.2), p < 0.0001]; well-being [5.4(4.9, 5.8) vs. 4.5(4.1, 4.9), p = 0.0136]; and financial distress (FD) [4.4(3.9, 5.0) vs. 2.2(1.8, 2.7), p < 0.0001]. Spiritual pain correlated (Spearman) with depression (r = 0.45, p < 0.0001), anxiety (r = 0.34, p < 0.0001), drowsiness (r = 0.26, p < 0.0001), and FD (r = 0.44, p < 0.0001). Multivariate analysis showed an association with FD [OR (95% Wald CI) = 1.204(1.104-1.313), p < 0.0001] and depression [1.218(1.110-1.336), p < 0.0001]. The odds that patients who had SP at baseline would also have SP at follow-up were 182% higher (OR = 2.82) than for patients who were SP-negative at baseline (p = 0.0029). SP at follow-up correlated with depression (r = 0.35, p < 0.0001), anxiety (r = 0.25, p = 0.001), well-being (r = 0.27, p = 0.0006), nausea (r = 0.29, p = 0.0002), and financial distress (r = 0.42, p < 0.0001). Spiritual pain, which is correlated with physical and psychological distress, was reported in more than 40% of ACPs. Employment of the ESAS-FS allows ACPs with SP to be identified and evaluated in an SCPC. More research is needed.

[Immunogenicity and safety of a booster dose of inactivated polio vaccine].

PubMed

Li, Xiao-mei; Zhang, Zhu-jia-zi; Wang, Hai-hong; Liu, Fang; Zhang, Li-wen; Chu, Ping; Xu, Ying; Zhang, He-run; Li, Juan; Liu, Dong-lei; Lu, Li

2013-10-01

To evaluate the immunogenicity and safety of a boost dose of inactivated polio vaccine (IPV) among children aged 18 months who had been administered with primary doses of IPV. Form 2011 to 2012, a total of 97 children were enrolled in the present study who were vaccinated with IPV at 2, 3, 4 months of age and boosted with the same vaccine at 18 months of age. Anti-poliovirus neutralizing antibody titers in serum were measured before and after booster vaccination, geometric mean titers (GMT) and seroprotection rate were calculated. Adverse events occurring within 30 days after booster vaccination were observed, including pain, redness/swelling and induration at the injection site, fever, vomit, abnormal crying, drowsiness, loss of appetite, irritability, and all other physical discomfort and related medications were also recorded. A descriptive analysis was performed for the safety assessment. Immunogenicity was assessed in 84 subjects. The pre-booster seropositivity rates of neutralizing antibody against poliovirus type 1, 2, 3 before booster were all 100% (84/84) and the corresponding GMT (95% CI) was 1: 148.5 (116.49-189.29) , 1: 237.68 (178.39-316.67) and 1: 231.87 (181.27-296.58) , respectively. The seropositivity rates of neutralizing antibody against the three types of poliovirus after booster were all 100% (84/84) and the corresponding GMT (95% CI) was 1: 1612.14 (1470.57-1767.34) , 1: 1854.92 (1715.83-2005.29) and 1: 1625.50 (1452.12-1819.58) , respectively. The pre-booster titer of neutralizing antibody against poliovirus type 1, 2, 3 mainly ranged 1: 128-1: 512, which accounted for 65% (55/84) , 55% (46/84) , 74% (62/84) in each type. After the booster immunization, titers of neutralizing antibody against type 1, 2, 3 were increased as subjects with titer ≥ 1: 1024 accounted for 94% (78/84) , 95% (80/84) , 92% (77/84) , respectively.Safety was evaluated in 96 subjects, of which 16 subjects reported adverse events with the rate of 17%. The observed local events were mainly tenderness 3% (3/96) , redness/swelling and induration were not reported. The systemic adverse events included loss of appetite (8%, 8/96) , irritability (8%, 8/96) , fever (7%, 7/96) , abnormal crying (6%, 6/96) , drowsiness (6%, 6/96) and vomit (1%, 1/96) . All reported adverse events were mild or moderate. All of the local events occurred in the day of vaccination and lasted for 1-2 days, while systemic events almost developed within 2 days after vaccination and last less than 3 days. IPV booster dose has good immunogenicity and safety profile, which provides effective protection against poliovirus.

Rapid changes in arousal states of healthy volunteers during robot-assisted gait training: a quantitative time-series electroencephalography study

PubMed Central

2014-01-01

Background Robot-assisted gait training (RAGT) is expected to be an effective rehabilitative intervention for patients with gait disturbances. However, the monotonous gait pattern provided by robotic guidance tends to induce sleepiness, and the resultant decreased arousal during RAGT may negatively affect gait training progress. This study assessed electroencephalography (EEG)-based, objective sleepiness during RAGT and examined whether verbal or nonverbal warning sounds are effective stimuli for counteracting such sleepiness. Methods Twelve healthy men walked on a treadmill for 6 min, while being guided by a Gait-Assistance Robot, under 3 experimental conditions: with sine-wave sound stimulation (SS), verbal sound stimulation (VS), and no sound stimulation (NS). The volunteers were provided with warning sound stimulation at 4 min (ST1), 4 min 20 s (ST2), 4 min 40 s (ST3), and 5 min (ST4) after the start of RAGT. EEGs were recorded at the central (Cz) and occipital (O1 and O2) regions (International 10–20 system) before and during RAGT, and 4-s segments of EEG data were extracted from the filtered data during the 8 experimental periods: middle of the eyes-closed condition; middle of the eyes-open condition; beginning of RAGT; immediately before ST1; immediately after ST1, ST2, ST3, and ST4. According to the method used in the Karolinska drowsiness test, the power densities of the theta, alpha 1, and alpha 2 bands were calculated as indices of objective sleepiness. Results Comparisons of the findings between baseline and before ST showed that the power densities of the alpha 1 and 2 bands tended to increase, whereas the theta power density increased significantly (P < .05). During NS, the power densities remained at a constant high level until after ST4. During SS and VS, the power densities were attenuated immediately to the same degree and maintained at a constant low level until after ST4. Conclusions This study is the first to demonstrate that EEG-measured arousal levels decrease within a short time during RAGT, but are restored and maintained by intermittent warning sound stimulation. PMID:24725811

Double-blind comparison of granisetron, promethazine, or a combination of both for the prevention of postoperative nausea and vomiting in females undergoing outpatient laparoscopies.

PubMed

Gan, Tong J; Candiotti, Keith A; Klein, Stephen M; Rodriguez, Yiliam; Nielsen, Karen C; White, William D; Habib, Ashraf S

2009-11-01

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) are common problems after surgery. Prophylactic combination antiemetic therapy is recommended for patients at high risk for developing PONV and PDNV. Granisetron, a serotonin antagonist, is an effective antiemetic that is devoid of sedative side effect. Although promethazine is effective, commonly used doses are associated with sedation. This study investigates the combination of low doses of granisetron and promethazine for the prevention of PONV. Women undergoing ambulatory gynecological laparoscopy were enrolled. A standard general anesthetic regimen was prescribed. Fifteen minutes before the expected end of surgery, the patients were randomly assigned to receive granisetron 0.1 mg iv, promethazine 6.25 mg iv, or a combination of the two drugs. Prophylaxis with oral promethazine 12.5 mg, granisetron 1 mg, or both was started in the respective groups 12 hr after the end of surgery and continued every 12 hr until postoperative day 3 (a total of five oral doses). The following outcomes were recorded: total response rate (defined as no vomiting, no more than mild nausea, and no use of rescue antiemetic); incidence of nausea, vomiting, and use of rescue antiemetics; severity of nausea; patient activity level; and patient satisfaction with PONV management. Patients in the combination group had a higher total response rate at 6, 24, 48, and 72 hr after surgery compared with those who received promethazine alone (at 24 hr, Combination 69.6%, Promethazine 36.2%, Granisetron 53.3%; P = 0.0079). The maximum nausea scores were also lower in the combination group at 6, 24, 48, and 72 hr (Combination 1.7 +/- 2.2, Promethazine 4.0 +/- 3.6, Granisetron 3.1 +/- 3.2 at 24 hr; P < 0.05). There was no difference in the sedation scores, incidence of drowsiness, patient activity level, and satisfaction with PONV management. Low-dose granisetron and promethazine combination was more effective in reducing PONV and PDNV than promethazine monotherapy. The combination also reduced the severity of nausea.

Assessment of Hyporheic Zone, Flood-Plain, Soil-Gas, Soil, and Surface-Water Contamination at the McCoys Creek Chemical Training Area, Fort Gordon, Georgia, 2009-2010

USGS Publications Warehouse

Guimaraes, Wladmir B.; Falls, W. Fred; Caldwell, Andral W.; Ratliff, W. Hagan; Wellborn, John B.; Landmeyer, James E.

2011-01-01

The U.S. Geological Survey, in cooperation with the U.S. Department of the Army Environmental and Natural Resources Management Office of the U.S. Army Signal Center and Fort Gordon, Georgia, assessed the hyporheic zone, flood plain, soil gas, soil, and surface water for contaminants at the McCoys Creek Chemical Training Area (MCTA) at Fort Gordon, from October 2009 to September 2010. The assessment included the detection of organic contaminants in the hyporheic zone, flood plain, soil gas, and surface water. In addition, the organic contaminant assessment included the analysis of organic compounds classified as explosives and chemical agents in selected areas. Inorganic contaminants were assessed in soil and surface-water samples. The assessment was conducted to provide environmental contamination data to the U.S. Army at Fort Gordon pursuant to requirements of the Resource Conservation and Recovery Act Part B Hazardous Waste Permit process. Ten passive samplers were deployed in the hyporheic zone and flood plain, and total petroleum hydrocarbons (TPH) and octane were detected above the method detection level in every sampler. Other organic compounds detected above the method detection level in the hyporheic zone and flood-plain samplers were trichloroethylene, and cis- and trans- 1, 2-dichloroethylene. One trip blank detected TPH below the method detection level but above the nondetection level. The concentrations of TPH in the samplers were many times greater than the concentrations detected in the blank; therefore, all other TPH concentrations detected are considered to represent environmental conditions. Seventy-one soil-gas samplers were deployed in a grid pattern across the MCTA. Three trip blanks and three method blanks were used and not deployed, and TPH was detected above the method detection level in two trip blanks and one method blank. Detection of TPH was observed at all 71 samplers, but because TPH was detected in the trip and method blanks, TPH was censored and, therefore, only 7 of the 71 samplers were reported as detecting TPH. In addition, benzene, toluene, ethylbenzene, and total xylene were detected above the method detection level in 22 samplers. Other compounds detected above the method detection level included naphthalene, octane, undecane, tridecane, 1,2,4-trimethylbenzene, trichloroethylene, perchloroethylene, chloroform, and 1,4-dichlorobenzene. Subsequent to the soil-gas survey, five locations with elevated contaminant mass were selected and a passive sampler was deployed at those locations to detect the presence of organic compounds classified as explosives or chemical agents. No explosives or chemical agents were detected above the method detection level, but some compounds were detected below the method detection level but above the nondetection level. Dimethyl disulfide, benzothiazole, chloroacetophenones, and para-chlorophenyl methyl sulfide were all detected below the method detection level but above the nondetection level. The compounds 2,4-dinitrotoluene, and para-chlorophenyl methyl sulfone were detected in samplers but also were detected in trip blanks and are not considered as present in the MCTA. The same five locations that were selected for sampling of explosives and chemical agents were selected for soil sampling. Metal concentrations in composite soil samples collected at five locations from land surface to a depth of 6 inches did not exceed the U.S. Environmental Protection Agency Regional Screening Levels for Industrial Soil. Concentrations in some compounds were higher than the South Carolina Department of Health and Environmental Control background levels for nearby South Carolina, including aluminum, arsenic, barium, beryllium, chromium, copper, iron, lead, manganese, nickel, and potassium. A surface-water sample was collected from McCoys Creek and analyzed for volatile organic compounds, semivolatile organic compounds, and inorganic compounds (metals). No volatile organic compounds and (or) semivolatile organic compounds were detected at levels above the maximum contaminant level of the U.S. Environmental Protection Agency (USEPA) National Primary Drinking Water Standard, and no inorganic compounds exceeded the maximum contaminant level of the USEPA National Primary Drinking Water Standard or the Georgia In-Stream Water-Quality Standard. Iron was the only inorganic compound detected in the surface-water sample (578 micrograms per liter) that exceeded the USEPA National Secondary Drinking Water Standard of 300 micrograms per liter.

The relative importance of real-time in-cab and external feedback in managing fatigue in real-world commercial transport operations.

PubMed

Fitzharris, Michael; Liu, Sara; Stephens, Amanda N; Lenné, Michael G

2017-05-29

Real-time driver monitoring systems represent a solution to address key behavioral risks as they occur, particularly distraction and fatigue. The efficacy of these systems in real-world settings is largely unknown. This article has three objectives: (1) to document the incidence and duration of fatigue in real-world commercial truck-driving operations, (2) to determine the reduction, if any, in the incidence of fatigue episodes associated with providing feedback, and (3) to tease apart the relative contribution of in-cab warnings from 24/7 monitoring and feedback to employers. Data collected from a commercially available in-vehicle camera-based driver monitoring system installed in a commercial truck fleet operating in Australia were analyzed. The real-time driver monitoring system makes continuous assessments of driver drowsiness based on eyelid position and other factors. Data were collected in a baseline period where no feedback was provided to drivers. Real-time feedback to drivers then occurred via in-cab auditory and haptic warnings, which were further enhanced by direct feedback by company management when fatigue events were detected by external 24/7 monitors. Fatigue incidence rates and their timing of occurrence across the three time periods were compared. Relative to no feedback being provided to drivers when fatigue events were detected, in-cab warnings resulted in a 66% reduction in fatigue events, with a 95% reduction achieved by the real-time provision of direct feedback in addition to in-cab warnings (p < 0.01). With feedback, fatigue events were shorter in duration a d occurred later in the trip, and fewer drivers had more than one verified fatigue event per trip. That the provision of feedback to the company on driver fatigue events in real time provides greater benefit than feedback to the driver alone has implications for companies seeking to mitigate risks associated with fatigue. Having fewer fatigue events is likely a reflection of the device itself and the accompanying safety culture of the company in terms of how the information is used. Data were analysed on a per-truck trip basis, and the findings are indicative of fatigue events in a large-scale commercial transport fleet. Future research ought to account for individual driver performance, which was not possible with the available data in this retrospective analysis. Evidence that real-time driver monitoring feedback is effective in reducing fatigue events is invaluable in the development of fleet safety policies, and of future national policy and vehicle safety regulations. Implications for automotive driver monitoring are discussed.

The architecture of a network level intrusion detection system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heady, R.; Luger, G.; Maccabe, A.

1990-08-15

This paper presents the preliminary architecture of a network level intrusion detection system. The proposed system will monitor base level information in network packets (source, destination, packet size, and time), learning the normal patterns and announcing anomalies as they occur. The goal of this research is to determine the applicability of current intrusion detection technology to the detection of network level intrusions. In particular, the authors are investigating the possibility of using this technology to detect and react to worm programs.

Level-dependent changes in detection of temporal gaps in noise markers by adults with normal and impaired hearing

PubMed Central

Horwitz, Amy R.; Ahlstrom, Jayne B.; Dubno, Judy R.

2011-01-01

Compression in the basilar-membrane input–output response flattens the temporal envelope of a fluctuating signal when more gain is applied to lower level than higher level temporal components. As a result, level-dependent changes in gap detection for signals with different depths of envelope fluctuation and for subjects with normal and impaired hearing may reveal effects of compression. To test these assumptions, gap detection with and without a broadband noise was measured with 1 000-Hz-wide (flatter) and 50-Hz-wide (fluctuating) noise markers as a function of marker level. As marker level increased, background level also increased, maintaining a fixed acoustic signal-to-noise ratio (SNR) to minimize sensation-level effects on gap detection. Significant level-dependent changes in gap detection were observed, consistent with effects of cochlear compression. For the flatter marker, gap detection that declines with increases in level up to mid levels and improves with further increases in level may be explained by an effective flattening of the temporal envelope at mid levels, where compression effects are expected to be strongest. A flatter effective temporal envelope corresponds to a reduced effective SNR. The effects of a reduction in compression (resulting in larger effective SNRs) may contribute to better-than-normal gap detection observed for some hearing-impaired listeners. PMID:22087921

Detecting Fraudulent Erasures at an Aggregate Level

ERIC Educational Resources Information Center

Sinharay, Sandip

2017-01-01

Wollack, Cohen, and Eckerly (2015) suggested the "erasure detection index" (EDI) to detect fraudulent erasures for individual examinees. Wollack and Eckerly (2017) extended the EDI to detect fraudulent erasures at the group level. The EDI at the group level was found to be slightly conservative. This paper suggests two modifications of…

Detecting Fraudulent Erasures at an Aggregate Level

ERIC Educational Resources Information Center

Sinharay, Sandip

2018-01-01

Wollack, Cohen, and Eckerly suggested the "erasure detection index" (EDI) to detect fraudulent erasures for individual examinees. Wollack and Eckerly extended the EDI to detect fraudulent erasures at the group level. The EDI at the group level was found to be slightly conservative. This article suggests two modifications of the EDI for…

A coloured oil level indicator detection method based on simple linear iterative clustering

NASA Astrophysics Data System (ADS)

Liu, Tianli; Li, Dongsong; Jiao, Zhiming; Liang, Tao; Zhou, Hao; Yang, Guoqing

2017-12-01

A detection method of coloured oil level indicator is put forward. The method is applied to inspection robot in substation, which realized the automatic inspection and recognition of oil level indicator. Firstly, the detected image of the oil level indicator is collected, and the detected image is clustered and segmented to obtain the label matrix of the image. Secondly, the detection image is processed by colour space transformation, and the feature matrix of the image is obtained. Finally, the label matrix and feature matrix are used to locate and segment the detected image, and the upper edge of the recognized region is obtained. If the upper limb line exceeds the preset oil level threshold, the alarm will alert the station staff. Through the above-mentioned image processing, the inspection robot can independently recognize the oil level of the oil level indicator, and instead of manual inspection. It embodies the automatic and intelligent level of unattended operation.

A prototype implementation of a network-level intrusion detection system. Technical report number CS91-11

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heady, R.; Luger, G.F.; Maccabe, A.B.

1991-05-15

This paper presents the implementation of a prototype network level intrusion detection system. The prototype system monitors base level information in network packets (source, destination, packet size, time, and network protocol), learning the normal patterns and announcing anomalies as they occur. The goal of this research is to determine the applicability of current intrusion detection technology to the detection of network level intrusions. In particular, the authors are investigating the possibility of using this technology to detect and react to worm programs.

Man vs. Machine: A Junior-level Laboratory Exercise Comparing Human and Instrumental Detection Limits

ERIC Educational Resources Information Center

Elias, Ryan J.; Hopfer, Helene; Hofstaedter, Amanda N.; Hayes, John E.

2017-01-01

The human nose is a very sensitive detector and is able to detect potent aroma compounds down to low ng/L levels. These levels are often below detection limits of analytical instrumentation. The following laboratory exercise is designed to compare instrumental and human methods for the detection of volatile odor active compounds. Reference…

Association between an aplastic basilar artery, unaccompanied by a primitive carotid-vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery.

PubMed

Behari, Sanjay; Krishna, Himanshu; Kumar, Marakani V Kiran; Sawlani, Vijay; Phadke, Rajendra V; Jain, Vijendra K

2004-05-01

Basilar artery (BA) aplasia when unaccompanied by a primitive carotid-vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported. This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA. The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.

A case of Cefepime encephalopathy, being difficult to distinguish from non-convulsive status epilepticus during the treatment of bacterial meningitis.

PubMed

Toda, Yusuke; Yamazaki, Mineo; Ota, Tomohiro; Fujisawa, Yosuke; Kimura, Kazumi

2016-10-28

A 64-year-old man with fever, appetite loss, and pain in the back of the neck visited our hospital. We diagnosed him as having bacterial meningitis because of pleocytosis of the cerebrospinal fluid, and started treatment with antibiotics. Multiple cerebral infarcts were found on brain MRI. We suspected that the origin of the bacterial meningitis was infective endocarditis, and administered Cefepime and Gentamicin according to the guidelines for treatment of infective endocarditis. Three days later, he became drowsy and had myoclonus and flapping of the extremities. An electroencephalograph showed generalized periodic discharge and a triphasic wave pattern. We thought that the cause of disturbance in consciousness was Cefepime-induced encephalopathy, and stopped administration of Cefepime. A few days later, he became clear, and the myoclonus and flapping disappeared. It was difficult to distinguish between non-convulsive status epilepticus and Cefepime-induced encephalopathy. However, since stopping Cefepime treatment had made the patient clear, we diagnosed his condition as Cefepime-induced encephalopathy, which often occurs in patients with renal or liver dysfunction, or in brain infarction or meningitis, which results in blood-brain barrier disruption. Thus, care should be taken when administering Cefepime to such patients.

Functional Imaging of Sleep Vertex Sharp Transients

PubMed Central

Stern, John M.; Caporro, Matteo; Haneef, Zulfi; Yeh, Hsiang J.; Buttinelli, Carla; Lenartowicz, Agatha; Mumford, Jeanette A.; Parvizi, Josef; Poldrack, Russell A.

2011-01-01

Objective The vertex sharp transient (VST) is an electroencephalographic (EEG) discharge that is an early marker of non-REM sleep. It has been recognized since the beginning of sleep physiology research, but its source and function remain mostly unexplained. We investigated VST generation using functional MRI (fMRI). Methods Simultaneous EEG and fMRI were recorded from 7 individuals in drowsiness and light sleep. VST occurrences on EEG were modeled with fMRI using an impulse function convolved with a hemodynamic response function to identify cerebral regions correlating to the VSTs. A resulting statistical image was thresholded at Z>2.3. Results Two hundred VSTs were identified. Significantly increased signal was present bilaterally in medial central, lateral precentral, posterior superior temporal, and medial occipital cortex. No regions of decreased signal were present. Conclusion The regions are consistent with electrophysiologic evidence from animal models and functional imaging of human sleep, but the results are specific to VSTs. The regions principally encompass the primary sensorimotor cortical regions for vision, hearing, and touch. Significance The results depict a network comprising the presumed VST generator and its associated regions. The associated regions functional similarity for primary sensation suggests a role for VSTs in sensory experience during sleep. PMID:21310653

The efficacy and safety of aripiprazole for tic disorders in children and adolescents: A systematic review and meta-analysis.

PubMed

Wang, Shuai; Wei, Yan-Zhao; Yang, Jian-Hong; Zhou, Yu-Ming; Cheng, Yu-Hang; Yang, Chao; Zheng, Yi

2017-08-01

The aims are to evaluate the efficacy and safety of aripiprazole for tic disorders (TDs) in children and adolescents. We searched PubMed, Embase, PsychINFO, Cochrane database as well as Chinese databases of CNKI, VIP, CBM and Wanfang from the database inception to October 2016, and 17 full-text studies (N=1305) were included in our article. The meta-analysis of 10 studies (N=817) showed that there was no significant difference in the reduction of total YGTSS score between aripiprazole and other drugs, and meta-analysis of 7 studies (n=324) which used tic symptom control ≧30% as outcome measure showed that there was no significant difference between aripiprazole and other treatments. The most common AEs of aripiprazole were the drowsiness, nausea/vomiting and increased appetite, and meta analysis which used the TESS scale as the outcome measurement showed that there was a significant difference between aripiprazole and haloperidol. In conclusion, these data provide moderate quality evidence that aripiprazole could be an effective and safe treatment option for TDs, and results from further trials are urgently needed to extend this evidence base. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Rectal methadone in cancer patients with pain. A preliminary clinical and pharmacokinetic study.

PubMed

Ripamonti, C; Zecca, E; Brunelli, C; Rizzio, E; Saita, L; Lodi, F; De Conno, F

1995-10-01

Cancer pain can be treated in most cases with oral analgesics. However, during their clinical history, 53% to 70% of patients will need alternative routes of opioid administration. The rectal administration of opioids is a simple alternative route for many patients. There are no data in the literature regarding the pharmacodynamics and pharmacokinetics of rectal methadone. We evaluated the analgesia, tolerability and absorption profile of methadone hydrochloride in six opioid-naive cancer patients with pain. A blood sample was collected before administration of a single dose of drug (10 mg) and then again after fixed times. At these fixed times the patients were asked about pain, nausea and drowsiness by means of a visual analogue scale of 0-100 mm (VAS). Pain relief was statistically significant as early as 30 minutes and up to eight hours after methadone administration. None of the patients reported significant side effects. The pharmacokinetics of rectal methadone showed rapid and extensive distribution phases followed by a slow elimination phase. Rectal methadone can be considered an effective analgesic therapy for patients with cancer pain for whom oral and/or parenteral opioids are not indicated or available.

Stationary gaze entropy predicts lane departure events in sleep-deprived drivers.

PubMed

Shiferaw, Brook A; Downey, Luke A; Westlake, Justine; Stevens, Bronwyn; Rajaratnam, Shantha M W; Berlowitz, David J; Swann, Phillip; Howard, Mark E

2018-02-02

Performance decrement associated with sleep deprivation is a leading contributor to traffic accidents and fatalities. While current research has focused on eye blink parameters as physiological indicators of driver drowsiness, little is understood of how gaze behaviour alters as a result of sleep deprivation. In particular, the effect of sleep deprivation on gaze entropy has not been previously examined. In this randomised, repeated measures study, 9 (4 male, 5 female) healthy participants completed two driving sessions in a fully instrumented vehicle (1 after a night of sleep deprivation and 1 after normal sleep) on a closed track, during which eye movement activity and lane departure events were recorded. Following sleep deprivation, the rate of fixations reduced while blink rate and duration as well as saccade amplitude increased. In addition, stationary and transition entropy of gaze also increased following sleep deprivation as well as with amount of time driven. An increase in stationary gaze entropy in particular was associated with higher odds of a lane departure event occurrence. These results highlight how fatigue induced by sleep deprivation and time-on-task effects can impair drivers' visual awareness through disruption of gaze distribution and scanning patterns.

Mortality rate and clinical features of highly pathogenic avian influenza in naturally infected chickens in Bangladesh.

PubMed

Biswas, P K; Christensen, J P; Ahmed, S S U; Barua, H; Das, A; Rahman, M H; Giasuddin, M; Habib, M A; Hannan, A S M A; Debnath, N C

2011-12-01

A retrospective study was performed to assess the mortality rates and clinical signs in commercial and backyard chickens naturally infected with the highly pathogenic avian influenza (HPAI) H5N1 virus in Bangladesh. All of the 33 commercial and 25 backyard farms, recorded during the first wave of HPAI outbreaks (January to November 2007) in Bangladesh, were enrolled in this study. The farm profile data, stock information and major clinical signs recognised by the farmers and/or farm attendants, were collected through a prototype questionnaire. The investigating veterinarians' retrospective appraisals of the clinical signs were recorded by interview. After the clinical onset, the incidence rates of mortality in breeder, commercial broiler, commercial layer and backyard chickens were, respectively: 0.0215, 0.0341, 0.0179 and 0.0703 per chicken-day at risk. The four major clinical signs observed were cyanotic combs and wattles, oedema of the head and face, drowsiness and huddling and ecchymotic discoloration of the leg shanks. The first sign (cyanotic combs and wattles) was equally observed in chickens from commercial and backyard farms (p = 0.44) but the second (oedema of the head and face) was more common in backyard farms (p = 0.03).

Regulating danger on the highways: hours of service regulations.

PubMed

Mansfield, Daniel; Kryger, Meir

2015-12-01

Current hours of service regulations governing commercial truck drivers in place in the United States, Canada, Australia, and the European Union are summarized and compared to facilitate the assessment of the effectiveness of such provisions in preventing fatigue and drowsiness among truck drivers. Current hours of service provisions governing commercial truck drivers were derived from governmental sources. The commercial truck driver hours of service provisions in the United States, Canada, and the European Union permit drivers to work 14 hours and those of Australia permit drivers to work 12 hours a day on a regular basis. The regulations do not state what a driver may do with time off. They are consistent with a driver being able to drive after 24 hours without sleep. They do not take into account circadian rhythm by linking driving or rest to time of day. Current hours of service regulations governing commercial truck drivers leave gaps--permitting drivers to work long hours on a regular basis, permitting driving after no sleep for 24 hours, and failing to take into account the importance of circadian rhythm, endangering the public safety and the truck drivers themselves. Copyright © 2015 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Disulfiram for binge eating disorder: an open trail.

PubMed

Farci, Anna Maria Giulia; Piras, Simona; Murgia, Magnolia; Chessa, Alessandra; Restivo, Angelo; Gessa, Gian Luigi; Agabio, Roberta

2015-01-01

To evaluate the efficacy and safety of disulfiram for treatment of binge eating disorder. Two hundred and fifty milligrams per day of disulfiram was administered to 12 patients affected by binge eating disorder for 16 weeks; the number of binge eating episodes per week and the number of participants who reported side effects were evaluated. Nine participants (75.0%) completed the trial, while the other 3 (25.0%) discontinued prematurely. Disulfiram significantly decreased the mean frequency of binge eating episodes per week from 7.9±1.2 to 0.9±0.6 (p<.001). All patients (100.0%) reduced the frequency of binge eating episodes, and 7 participants (58.3%) achieved remission of binge eating. Eleven participants (91.7%) reported side effects [drowsiness (N=9), headache (N=7), dysgeusia (N=3), tachycardia (N=3), dizziness (N=2), and nausea (N=2)]. While disulfiram reduced the frequency of binge eating episodes, side effects were observed in the majority of participants. Longer-term placebo-controlled studies are warranted to exclude the contribution of a placebo response from these results and to evaluate drugs with similar pharmacological activity but improved tolerability. Copyright © 2014 Elsevier Ltd. All rights reserved.

[The Current State of Inappropriate Drug Use among Elderly Assisted-Living Residents].

PubMed

Hirotani, Yoshihiko; Kawamura, Hitomi; Nakamura, Mayuri; Urashima, Yoko; Myotoku, Michiaki

2015-12-01

Previous studies have reported that elderly assisted-living residents use multiple drug combinations and inappropriate drugs.The aim of this study was to assess the drug use and its consequences in residents of a nursing facility.We examined the prescriptions of all residents in a nursing facility in Osaka from their medical records.Of the total 67 residents, 48 were women.The average age of the residents was 86 years, the average number of prescription drugs they took was 6.4, and the average number of diseases present was 4.9. Correlation between the number of diseases and the drugs taken was significant (p<0.05), but the correlation between the degree of independence for activities of daily living and the number of the drugs taken was not significant.The most commonly present health condition was bone fracture.About 50% of the residents used a psychotropic drug and prescription drugs such as amantadine and hydroxyzine, which are not advisable for elderly people.It is necessary for the elderly to avoid the use of drugs that cause delirium and drowsiness, and future studies should focus on methods to prevent disuse syndrome in the elderly.

Highway driving safety the day after using sleep medication: the direction of lapses and excursions out-of-lane in drowsy drivers.

PubMed

Verster, Joris C; Mooren, Loes; Bervoets, Adriana C; Roth, Thomas

2017-10-24

The primary outcome measure of the on-road driving test is the Standard Deviation of Lateral Position. However, other outcome measures, such as lapses and excursions out-of-lane, also need to be considered as they may be related to crash risk. The aim of this study was to determine the direction of lapses and excursions out-of-lane (i.e. towards/into the adjacent traffic lane or towards/into the road shoulder). In total, data from 240 driving tests were re-analysed, and 628 lapses and 401 excursions out-of-lane were identified. The analyses revealed that lapses were made equally frequently over left (49.4%) and over right (43.3%). In contrast, excursions out-of-lane were almost exclusively directed over right into the (safer) road shoulder (97.3%). These findings suggest that drivers are unaware of having lapses, whereas excursions out-of-lane are events where the driver is aware of loss of vehicle control. © 2017 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

Simultaneous cranioplasty and subdural-peritoneal shunting for contralateral symptomatic subdural hygroma following decompressive craniectomy.

PubMed

Lin, Muh-Shi; Chen, Tzu-Hsuan; Kung, Woon-Man; Chen, Shuo-Tsung

2015-01-01

Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits. Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications. Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma. The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus.

Caffeine use and dependence in adolescents: one-year follow-up.

PubMed

Oberstar, Joel V; Bernstein, Gail A; Thuras, Paul D

2002-01-01

The objectives were to conduct a 1-year follow-up of daily caffeine-using adolescents to further describe caffeine dependence symptoms and to determine whether caffeine dependence is associated with other substance dependence disorders. Twenty-one of 36 (58.3%) adolescents who participated in a study of caffeine dependence returned for follow-up. The previous study was a case series of adolescents who consumed caffeine daily and met some Diagnostic and Statistical Manual of Mental Disorders (fourth edition) substance dependence criteria as applied to caffeine. At follow-up, caffeine consumption from beverages was 179.9 +/- 151.8 mg/day. Of the 21 teenagers, 23.8% (n = 5) met criteria for caffeine dependence. Four of these participants developed caffeine dependence during the follow-up period. Other substance dependence disorders were not overrepresented in the caffeine dependent group compared to the caffeine nondependent group. The most commonly reported withdrawal symptoms in dependent teenagers (at baseline and follow-up combined) were feeling drowsy/tired, fatigued, or sluggish/slowed down (83.3% each) and headache (75.0%). Caffeine dependence occurs in some adolescents who drink caffeine daily and is marked by symptoms similar to those found in adults.

[CLINICAL INVESTIGATION OF AN EXCESSIVE SLEEPINESS COMPLAINT].

PubMed

Evangelista, Elisa; Barateau, Lucie; Dauvilliers, Yves

2016-06-01

Excessive sleepiness is a common problem, defined by a complaint of excessive daytime sleepiness almost daily with an inability to stay awake and alert dosing periods at sleep, with episodes of irresistible sleep need or drowsiness or non-intentional sleep, or by a night's sleep time overly extended often associated with sleep inertia. This sleepiness is variable in terms of phenotype and severity to be specified by the out-patient clinic. It is considered to be chronic beyond three months and often responsible for significant functional impairment of school and professional performance, of the accidents and cardiovascular risk. We need to decipher the causes of excessive sleepiness: sleep deprivation, toxic and iatrogenic, psychiatric disorders (including depression), non-psychiatric medical problems (obesity, neurological pathologies...), sleep disorders (as for example the sleep apnea syndrome), and finally the central hypersomnias namely narcolepsy type 1 and 2, idiopathic hypersomnia, and Kleine-Levin syndrome. If careful questioning often towards one of these etiologies, need most of the time a paraclinical balance with a sleep recording to confirm the diagnosis. Patients affected with potential central hypersomnia must be referred to the Sleep Study Centers that have the skills and the appropriate means to achieve this balance sheet.

Subjective symptoms and their evolution in a small group of magnetic resonance imaging (MRI) operators recently engaged.

PubMed

Zanotti, G; Ligabue, G; Gobba, F

2015-09-01

Using a specific questionnaire, we examined subjective symptoms in a group of 17 physicians (9 males and 8 females, mean age 32.9 ± 3.71), attending a Postgraduate Medical School in Radiology and engaged in MRI for less than 1 year. Sixteen subjects (94%) reported the presence of at least one of the investigated symptoms during the period of MRI activity. The main symptoms were: unusual drowsiness/tiredness (88%), concentration problems (82%), headaches (76%), sleep disorders (47%), nausea (47%), illusion of movement (47%) and dizziness/vertigo (35%); the former two were subjectively related to MRI by the majority of the operators. These symptoms appeared (or worsened) in more than 15 min and, in the vast majority disappeared 30 min, or more, after the end of exposure. In 13 subjects (81%), the symptom (or some symptoms) appeared at least weekly. In this small group of health care workers recently exposed to MRI, the prevalence of subjective symptoms was higher than reported in other similar studies but, notably, the majority of subjects (77%) reported a regression within 4-8 weeks, suggesting some form of adaptation.

Association of anticholinergic burden with adverse effects in older people with intellectual disabilities: an observational cross-sectional study.

PubMed

O'Dwyer, Máire; Maidment, Ian D; Bennett, Kathleen; Peklar, Jure; Mulryan, Niamh; McCallion, Philip; McCarron, Mary; Henman, Martin C

2016-12-01

No studies to date have investigated cumulative anticholinergic exposure and its effects in adults with intellectual disabilities. To determine the cumulative exposure to anticholinergics and the factors associated with high exposure. A modified Anticholinergic Cognitive Burden (ACB) scale score was calculated for a representative cohort of 736 people over 40 years old with intellectual disabilities, and associations with demographic and clinical factors assessed. Age over 65 years was associated with higher exposure (ACB 1-4 odds ratio (OR) = 3.28, 95% CI 1.49-7.28, ACB 5+ OR = 3.08, 95% CI 1.20-7.63), as was a mental health condition (ACB 1-4 OR = 9.79, 95% CI 5.63-17.02, ACB 5+ OR = 23.74, 95% CI 12.29-45.83). Daytime drowsiness was associated with higher ACB (P<0.001) and chronic constipation reported more frequently (26.6% ACB 5+ v. 7.5% ACB 0, P<0.001). Older people with intellectual disabilities and with mental health conditions were exposed to high anticholinergic burden. This was associated with daytime dozing and constipation. © The Royal College of Psychiatrists 2016.

Assessment of hyporheic zone, flood-plain, soil-gas, soil, and surface-water contamination at the Old Incinerator Area, Fort Gordon, Georgia, 2009-2010

USGS Publications Warehouse

Guimaraes, Wladmir B.; Falls, W. Fred; Caldwell, Andral W.; Ratliff, W. Hagan; Wellborn, John B.; Landmeyer, James E.

2011-01-01

The U.S. Geological Survey, in cooperation with the U.S. Department of the Army Environmental and Natural Resources Management Office of the U.S. Army Signal Center and Fort Gordon, Georgia, assessed the hyporheic zone, flood plain, soil gas, soil, and surface-water for contaminants at the Old Incinerator Area at Fort Gordon, from October 2009 to September 2010. The assessment included the detection of organic contaminants in the hyporheic zone, flood plain, soil gas, and surface water. In addition, the organic contaminant assessment included the analysis of explosives and chemical agents in selected areas. Inorganic contaminants were assessed in soil and surface-water samples. The assessment was conducted to provide environmental contamination data to the U.S. Army at Fort Gordon pursuant to requirements of the Resource Conservation and Recovery Act Part B Hazardous Waste Permit process. Total petroleum hydrocarbons were detected above the method detection level in all 13 samplers deployed in the hyporheic zone and flood plain of an unnamed tributary to Spirit Creek. The combined concentrations of benzene, toluene, ethylbenzene, and total xylene were detected at 3 of the 13 samplers. Other organic compounds detected in one sampler included octane and trichloroethylene. In the passive soil-gas survey, 28 of the 60 samplers detected total petroleum hydrocarbons above the method detection level. Additionally, 11 of the 60 samplers detected the combined masses of benzene, toluene, ethylbenzene, and total xylene above the method detection level. Other compounds detected above the method detection level in the passive soil-gas survey included octane, trimethylbenzene, perchlorethylene, and chloroform. Subsequent to the passive soil-gas survey, six areas determined to have relatively high contaminant mass were selected, and soil-gas samplers were deployed, collected, and analyzed for explosives and chemical agents. No explosives or chemical agents were detected above their method detection levels, but those that were detected were above the nondetection level. The same six locations that were sampled for explosives and chemical agents were selected for the collection of soil samples. No metals that exceeded the Regional Screening Levels for Industrial Soils as classified by the U.S. Environmental Protection Agency were detected at any of the six Old Incinerator Area locations. The soil samples also were compared to values from the ambient, uncontaminated (background) levels for soils in South Carolina. Because South Carolina is adjacent to Georgia and the soils in the coastal plain are similar, these comparisons are valid. No similar values are available for Georgia to use for comparison purposes. The only metal detected above the ambient background levels for South Carolina was barium. A surface-water sample collected from a tributary west and north of the Old Incinerator Area was analyzed for volatile organic compounds, semivolatile organic compounds, and inorganic compounds (metals). The only volatile organic and (or) semivolatile organic compound that was detected above the laboratory reporting level was toluene. The compounds 4-isopropyl-1-methylbenzene and isophorone were detected above the nondetection level but below the laboratory reporting level and were estimated. These compounds were detected at levels below the maximum contaminant levels set by the U.S. Environmental Protection Agency National Primary Drinking Water Standard. Iron was the only inorganic compound detected in the surface-water sample that exceeded the maximum contaminant level set by the U.S. Environmental Protection Agency National Secondary Drinking Water Standard. No other inorganic compounds exceeded the maximum contaminant levels for the U.S. Environmental Protection Agency National Primary Drinking Water Standard, National Secondary Drinking Water Standard, or the Georgia In-Stream Water Quality Standard.

40 CFR Table 1 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 10 2014-07-01 2014-07-01 false Detection Sensitivity Levels (grams per hour) 1 Table 1 to Subpart A of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Levels (grams per hour) Monitoring frequency per subpart a Detection sensitivity level Bi-Monthly 60 Semi...

40 CFR Table 1 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 10 2012-07-01 2012-07-01 false Detection Sensitivity Levels (grams per hour) 1 Table 1 to Subpart A of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Levels (grams per hour) Monitoring frequency per subpart a Detection sensitivity level Bi-Monthly 60 Semi...

40 CFR Table 1 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Detection Sensitivity Levels (grams per hour) 1 Table 1 to Subpart A of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Levels (grams per hour) Monitoring frequency per subpart a Detection sensitivity level Bi-Monthly 60 Semi...

40 CFR Table 1 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Detection Sensitivity Levels (grams per hour) 1 Table 1 to Subpart A of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Levels (grams per hour) Monitoring frequency per subpart a Detection sensitivity level Bi-Monthly 60 Semi...

40 CFR Table 1 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 10 2013-07-01 2013-07-01 false Detection Sensitivity Levels (grams per hour) 1 Table 1 to Subpart A of Part 63 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Levels (grams per hour) Monitoring frequency per subpart a Detection sensitivity level Bi-Monthly 60 Semi...

Pharmacokinetics of betamethasone after single-dose intramuscular administration of betamethasone phosphate and betamethasone acetate to healthy subjects.

PubMed

Salem, Isam I; Najib, Naji M

2012-01-01

Betamethasone is used for its antiinflammatory and immunosuppressive effects in disorders of many organ systems. However, the pharmacokinetic properties of betamethasone in plasma after intramuscular injection of betamethasone sodium phosphate and betamethasone acetate dual-acting suspension need further investigation. The main aim of this study was to determine the pharmacokinetic parameters of betamethasone, betamethasone acetate, and betamethasone phosphate after the administration of a single intramuscular dose of the dual-acting suspension to healthy human volunteers. Two different studies were conducted in healthy males. Volunteers were judged healthy based on their medical history, physical examination, and laboratory test results. Before confinement, all volunteers were tested for freedom from alcohol and drugs of abuse. Following a 10-hour overnight fasting, a single dose of 1 mL of the dual-acting suspension containing 3 mg of betamethasone phosphate and 3 mg of betamethasone acetate was administered by intramuscular injection. Blood sampling covered 48 hours. The plasma samples obtained in the second study were stabilized to enable pharmacokinetic profiling of betamethasone esters. Twenty-four healthy males with mean (SD) age of 27 (6.62) years participated in each study. No incidences of serious adverse events were recorded during the studies. Six mild adverse events were reported in 2 subjects in the second study. One subject suffered from pain at the injection site and insomnia, and another subject complained of heartburn and drowsiness. Betamethasone phosphate appeared to be readily absorbed with a mean AUC(0-t) of 96.01 ng/h/mL and an AUC(0-∞) of 97.96 (23.38) ng/h/mL. Betamethasone peak plasma concentration reached a mean t(½) of 12.92 hours. Betamethasone acetate was not detected in the volunteers' plasma in either study (total of 2208 plasma samples). The observed pharmacokinetic parameters suggested that the acetate ester, and not the phosphate ester, of betamethasone acts as a prodrug or reservoir for betamethasone, conferring on it sustained- and extended-release characteristics. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

A Field-Based Cleaning Protocol for Sampling Devices Used in Life-Detection Studies

NASA Astrophysics Data System (ADS)

Eigenbrode, Jennifer; Benning, Liane G.; Maule, Jake; Wainwright, Norm; Steele, Andrew; Amundsen, Hans E. F.

2009-06-01

Analytical approaches to extant and extinct life detection involve molecular detection often at trace levels. Thus, removal of biological materials and other organic molecules from the surfaces of devices used for sampling is essential for ascertaining meaningful results. Organic decontamination to levels consistent with null values on life-detection instruments is particularly challenging at remote field locations where Mars analog field investigations are carried out. Here, we present a seven-step, multi-reagent decontamination method that can be applied to sampling devices while in the field. In situ lipopolysaccharide detection via low-level endotoxin assays and molecular detection via gas chromatography-mass spectrometry were used to test the effectiveness of the decontamination protocol for sampling of glacial ice with a coring device and for sampling of sediments with a rover scoop during deployment at Arctic Mars-analog sites in Svalbard, Norway. Our results indicate that the protocols and detection technique sufficiently remove and detect low levels of molecular constituents necessary for life-detection tests.

A field-based cleaning protocol for sampling devices used in life-detection studies.

PubMed

Eigenbrode, Jennifer; Benning, Liane G; Maule, Jake; Wainwright, Norm; Steele, Andrew; Amundsen, Hans E F

2009-06-01

Analytical approaches to extant and extinct life detection involve molecular detection often at trace levels. Thus, removal of biological materials and other organic molecules from the surfaces of devices used for sampling is essential for ascertaining meaningful results. Organic decontamination to levels consistent with null values on life-detection instruments is particularly challenging at remote field locations where Mars analog field investigations are carried out. Here, we present a seven-step, multi-reagent decontamination method that can be applied to sampling devices while in the field. In situ lipopolysaccharide detection via low-level endotoxin assays and molecular detection via gas chromatography-mass spectrometry were used to test the effectiveness of the decontamination protocol for sampling of glacial ice with a coring device and for sampling of sediments with a rover scoop during deployment at Arctic Mars-analog sites in Svalbard, Norway. Our results indicate that the protocols and detection technique sufficiently remove and detect low levels of molecular constituents necessary for life-detection tests.

Assessment of soil-gas contamination at building 310 underground storage tank area, Fort Gordon, Georgia, 2010-2011

USGS Publications Warehouse

Guimaraes, Wladmir B.; Falls, W. Fred; Caldwell, Andral W.; Ratliff, W. Hagan; Wellborn, John B.; Landmeyer, James E.

2012-01-01

Soil gas was assessed for contaminants in the building 310 underground storage tank area adjacent to the Dwight D. Eisenhower Army Medical Center at Ft. Gordon, Georgia, from October 2010 to September 2011. The assessment, which also included the detection of organic compounds in soil gas, provides environmental contamination data to Fort Gordon personnel pursuant to requirements of the Resource Conservation and Recovery Act Part B Hazardous Waste Permit process. The study was conducted by the U.S. Geological Survey, in cooperation with the U.S. Department of the Army Environmental and Natural Resources Management Office of the U.S. Army Signal Center and Fort Gordon. Soil-gas samplers were deployed below land surface at 37 locations in the building 310 underground storage tank area. Soil-gas samplers were deployed in a grid pattern near the storage tank area as well as downslope of the tank area in the direction of groundwater flow toward an unnamed tributary to Butler Creek. Total petroleum hydrocarbons were detected in 35 of the 37 soil-gas samplers at levels above the method detection level, and the combined mass of benzene, toluene, ethylbenzene, and total xylenes were detected above their detection levels in 8 of the 37 samplers. In addition, the combined masses of undecane, tridecane, and pentadecane were detected at or above their method detection levels in 9 of the 37 samplers. Other volatile organic compounds detected above their respective method detection levels were chloroform, 1,2,4-trimethylbenzene, and perchloroethylene. In addition, naphthalene, 2-methyl naphthalene, and 1,2,4-trimethylbenzene were detected below the method detection levels, but above the nondetection level.

Pickless event detection and location: The waveform correlation event detection system (WCEDS) revisited

DOE PAGES

Arrowsmith, Stephen John; Young, Christopher J.; Ballard, Sanford; ...

2016-01-01

The standard paradigm for seismic event monitoring breaks the event detection problem down into a series of processing stages that can be categorized at the highest level into station-level processing and network-level processing algorithms (e.g., Le Bras and Wuster (2002)). At the station-level, waveforms are typically processed to detect signals and identify phases, which may subsequently be updated based on network processing. At the network-level, phase picks are associated to form events, which are subsequently located. Furthermore, waveforms are typically directly exploited only at the station-level, while network-level operations rely on earth models to associate and locate the events thatmore » generated the phase picks.« less

Car Crashes and Central Disorders of Hypersomnolence: A French Study.

PubMed

Pizza, Fabio; Jaussent, Isabelle; Lopez, Regis; Pesenti, Carole; Plazzi, Giuseppe; Drouot, Xavier; Leu-Semenescu, Smaranda; Beziat, Severine; Arnulf, Isabelle; Dauvilliers, Yves

2015-01-01

Drowsiness compromises driving ability by reducing alertness and attentiveness, and delayed reaction times. Sleep-related car crashes account for a considerable proportion of accident at the wheel. Narcolepsy type 1 (NT1), narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) are rare central disorders of hypersomnolence, the most severe causes of sleepiness thus being potential dangerous conditions for both personal and public safety with increasing scientific, social, and political attention. Our main objective was to assess the frequency of recent car crashes in a large cohort of patients affected with well-defined central disorders of hypersomnolence versus subjects from the general population. We performed a cross-sectional study in French reference centres for rare hypersomnia diseases and included 527 patients and 781 healthy subjects. All participants included needed to have a driving license, information available on potential accident events during the last 5 years, and on potential confounders; thus analyses were performed on 282 cases (71 IH, 82 NT2, 129 NT1) and 470 healthy subjects. Patients reported more frequently than healthy subjects the occurrence of recent car crashes (in the previous five years), a risk that was confirmed in both treated and untreated subjects at study inclusion (Untreated, OR = 2.21 95%CI = [1.30-3.76], Treated OR = 2.04 95%CI = [1.26-3.30]), as well as in all disease categories, and was modulated by subjective sleepiness level (Epworth scale and naps). Conversely, the risk of car accidents of patients treated for at least 5 years was not different to healthy subjects (OR = 1.23 95%CI = [0.56-2.69]). Main risk factors were analogous in patients and healthy subjects. Patients affected with central disorders of hypersomnolence had increased risk of recent car crashes compared to subjects from the general population, a finding potentially reversed by long-term treatment.

Intracerebroventricular opiate infusion for refractory head and facial pain

PubMed Central

Lee, Darrin J; Gurkoff, Gene G; Goodarzi, Amir; Muizelaar, J Paul; Boggan, James E; Shahlaie, Kiarash

2014-01-01

AIM: To study the risks and benefits of intracerebroventricular (ICV) opiate pumps for the management of benign head and face pain. METHODS: SSix patients with refractory trigeminal neuralgia and/or cluster headaches were evaluated for implantation of an ICV opiate infusion pump using either ICV injections through an Ommaya reservoir or external ventricular drain. Four patients received morphine ICV pumps and two patientS received a hydromorphone pump. Of the Four patients with morphine ICV pumps, one patient had the medication changed to hydromorphone. Preoperative and post-operative visual analog scores (VAS) were obtained. Patients were evaluated post-operatively for a minimum of 3 mo and the pump dosage was adjusted at each outpatient clinic visit according to the patient’s pain level. RESULTS: All 6 patients had an intracerebroventricular opiate injection trial period, using either an Ommaya reservoir or an external ventricular drain. There was an average VAS improvement of 75.8%. During the trial period, no complications were observed. Pump implantation was performed an average of 3.7 wk (range 1-7) after the trial injections. After implantation, an average of 20.7 ± 8.3 dose adjustments were made over 3-56 mo after surgery to achieve maximal pain relief. At the most recent follow-up (26.2 mo, range 3-56), VAS scores significantly improved from an average of 7.8 ± 0.5 (range 6-10) to 2.8 ± 0.7 (range 0-5) at the final dose (mean improvement 5.0 ± 1.0, P < 0.001). All patients required a stepwise increase in opiate infusion rates to achieve maximal benefit. The most common complications were nausea and drowsiness, both of which resolved with pump adjustments. On average, infusion pumps were replaced every 4-5 years. CONCLUSION: These results suggest that ICV delivery of opiates may potentially be a viable treatment option for patients with intractable pain from trigeminal neuralgia or cluster headache. PMID:25133146

[Analgesic effect and clinical tolerability of the combination of paracetamol 500 mg and caffeine 50 mg versus paracetamol 400 mg and dextropropoxyphene 30 mg in back pain].

PubMed

Kuntz, D; Brossel, R

1996-09-07

A double-blind randomized multicentric study was performed to test the hypothesis that the analgesic effect of paracetamol-cafeine is equivalent to that of paracetamol-dextropropoxyphen in patients suffering from pain due to osteoarthritis of the spine. Rhumatologists included 124 patients who were randomized into two groups of 62 each. Pain was measured daily during the seven-day treatment Huskisson's Analog Visual Scales; 112 were per protocol and evaluable. The two treatment groups were statistically similar for demographics, vital signs, medical and treatment history. A majority of them had pain located at the lumbar spine only; the other patients had either pain at the cervical or dorsal spine or at several sites. At the end of the week there was a major reduction in pain level: 51.2% in patients given paracetamol-cafeine and 47.0% in those given paracetamol-dextropropoxyphen. The main criteria of efficacy--the percentage of success (decrease of pain > 50%)--was similar in the two groups as well in the intention-to-treat population (p = 0.01) as the per protocol population (p = 0.028). Kinetics of pain decrease during the first day of treatment were assessed with an hourly evaluation during the six first hours and at the 12th hour. There was no difference between the two groups. There was no serious adverse event and the frequency and intensity of the adverse events were similar in the two groups. The potentializing action of cafeine on paracetamol-induced pain relief enables a degree of pain relief equivalent to that of a combination using an analgesic with a peripheral action, paracetamol, and another with a central action, dextropoxyphen. The fact that the paracetamol-cafeine combination does not have a central action avoids secondary effects induced by central analgesics (drowsiness, constipation) in patients with osteoarthritis back pain.

Patient-reported Outcomes from A National, Prospective, Observational Study of Emergency Department Acute Pain Management With an Intranasal Nonsteroidal Anti-inflammatory Drug, Opioids, or Both.

PubMed

Pollack, Charles V; Diercks, Deborah B; Thomas, Stephen H; Shapiro, Nathan I; Fanikos, John; Mace, Sharon E; Rafique, Zubaid; Todd, Knox H

2016-03-01

Patient compliance and satisfaction with analgesics prescribed after emergency department (ED) care for acute pain are poorly understood, largely because of the lack of direct patient follow-up with the ED provider. Our objective was to compare patient satisfaction with three analgesia regimens prescribed for post-ED care-a nasally administered nonsteroidal anti-inflammatory drug (NSAID), an opioid, or combination therapy-by collecting granular follow-up on analgesic use, pain scores, side effects, work activity levels, and overall satisfaction directly from patients. We designed a prospective registry linking ED assessment and analgesic management for acute pain of specific musculoskeletal or visceral etiologies with self-reported automated telephonic follow-up daily for the 4 days post-ED discharge. Patients were prescribed a specific NSAID (SPRIX, ketorolac tromethamine for nasal instillation) only, an oral opioid only, or both with the opioid clearly defined as rescue therapy, at the ED provider's discretion. There were 824 evaluable subjects. Maximum pain scores improved day to day more effectively with a ketorolac-based approach. Self-reported rates of return to work and work effectiveness were higher with SPRIX than with opioids or combination therapy. Adverse effects of nausea, constipation, drowsiness, and abdominal pain were higher each day among patients taking an opioid; nasal irritation was more common with SPRIX. Overall satisfaction at the end of the follow-up period was higher with SPRIX-based treatment than with opioid monotherapy. Automated telephonic follow-up of ED patients prescribed short-term analgesia is feasible. Ketorolac-based analgesia after an ED visit for many acute pain syndromes was associated with favorable patient outcomes and higher satisfaction than opioid-based therapy. SPRIX, an NSAID that is not available over the counter and has a novel delivery approach, may be useful for short-term post-ED outpatient analgesia. © 2016 by the Society for Academic Emergency Medicine.

Car Crashes and Central Disorders of Hypersomnolence: A French Study

PubMed Central

Lopez, Regis; Pesenti, Carole; Plazzi, Giuseppe; Drouot, Xavier; Leu-Semenescu, Smaranda; Beziat, Severine; Arnulf, Isabelle; Dauvilliers, Yves

2015-01-01

Background Drowsiness compromises driving ability by reducing alertness and attentiveness, and delayed reaction times. Sleep-related car crashes account for a considerable proportion of accident at the wheel. Narcolepsy type 1 (NT1), narcolepsy type 2 (NT2) and idiopathic hypersomnia (IH) are rare central disorders of hypersomnolence, the most severe causes of sleepiness thus being potential dangerous conditions for both personal and public safety with increasing scientific, social, and political attention. Our main objective was to assess the frequency of recent car crashes in a large cohort of patients affected with well-defined central disorders of hypersomnolence versus subjects from the general population. Methods We performed a cross-sectional study in French reference centres for rare hypersomnia diseases and included 527 patients and 781 healthy subjects. All participants included needed to have a driving license, information available on potential accident events during the last 5 years, and on potential confounders; thus analyses were performed on 282 cases (71 IH, 82 NT2, 129 NT1) and 470 healthy subjects. Results Patients reported more frequently than healthy subjects the occurrence of recent car crashes (in the previous five years), a risk that was confirmed in both treated and untreated subjects at study inclusion (Untreated, OR = 2.21 95%CI = [1.30–3.76], Treated OR = 2.04 95%CI = [1.26–3.30]), as well as in all disease categories, and was modulated by subjective sleepiness level (Epworth scale and naps). Conversely, the risk of car accidents of patients treated for at least 5 years was not different to healthy subjects (OR = 1.23 95%CI = [0.56–2.69]). Main risk factors were analogous in patients and healthy subjects. Conclusion Patients affected with central disorders of hypersomnolence had increased risk of recent car crashes compared to subjects from the general population, a finding potentially reversed by long-term treatment. PMID:26052938

Oculometric variations during mind wandering

PubMed Central

Grandchamp, Romain; Braboszcz, Claire; Delorme, Arnaud

2014-01-01

A significant body of literature supports the contention that pupil size varies depending on cognitive load, affective state, and level of drowsiness. Here we assessed whether oculometric measures such as gaze position, blink frequency and pupil size were correlated with the occurrence and time course of self-reported mind-wandering episodes. We recorded the pupil size of two subjects engaged in a monotonous breath counting task while keeping their eyes on a fixation cross. This task is conducive to producing mind-wandering episodes. Each subject performed ten 20-min sessions, for total duration of about 4 h. Subjects were instructed to report spontaneous mind-wandering episodes by pressing a button when they lost count of their breath. After each button press, subjects filled in a short questionnaire describing the characteristics of their mind-wandering episode. We observed larger pupil size during the breath-focusing period compared to the mind-wandering period (p < 0.01 for both subjects). Our findings contradict previous research showing a higher baseline pupil size during mind wandering episodes in visual tasks. We discuss possible explanations for this discrepancy. We also analyzed nine other oculometric measures including blink rate, blink duration and gaze position. We built a support vector machine (SVM) classifier and showed that mean pupil size was the most reliable predictor of mind wandering in both subjects. The classification accuracy of mind wandering data segments vs. breath-focusing data segments was 81% for the first subject and 77% for the second subject. Additionally, we analyzed oculometric measures in light of the phenomenological data collected in the questionnaires. We showed that how well subjects remembered their thoughts while mind wandering was positively correlated with pupil size (subject 1, p < 0.001; subject 2, p < 0.05). Feelings of well being were also positively correlated with pupil size (subject 1, p < 0.001; subject 2, p < 0.001). Our results suggest that oculometric data could be used as a neurocognitive marker of mind-wandering episodes. PMID:24575056

Chapter 13: Interannual Differences in Detections of Marbled Murrelets in Some Inland California Stands

Treesearch

C. John Ralph

1995-01-01

I compared the mean level of detections of Marbled Murrelets by month over five years at three inland sites in northern California. These areas all have relatively high levels of detections. There were no significant differences in mean detection levels year to year at any site, and for any month with the exception of April at one site. This lack of evidence for...

Notched-noise precursors improve detection of low-frequency amplitude modulationa)

PubMed Central

Almishaal, Ali; Bidelman, Gavin M.; Jennings, Skyler G.

2017-01-01

Amplitude modulation (AM) detection was measured with a short (50 ms), high-frequency carrier as a function of carrier level (Experiment I) and modulation frequency (Experiment II) for conditions with or without a notched-noise precursor. A longer carrier (500 ms) was also included in Experiment I. When the carrier was preceded by silence (no precursor condition) AM detection thresholds worsened for moderate-level carriers compared to lower- or higher-level carriers, resulting in a “mid-level hump.” AM detection thresholds with a precursor were better than those without a precursor, primarily for moderate-to-high level carriers, thus eliminating the mid-level hump in AM detection. When the carrier was 500 ms, AM thresholds improved by a constant (across all levels) relative to AM thresholds with a precursor, consistent with the longer carrier providing more “looks” to detect the AM signal. Experiment II revealed that improved AM detection with compared to without a precursor is limited to low-modulation frequencies (<60 Hz). These results are consistent with (1) a reduction in cochlear gain over the course of the precursor perhaps via the medial olivocochlear reflex or (2) a form of perceptual enhancement which may be mediated by adaptation of inhibition. PMID:28147582

[Spectral features analysis of Pinus massoniana with pest of Dendrolimus punctatus Walker and levels detection].

PubMed

Xu, Zhang-Hua; Liu, Jian; Yu, Kun-Yong; Gong, Cong-Hong; Xie, Wan-Jun; Tang, Meng-Ya; Lai, Ri-Wen; Li, Zeng-Lu

2013-02-01

Taking 51 field measured hyperspectral data with different pest levels in Yanping, Fujian Province as objects, the spectral reflectance and first derivative features of 4 levels of healthy, mild, moderate and severe insect pest were analyzed. On the basis of 7 detecting parameters construction, the pest level detecting models were built. The results showed that (1) the spectral reflectance of Pinus massoniana with pests were significantly lower than that of healthy state, and the higher the pest level, the lower the reflectance; (2) with the increase in pest level, the spectral reflectance curves' "green peak" and "red valley" of Pinus massoniana gradually disappeared, and the red edge was leveleds (3) the pest led to spectral "green peak" red shift, red edge position blue shift, but the changes in "red valley" and near-infrared position were complicated; (4) CARI, RES, REA and REDVI were highly relevant to pest levels, and the correlations between REP, RERVI, RENDVI and pest level were weak; (5) the multiple linear regression model with the variables of the 7 detection parameters could effectively detect the pest levels of Dendrolimus punctatus Walker, with both the estimation rate and accuracy above 0.85.

[Stress and fatigue in long distance 2-man cockpit crew].

PubMed

Samel, A; Wegmann, H H; Vejvoda, M; Wittiber, K

1996-01-01

Common rules on flight-duty times and rest requirements within the European Union are under intense discussion. In the deliberations, results from scientific investigations should be considered. As part of a research programme concerning legal aspects of two-pilot operations on long-haul routes, the purpose of the studies was to investigate two-crew extended range operations during transmeridian and transequatorial flight schedules. The studies were conducted with two German charter airlines on the transmeridian routes Düsseldorf (DUS)-Atlanta (ATL) and Hamburg (HAM)-Los Angeles (LAX), and on the north-south route Frankfurt (FRA)-Mahe (SEZ) including two consecutive night flights with a short layover. In total, 25 rotations (50 flights) have been investigated by pre-, in-, and post-flight data collection from the two pilots being the minimum required crew. Recordings included sleep, taskload, fatigue and stress by measurements of EEG, ECG, motor activity and subjective ratings. During the transmeridian schedules, pilots lost one night of sleep because of the return flights which were conducted at night. The resulting sleep deficit was 8.2 h. During the layover of the SEZ-rotation with a duration of 14 h on average, sleep was shortened by 2 h compared with baseline sleep. The two consecutive night flights resulted in a sleep loss of 9.3 h upon return to home base. Inflight ratings of taskload showed low levels during the atlantic flights, and moderate grades during the north-south transitions. Fatigue ratings exhibited an increasing level with progressing flight duration. Towards the end of long US-westcoast flights performed at day-time, and in all night flights, fatigue was enhanced compared to the "baseline" ratings collected during the DUS-ATL flights. Fatigue was scored at a critical level by several pilots, particularly during the return flight SEZ-FRA when fatigue was severely pronounced. The subjective fatigue ratings were confirmed by the objective measurements of motor activity, brain-wave activity (occurrences of micro-sleep) and heart rate which indicated drowsiness and a low state of vigilance and alertness during all night flights under study. From the findings it is concluded that duty schedules, as conducted on the route HAM-LAX (because of long duty hours), and particularly on the route FRA-SEZ, (because of consecutive night duties) are coming close to the limits of mental and physiological capacity. With respect to legal aspects, the results have significance and should promote further deliberations for advanced schemes of flight duty time limitations and rest requirements.

Statistical sensor fusion analysis of near-IR polarimetric and thermal imagery for the detection of minelike targets

NASA Astrophysics Data System (ADS)

Weisenseel, Robert A.; Karl, William C.; Castanon, David A.; DiMarzio, Charles A.

1999-02-01

We present an analysis of statistical model based data-level fusion for near-IR polarimetric and thermal data, particularly for the detection of mines and mine-like targets. Typical detection-level data fusion methods, approaches that fuse detections from individual sensors rather than fusing at the level of the raw data, do not account rationally for the relative reliability of different sensors, nor the redundancy often inherent in multiple sensors. Representative examples of such detection-level techniques include logical AND/OR operations on detections from individual sensors and majority vote methods. In this work, we exploit a statistical data model for the detection of mines and mine-like targets to compare and fuse multiple sensor channels. Our purpose is to quantify the amount of knowledge that each polarimetric or thermal channel supplies to the detection process. With this information, we can make reasonable decisions about the usefulness of each channel. We can use this information to improve the detection process, or we can use it to reduce the number of required channels.

Investigations of internal noise levels for different target sizes, contrasts, and noise structures

NASA Astrophysics Data System (ADS)

Han, Minah; Choi, Shinkook; Baek, Jongduk

2014-03-01

To describe internal noise levels for different target sizes, contrasts, and noise structures, Gaussian targets with four different sizes (i.e., standard deviation of 2,4,6 and 8) and three different noise structures(i.e., white, low-pass, and highpass) were generated. The generated noise images were scaled to have standard deviation of 0.15. For each noise type, target contrasts were adjusted to have the same detectability based on NPW, and the detectability of CHO was calculated accordingly. For human observer study, 3 trained observers performed 2AFC detection tasks, and correction rate, Pc, was calculated for each task. By adding proper internal noise level to numerical observer (i.e., NPW and CHO), detectability of human observer was matched with that of numerical observers. Even though target contrasts were adjusted to have the same detectability of NPW observer, detectability of human observer decreases as the target size increases. The internal noise level varies for different target sizes, contrasts, and noise structures, demonstrating different internal noise levels should be considered in numerical observer to predict the detection performance of human observer.

Predictors of detection of alcohol use episodes using a transdermal alcohol sensor.

PubMed

Barnett, Nancy P; Meade, E B; Glynn, Tiffany R

2014-02-01

The objective of this investigation was to establish the ability of the Secure Continuous Remote Alcohol Monitoring (SCRAM) alcohol sensor to detect different levels of self-reported alcohol consumption, and to determine whether gender and body mass index, alcohol dependence, bracelet version, and age of bracelet influenced detection of alcohol use. Heavy drinking adults (N = 66, 46% female) wore the SCRAM for 1-28 days and reported their alcohol use in daily Web-based surveys. Participant reports of alcohol use were matched with drinking episodes identified from bracelet readings. On days when bracelets were functional, 690 drinking episodes were reported and 502 of those episodes (72.8%) were detected using sensor data. Using generalized estimating equations, we found no gender differences in detection of reported drinking episodes (77% for women, 69% for men). In univariate analyses, at the level of fewer than 5 drinks, women's episodes were more likely to be detected, likely because of the significantly higher transdermal alcohol concentration levels of these episodes, whereas at the level of 5 or more drinks, there was no gender difference in detection (92.6% for women, 93.4% for men). In multivariable analyses, no variables other than number of drinks significantly predicted alcohol detection. In summary, the SCRAM sensor is very good at detecting 5 or more drinks; performance of the monitor below this level was better among women because of their higher transdermal alcohol concentration levels. Individual person characteristics and bracelet features were not related to detection after number of drinks was included. Minimal bracelet malfunctions were noted.

Predictors of Detection of Alcohol Use Episodes Using a Transdermal Alcohol Sensor

PubMed Central

Barnett, Nancy P.; Meade, E.B.; Glynn, Tiffany R.

2014-01-01

The objective of this investigation was to establish the ability of the Secure Continuous Remote Alcohol Monitoring (SCRAM) alcohol sensor to detect different levels of self-reported alcohol consumption, and to determine whether gender and body mass index, alcohol dependence, bracelet version, and age of bracelet influenced detection of alcohol use. Method Heavy drinking adults (N = 66; 46% female) wore the SCRAM for 1–28 days and reported their alcohol use in daily web-based surveys. Participant reports of alcohol use were matched with drinking episodes identified from bracelet readings. Results On days when bracelets were functional, 690 drinking episodes were reported and 502 of those episodes (72.8%) were detected using sensor data. Using Generalized Estimating Equations, we found no gender differences in detection of reported drinking episodes (77% for women, 69% for men). In univariate analyses, at the level of fewer than five drinks, women’s episodes were more likely to be detected, likely due to the significantly higher TAC levels of these episodes, whereas at the level of five or more drinks, there was no gender difference in detection (92.6% for women, 93.4% of men’s). In multivariable analyses, no variables other than number of drinks significantly predicted alcohol detection. Conclusion The SCRAM sensor is very good at detecting five or more drinks; performance of the monitor below this level was better among women due to their higher TAC levels. Individual person characteristics and bracelet features were not related to detection after number of drinks was included. Minimal bracelet malfunctions were noted. PMID:24490713

Detection and Prevention of Android Malware Attempting to Root the Device

DTIC Science & Technology

2014-03-01

detect the operation of malware trying to root the phone. This research aims to detect the Exploid, RageAgainstTheCage, and Gingerbreak exploits on...attackers can use malware to root the system. By placing sensors inside the critical paths, the research detected all 379 malware samples trying the root...zero false positive results. Unlike static signature detection at the application level, this research provides dynamic detection at the kernel level

Assessment of groundwater, soil-gas, and soil contamination at the Vietnam Armor Training Facility, Fort Gordon, Georgia, 2009-2011

USGS Publications Warehouse

Guimaraes, Wladmir B.; Falls, W. Fred; Caldwell, Andral W.; Ratliff, W. Hagan; Wellborn, John B.; Landmeyer, James E.

2012-01-01

The U.S. Geological Survey, in cooperation with the U.S. Department of the Army Environmental and Natural Resources Management Office of the U.S. Army Signal Center and Fort Gordon, Georgia, assessed the groundwater, soil gas, and soil for contaminants at the Vietnam Armor Training Facility (VATF) at Fort Gordon, from October 2009 to September 2011. The assessment included the detection of organic compounds in the groundwater and soil gas, and inorganic compounds in the soil. In addition, organic contaminant assessment included organic compounds classified as explosives and chemical agents in selected areas. The assessment was conducted to provide environmental contamination data to the U.S. Army at Fort Gordon pursuant to requirements of the Resource Conservation and Recovery Act Part B Hazardous Waste Permit process. This report is a revision of "Assessment of soil-gas, surface-water, and soil contamination at the Vietnam Armor Training Facility, Fort Gordon, Georgia, 2009-2010," Open-File Report 2011-1200, and supersedes that report to include results of additional samples collected in July 2011. Four passive samplers were deployed in groundwater wells at the VATF in Fort Gordon. Total petroleum hydrocarbons and benzene and octane were detected above the method detection level at all four wells. The only other volatile organic compounds detected above their method detection level were undecane and pentadecane, which were detected in two of the four wells. Soil-gas samplers were deployed at 72 locations in a grid pattern across the VATF on June 3, 2010, and then later retrieved on June 9, 2010. Total petroleum hydrocarbons were detected in 71 of the 72 samplers (one sampler was destroyed in the field and not analyzed) at levels above the method detection level, and the combined mass of benzene, toluene, ethylbenzene, and total xylene (BTEX) was detected above the detection level in 31 of the 71 samplers that were analyzed. Other volatile organic compounds detected above their respective method detection levels were naphthalene, 2-methyl-naphthalene, tridecane, 1,2,4-trimethylbenzene, and perchloroethylene. After the results of the 71 soil-gas samplers were received, 31 additional passive soil-gas samplers were deployed on July 14, 2011, and retrieved on July 18, 2011. These 31 samplers were deployed on a larger areal scale to better define the extent of the contamination. Total petroleum hydrocarbons were detected above their method detection level at all 31 samplers, whereas BTEX was detected above its method detection level at 17 of the 31 samplers. Other organic compounds detected above their method detection levels were naphthalene, 2-methyl-naphthalene, octane, undecane, tridecane, pentadecane, 1,2,4-trimethylbenzene, 1,3,5-trimethylbenzene, chloroform, and perchloroethylene. Subsequent to the 2010 soil-gas survey, four areas determined to have elevated contaminant mass were selected and sampled for explosives and chemical agents. No detections of explosives or chemical agents above their respective method detection levels were found at any of the sampling locations. The same four locations that were sampled for explosives and chemical agents were selected for the collection of soil samples. A fifth location also was selected on the basis of the elevated contaminant mass of the soil-gas survey. No metals that exceeded the Regional Screening Levels for Industrial Soils, as classified by the U.S. Environmental Protection Agency, were detected at any of the five VATF locations. The soil samples also were compared to values from the ambient, uncontaminated (background) levels for soils in South Carolina, as classified by the South Carolina Department of Health and Environmental Control. Because South Carolina is adjacent to Georgia and the soils in the Coastal Plain are similar, these comparisons are valid. No similar values are available for Georgia to use for comparison purposes. The metals that were detected above the ambient background levels for South Carolina, as classified by the South Carolina Department of Health and Environmental Control, include aluminum, arsenic, barium, beryllium, calcium, chromium, copper, iron, lead, magnesium, manganese, nickel, potassium, sodium, and zinc.

40 CFR Table 1 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 7 2014-07-01 2014-07-01 false Detection Sensitivity Levels (grams per hour) 1 Table 1 to Subpart A of Part 60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Pt. 60, Subpt. A, Table 1 Table 1 to Subpart A of Part 60-Detection Sensitivity Levels (grams per...

40 CFR Table 3 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 16 2013-07-01 2013-07-01 false Detection Sensitivity Levels (grams per hour) 3 Table 3 to Subpart A of Part 65 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... 3 Table 3 to Subpart A of Part 65—Detection Sensitivity Levels (grams per hour) Monitoring Frequency...

40 CFR Table 3 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Detection Sensitivity Levels (grams per hour) 3 Table 3 to Subpart A of Part 65 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... 3 Table 3 to Subpart A of Part 65—Detection Sensitivity Levels (grams per hour) Monitoring Frequency...

40 CFR Table 3 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Detection Sensitivity Levels (grams per hour) 3 Table 3 to Subpart A of Part 65 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... 3 Table 3 to Subpart A of Part 65—Detection Sensitivity Levels (grams per hour) Monitoring Frequency...

40 CFR Table 3 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 16 2012-07-01 2012-07-01 false Detection Sensitivity Levels (grams per hour) 3 Table 3 to Subpart A of Part 65 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... 3 Table 3 to Subpart A of Part 65—Detection Sensitivity Levels (grams per hour) Monitoring Frequency...

40 CFR Table 1 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 7 2013-07-01 2013-07-01 false Detection Sensitivity Levels (grams per hour) 1 Table 1 to Subpart A of Part 60 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Pt. 60, Subpt. A, Table 1 Table 1 to Subpart A of Part 60-Detection Sensitivity Levels (grams per...

40 CFR Table 3 to Subpart A of... - Detection Sensitivity Levels (grams per hour)

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Detection Sensitivity Levels (grams per hour) 3 Table 3 to Subpart A of Part 65 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... 3 Table 3 to Subpart A of Part 65—Detection Sensitivity Levels (grams per hour) Monitoring Frequency...

Incentives for Cheating Given Imperfect Detection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Canavan, G.H.

1998-10-01

The incentives for cheating given imperfect detection can be discussed within the context of first strike stability. The cost reduction due to is balanced against the sanctions that would be imposed if cheating was detected. For small political sanctions, the optimum level is at high levels of cheating. For large sanctions, the optimum is at quite low levels, which discourages cheating.

Personality and attention: Levels of neuroticism and extraversion can predict attentional performance during a change detection task.

PubMed

Hahn, Sowon; Buttaccio, Daniel R; Hahn, Jungwon; Lee, Taehun

2015-01-01

The present study demonstrates that levels of extraversion and neuroticism can predict attentional performance during a change detection task. After completing a change detection task built on the flicker paradigm, participants were assessed for personality traits using the Revised Eysenck Personality Questionnaire (EPQ-R). Multiple regression analyses revealed that higher levels of extraversion predict increased change detection accuracies, while higher levels of neuroticism predict decreased change detection accuracies. In addition, neurotic individuals exhibited decreased sensitivity A' and increased fixation dwell times. Hierarchical regression analyses further revealed that eye movement measures mediate the relationship between neuroticism and change detection accuracies. Based on the current results, we propose that neuroticism is associated with decreased attentional control over the visual field, presumably due to decreased attentional disengagement. Extraversion can predict increased attentional performance, but the effect is smaller than the relationship between neuroticism and attention.

Modelling community dynamics based on species-level abundance models from detection/nondetection data

USGS Publications Warehouse

Yamaura, Yuichi; Royle, J. Andrew; Kuboi, Kouji; Tada, Tsuneo; Ikeno, Susumu; Makino, Shun'ichi

2011-01-01

1. In large-scale field surveys, a binary recording of each species' detection or nondetection has been increasingly adopted for its simplicity and low cost. Because of the importance of abundance in many studies, it is desirable to obtain inferences about abundance at species-, functional group-, and community-levels from such binary data. 2. We developed a novel hierarchical multi-species abundance model based on species-level detection/nondetection data. The model accounts for the existence of undetected species, and variability in abundance and detectability among species. Species-level detection/nondetection is linked to species- level abundance via a detection model that accommodates the expectation that probability of detection (at least one individuals is detected) increases with local abundance of the species. We applied this model to a 9-year dataset composed of the detection/nondetection of forest birds, at a single post-fire site (from 7 to 15 years after fire) in a montane area of central Japan. The model allocated undetected species into one of the predefined functional groups by assuming a prior distribution on individual group membership. 3. The results suggest that 15–20 species were missed in each year, and that species richness of communities and functional groups did not change with post-fire forest succession. Overall abundance of birds and abundance of functional groups tended to increase over time, although only in the winter, while decreases in detectabilities were observed in several species. 4. Synthesis and applications. Understanding and prediction of large-scale biodiversity dynamics partly hinge on how we can use data effectively. Our hierarchical model for detection/nondetection data estimates abundance in space/time at species-, functional group-, and community-levels while accounting for undetected individuals and species. It also permits comparison of multiple communities by many types of abundance-based diversity and similarity measures under imperfect detection.

Evaluation of 3M™ Molecular Detection Assay (MDA) Listeria for the Detection of Listeria species in Selected Foods and Environmental Surfaces: Collaborative Study, First Action 2014.06.

PubMed

Bird, Patrick; Flannery, Jonathan; Crowley, Erin; Agin, James; Goins, David; Monteroso, Lisa; Benesh, DeAnn

2015-01-01

The 3M™ Molecular Detection Assay (MDA) Listeria is used with the 3M Molecular Detection System for the detection of Listeria species in food, food-related, and environmental samples after enrichment. The assay utilizes loop-mediated isothermal amplification to rapidly amplify Listeria target DNA with high specificity and sensitivity, combined with bioluminescence to detect the amplification. The 3M MDA Listeria method was evaluated using an unpaired study design in a multilaboratory collaborative study and compared to the AOAC Official Method of AnalysisSM (OMA) 993.12 Listeria monocytogenes in Milk and Dairy Products reference method for the detection of Listeria species in full-fat (4% milk fat) cottage cheese (25 g test portions). A total of 15 laboratories located in the continental United States and Canada participated. Each matrix had three inoculation levels: an uninoculated control level (0 CFU/test portion), and two levels artificially contaminated with Listeria monocytogenes, a low inoculum level (0.2-2 CFU/test portion) and a high inoculum level (2-5 CFU/test portion) using nonheat-stressed cells. In total, 792 unpaired replicate portions were analyzed. Statistical analysis was conducted according to the probability of detection (POD) model. Results obtained for the low inoculum level test portions produced a difference in cross-laboratory POD value of -0.07 with a 95% confidence interval of (-0.19, 0.06). No statistically significant differences were observed in the number of positive samples detected by the 3M MDA Listeria method versus the AOAC OMA method.

75 FR 17645 - Polychlorinated Biphenyls (PCBs); Reassessment of Use Authorizations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... reassessing the definitions of ``excluded manufacturing process,'' ``quantifiable level/level of detection... reassessing the definitions of ``excluded manufacturing process,'' ``quantifiable level/level of detection... to authorize by rule the manufacturing, processing, distribution in commerce, and use of PCBs in a...

Assessment of groundwater, soil-gas, and soil contamination at the Vietnam Armor Training Facility, Fort Gordon, Georgia, 2009-2010

USGS Publications Warehouse

Guimaraes, Wladmir B.; Falls, W. Fred; Caldwell, Andral W.; Ratliff, W. Hagan; Wellborn, John B.; Landmeyer, James E.

2011-01-01

The U.S. Geological Survey, in cooperation with the U.S. Department of the Army Environmental and Natural Resources Management Office of the U.S. Army Signal Center and Fort Gordon, Georgia, assessed the groundwater, soil gas, and soil for contaminants at the Vietnam Armor Training Facility (VATF) at Fort Gordon, from October 2009 to September 2010. The assessment included the detection of organic compounds in the groundwater and soil gas, and inorganic compounds in the soil. In addition, organic contaminant assessment included organic compounds classified as explosives and chemical agents in selected areas. The assessment was conducted to provide environmental contamination data to the U.S. Army at Fort Gordon pursuant to requirements of the Resource Conservation and Recovery Act Part B Hazardous Waste Permit process. Four passive samplers were deployed in groundwater wells at the VATF in Fort Gordon. Total petroleum hydrocarbons were detected above the method detection level at all four wells. The only other volatile organic compounds detected above their method detection level were undecane and pentadecane, which were detected in two of the four wells sampled. Soil-gas samplers were deployed at 72 locations in a grid pattern across the VATF. Total petroleum hydrocarbons were detected in 71 of the 72 samplers (one sampler was destroyed in the field and not analyzed) at levels above the method detection level, and the combined mass of benzene, toluene, ethylbenzene, and total xylene was detected above the detection level in 31 of the 71 samplers that were analyzed. Other volatile organic compounds detected above their respective method detection levels were naphthalene, 2-methyl-naphthalene, tridecane, 1,2,4-trimethylbenzene, and perchloroethene. Subsequent to the soil-gas survey, four areas determined to have elevated contaminant mass were selected and sampled for explosives and chemical agents. No detections of explosives or chemical agents above their respective method detection levels were found at any of the sampling locations. The same four locations that were sampled for explosives and chemical agents were selected for the collection of soil samples. A fifth location also was selected on the basis of the elevated contaminant mass of the soil-gas survey. No metals that exceeded the Regional Screening Levels for Industrial Soils as classified by the U.S. Environmental Protection Agency were detected at any of the five VATF locations. The soil samples also were compared to values from the ambient, uncontaminated (background) levels for soils in South Carolina, as classified by the South Carolina Department of Health and Environmental Control. Because South Carolina is adjacent to Georgia and the soils in the coastal plain are similar, these comparisons are valid. No similar values are available for Georgia to use for comparison purposes. The metals that were detected above the ambient background levels for South Carolina, as classified by the South Carolina Department of Health and Environmental Control, include aluminum, arsenic, barium, beryllium, calcium, chromium, copper, iron, lead, magnesium, manganese, nickel, potassium, sodium, and zinc.

Neural correlates of binaural masking level difference in the inferior colliculus of the barn owl (Tyto alba).

PubMed

Asadollahi, Ali; Endler, Frank; Nelken, Israel; Wagner, Hermann

2010-08-01

Humans and animals are able to detect signals in noisy environments. Detection improves when the noise and the signal have different interaural phase relationships. The resulting improvement in detection threshold is called the binaural masking level difference. We investigated neural mechanisms underlying the release from masking in the inferior colliculus of barn owls in low-frequency and high-frequency neurons. A tone (signal) was presented either with the same interaural time difference as the noise (masker) or at a 180 degrees phase shift as compared with the interaural time difference of the noise. The changes in firing rates induced by the addition of a signal of increasing level while masker level was kept constant was well predicted by the relative responses to the masker and signal alone. In many cases, the response at the highest signal levels was dominated by the response to the signal alone, in spite of a significant response to the masker at low signal levels, suggesting the presence of occlusion. Detection thresholds and binaural masking level differences were widely distributed. The amount of release from masking increased with increasing masker level. Narrowly tuned neurons in the central nucleus of the inferior colliculus had detection thresholds that were lower than or similar to those of broadly tuned neurons in the external nucleus of the inferior colliculus. Broadly tuned neurons exhibited higher masking level differences than narrowband neurons. These data suggest that detection has different spectral requirements from localization.

Occurrence and distribution of selected contaminants in public drinking-water supplies in the surficial aquifer in Delaware

USGS Publications Warehouse

Ferrari, Matthew J.

2001-01-01

Water samples were collected from August through November 2000 from 30 randomly selected public drinking-water supply wells screened in the unconfined aquifer in Delaware, and analyzed to assess the occurrence and distribution of selected pesticide compounds, volatile organic compounds, major inorganic ions, and nutrients. Water from a subset of 10 wells was sampled and analyzed for radium and radon. The average age of ground water entering the well screens in all the wells was determined to be generally less than 20 years. Low concentrations of pesticide compounds and volatile organic compounds were detected throughout the State of Delaware, with several compounds often detected in each water sample. Pesticide and metabolite (pesticide degradation products) concentrations were generally less than 1 microgram per liter, and were detected in sam-ples from 27 of 30 wells. Of the 45 pesticides and 13 metabolites analyzed, 19 compounds (13 pesticides and 6 metabolites) were detected in at least 1 of the 30 samples. Desethylatrazine, alachlor ethane sulfonic acid, metolachlor ethane sulfonic acid, metolachlor, and atrazine were the most frequently detected pesticide compounds, and were present in at least half the samples. None of the pesticide detections was above the U.S. Environmental Protection Agency's Primary Maximum Contaminant Levels or Health Advisories. Volatile organic compounds also were present at low concentrations (generally less than 1 microgram per liter) in samples from all 30 wells. Of the 85 volatile organic com-pounds analyzed, 34 compounds were detected in at least 1 of the 30 samples. Chloroform, tetrachloroethene, and methyl tert-butyl ether were the most frequently detected volatile organic compounds, and were found in at least half the samples. None of the volatile organic compound detections was above U.S. Environmental Protection Agency's Primary Maximum Contaminant Levels or Health Advisories. A few samples contained compounds with concentrations above the U.S. Environmental Protection Agency's Primary Maximum Contaminant Levels or Secondary Maximum Contaminant Levels for inorganic compounds and radionuclides. One sample out of 30 contained a concentration of nitrite plus nitrate above the U.S. Environmental Protection Agency's Primary Maximum Contaminant Level of 10 milligrams per liter as nitrogen. Iron and manganese concentrations above the U.S. Environmental Protection Agency's Secondary Maximum Contaminant Levels were found in 7 of 30 ground-water samples, most of them from Sussex County. In the 10 wells sampled for radionuclides, only one sample had detectable levels of radium-224 and -226, and another sample contained detectable levels of radium-228; both of these samples also had detectable gross-alpha and gross-beta activities. None of these activities were above the U.S. Environ-mental Protection Agency's Primary Maximum Contaminant Levels or Secondary Maximum Contaminant Levels. Radon was detected in all 10 samples, but was above the current U.S. Environmental Protection Agency's proposed Primary Maximum Contaminant Level of 300 picocuries per liter in only one sample.

Automatic QRS complex detection using two-level convolutional neural network.

PubMed

Xiang, Yande; Lin, Zhitao; Meng, Jianyi

2018-01-29

The QRS complex is the most noticeable feature in the electrocardiogram (ECG) signal, therefore, its detection is critical for ECG signal analysis. The existing detection methods largely depend on hand-crafted manual features and parameters, which may introduce significant computational complexity, especially in the transform domains. In addition, fixed features and parameters are not suitable for detecting various kinds of QRS complexes under different circumstances. In this study, based on 1-D convolutional neural network (CNN), an accurate method for QRS complex detection is proposed. The CNN consists of object-level and part-level CNNs for extracting different grained ECG morphological features automatically. All the extracted morphological features are used by multi-layer perceptron (MLP) for QRS complex detection. Additionally, a simple ECG signal preprocessing technique which only contains difference operation in temporal domain is adopted. Based on the MIT-BIH arrhythmia (MIT-BIH-AR) database, the proposed detection method achieves overall sensitivity Sen = 99.77%, positive predictivity rate PPR = 99.91%, and detection error rate DER = 0.32%. In addition, the performance variation is performed according to different signal-to-noise ratio (SNR) values. An automatic QRS detection method using two-level 1-D CNN and simple signal preprocessing technique is proposed for QRS complex detection. Compared with the state-of-the-art QRS complex detection approaches, experimental results show that the proposed method acquires comparable accuracy.

Excessive Video Game Use, Sleep Deprivation, and Poor Work Performance Among U.S. Marines Treated in a Military Mental Health Clinic: A Case Series.

PubMed

Eickhoff, Erin; Yung, Kathryn; Davis, Diane L; Bishop, Frank; Klam, Warren P; Doan, Andrew P

2015-07-01

Excessive use of video games may be associated with sleep deprivation, resulting in poor job performance and atypical mood disorders. Three active duty service members in the U.S. Marine Corps were offered mental health evaluation for sleep disturbance and symptoms of blunted affect, low mood, poor concentration, inability to focus, irritability, and drowsiness. All three patients reported insomnia as their primary complaint. When asked about online video games and sleep hygiene practices, all three patients reported playing video games from 30 hours to more than 60 hours per week in addition to maintaining a 40-hour or more workweek. Our patients endorsed sacrificing sleep to maintain their video gaming schedules without insight into the subsequent sleep deprivation. During the initial interviews, they exhibited blunted affects and depressed moods, but appeared to be activated with enthusiasm and joy when discussing their video gaming with the clinical provider. Our article illustrates the importance of asking about online video gaming in patients presenting with sleep disturbances, poor work performance, and depressive symptoms. Because excessive video gaming is becoming more prevalent worldwide, military mental health providers should ask about video gaming when patients report problems with sleep. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

β oscillation during slow wave sleep and rapid eye movement sleep in the electroencephalogram of a transgenic mouse model of Huntington's disease.

PubMed

Jeantet, Yannick; Cayzac, Sebastien; Cho, Yoon H

2013-01-01

To search for early abnormalities in electroencephalogram (EEG) during sleep which may precede motor symptoms in a transgenic mouse model of hereditary neurodegenerative Huntington's disease (HD). In the R6/1 transgenic mouse model of HD, rhythmic brain activity in EEG recordings was monitored longitudinally and across vigilance states through the onset and progression of disease. Mice with chronic electrode implants were recorded monthly over wake-sleep cycles (4 hours), beginning at 9-11 weeks (presymptomatic period) through 6-7 months (symptomatic period). Recording data revealed a unique β rhythm (20-35 Hz), present only in R6/1 transgenic mice, which evolves in close parallel with the disease. In addition, there was an unusual relationship between this β oscillation and vigilance states: while nearly absent during the active waking state, the β oscillation appeared with drowsiness and during slow wave sleep (SWS) and, interestingly, strengthened rather than dissipating when the brain returned to an activated state during rapid eye movement (REM) sleep. In addition to providing a new in vivo biomarker and insight into Huntington's disease pathophysiology, this serendipitous observation opens a window onto the rarely explored neurophysiology of the cortico-basal ganglia circuit during SWS and REM sleep.

Relationship of early infant state measures to behavior over the first year of life in the tufted capuchin monkey (Cebus apella).

PubMed

Byrne, G; Suomi, S J

1998-01-01

Data on activity states were collected from 29 group-housed capuchin monkey (Cebus apella) infants for 3 h each week from birth to 11 weeks of age. The amounts of time spent in sleeping/drowsy, alert-quiet, and alert-active states were measured in these subjects. Videotaped observations of these infants were recorded 3 times/week in the home cage over the first year of life and were scored for a number of social and exploratory behaviors. The extent to which early infant activity state scores predicted later behavior in the home cage was examined. Infant state measures correlated significantly with home cage behavior during months 2-6 in that infants that had been more active in early infancy spent more time alone, with other animals, and in exploration and play and less time with mothers than did quieter infants. Early state measures were less successful in predicting home cage scores beyond 8 months of age, whereas differences in behavior attributable to housing variables became more salient in the latter part of the first year. There was also a negative correlation between mother and infant activity in months 2 and 3, in that more sedentary mothers tended to have more active infants.

Functional imaging of sleep vertex sharp transients.

PubMed

Stern, John M; Caporro, Matteo; Haneef, Zulfi; Yeh, Hsiang J; Buttinelli, Carla; Lenartowicz, Agatha; Mumford, Jeanette A; Parvizi, Josef; Poldrack, Russell A

2011-07-01

The vertex sharp transient (VST) is an electroencephalographic (EEG) discharge that is an early marker of non-REM sleep. It has been recognized since the beginning of sleep physiology research, but its source and function remain mostly unexplained. We investigated VST generation using functional MRI (fMRI). Simultaneous EEG and fMRI were recorded from seven individuals in drowsiness and light sleep. VST occurrences on EEG were modeled with fMRI using an impulse function convolved with a hemodynamic response function to identify cerebral regions correlating to the VSTs. A resulting statistical image was thresholded at Z>2.3. Two hundred VSTs were identified. Significantly increased signal was present bilaterally in medial central, lateral precentral, posterior superior temporal, and medial occipital cortex. No regions of decreased signal were present. The regions are consistent with electrophysiologic evidence from animal models and functional imaging of human sleep, but the results are specific to VSTs. The regions principally encompass the primary sensorimotor cortical regions for vision, hearing, and touch. The results depict a network comprising the presumed VST generator and its associated regions. The associated regions functional similarity for primary sensation suggests a role for VSTs in sensory experience during sleep. Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Therapeutic effects of antimotion sickness medications on the secondary symptoms of motion sickness

NASA Technical Reports Server (NTRS)

Wood, C. D.; Stewart, J. J.; Wood, M. J.; Manno, J. E.; Manno, B. R.

1990-01-01

In addition to nausea and vomiting, motion sickness involves slowing of brain waves, loss of performance, inhibition of gastric motility and the Sopite Syndrome. The therapeutic effects of antimotion sickness drugs on these reactions were evaluated. The subjects were rotated to the M-III end-point of motion sickness. Intramuscular (IM) medications were then administered. Side effects before and after rotation were reported on the Cornell Medical Index. Brain waves were recorded on a Grass Model 6 Electroencephalograph (EEG), and gastric emptying was studied after an oral dose of 1 mCi Technetium 99m DTPA in 10 oz. isotonic saline. An increase in dizziness and drowsiness was reported with placebo after rotation. This was not prevented by IM scopolamine 0.1 mg or ephedrine 25 mg. EEG recordings indicated a slowing of alpha waves with some thea and delta waves from the frontal areas after rotation. IM ephedine and dimenhydrinate counteracted the slowing while 0.3 mg scopolamine had an additive effect. Alterations of performance on the pursuit meter correlated with the brain wave changes. Gastric emptying was restored by IM metoclopramide. Ephedrine IM but not scopolamine is effective for some of the secondary effects of motion sickness after it is established.

Symptoms Experienced and Information Needs of Women Receiving Chemotherapy.

PubMed

Uysal, Neşe; Toprak, Filiz Ünal; Kutlutsürkan, Sevinç; Erenel, Ayten Şentürk

2018-01-01

This study is carried out to determine the symptoms and information necessity on chemotherapy (CT) treatment of the women with breast cancer. A total of 170 women older than 18 years old, who receive CT with breast cancer diagnosis, are volunteered to participate in the study. Mixed method was used in the study. Data are collected using Descriptive Data Form, Interview Form and Memorial Symptom Assessment Scale. As a result of the cluster analysis, four clusters and the symptoms within have been obtained. These are: pain, lack of energy, feeling drowsy, sweat, swelling of hands, and feet in the first cluster; feeling nervous, difficulty sleeping, feeling sad, worrying in the second cluster; nausea, feeling bloating, change in the way food tastes, hair loss, constipation in the third cluster; vomiting, diarrhea, problems with sexual interest, lack of appetite, dizziness, and weight loss in the forth cluster. Women's information necessity related to the CT are follows: the effects of CT, other treatment options beyond CT, complementary methods, the effect of the CT treatment on reproductive health and sexuality, nutrition, and symptom control. The results of this study will enable determination of symptom clusters, which health professionals are easier to focus on these symptoms. An understanding information need of patients can help to ensure that individual's coping strategies and self-management.

Measuring the symptom burden associated with the treatment of chronic myeloid leukemia

PubMed Central

Gonzalez, Araceli G. Garcia; Ault, Patricia; Mendoza, Tito R.; Sailors, Mary L.; Williams, Janet L.; Huang, Furong; Nazha, Aziz; Kantarjian, Hagop M.; Cleeland, Charles S.; Cortes, Jorge E.

2013-01-01

We developed a module of the MD Anderson Symptom Inventory (MDASI) for patients with chronic myeloid leukemia (CML). To develop the MDASI-CML, we identified CML-specific symptoms from qualitative interviews with 35 patients. A list of candidate symptoms was reduced by a panel of patients, caregivers, and clinicians to the 13 core MDASI symptom items and 6 CML-specific items; these items were subsequently administered to 30 patients. Cognitive debriefing confirmed that the items were clear, relevant, and easy to use. One additional CML-specific symptom item was added, for a total of 7. The refined MDASI-CML was administered to 152 patients once every 2 weeks for 1 year. The content, concurrent, known-group, and construct validity of the MDASI-CML were evaluated. The internal consistency and test-retest reliabilities of the module were adequate. Longitudinal analysis showed relatively stable symptom severity scores over time. The most severe symptoms were fatigue, drowsiness, disturbed sleep, muscle soreness and cramping, and trouble remembering things. Approximately one-third of the patients who completed the MDASI-CML reported persistent moderate-to-severe symptoms. The MDASI-CML is a valid and reliable symptom assessment instrument that can be used in clinical studies of symptom status in patients with CML. This trial was registered at www.clinicaltrials.gov as #NCT01046305. PMID:23777764

An Official American Thoracic Society Statement: The Importance of Healthy Sleep. Recommendations and Future Priorities

PubMed Central

Mukherjee, Sutapa; Patel, Sanjay R.; Kales, Stefanos N.; Ayas, Najib T.; Strohl, Kingman P.; Gozal, David; Malhotra, Atul

2015-01-01

Rationale: Despite substantial public interest, few recommendations on the promotion of good sleep health exist to educate health care providers and the general public on the importance of sleep for overall health. Objectives: The aim of this American Thoracic Society (ATS) statement is to provide a review of the current scientific literature to assist health care providers, especially pulmonologists and sleep physicians, in making recommendations to patients and the general public about the importance of achieving good quality and adequate quantity of sleep. Methods: ATS members were invited, based on their expertise in sleep medicine, and their conclusions were based on both empirical evidence identified after comprehensive literature review and clinical experience. Main Results: We focus on sleep health in both children and adults, including the impact of occupation on sleep, the public health implications of drowsy driving, and the common sleep disorders of obstructive sleep apnea and insomnia. This ATS statement also delineates gaps in research and knowledge that should be addressed and lead to new focused research priorities to advance knowledge in sleep and sleep health. Conclusions: Good quality and quantity of sleep are essential for good health and overall quality of life; therefore a strong recommendation was made for the implementation of public education programs on the importance of sleep health. PMID:26075423

Efficacy of Zolpidem for Dystonia: A Study Among Different Subtypes

PubMed Central

Miyazaki, Yoshimichi; Sako, Wataru; Asanuma, Kotaro; Izumi, Yuishin; Miki, Tetsuro; Kaji, Ryuji

2012-01-01

Although there are some newly developed options to treat dystonia, its medical treatment is not always satisfactory. Zolpidem, an imidazopyridine agonist with a high affinity on benzodiazepine subtype receptor BZ1 (ω1), was found to improve clinical symptoms of dystonia in a limited number of case reports. To investigate what subtype of dystonia is responsive to the therapy, we conducted an open label study to assess the efficacy of zolpidem (5–20 mg) in 34 patients suffering from miscellaneous types of dystonia using the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). Patients were entered into the study if they had been refractory to other medications as evaluated by BFMDRS (no change in the previous two successive visits). After zolpidem therapy, the scores in the patients as a whole were decreased from 7.2 ± 7.9 to 5.5 ± 5.0 (P = 0.042). Patients with generalized dystonia, Meige syndrome/blepharospasm, and hand dystonia improved in the scale by 27.8, 17.8, and 31.0%, respectively, whereas no improvement was found in cervical dystonia patients. Overall response rate among patients were comparable to that of trihexyphenidyl. Zolpidem may be a therapeutic option for generalized dystonia, Meige syndrome, and hand dystonia including musician’s. Drowsiness was the dose-limiting factor. PMID:22529836

Frequent sleep-related bitemporal focal seizures in transient epileptic amnesia syndrome: Evidence from ictal video-EEG.

PubMed

Burkholder, David B; Jones, Amy L; Jones, David T; Fabris, Rachel R; Britton, Jeffrey W; Lagerlund, Terrence D; So, Elson L; Cascino, Gregory D; Worrell, Gregory A; Shin, Cheolsu; St Louis, Erik K

2017-06-01

Two patients who shared similar presenting clinical features of anterograde and retrograde autobiographical amnesia typical of transient epileptic amnesia (TEA) underwent prolonged video electroencephalogram (VEEG) monitoring and were found to have sleep-activated epileptiform activity and frequent subclinical bitemporal seizures predominantly during sleep. Case 1 is a 59-year-old woman whose presenting complaint was memory impairment. Over 18 months, she had three distinct 8-h-long episodes of confusion and disorientation with persistent anterograde and retrograde autobiographical amnesia. VEEG recorded frequent interictal bitemporal sharp waves confined to sleep, and 14 subclinical seizures, also mostly during sleep. Case 2 is a 50-year-old woman with known focal epilepsy also presented with memory complaints. Over the course of 1 year, she had two discrete 2-h-long episodes of amnesia, with ongoing anterograde and retrograde autobiographical amnesia. VEEG recorded independent bitemporal sharp waves, and 14 subclinical seizures during sleep and drowsiness. Memory impairment improved in both patients with successful treatment of their seizures. Although the etiology of accelerated long-term forgetting (ALF) and remote memory impairment (RMI) in transient epileptic amnesia (TEA) is unknown, these cases suggest frequent sleep-related seizures may contribute, and they highlight the importance of video-EEG monitoring.

Bilastine and the central nervous system.

PubMed

Montoro, J; Mullol, J; Dávila, I; Ferrer, M; Sastre, J; Bartra, J; Jáuregui, I; del Cuvillo, A; Valero, A

2011-01-01

Antihistamines have been classifed as first or second generation drugs, according to their pharmacokinetic properties, chemical structure and adverse effects. The adverse effects of antihistamines upon the central nervous system (CNS) depend upon their capacity to cross the blood-brain barrier (BBB) and bind to the central H1 receptors (RH1). This in turn depends on the lipophilicity of the drug molecule, its molecular weight (MW), and affinity for P-glycoprotein (P-gp) (CNS xenobiotic substances extractor protein). First generation antihistamines show scant affinity for P-gp, unlike the second generation molecules which are regarded as P-gp substrates. Histamine in the brain is implicated in many functions (waking-sleep cycle, attention, memory and learning, and the regulation of appetite), with numerous and complex interactions with different types of receptors in different brain areas. Bilastine is a new H1 antihistamine that proves to be effective in treating allergic rhinoconjunctivitis (seasonal and perennial) and urticaria. The imaging studies made, as well as the objective psychomotor tests and subjective assessment of drowsiness, indicate the absence of bilastine action upon the CNS. This fact, and the lack of interaction with benzodiazepines and alcohol, define bilastine as a clinically promising drug with a good safety profile as regards adverse effects upon the CNS.

Transient widespread cortical and splenial lesions in acute encephalitis/encephalopathy associated with primary Epstein-Barr virus infection.

PubMed

Zhang, Shuo; Feng, Juan; Shi, Yifang

2016-01-01

Infection with Epstein-Barr virus (EBV) is very common and usually occurs in childhood or early adulthood. Encephalitis/encephalopathy is an uncommon but serious neurological complication of EBV. A case of EBV-associated encephalitis/encephalopathy with involvement of reversible widespread cortical and splenial lesions is presented herein. An 8-year-old Chinese girl who presented with fever and headache, followed by seizures and drowsiness, was admitted to the hospital. Magnetic resonance imaging revealed high signal intensities on diffusion-weighted imaging in widespread cortical and splenial lesions. The clinical and laboratory examination results together with the unusual radiology findings suggested acute encephalitis/encephalopathy due to primary EBV infection. After methylprednisolone pulse therapy together with ganciclovir, the patient made a full recovery without any brain lesions. The hallmark clinical-radiological features of this patient included severe encephalitis/encephalopathy at onset, the prompt and complete recovery, and rapidly reversible widespread involvement of the cortex and splenium. Patients with EBV encephalitis/encephalopathy who have multiple lesions, even with the widespread involvement of cortex and splenium of the corpus callosum, may have a favorable outcome with complete disappearance of all brain lesions. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Postoperative pain control after arthroscopic rotator cuff repair.

PubMed

Uquillas, Carlos A; Capogna, Brian M; Rossy, William H; Mahure, Siddharth A; Rokito, Andrew S

2016-07-01

Arthroscopic rotator cuff repair (ARCR) can provide excellent clinical results for patients who fail to respond to conservative management of symptomatic rotator cuff tears. ARCR, however, can be associated with severe postoperative pain and discomfort that requires adequate analgesia. As ARCR continues to shift toward being performed as an outpatient procedure, it is incumbent on physicians and ambulatory surgical centers to provide appropriate pain relief with minimal side effects to ensure rapid recovery and safe discharge. Although intravenous and oral opioids are the cornerstone of pain management after orthopedic procedures, they are associated with drowsiness, nausea, vomiting, and increased length of hospital stay. As health care reimbursements continue to become more intimately focused on quality, patient satisfaction, and minimizing of complications, the need for adequate pain control with minimal complications will continue to be a principal focus for providers and institutions alike. We present a review of alternative modalities for pain relief after ARCR, including cryotherapy, intralesional anesthesia, nerve blockade, indwelling continuous nerve block catheters, and multimodal anesthesia. In choosing among these modalities, physicians should consider patient- and system-based factors to allow the efficient delivery of analgesia that optimizes recovery and improves patient satisfaction. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Critical appraisal of bilastine for the treatment of allergic rhinoconjunctivitis and urticaria.

PubMed

Sadaba, Belen; Azanza, Jose Ramon; Gomez-Guiu, Almundena; Rodil, Raquel

2013-01-01

Bilastine is a second generation antihistamine indicated for the treatment of seasonal or perennial allergic rhinoconjunctivitis and chronic urticaria with a daily dose of 20 mg, in adults and children over 12 years of age. The efficacy of bilastine has been shown to be similar to that of the comparator drugs for the control of the nasal and nonnasal symptoms of allergic rhinoconjunctivitis, while also showing a subjective improvement in the quality of life and in overall clinical impression. For chronic urticaria the symptoms (itching and the development of papules) lessens from the second day of treatment onwards, in a similar way to other antihistamines used as comparators. Bilastine should not be administered at meal times to avoid interference with the absorption process. It is not distributed to the central nervous system, is scarcely metabolized, and elimination is through the kidneys and feces, with a 14-hour elimination half-life. It has no effect on cytochrome P450. During clinical development, bilastine was shown to be a drug that is adequately tolerated, with a similar effect to placebo with regard to drowsiness and changes in heart rate. In relation to its use, headaches were the most frequent adverse effect to be reported. No cardiotoxic effects have been observed, and the therapeutic dose does not alter the state of alertness.

Cannabinoids for nausea and vomiting related to chemotherapy: Overview of systematic reviews.

PubMed

Schussel, Victor; Kenzo, Lucas; Santos, Andreia; Bueno, Júlia; Yoshimura, Ellen; de Oliveira Cruz Latorraca, Carolina; Pachito, Daniela Vianna; Riera, Rachel

2018-04-01

Nausea and vomiting are common and distressing adverse events of chemotherapy. This review focuses on the findings and quality of systematic reviews (SRs) of cannabinoids for chemotherapy-induced nausea and vomiting (CINV). Review of SRs, a systematic literature search, was conducted in several electronic databases and included SRs evaluating cannabinoids for CINV in cancer patients. Methodological quality and quality of reporting were evaluated by AMSTAR and PRISMA, respectively. Initial search retrieved 2,206 records, and 5 SRs were included. On the basis of findings of the sole SR judged as high methodological quality, cannabinoids seem to be more effective than placebo, equal to prochlorperazine for reducing CINV, and to be preferred by patients. The response to different combinations of antiemetic agents seems to be equal to 1 antiemetic alone. The average of AMSTAR score was 5, and the average of PRISMA score was 13.2. Cannabinoids represent a valuable option for treating CINV, despite the adverse events related to treatment, such as drowsiness and cognitive impairment. There is no good quality evidence to recommend or not the use of cannabinoids for CINV. More studies are still needed to evaluate the effectiveness of cannabinoids when compared with modern antiemetics. Copyright © 2017 John Wiley & Sons, Ltd.

Management of an oral ingestion of transdermal fentanyl patches: a case report and literature review.

PubMed

Faust, Andrew C; Terpolilli, Ralph; Hughes, Darrel W

2011-01-01

Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Summary. A 32-year-old man was brought to the emergency department (ED) via emergency medical services for toxic ingestion and suicide attempt. The patient chewed and ingested two illegally purchased transdermal fentanyl patches. In the ED, the patient was obtunded, dizzy and drowsy. Initial vital signs showed the patient to be afebrile and normotensive with a heart rate of 63, respiratory rate of 16, and oxygen saturation of 100% on 2 liters nasal cannula after administration of 2 milligrams of intravenous naloxone. The patient was treated with whole bowel irrigation and continuous intravenous naloxone infusion for approximately 48 hours without complications. Conclusion. Despite numerous case reports describing oral ingestion of fentanyl patches, information on the management of such intoxication is lacking. We report successful management of such a case utilizing whole bowel irrigation along with intravenous push and continuous infusion naloxone.

Management of an Oral Ingestion of Transdermal Fentanyl Patches: A Case Report and Literature Review

PubMed Central

Faust, Andrew C.; Terpolilli, Ralph; Hughes, Darrel W.

2011-01-01

Purpose. Fentanyl is available as a transdermal system for the treatment of chronic pain in opioid-tolerant patients; however, it carries a black box warning due to both the potency of the product and the potential for abuse. In this report, we describe a case of transbuccal and gastrointestinal ingestion of fentanyl patches and the management of such ingestion. Summary. A 32-year-old man was brought to the emergency department (ED) via emergency medical services for toxic ingestion and suicide attempt. The patient chewed and ingested two illegally purchased transdermal fentanyl patches. In the ED, the patient was obtunded, dizzy and drowsy. Initial vital signs showed the patient to be afebrile and normotensive with a heart rate of 63, respiratory rate of 16, and oxygen saturation of 100% on 2 liters nasal cannula after administration of 2 milligrams of intravenous naloxone. The patient was treated with whole bowel irrigation and continuous intravenous naloxone infusion for approximately 48 hours without complications. Conclusion. Despite numerous case reports describing oral ingestion of fentanyl patches, information on the management of such intoxication is lacking. We report successful management of such a case utilizing whole bowel irrigation along with intravenous push and continuous infusion naloxone. PMID:21629807

Effect of working hours on cardiovascular-autonomic nervous functions in engineers in an electronics manufacturing company.

PubMed

Sasaki, T; Iwasaki, K; Oka, T; Hisanaga, N; Ueda, T; Takada, Y; Fujiki, Y

1999-01-01

A field survey of 147 engineers (23-49 years) in an electronics manufacturing company was conducted to investigate the effect of working hours on cardiovascular-autonomic nervous functions (urinary catecholamines, heart rate variability and blood pressure). The subjects were divided into 3 groups by age: 23-29 (n = 49), 30-39 (n = 74) and 40-49 (n = 24) year groups. Subjects in each age group were further divided into shorter (SWH) and longer (LWH) working hour subgroups according to the median of weekly working hours. In the 30-39 year group, urinary noradrenaline in the afternoon for LWH was significantly lower than that for SWH and a similar tendency was found in the LF/HF ratio of heart rate variability at rest. Because these two autonomic nervous indices are related to sympathetic nervous activity, the findings suggested that sympathetic nervous activity for LWH was lower than that for SWH in the 30-39 year group. Furthermore, there were significant relationships both between long working hours and short sleeping hours, and between short sleeping hours and high complaint rates of "drowsiness and dullness" in the morning in this age group. Summarizing these results, it appeared that long working hours might lower sympathetic nervous activity due to chronic sleep deprivation.

Two novel compound heterozygous mutations in the BCKDHB gene that cause the intermittent form of maple syrup urine disease.

PubMed

Guo, Yi; Liming, Liu; Jiang, Li

2015-12-01

Intermittent maple syrup urine disease (MSUD) is a potentially life-threatening metabolic disorder caused by a deficiency of branched chain α-ketoacid dehydrogenase (BCKD) complex. In contrast to classic MSUD, children with the intermittent form usually have an atypical clinical manifestation. Here, we describe the presenting symptoms and clinical course of a Chinese boy with intermittent MSUD. Mutation analysis identified two previously unreported mutations in exon 7 of the BCKDHB gene: c.767A > G (p.Y256C) and c.768C > G (p.Y256X); the parents were each heterozygous for one of these mutations. In silico analysis predicted Y256C probably affects protein structure; Y256X leads to a premature stop codon. This case demonstrates intermittent MSUD should be suspected in cases with symptoms of recurrent encephalopathy, especially ataxia or marked drowsiness, which usually present after the neonatal period and in conjunction with infection. symmetrical basal ganglia damage but normal myelination in the posterior limb will assist differential diagnosis; alloisoleucine is a useful diagnostic marker and mutation analysis may be of prognostic value. These novel mutations Y256C and Y256X result in the clinical manifestation of a variant form of MSUD, expanding the mutation spectrum of this disease.

A randomised trial of the effect of the glycine reuptake inhibitor Org 25935 on cognitive performance in healthy male volunteers.

PubMed

Christmas, David; Diaper, Alison; Wilson, Sue; Rich, Ann; Phillips, Suzanne; Udo de Haes, Joanna; Sjogren, Magnus; Nutt, David

2014-03-01

Cognitive impairment is integral to many neurological illnesses. Specific enhancement of glutamatergic transmission may improve memory and learning. Org 25935 increases the synaptic availability of glycine, an obligate co-agonist with glutamate at N-methyl-D-aspartate receptors. We hypothesised that Org 25935 would acutely improve the learning and memory of healthy volunteers. A randomised, double-blind, parallel-group, single-dose study of Org 25935 and placebo was carried out. Thirty-two healthy male volunteers took either 12-mg Org 25935 or matching placebo and were later assessed with the manikin task, digit span and verbal memory tests. Systematic assessments of cardiovascular and adverse events were also taken. There was no effect of Org 25935 on reaction time, number of correct responses or learning (greater or slower improvement over successive tasks) compared with placebo. Org 25935 caused significantly more dizziness and drowsiness compared with placebo; these side effects were mainly mild. A single dose of Org 25935 does not improve learning or memory in healthy male individuals. However, the drug was well tolerated, and it remains to be seen whether it would have a positive effect on cognition in patient groups with pre-existing cognitive deficits.

E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis

PubMed Central

Gomez, Juliana B.; Maque, Yvan; Moquillaza, Manuel A.; Anicama, William E.

2013-01-01

Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell's palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β-lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis. PMID:24324900

E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis.

PubMed

Gomez, Juliana B; Maque, Yvan; Moquillaza, Manuel A; Anicama, William E

2013-01-01

Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell's palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β -lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

Outpatient Palliative Cardiology Service Embedded Within a Heart Failure Clinic: Experiences With an Emerging Model of Care.

PubMed

Gandesbery, Benjamin; Dobbie, Krista; Gorodeski, Eiran Z

2018-04-01

The role of palliative care consultation in the outpatient treatment of patients with symptomatic heart failure (HF) is poorly studied. In August 2015, we created an outpatient palliative care service embedded within the HF clinic at Cleveland Clinic main campus. To characterize patients cared for by our novel outpatient palliative cardiology service, including their degree of HF, symptoms, comorbidities, topics addressed in clinic, palliative treatments prescribed, advanced directives status, and mortality. We conducted a retrospective chart review of all patients evaluated by this outpatient service. Eighty patients were seen in 229 outpatient encounters. The most commonly reported symptoms were tiredness (74%), pain (64%), dyspnea (57%), drowsiness (45%), anxiety (45%), and depression (43%). The most frequently addressed issues were pain management (55%) and advanced care planning (54%). The most common palliative medications prescribed in palliative care clinic were opiates (48%), laxatives (22%), antineuropathics (22%), and antidepressants (16%). The 1-year survival rate was 70% (CI 65-75%). Embedding palliative medicine services in an HF outpatient clinic is feasible. Patients seen in this setting had an array of quality-of-life limiting symptoms and were medically managed with several interventions familiar to palliative medicine specialists. Outpatients with chronic HF have a significant symptom burden and may benefit from outpatient specialist palliative care.

Cell phone users, reported crash risk, unsafe driving behaviors and dispositions: a survey of motorists in Maryland.

PubMed

Beck, Kenneth H; Yan, Fang; Wang, Min Qi

2007-01-01

The purpose of this investigation was to identify risky driving behaviors and dispositions that distinguish drivers who use a cell phone while operating a motor vehicle from non-cell phone using drivers. Annual telephone surveys were used to identify drivers who reported using a cell phone while driving in the last month (n=1803) and were compared to those who said they did not use cell phones while driving (n=1578). Cell phone using drivers were more likely to report driving while drowsy, going 20 mph over the speed limit, driving aggressively, running a stop sign or red light, and driving after having had several drinks. They were also more likely to have had a prior history of citation and crash involvement than non-cell phone using drivers. Cell phone using drivers also reported they were less careful and more in a hurry when they drive than non-cell phone using drivers. Cell phone using drivers report engaging in many behaviors that place them at risk for a traffic crash, independent of the specific driving impairments that cell phone usage may produce. Strategies that combine coordinated and sustained enforcement activities along with widespread public awareness campaigns hold promise as effective countermeasures for these drivers, who resemble aggressive drivers in many respects.

Further clinical evidence for the existence of neurotoxicity in a population of the European adder (Vipera berus berus) in eastern Hungary: second authenticated case.

PubMed

Malina, Tamás; Babocsay, Gergely; Krecsák, László; Erdész, Csaba

2013-12-01

We report a recent case of common adder (Vipera berus) envenoming causing paralytic signs and symptoms. A 12-year-old girl was bitten by the nominate subspecies of the common adder (V. berus berus) in eastern Hungary on May 2, 2012, 22 km away from where the first neurotoxic V. berus berus envenoming was reported in 2008. The patient developed unambiguous cranial nerve disturbances, manifested in bilateral impairment characterized by oculomotor paralysis with partial ptosis, gaze paresis, and diplopia. Drowsiness and photophobia were her additional symptoms; both occurred only during the first day of envenoming. Until now among viper envenomings in Europe, photophobia has only been documented by victims of Vipera aspis. Supportive and symptomatic treatments were administered during 3 days of hospitalization. Although case reports of V. berus berus envenomings are often published, clinical experience with neurotoxicity by this subspecies still remains rare. Population-based and geographic variation of venom composition in V. berus berus seems to include neurotoxic envenomings in certain populations. This second authenticated case provides new clinical evidence for the existence of a possible neurotoxic V. berus berus population in a restricted geographical area in eastern Hungary. Wilderness Medical Society.