Sleep History Research Articles

ReeBundle: A Method for Topological Modeling of White Matter Pathways Using Diffusion MRI.

Tractography can generate millions of complex curvilinear fibers (streamlines) in 3D that exhibit the geometry of white matter pathways in the brain. Common approaches to analyzing white matter connectivity are based on adjacency matrices that quantify connection strength but do not account for any topological information. A critical element in neurological and developmental disorders is the topological deterioration and irregularities in streamlines. In this paper, we propose a novel Reeb graph-based method "ReeBundle" that efficiently encodes the topology and geometry of white matter fibers. Given the trajectories of neuronal fiber pathways (neuroanatomical bundle), we re-bundle the streamlines by modeling their spatial evolution to capture geometrically significant events (akin to a fingerprint). ReeBundle parameters control the granularity of the model and handle the presence of improbable streamlines commonly produced by tractography. Further, we propose a new Reeb graph-based distance metric that quantifies topological differences for automated quality control and bundle comparison. We show the practical usage of our method using two datasets: (1) For International Society for Magnetic Resonance in Medicine (ISMRM) dataset, ReeBundle handles the morphology of the white matter tract configurations due to branching and local ambiguities in complicated bundle tracts like anterior and posterior commissures; (2) For the longitudinal repeated measures in the Cognitive Resilience and Sleep History (CRASH) dataset, repeated scans of a given subject acquired weeks apart lead to provably similar Reeb graphs that differ significantly from other subjects, thus highlighting ReeBundle's potential for clinical fingerprinting of brain regions.

Cognitive and sleep evaluation of Myotonic dystrophy type I: A protocol for a case‐control study

AbstractBackgroundMyotonic dystrophy type 1 (DM1) is one of the most common inherited muscular dystrophies in adults. It is caused by CTG repeat expansions in the 3' untranslated region (UTR) of the DMPK gene on Chromosome 19. Apart from muscle, the disease can involve the eye, heart, brain and endocrine system. Cognitive and sleep disturbances are common but poorly recognized non‐motor manifestations of DM1.MethodWe plan to recruit 30 genetically proven DM1 patients from the prospective MRC‐funded International Centre for Genomic Medicine in Neuromuscular Diseases (ICGNMD) cohort. Neuromuscular phenotyping will be done by the same neuromuscular expert. The muscle strength will be assessed by the Medical Research Council scale and Muscular Impairment Rating Scale (MIRS). We will exclude patients with severe depression. An age and sex‐matched control group of 30 healthy participants will be included to evaluate patients’ cognitive profiles. A comprehensive neuropsychological evaluation (NPS) to assess multiple cognitive domains will be conducted on all patients. A prescheduled sleep history, Epworth Sleepiness Scale (ESS), Pittsburg sleep quality index (PSQI) and full‐night diagnostic polysomnography will be done in all patients.ResultThe outcomes include the NPS domains comparing cognitive impairment compared to controls and the severity and type of sleep apnea (apnea‐hypopnea index [AHI])ConclusionThe study will investigate the DM1 cognitive profile and its relationship with sleep disturbance using motor scales, neuropsychological assessment and polysomnography.

The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023.

Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).

Dietary amino acid intake and sleep duration are additively involved in future cognitive decline in Japanese adults aged 60 years or over: a community-based longitudinal study

BackgroundSleep duration and amino acid intake are independently associated with cognitive decline. This study aimed to determine the longitudinal association between sleep duration and cognitive impairment incidence and to examine the involvement of diet, particularly amino acid intake, in these associations in community dwellers.MethodsIn this longitudinal study in a community-based setting, we analyzed data from 623 adults aged 60–83 years without cognitive impairment at baseline. Sleep duration was assessed using a self-report questionnaire. Amino acid intake was assessed using 3-day dietary records. Cognitive impairment was defined as a Mini-Mental State Examination score ≤ 27. Participants were classified into short-, moderate-, and long-sleep groups according to baseline sleep duration (≤ 6, 7–8, and > 8 h, respectively). Using moderate sleep as a reference, odds ratios (ORs) and 95% confidence intervals (CIs) of short- and long-sleep for cognitive-impairment incidence were estimated using the generalized estimating equation. Participants were classified according to sex-stratified quartiles (Q) of 19 amino acid intake: Q1 and Q2–Q4 were low- and middle to high-intake groups, respectively. Using middle- to high-intake as a reference, ORs and 95% CIs of low intake for cognitive impairment incidence were estimated using the generalized estimating equation in each sleep-duration group. Follow-up period, sex, age, body mass index, depressive symptoms, education, smoking status, employment status, sleep aids use, physical activity, medical history, and Mini-Mental State Examination score at baseline were covariates.ResultsMean follow-up period was 6.9 ± 2.1 years. Adjusted ORs (95% CIs) for cognitive impairment in short- and long-sleep groups were 0.81 (0.49–1.35, P = 0.423) and 1.41 (1.05–1.87, P = 0.020), respectively. Particularly in long sleepers (i.e., > 8 h), cognitive impairment was significantly associated with low cystine, proline, and serine intake [adjusted ORs (95% CIs) for cognitive impairment were 2.17 (1.15–4.11, P = 0.017), 1.86 (1.07–3.23, P = 0.027), and 2.21 (1.14–4.29, P = 0.019), respectively].ConclusionsCommunity-dwelling adults aged ≥ 60 years who sleep longer are more likely to have cognitive decline, and attention should be paid to the low cystine, proline, and serine intake.

A - 113 Strengths-Based Neuropsychology in Neurological Surgery: a Neuropsychiatric Case Study of Treatment Refractory Right-Sided Focal Seizures.

Psychiatric comorbidity is high among patients with epilepsy, found more frequently with right-sided seizure foci. Neurosurgical intervention is often the standard of care for refractory epilepsy; unfortunately, psychiatric symptoms can impact a patient's compliance and participation in the pre-surgical process. This pre-surgical epilepsy case illustrates the importance of neuropsychological evaluation in clarifying the relationship between cognitive functioning and long-standing psychiatric comorbidities to inform surgical candidacy. A 20-year-old, left-handed, bilingual Caucasian female with seven years of education with cortical dysplasia associated with intractable right-hemisphere localization-related epilepsy underwent neuropsychological evaluation for progressive short-term memory and word-finding difficulty as part of a pre-surgical workup. A clinical interview, neuropsychological testing, and comprehensive review of available electronic medical records (EMR) were completed. Neuropsychological estimates of current intellectual functioning were low average but variable, revealing a relative strength in non-verbal learning and memory compared to verbal abilities. Self-report emotional measures evidenced clinically elevated levels of anxiety and depression and reduced quality of life due to epilepsy. Psychiatric diagnoses included attention-deficit/hyperactivity disorder, obsessive-compulsive disorder, oppositional defiant disorder, and panic attacks. EMR and clinical interview indicated medication non-compliance, alcohol intoxication, dysregulated sleep hygiene, seizure-related injuries, and history of status epilepticus. Consistent with the literature, this pre-surgical case demonstrated significant psychiatric symptoms in the context of right-sided treatment refractory epilepsy. While psychiatric comorbidities contributed to non-adherence with medical recommendations, under-functioning in vocational goals, and general hopelessness, the neuropsychological evaluation revealed strengths that impacted surgical candidacy and rapport-building that facilitated patient engagement and understanding of the surgical process.

B - 48 Heal-Thy Brain: the Intersectionality of Race, Sleep, and Socioeconomic Factors in ADHD.

This Paper is an examination of the history of sleep, sleep disorders, and socioeconomic factors as it relates to children and adolescents with Attention-Deficit/Hyperactivity Disorder. Previous research has revealed that many neurodivergent children struggle to obtain an adequate amount of sleep, which can negatively impact their daily lives. While discussing neurodivergence and sleep, there has also been a correlation to racial disparities regarding children of color having more "sleep debt" and sleep disturbances than others. As a consequence of these constraints, attempts to diagnose and treat ADHD have been severely underrepresented. Google Scholar and JSTOR databases from 2015 to 2023 were searched for studies. The samples reviewed included youth of various races, including Black, White, and Hispanic. Socioeconomic statuses within the samples also ranged in income between $50,000 and $100,000. Children with ADHD and multiple sleep problems have been shown to have more caregiver deficits and poorer quality of life, family functioning, and school attendance than children without a sleep problem (Sung et al., 2008). Teachers also reported more symptoms in Black youths, despite underreporting by parents. Lastly, a child in a low SES family being on average 2.21 times more likely to have ADHD than their high SES peers (Russell et al., 2015). Overall, examining the intersectionality of ADHD can provide clinicians and physicians with useful information at the time of diagnosis and will facilitate campaigns to better help neurodivergent oppressed populations.

Association Between Poor Sleep and Myocardial Infarction in Patients with Psoriasis: Findings from a Cross-Sectional Study with the National Psoriasis Foundation.

Poor sleep quality occurs in patients with psoriasis at rates nearly twice that of the general population. Chronic sleep impairment is an independent risk factor for the development of cardiovascular disease. Here, we examine the association between sleep quantity and history of myocardial infarction in patients with psoriasis. This observational, cross-sectional study utilized data from the 2020 National Psoriasis Foundation Annual Survey. Effect estimates were obtained using a multivariate logistic regression model, which controlled for prespecified covariates. Based on data from 1405 individuals with psoriasis, our analysis demonstrated a significant association between sleep quantity and history of myocardial infarction: odds ratio (OR) 0.67 [95% confidence interval (CI) 0.49-0.92], p = 0.012. The association was not significantlyinfluencedby psoriasis severity(OR 1.01, [95% CI 0.99-1.03], p = 0.38), comorbid psoriatic arthritis(OR 1.06, [95% CI 0.48-2.38], p = 0.88), sleep apnea, or other traditional risk factors for myocardial infarction. Our analyses indicate an association between sleep quantity and history of myocardial infarction in patients with psoriasis. For each hour increase in average nightly sleep, patients with psoriasis have a 33% decrease in the odds of having a history of myocardial infarction. The chief limitation of this study is its cross-sectional design limiting ascertainment of causality.

Salivary Biomarker Levels in Children with Sleep Problems Before and After Twin Block Therapy.

Disturbances in sleep have a wide-ranging effect on a child's life profoundly impacting the standard of living. The aim of this study was to investigate levels of Salivary Tumor Necrosis Factor-Alpha (TNF-α) and Malondialdehyde (MDA) in a group of children with class II malocclusion and sleep problems before and after twin block appliance therapy. Eleven children aged 8-12 years with skeletal class II malocclusion and at least one sleep disorder participated in the study. All children were subjected to a recording of their sleep history and a clinical and radiographic examination. Pre-treatment levels of salivary TNF-α and MDA were recorded. A twin block appliance was custom made and delivered to every child. After a minimum follow-up period of 9 months, all children were recalled for a re-evaluation of salivary biomarker levels. Levels of salivary biomarkers TNF-α and MDA significantly decreased in children following myofunctional therapy using a twin block appliance. The measurement of TNF-α and MDA could be used as an alternative and noninvasive method to evaluate prognosis of twin block therapy for children with sleep-disordered breathing (SDB).

Prevalence of anxiety disorders and its associated factors among adolescents in Arpookara Panchayat

Background: Adolescents (10 -19 years) constitute 1.3 billion in the world today. According to WHO mental health issues constitute 13% of the global burden of disease in adolescents of which anxiety disorders are the most common. Objective was to estimate the prevalence of anxiety disorders among adolescents using SCARED tool, to find the association of selected factors with anxiety disorders. Methods: A cross sectional study was conducted among 590 adolescents in Arpookara Panchayat. A semi-structured pretested questionnaire was used for collecting sociodemographic details. Anxiety disorder was assessed using Screen for Child Anxiety Related Emotional Disorder (SCARED) tool. Data was coded and entered in Microsoft excel and analysed using IBM SPSS software version 20 Results: The mean age of the study participants was 15.04 with SD ±3.013. Prevalence of anxiety disorders using SCARED tool was found to be 21.4%. Factors found to have statistically significant association with anxiety on univariate analysis were female gender (p=0.001), mother’s education more than high school level (p=0.036), time spent with father (p=0.001), time spent with mother(p=0.001), inadequate sleep (p=0.001) and family history of mental illness(p=0.043). On binary logistic regression following factors with p<0.05 were found to be independent predictors of anxiety-female gender (OR=2.037), mother’s education more than high school level (OR=1.469) adequate time spent with father (OR=0.713), inadequate sleep (OR=14.726), family history of mental illness (OR=3.521) Conclusions: More than one fifth of adolescents are having anxiety disorders. There should be efforts for early diagnosis and prompt treatment of anxiety disorders among adolescents.

The insensitivity of sleep to an unfamiliar sleeping environment in patients with insomnia disorder.

Sleeping in an unfamiliar environment, such as a sleep laboratory, is thought to disturb sleep in healthy individuals and could express a hyperarousal state called the first night effect. Insomnia disorder (ID) is a highly prevalent health problem characterized by increased arousal during the night and daytime. Whether or nota similar phenomenon occurs in patients with ID is unclear. This study aimed to investigate the effect of an unfamiliar environment on the sleep of patients with ID. In an unfamiliar sleep laboratory, polysomnographic recording testing was performed for two consecutive nights in patients with ID and age- and sex-matched healthy controlsubjects (HC). We collected sleep diaries and questionnaires regarding sleep, medical conditions, psychological status, and health history. Sleep continuity and architecture in both groups were compared and analyzed for two consecutive nights. Participants with ID(n = 39) and HC(n = 35) demonstrated differentially poor sleep on laboratory adaptation after exposure to the sleep laboratory. Patients with ID had longer rapid eye movement (REM) latency on the first night than on the second sleep night. HC showed increased duration and percentage of N1, decreased duration and percentage of N3, and decreased REM percentage during initial nights compared to subsequent nights. The other sleep variables showed no differences between the first and second sleep nights in patients with ID and HC. An unfamiliar sleep environment does not aggravate the disruption of sleep continuity and sleep architecture but only affects the REM latency in patients with ID compared with HC.

Erasmus and Sleep: A Case Study for the History of Sleep in the Early Modern Period

Erasmus and Sleep: A Case Study for the History of Sleep in the Early Modern Period

Yield of Postmortem Skeletal Surveys in Infants Presenting to Emergency Care With Sudden and Unexpected Death.

Child abuse should be considered in cases of sudden unexpected infant death (SUID). Postmortem skeletal surveys (PM-SS) are recommended to evaluate for abusive fractures in SUID. Little is known about the yield of PM-SS among infants presenting to emergency care with SUID. Our objectives were to (1) describe the presentation and care of infants with SUID at a tertiary children's hospital emergency department and (2) report PM-SS use and findings. We performed a retrospective study of infants younger than 12 months with SUID presenting to an urban emergency department from 2007 to 2019. We describe their presentation and care, including PM-SS performance and findings, referrals to the medical examiner, and reports to child protective services (CPS). We assessed for associations between race, payer, and presentation with reports to CPS. Of 73 infants with SUID, concern for unsafe sleep was documented in 45 (61.6%) and 71 (97.3%) underwent cardiopulmonary resuscitation by a medical professional. All 73 (100%) underwent PM-SS and were referred to the medical examiner. Twelve definite fractures (11 rib, 1 classic metaphyseal lesion) and 8 possible fractures (7 rib, 1 classic metaphyseal lesion) were identified among 6 (8.2%) infants. Forty-three (58.9%) were reported to CPS. There were no associations between race, payer, age, or history of unsafe sleep and CPS reports. One in 12 cases of SUID had a possible and/or definite fracture identified on plain radiography. Multicenter studies are needed to compare yield across different postmortem imaging modalities and populations.

Central Disorders of Hypersomnolence.

The goals of this article are to describe the clinical approach to and management of patients with central disorders of hypersomnolence, and to understand and differentiate available diagnostic tools. Updated clinical practice guidelines for the treatment of central disorders of hypersomnolence and narcolepsy specifically highlight new treatment options. Approval for a lower-sodium oxybate formulation that contains 92% less sodium than the standard sodium oxybate for the treatment of narcolepsy and idiopathic hypersomnia adds to the number of medications available for these disorders, allowing for a more tailored management of symptoms. Central disorders of hypersomnolence are characterized by excessive daytime sleepiness that impacts daily functions. These disorders can be differentiated by obtaining a detailed clinical sleep history and by a thoughtful interpretation of sleep diagnostic testing. Tailoring treatment approaches to meet the needs of individuals and accounting for medical and psychiatric comorbidities may improve quality of life.

Clinical Evaluation of the Sleepy and Sleepless Patient.

This article addresses the approach to the evaluation of patients who present to a neurologist with excessive daytime sleepiness or difficulty sleeping. Greater emphasis on the importance of sleep reflects the growing scientific understanding that sleep is critical to overall health and well-being. Consumer sleep technologies, which measure parameters related to sleep, may provide insight into an individual's sleep-related symptoms and tendencies and have a role in patient-centered sleep evaluation when used within an appropriate clinical context. A thorough review of a patient's history and physical examination findings are important components of the assessment and management of their sleep-related symptoms. An understanding of how the clinical context relates to the categorization of sleep disorders can impact a patient's symptoms, comorbid neurologic disorders, and overall well-being. Many neurologic conditions are strongly associated with sleep disturbance, risk factors for the development of a sleep disorder, or both. Therefore, it is critical for neurologists to be familiar and comfortable with taking a focused sleep history. Modalities such as in-laboratory polysomnography, home sleep apnea testing, multiple sleep latency testing, and actigraphy, as well as contextualized and prudent use of data obtained from consumer sleep technologies, can be helpful in appropriately selected patients. Mindful integration of these objective data facilitates the diagnosis and management of sleep disorders.

Establishment of a nomogram for predicting functional constipation among children in China: Using the Rome IV criteria

Background and study aimsChildhood functional constipation (FC) is gradually becoming an emerging public health problem. This study aimed to develop a personalized nomogram for the prediction of incident FC among Chinese children, and the diagnosis of FC was based on the Rome IV criteria. Patients and methodsThis cross-sectional study was conducted from Nov. 2020 to Jan. 2021 among children residing in Anhui province, China. An electronic questionnaire regarding the general demographic and clinical characteristics of all children was completed by their primary caregivers. The multivariate logistic regression analysis was applied to identify risk factors for FC. Moreover, a nomogram was constructed for FC based on the risk factors identified from the multivariate analysis. ResultsIn this study, a total of 901 electronic questionnaires were collected, of which 832 (92.3%) questionnaires were properly completed and included in the final analysis. The prevalence of FC among Chinese children was 11.3% based on the Rome IV criteria. After controlling for potential confounding factors, the multivariate logistic regression analysis showed that inadequate sleep, picky eating, and positive family history of FC were identified as key risk factors of FC. The area under the receiver operating characteristic curve of the nomogram was 0.694 (95 %CI: 0.6412–0.7459). Further, a calibration curve drawn illustrated that the predicted probabilities reasonably approximately the actual prevalence of FC in this population. ConclusionInadequate sleep, picky eating, and positive family history of FC were identified as risk factors of FC. An easy-to-use nomogram was constructed based on these three significant factors. Besides, this nomogram was validated to have acceptable discrimination and calibration capabilities. Hence, this nomogram may enable clinical professionals to predict the risk of FC among Chinese children and further provide optimized disease prevention and intervention for this population.

Huntington's and the History of Sleep.

Huntington's and the History of Sleep.

Normative Values forPupillary Light Reflex Metrics Among Healthy Service Academy Cadets.

Assessments of the pupil's response to light have long been an integral part of neurologic examinations. More recently, the pupillary light reflex (PLR) has shown promise as a potential biomarker for the diagnosis of mild traumatic brain injury. However, to date, few large-scale normative data are available for comparison and reference, particularly, in military service members. The purpose of this study was to report normative values for eight PLR measurements among healthy service academy cadets based on sex, age, sleep, race, ethnicity, anisocoria, and concussion history. Freshmen entering a U.S. Service Academy completed a quantitative pupillometric assessment in conjunction with baseline concussion testing. PLR measurements were conducted using a Neuroptics PLR-3000 with a 121µW light stimulus. The device measured maximum and minimum pupil diameter (mm), latency (time to maximum pupil constriction post-light stimulus [s]), peak and average constriction velocity (mm/s), average dilation velocity (mm/s), percentage pupil constriction, and T75 (time for pupil re-dilation from minimum pupil diameter to 75% maximum diameter [s]). During baseline testing, cadets also reported concussion history (yes and no) and hours slept the night before (<5.5 and ≥5.5). Normative values for each PLR measurement were calculated as mean ± SD, percentiles, and interquartile range. Mann-Whitney U tests were used to assess differences based on sex, concussion history, ethnicity, and hours slept for each PLR measurement. Kruskall-Wallis testing was used to assess differences based on age, race, and anisocoria. Alpha was set at .05 and nonparametric effect sizes (r) were calculated for statistically significant results. Effect sizes were interpreted as no effect (r < .1), small (r ≥.1-<.3), medium (r ≥.3-<.5), or large (r ≥ .5). All procedures were reviewed and approved by the local institutional review board and the U.S. Army Human Research Protection Office before the study was conducted. Each subject provided informed consent to participate in the study before data collection. Of the 1,197 participants baselined, 514 cadets (131 female; 18.91 ± 0.96years) consented and completed a valid baseline pupillometric assessment. Eighty participants reported at least one previous concussion and participants reported an average of 5.88 ± 1.63 h slept the previous night. Mann-Whitney U results suggest females had larger initial (z = -3.240; P = .001; r = .10) and end pupil diameter (z = -3.080; P = .002; r = .10), slower average dilation velocity (z = 3.254; P = .001; r = .11) and faster T75 values (z = -3.342; P = .001; r = .11). Age, sleep, and race stratified by sex, also displayed a significant impact on specific PLR metrics with effect sizes ranging from small to medium, while ethnicity, anisocoria, and concussion history did not display an impact on PLR metrics. This study provides the largest population-specific normative values for eight PLR measurements. Initial and end pupil diameter, dilation velocity, and the T75 metrics differed by sex; however, these differences may not be clinically significant as small effect size was detected for all metrics. Sex, age, sleep, and race may impact specific PLR metrics and are worth consideration when performing PLR assessments for mild traumatic brain injury management.

Awakening a Nation: A Rhetorical Analysis of Derek Walcott’s “The Sea Is History”

This paper analyses Derek Walcott’s (1930 – 2017) poem “The Sea Is History” (1979) from a rhetorical perspective. The rhetorical analysis of the poem enables us to uncover the implicit cultural values of Caribbean people and the oppressive discourses of colonialism. Based on the rhetorical reading of the poem, this study questions the traditional notion of history in the postcolonial framework. “The Sea Is History” is from Walcott’s collection The Star-Apple Kingdom, originally published in 1979. In the poem, the author communicates with the reader by triggering an inner reaction through rhetorical questions. “The Sea Is History” is also notable for the use of metaphor and imagery. Walcott’s preoccupation with his nation’s notions of the past, culture, and language is expressed in the poet’s use of metaphors to call on the Caribbean to awaken from a deep sleep and hold history to account. The author’s inclusion of elements of the narrative is underpinned by a strong postcolonial feeling, transforming this narrative poem into the biography of an oppressed nation kept as slaves for centuries. By using allusions to the Bible, Walcott juxtaposes biblical stories with the past and the memory of his nation, hence his rhetorical question: “Where are your monuments, your battles, martyrs? Where is your tribal memory?”. Moreover, by placing biblical markers on certain passages of the voyage to the Caribbean – Genesis, Exodus, the Ark of the Covenant, and the Song of Solomon – the poet highlights it as a significant event that amounts to a religious text, at the same time pointing out that the events in the Bible are not universally accepted as actual events, whereas the past of his people is a true experience that reflects the colonial history of the Caribbean.

A real-time, personalized sleep intervention using mathematical modelling and wearable devices.

The prevalence of artificial light exposure has enabled us to be active any time of the day or night, leading to the need for high alertness outside of traditional daytime hours. To address this need, we developed a personalized sleep intervention framework that analyzes real-world sleep-wake patterns obtained from wearable devices to maximize alertness during specific target periods. Our framework utilizes a mathematical model that tracks the dynamic sleep pressure and circadian rhythm based on the user's sleep history. In this way, the model accurately predicts real-time alertness, even for shift workers with complex sleep and work schedules (N=71, t=13~21days). This allowed us to discover a new sleep-wake pattern called the Adaptive Circadian Split Sleep (ACSS), which incorporates a main sleep period and a late nap to enable high alertness during both work and non-work periods of shift workers. We further developed a mobile application that integrates this framework to recommend practical, personalized sleep schedules for individual users to maximize their alertness during a targeted activity time based on their desired sleep onset and available sleep duration. This can reduce the risk of errors for those who require high alertness during non-traditional activity times and improve the health and quality of life for those leading shift work-like lifestyles.

Long haul in asymptomatic and mild symptomatic COVID-19 patients: A community-based study in Northern India

Introduction: COVID-19, is a highly contagious disease caused by Novel Corona Virus SARS-Cov-2. After initial infection, most patients recover completely, but in some patients, symptoms may persist for variable duration. This study was planned to evaluate different persistent symptoms of long COVID among the people of Northern India, who had asymptomatic or mild disease during active infection stage. Methods: A cross sectional study was done in Chandigarh, India, during August 2021 to June 2022. A total of 647 recovered COVID-19 patients, who had suffered of COVID almost ≥3 months back were included in the study. A self-designed questionnaire was developed for the survey. Participants were followed up till 3 months. Results: Out of 647 subjects enrolled, 27.5% had some post-COVID symptoms. Among symptomatic, 55.1% were males and 44.9% were females. Post-COVID headache was significantly more common in females. Sleep disturbances and history of pain and pressure that spreads to arms were significantly more common among non-smokers. Sleep disturbances and change of appetite were significantly more common among non-alcohol users. Chest discomfort and change of appetite were found to be significantly more common among non-hypertensive subjects. Symptoms of chest discomfort, sleep disturbances, anxiety, feeling of sadness on daily basis and forgetfulness was significantly more common among subjects without underlying heart disease, while weakness among patients with underlying lung disease. Poor concentration was found to be significantly more common among patients without underlying lung disease and that in the age group 26-50 years, followed by 51-75 years and 76-100 years. Conclusion: This study attempted to assess the prevalence of post COVID complications among the asymptomatic and mild COVID patients. From the clinical point of view, physicians should be aware of the symptoms, signs, and biomarkers present in patients previously affected by COVID-19 to promptly assess, identify and halt long COVID-19 progression, minimize the risk of chronic effects and to re-establish pre-COVID-19 health.