Index Of Vigilance Research Articles

Headache in diabetes.

Diabetes can present with multiple manifestations and subjective symptoms. One of these is headache. Headache can be a clinical presentation of diabetes per se, its complications or its comorbidities. It can also point towards certain causes of secondary diabetes, as well as iatrogenic issues. This communication lists the various causes of headache in diabetes, so as to help the clinician keep a high index of vigilance.

Arousal and salience network connectivity alterations in surgical temporal lobe epilepsy.

It is poorly understood why patients with mesial temporal lobe epilepsy (TLE) have cognitive deficits and brain network changes that extend beyond the temporal lobe, including altered extratemporal intrinsic connectivity networks (ICNs). However, subcortical arousal structures project broadly to the neocortex, are affected by TLE, and thus may contribute to these widespread network effects. The authors' objective was to examine functional connectivity (FC) patterns between subcortical arousal structures and neocortical ICNs, possible neurocognitive relationships, and FC changes after epilepsy surgery. The authors obtained resting-state functional magnetic resonance imaging (fMRI) in 50 adults with TLE and 50 controls. They compared nondirected FC (correlation) and directed FC (Granger causality laterality index) within the salience network, default mode network, and central executive network, as well as between subcortical arousal structures; these 3 ICNs were also compared between patients and controls. They also used an fMRI-based vigilance index to relate alertness to arousal center FC. Finally, fMRI was repeated in 29 patients > 12 months after temporal lobe resection. Nondirected FC within the salience (p = 0.042) and default mode (p = 0.0008) networks, but not the central executive network (p = 0.79), was decreased in patients in comparison with controls (t-tests, corrected). Nondirected FC between the salience network and subcortical arousal structures (nucleus basalis of Meynert, thalamic centromedian nucleus, and brainstem pedunculopontine nucleus) was reduced in patients in comparison with controls (p = 0.0028-0.015, t-tests, corrected), and some of these connectivity abnormalities were associated with lower processing speed index, verbal comprehension, and full-scale IQ. Interestingly, directed connectivity measures suggested a loss of top-down influence from the salience network to the arousal nuclei in patients. After resection, certain FC patterns between the arousal nuclei and salience network moved toward control values in the patients, suggesting that some postoperative recovery may be possible. Although an fMRI-based vigilance measure suggested that patients exhibited reduced alertness over time, FC abnormalities between the salience network and arousal structures were not influenced by the alertness levels during the scans. FC abnormalities between subcortical arousal structures and ICNs, such as the salience network, may be related to certain neurocognitive deficits in TLE patients. Although TLE patients demonstrated vigilance abnormalities, baseline FC perturbations between the arousal and salience networks are unlikely to be driven solely by alertness level, and some may improve after surgery. Examination of the arousal network and ICN disturbances may improve our understanding of the downstream clinical effects of TLE.

X-linked genodermatoses from diagnosis to tailored therapy.

Genodermatoses are rare heterogeneous genetic skin diseases with multiorgan involvement. They severely impair an individual's well-being and can also lead to early death. During the progress of this review, we have implemented a targeted research approach, diligently choosing the most relevant and exemplary articles within the subject matter. Our method entailed a systematic exploration of the scientific literature to ensure a compre-hensive and accurate compilation of the available sources. Among genodermatoses, X-linked ones are of particular importance and should always be considered when pediatric males are affected. Regardless of other syndromic forms without prevalence of skin symptoms, X-linked genodermatoses can be classified in three main groups: keratinization defects, pigmentation defects, and inflammatory skin diseases. Typical examples are dyskeratosis congenita, keratosis follicularis spinulosa decalvans, hypohidrotic ectodermal dysplasia, chondrodysplasia punctata, hypohidrotic ectodermal dysplasia, incontinentia pigmenti, chronic granulomatous disease, CHILD syndrome and ichthyosis. In this field, genetic diagnosis of the specific disease is important, also considering that numerous clinical trials of orphan drugs and genetic therapies are being proposed for these rare genetic diseases. Thus, this chapter starts from clinical to molecular testing and ends with a review of all clinical trials on orphan drugs and gene therapy for genodermatoses.

Diagnosis of Abusive Head Trauma : Neurosurgical Perspective.

Abusive head trauma (AHT) is the most severe form of physical abuse in children. Such injury involves traumatic damage to the head and/or spine of infants and young children. The term AHT was introduced to include a wider range of injury mechanisms, such as intentional direct blow, throw, and even penetrating trauma by perpetuator(s). Currently, it is recommended to replace the former term, shaken baby syndrome, which implicates shaking as the only mechanism, with AHT to include diverse clinical and radiological manifestations. The consequences of AHT cause devastating medical, social and financial burdens on families, communities, and victims. The potential harm of AHT to the developing brain and spinal cord of the victims is tremendous. Many studies have reported that the adverse effects of AHT are various and serious, such as blindness, mental retardation, physical limitation of daily activities and even psychological problems. Therefore, appropriate vigilance for the early recognition and diagnosis of AHT is highly recommended to stop and prevent further injuries. The aim of this review is to summarize the relevant evidence concerning the early recognition and diagnosis of AHT. To recognize this severe type of child abuse early, all health care providers maintain a high index of suspicion and vigilance. Such suspicion can be initiated with careful and thorough history taking and physical examinations. Previously developed clinical prediction rules can be helpful for decision-making regarding starting an investigation when considering meaningful findings. Even the combination of biochemical markers may be useful to predict AHT. For a more confirmative evaluation, neuroradiological imaging is required to find AHT-specific findings. Moreover, timely consultation with ophthalmologists is needed to find a very specific finding, retinal hemorrhage.

Clinical characteristics of multi-inflammatory syndrome in children associated with COVID 19 at the time of first contact with a primary care physician: an observational study

Background: MIS-C is a new clinical syndrome with many similarities with well-known common childhood illness. This present study aims to describe the clinical profile at the time of first contact with the primary care provider and to delineate it from other common illness.Methods: Retrospective observational study in a referral hospital, GMC Thrissur, Kerala. All 43 diagnosed cases during the study period were enrolled. Data was retrieved from the case sheets and reference letters. Data was analysed in Statistical package for social sciences (SPSS) 20 software.Results: 43 patients were diagnosed with MIS-C with a mean age at diagnosis was 7.3 years with a male preponderance. Fever was the universal symptom, gastrointestinal symptoms in 27 (62.7%), rash in 24 (55.8%), shock in 2 (4.6%), lymphadenopathy in 2, seizures in 2, altered sensorium in 1, palatal palsy in 1etc were the presenting symptoms. 12 (27.9%) of patients had no history of COVID 19 infection. The mean latency for MIS-C was 21 days (range 6-60 days). 17 (39.5%) patients developed shock later.Conclusions: The symptom triad of fever, rash and gastrointestinal symptoms was the common presenting symptom at the first contact. Fever was present in all children. One third of patients had no history of symptomatic covid 19. Shock was the presenting symptom only in 2 (4.6%), but subsequently 17 (39.5%) children developed shock within 5 days of onset of symptoms. High index of suspicion and vigilance should be maintained by the primary care provider for the timely diagnosis and referral to higher centre.

Clinical Features and Outcomes of Acute Chlorine Gas Inhalation; a Brief Report.

Introduction:On March 6th,2020, chlorine gas leak was reported at Engro Polymer & Chemicals Plant in Karachi City, Pakistan. This study aimed to evaluate the clinical features and outcomes of patients who presented to emergency department (ED) following this event.Methods:This retrospective cross-sectional study, evaluated the clinical features and outcomes (length of hospital stay, complications, and mechanical ventilation requirement) of patients presenting to ED of Aga Khan University Hospital, Karachi, Pakistan, with history of chlorine gas exposure at the Engro Plant from 6th March to 14th March 2020. Results:38 patients with mean age of 33.1 ± 8.1 years presented to ED with history of chlorine gas exposure (100% male). 4 (10.5%) cases had comorbid diseases. Most common presenting symptom was dyspnea, observed in 33 (86.8%) cases, followed by cough, seen in 27 (71.1%) subjects. 13.2% (5/38) patients had infiltration on chest x-ray and 33 (86.8 %) required hospitalization. 6 (15.8%) patients had repeat presentation requiring hospitalization or ED visit. 18 (47.4%) were managed with high flow oxygen therapy, 9 (23.7%) required non-invasive ventilation and one patient was intubated due to development of pneumo-mediastinum. Mean length of stay was 1.55 ± 1.58 days and no patients died. Presence of tachycardia was the only finding significantly associated with need for oxygen (p = 0.033) and non-invasive ventilation (p = 0.012).Conclusion:The majority of patients presenting with acute chlorine gas exposure showed good clinical outcomes and rapid recovery, however, a high index of suspicion and vigilance should be maintained for complications such as pneumomediastinum and acute respiratory distress syndrome in these patients.

Vigilance index for outdoor air quality around schools and nurseries

BACKGROUND AND AIM: Every day a lot of children breathe air that is so polluted it puts their health and development at serious risk. Children are particularly vulnerable to the effects of air pollution because they breathe more rapidly than adults and so absorb more pollutants. A vigilance index was therefore developed to alert authorities about the outdoor air quality around schools and nurseries in Wallonia, Belgium. METHODS: A long-term air quality index (AQI) was built to reflect long-term health impact of traffic-related pollutants. Annual concentrations of NO2, PM10 and PM2,5 were estimated on each location of schools and nurseries (7130 address points) in Wallonia using ATMO-street model. This model represents the varying concentrations of air pollutants across a region, taking into account the regional and urban background but also capturing so called street canyon effects into one single air quality map. The AQI and its sub-indices are subdivided into 10 index classes. The concentration scales of NO2, PM10 and PM2,5 sub-indices were determined based on the relative risk of mortality associated with long-term exposure to these air pollutants. The highest sub-index value is attributed to the final long-term AQI. RESULTS:The results showed that 868 structures (12%) are impacted by poor to execrable air quality (AQI ≥ 6), i.e. 14% of schools and 10% of nurseries. PM10 was generally the highest sub-index at the locations and therefore the most critical pollutant for determining the long-term AQI. Results are presented into a secured web app, with an interactive interface via ArcGiS Dashboard. A pop-up window provides details for each structure: type, municipality, AQI value, sub-index values and annual concentrations of pollutants. CONCLUSIONS:This study provides a vigilance index to accurately assess the impact that the air quality has on children’s health. Using this information, policymakers can take action to check and reduce levels in pollution hotspots. KEYWORDS: Air pollution, Children's environmental health, Traffic-related, Long-term exposure, Spatial statistics

EEG Based Evaluation of Examination Stress and Test Anxiety Among College Students

BackgroundAdolescence is a crucial chapter in life and the presence of stress, depression, and anxiety at this stage is a great concern. Prolonged stress is one of the risk factors that may induce suicidal thoughts, destructive ideation, abuse of alcohol, and drugs in adulthood. Based on a record from National Crime Records Bureau, In India over 2320 children were committed suicide per year because of failure in examinations. This raised number implies the severity of this issue and its major impact on society. ObjectivesThe main objective of this paper is to analyze the cognitive stress in students during examination period using EEG biomarkers. Methods and ResultsEEG signal was acquired in two different test conditions such as before examination with 12 minutes and after examination with 3 minutes from 14 subjects with eight electrodes located using wireless Enobio device (Neuro electrics) with 10-20 international lead system. The three brain waves such as theta, alpha, beta relative band energies were considered, and EEG band ratios such as heart rate, neural activity, arousal index, vigilance index and cognitive performance attentional resource index extracted between before and after examination condition using db4 wavelet family with 6 level decomposition. The statistical results suggest that after examination the relative sub-band energies α, β, and θ were decreased significantly (p < 0.05) as compared to before examination. Also, the EEG band ratio such as heart rate and vigilance index shows significant (p < 0.05) decrease after the examination as compared to before examination. It was found that there was a significant (p < 0.05) rise in the arousal index, Cognitive performance attentional resource index (CPARI), and neural activity after the examination as compared to before examination. ConclusionThe experimental results found that the memory and concentration were high before examination, which concludes that adolescence group examination stress was high before examination period as compared to after examination. In the case of gender group comparison, theta energy band for male students was found high compared to female students in before examination state such that it concludes that male students were highly stressed (before examination) than female students. Overall, our results suggest that after examination male students with lower heart rate index than female students which implies the male students control their stress levels as compared to females in the same stress situation.

Clinicopathologic features and clinical outcomes of intravenous leiomyomatosis of the uterus: A case series.

Rationale:Intravenous leiomyomatosis (IVL) is a rare and special type of smooth muscle tumor originating in the uterus. It is classified as a benign disease according to its histological features but shows the behavioral characteristics of a malignant tumor. It is easily misdiagnosed and recurrent. The purpose of this study was to retrospectively analyze clinicopathological data of 25 cases of IVL in order to enhance clinicians’ understanding of this rare disease.Patient concerns:We screened and identified 25 cases of IVL at our hospital from October 2013 to January 2020. Five patients had tumors.Diagnoses:The diagnosis in each case was pathologically confirmed after surgical treatment.Interventions:All patients were managed surgically. Although the surgical procedures were different, the surgical approach was geared towards achieving complete excision. Three patients received hormonal therapy with gonadotropinreleasing hormone agonists after surgery.Outcomes:We retrospectively reviewed all medical records and analyzed the clinicopathologic features and clinical outcomes of this disease as well as the correlations between the clinical features and risk of recurrence. Neither the symptoms nor the preoperative imaging results were suggestive of IVL in any of the cases. Except for two patients who were lost to follow-up, twenty-three patients who were followed up are still alive. Three patients experienced a recurrence.Lessons:The clinical manifestations and ultrasound images of IVL in the early stages are not typical; thus, IVL is easily misdiagnosed as uterine leiomyoma. Radiologists, pathologists, and surgeons should have a thorough understanding of IVL and a high index of vigilance for IVL in clinical practice. Surgery should always be aimed at achieving complete tumor excision. Patients with large lesions (≥7 cm) and lesions extending to the broad ligament may have an increased risk of recurrence. Early detection, diagnosis, and treatment are very important; once the diagnosis is confirmed, regular follow-ups are crucial.

HOW CAN MACHINE LEARNING HELP THE AUTHORITIES?

Corona Virus Desease (COVID-19) pandemic is causing health crisis in every region in the world, especially in Indonesia. One of the effective methods against the virus is wearing face mask in public place as the regulation made by the authorities. This paper introduces face mask detection that can be used by the authorities to make mitigation, evaluation, prevention, and action planning against COVID-19. On the other hand, this solution can be used as communication tool to evaluate people’s habit on wearing face mask. The face mask recognition in this study is developed with machine learning algorithm through the image classification method: MobileNetv2. The proposed model can be integrated with surveillance camera to impede the Covid-19 transmission by allowing the detection of people who are not wearing face mask. After the training, validation, and testing phase, the model can provide the percentage of people using face mask in some cities with high accuracy. The data produced also have a strong correlation to the vigilance index of COVID-19.

KUALITAS UDARA DAN POTENSI TRANSMISI COVID-19 DI PULAU JAWA

Penularan SARS-CoV-2 di Indonesia semakin mengkhawatirkan. Pandemik COVID-19 tidak hanya berdampak pada individu yang terinfeksi langsung, tetapi juga berimbas kepada para penyintas kolateral, yaitu mereka yang kehidupannya ikut terdisrupsi akibat krisis. Pulau Jawa adalah episentrum penularan COVID-19 di Indonesia. Beberapa studi menunjukkan bahwa kejadian COVID-19 memiliki hubungan yang erat dengan tingginya konsentrasi zat partikulat di udara. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas udara dan risiko penularan COVID-19 di Pulau Jawa. Kualitas udara diukur dengan konsentrasi NO2, sedangkan risiko penularan COVID-19 direfleksikan oleh Indeks Kewaspadaan COVID-19. Penelitian ini menggunakan empat model untuk melihat pengaruh kadar NO2 terhadap Indeks Kewaspadaan COVID-19, dimana variabel kepadatan penduduk ditambahkan sebagai kontrol. Model-0 adalah model dasar tanpa efek kelompok dan efek spasial. Model-1 adalah pengembangan dari Model-0 dengan menambahkan efek spasial. Model-2 adalah pengembangan dari Model-0 dengan menambahkan efek kelompok. Sedangkan, Model-3 adalah model lengkap dengan efek kelompok dan efek spasial. Hasil analisis menunjukkan bahwa Model-3 adalah model terbaik dalam menjelaskan pengaruh kadar NO2 terhadap Indeks Kewaspadaan COVID-19. Model-3 mampu meningkatkan kinerja model secara substansial. Hasil pengujian mengindikasikan bahwa kadar NO2 berpengaruh positif dan signifikan terhadap Indeks Kewaspadaan COVID-19, setelah efek kelompok dan efek spasial diperhitungkan. Dengan demikian, disimpulkan bahwa semakin tinggi konsentrasi NO2 yang mencerminkan semakin buruk kualitas udara, semakin tinggi pula risiko penularan COVID-19. Hasil ini memiliki implikasi penting untuk strategi pencegahan penyebaran COVID-19, khususnya pada daerah-daerah dengan tingkat pencemaran udara yang tinggi.

Effects of a seat-integrated mobilization system during passive driver fatigue

ObjectiveThe aim of this study is to evaluate the effectiveness of a seat-integrated mobilization system for maintaining vigilance under monotonous driving situations. MethodFor this purpose, vigilance indicators were compared intra-individually in a test condition with mobilization (seat-integrated stimulation) and a placebo condition under standardized conditions in a real driving study (N = 31). During a monotonous two-hour ride, physiological (brain activity by the EEG alpha spindle rate), performance-based (reaction times) and subjective indicators were recorded. ResultsThe necessary precondition for the paradigm of inducing fatigue through monotony was confirmed by a significant increase in the EEG alpha spindle rate and the subjective vigilance indices. The mobilization system had a significant impact on the most fatigue-sensitive parameter of the alpha spindle rate, whereas the other parameters of vigilance did not reflect a significant effect of mobilization. ConclusionThe Mobilization Seat is an effective measure to prevent drivers’ fatigue during monotonous situations.

Integration of Simultaneous Resting-State Electroencephalography, Functional Magnetic Resonance Imaging, and Eye-Tracker Methods to Determine and Verify Electroencephalography Vigilance Measure.

Background/Introduction: Concurrent electroencephalography and resting-state functional magnetic resonance imaging (rsfMRI) have been widely used for studying the (presumably) awake and alert human brain with high temporal/spatial resolution. Although rsfMRI scans are typically collected while individuals are instructed to focus their eyes on a fixated cross, objective and verified experimental measures to quantify degree of vigilance are not readily available. Electroencephalography (EEG) is the modality extensively used for estimating vigilance, especially during eyes-closed resting state. However, pupil size measured using an eye-tracker device could provide an indirect index of vigilance. Methods: Three 12-min resting scans (eyes open, fixating on the cross) were collected from 10 healthy control participants. We simultaneously collected EEG, fMRI, physiological, and eye-tracker data and investigated the correlation between EEG features, pupil size, and heart rate. Furthermore, we used pupil size and EEG features as regressors to find their correlations with blood-oxygen-level-dependent fMRI measures. Results: EEG frontal and occipital beta power (FOBP) correlates with pupil size changes, an indirect index for locus coeruleus activity implicated in vigilance regulation (r = 0.306, p < 0.001). Moreover, FOBP also correlated with heart rate (r = 0.255, p < 0.001), as well as several brain regions in the anticorrelated network, including the bilateral insula and inferior parietal lobule. Discussion: In this study, we investigated whether simultaneous EEG-fMRI combined with eye-tracker measurements can be used to determine EEG signal feature associated with vigilance measures during eyes-open rsfMRI. Our results support the conclusion that FOBP is an objective measure of vigilance in healthy human subjects. Impact statement We revealed an association between electroencephalography frontal and occipital beta power (FOBP) and pupil size changes during an eyes-open resting state, which supports the conclusion that FOBP could serve as an objective measure of vigilance in healthy human subjects. The results were validated by using simultaneously recorded heart rate and functional magnetic resonance imaging (fMRI). Interestingly, independently verified heart rate changes can also provide an easy-to-determine measure of vigilance during resting-state fMRI. These findings have important implications for an analysis and interpretation of dynamic resting-state fMRI connectivity studies in health and disease.

The influence of male faces on stereotype activation among women in STEM: An ERP investigation

Members of stereotyped groups are vigilant to situational cues signaling threats to their social identity. In one psychophysiological experiment, we examined whether mere exposure to a watching male face would increase attentional vigilance among female STEM students due to the activation of math-gender stereotypes. Male and female students performed an alleged math intelligence task while being primed with male faces or control images. Automatic responses to errors were captured with error-related negativity (ERN), a neural index of error vigilance. Women showed larger ERN upon making errors when primed with male faces compared to control images, whereas no such priming effect occurred among men. Moreover, this face priming effect was pronounced only among women highly invested in pursuing STEM careers. These findings suggest that minimalistic social cues may activate negative stereotypes early in informational processing, thereby selectively shunting attention on errors in stereotype-relevant tasks among individuals invested in the performance domain.

Microstructure of cortical activity during sleep reflects respiratory events and state of daytime vigilance

Besides visual sleep stage scoring, it is possible to separate sleep stages by analyzing spatially distributed three-channel electroencephalogram (EEG) root mean square (RMS) amplitudes. This approach allows qualitative and quantitative evaluation of sleep architecture. The aim of this study was to analyze the effect of apnea–hypopnea index (AHI) and state of vigilance on the microstructure of cortical activity during sleep using EEG cluster analysis. In 31 obstructive sleep apnea (OSA) patients, cortical EEG patterns were recorded during polysomnography and subjected to EEG cluster analysis. The results were subsequently correlated to AHI as well as to subjective (Epworth Sleepiness Scale) and objective (pupillographic sleepiness test) daytime sleepiness using linear regression. In 18/31 patients, cortical EEG patterns were recorded again the following night during continuous positive airway pressure (CPAP) titration and compared to the results of the first night. Linear regression analyses revealed dependencies of specific cortical EEG patterns on AHI (intra-cluster distance of N2 [p = 0.019], N3 [p = 0.024]; inter-cluster distance of wake-N2 [p = 0.046], wake-N3 [p = 0.047], N2–N3 [p = 0.021]) and on objective daytime sleepiness (wake intra-cluster distance [p = 0.047], inter-cluster distance of wake-N3 [p = 0.042]), but not on subjective daytime sleepiness. Specifically, an increase in EEG pattern variability was found in patients with high AHI values, which could be reduced by CPAP therapy. This new approach enables objective analysis and visualization of sleep macro- and microstructure. The variance of neuronal EEG signal patterns enables conclusions on the presence of pathological respiratory events and objectively measured daytime sleepiness.

The Role of Exercise-Induced Arousal and Exposure to Blue-Enriched Lighting on Vigilance.

It is currently assumed that exposure to an artificial blue-enriched light enhances human alertness and task performance, but recent research has suggested that behavioral effects are influenced by the basal state of arousal. Here, we tested whether the effect of blue-enriched lighting on vigilance performance depends on participants’ arousal level. Twenty-four participants completed four sessions (blue-enriched vs. dim light × low vs. high arousal) at 10 pm on four consecutive days, following a repeated-measures design. Participants’ arousal was manipulated parametrically through the execution of a cycling task at two intensities (low vs. moderate), and was checked by monitoring their heart rate. On each session, distal and proximal skin temperatures were recorded as a neuroergonomic index of vigilance, while participants performed a 20-min psychomotor vigilance task (PVT) under either blue-enriched light or dim light conditions. The Positive and Negative Affect Schedule (PANAS), Karolinska Sleepiness Scale (KSS), and Borg Rating of Perceived Exertion Scale (RPE) were used to measure subjective psychological state. The results showed that the exercise-induced manipulation of arousal produced robust alerting effects in most measures, while the lighting manipulation only attenuated subjective sleepiness and enhanced positive affect, but it did not influence behavior or physiology. Acute exposure to a blue-enriched light was practically ineffective when the arousal level was over baseline. The present research favored the use of acute physical exercise over acute exposure to blue-enriched lighting in order to boost humans’ alertness when necessary, as in work settings where maintaining optimal levels of attention is difficult (shift work, night-work, vigilance tasks) and necessary to prevent human error and accidents.

The therapeutic potential of attentional bias modification training for insomnia: study protocol for a randomised controlled trial

BackgroundThe efficacy of attentional bias modification (ABM) as a treatment for anxiety and depression has been extensively studied with promising results. Despite some evidence of sleep-related attentional biases in insomnia, only a small number of studies, yielding mixed results, have examined the application of ABM in insomnia. This study specifically aims to determine whether ABM can reduce (i) the presence of an attentional bias for sleep-related threatening words; (ii) insomnia symptom severity; (iii) sleep onset latency; and (iv) pre-sleep cognitive arousal amongst individuals with insomnia compared to a non-treatment control group of individuals with insomnia.Methods/designWe propose a randomised controlled trial of 90 individuals from the general population who meet the criteria for Insomnia Disorder. Following an initial examination for the presence of a sleep-related attentional bias using the dot-probe paradigm, participants will be randomised to an online attentional bias modification training condition, or to a standard attentional bias task (non-treatment) control condition. Both conditions will be delivered online by a web platform. All participants allocated to the non-treatment control group will be offered ABM training once the study is complete. The primary outcome will be the attentional bias indices of vigilance and disengagement and self-reported insomnia symptoms, sleep onset latency and pre-sleep cognitive arousal. Attentional bias and insomnia symptoms will be assessed at baseline (day 1) and post-treatment (2 days after the final training session: day 9). Insomnia symptoms will be again assessed at follow-up (day 16). Secondary outcomes include examining whether sleep associated monitoring and worry are related to a sleep-related attentional bias in insomnia, and whether such reports reduce following ABM. All main analyses will be carried out on completion of follow-up assessments. The trial is supported by the Department of Psychology, Sociology and Politics at Sheffield Hallam University.DiscussionThis study will extend the research base examining the efficacy of attentional bias modification for insomnia.Trial registrationISRCTN (ISRCTN11643569, registered on 5 June 2018).

COMPARISON OF CHOLINERGIC STATUS EVALUATED VIA QUANTITATIVE EEG PARAMETERS IN NORMAL SUBJECTS AND PATIENTS SUSPECTED OF DEMENTIA

This study evaluated quantitative electroencephalography (QEEG) variables to distinguish normal subjects from patients who were being investigated for dementia and followed-up with or without acetylcholinesterase inhibitor (AChEI) treatment. Means from 4 EEG epochs obtained with eyes closed (E.Cl.) 80 sec. per epoch or eyes open (E.O.) 25 sec. per epoch, the peak frequency with eyes closed and the vigilance index (ratio of E.O./E.Cl. mean power) were calculated. A normal group and a group suspected of having primary dementia were followed after 10±4 with or 11±4 months without AChEI treatment. Student's t tests compared the means and standard deviations and the extent of changes between the baseline and follow-up assessments. Based on earlier studies when cholinergic and anticholinergic drugs tested in humans, demonstrates the anticholinergic effect on EEG by reducing power of basic rhythm (Alfa-rhythm) and increase power when eyes are open, why vigilance index reflects the anticholinergic effect on the EEG. When the normal group were compared with those of the suspected dementia group at baseline, all variables were significantly altered. The vigilance index and power of the E.O. increased, the peak frequency and E.Cl. power was reduced (Fig 1). At follow-up, the vigilance index and E.O. power of the untreated group increased (p = 0.06, respectively 0.07) compared to AChEI treated group (p = 0.46 respectively 0.43). The ratio of the change compared to baseline was unchanged for the vigilance-index (1.0) for the AchEI treated, while increased (1.15) in the untreated group. For E.O power reduced (0.69) for the treated and increased (1.43) for the treated group. The treated group exhibited a higher proportion of patients with a decreased or unchanged vigilance index and fewer patients with an increased vigilance index than the untreated patients (Fig. 2). The examined variables. A (left) Normal EEG with four epochs superimposed n the graphs. B (right) shows an examination of a patient at baseline (above) under E.CI. and E.O. conditions and follow-up (tower) in B. The patient did not receive AChEI treatment. Thus, the power ratio value of the E.O./E.CI. (vigilance index) increased at follow-up. Comparison of the vigilance index at the follow-up EEG of patients who were treated with or without AChEI after the baseline EEG. The treated group exhibited a higher proportion of patients with a decreased or unchanged vigilance index and fewer patients with an increased vigilance index compared to untreated patients. These data support the hypothesis that acetylcholine levels further reduction halts or even increases in patients treated with AChEI. The increased vigilance index in AChEI treated group suggests that these patients did not respond to the treatment at this follow-up visit (non-responders). The vigilance index reflects the cholinergic status, and it was clearly increased in the early dementia group and at follow-up for those not treated with AChEI, but was not changed in the treated patients. The vigilance index may be used to assess cholinergic deficits in patients with dementia and evaluate the effects of AChEI treatment.

Electroencephalographic and skin temperature indices of vigilance and inhibitory control

Abstract Neurophysiological markers of the ability to sustain attention and exert inhibitory control of inappropriate responses have usually relied on neuroimaging methods, which are not easily applicable to real-world settings. The current research tested the ability of electroencephalographic and skin temperature markers to predict performance during the Sustained Attention to Response Task (SART), which demands vigilance and inhibitory control. In Experiment 1, we recorded the electroencephalogram (EEG) during the performance of SART and found that event-related potentials underlying inhibitory control (N1 and N2/P3) were influenced by a time on task effect, suggesting a decrement in attentional resources necessary for optimal inhibitory control. In Experiments 2 and 3, we recorded skin temperatures (distal, proximal and the distal-proximal temperature gradient –DPG) and found that they were sensitive to differential demands of mental workload, and that they were related to behavioural performance in the SART. This study suggests that the recording of EEG and skin temperature may be used to monitor fluctuations of attention in natural settings, although further research should clarify the exact psychological interpretation of these physiological indices.

Typical features of Parkinson disease and diagnostic challenges with microdeletion 22q11.2.

ObjectiveTo delineate the natural history, diagnosis, and treatment response of Parkinson disease (PD) in individuals with 22q11.2 deletion syndrome (22q11.2DS), and to determine if these patients differ from those with idiopathic PD.MethodsIn this international observational study, we characterized the clinical and neuroimaging features of 45 individuals with 22q11.2DS and PD (mean follow-up 7.5 ± 4.1 years).Results22q11.2DS PD had a typical male excess (32 male, 71.1%), presentation and progression of hallmark motor symptoms, reduced striatal dopamine transporter binding with molecular imaging, and initial positive response to levodopa (93.3%). Mean age at motor symptom onset was relatively young (39.5 ± 8.5 years); 71.4% of cases had early-onset PD (<45 years). Despite having a similar age at onset, the diagnosis of PD was delayed in patients with a history of antipsychotic treatment compared with antipsychotic-naive patients (median 5 vs 1 year, p = 0.001). Preexisting psychotic disorders (24.5%) and mood or anxiety disorders (31.1%) were common, as were early dystonia (19.4%) and a history of seizures (33.3%).ConclusionsMajor clinical characteristics and response to standard treatments appear comparable in 22q11.2DS-associated PD to those in idiopathic PD, although the average age at onset is earlier. Importantly, treatment of preexisting psychotic illness may delay diagnosis of PD in 22q11.DS patients. An index of suspicion and vigilance for complex comorbidity may assist in identifying patients to prioritize for genetic testing.