Continuous positive air pressure treatment for obstructive sleep apnoea patients : effects on sleep quality and quantity as measured by actigraphy

Objectives Actigraphy can reliably assess sleep in healthy adults and be used to estimate total sleep time in suspected obstructive sleep apnoea (OSA) patients. We compared sleep quality for Continuous Positive Air Pressure (CPAP) treated OSA patients and controls, evaluating the impact of stopping CPAP for one night. Methods 11 men, aged 51–75 years (m = 65.6 years), compliant CPAP users, treated for 1–19 years (m = 7.8 years) wore Cambridge Neurotechnology Ltd actiwatches for one night while using CPAP and for one night sleeping without CPAP. A control group of 11 healthy men, aged 63–74 years (m = 64.1 years) slept normally whilst wearing an actiwatch. Subsequent daytime sleepiness was recorded using Karolinska sleepiness scores (KSS). Results Actimetry showed no significant differences between actual sleep time, sleep efficiency, sleep disturbance index or number of wake bouts when comparing OSA participants using CPAP, with controls; there was no difference in subsequent daytime sleepiness, control KSS = 4.21, OSA KSS = 4.17. Without CPAP there was no significant difference in sleep length or sleep onset latency compared with using CPAP, but there was a significant impact on sleep quality as shown by: increased sleep disturbance index from 7.9 to 13.8 [t(10) = 3.510, P < 0.05], decreased percent of actual sleep from 92.05% to 86.15% [t(10) = 3.51, P < 0.05], decreased sleep efficiency from 86.6% to 81% [t(10) = 2.204, P < 0.05] and increased number of wake bouts from 29 to 42.5 [t(10) = 3.877, P < 0.05]. Daytime sleepiness became significantly worse increasing from KSS 4.17 to 6.27 [t(10) = )4.96, P < 0.05]. Conclusion There was no disparity in sleep quality or KSS scores between CPAP treated OSA patients and healthy controls of a similar age. Treated OSA patients obtained quality sleep with no elevated day time sleepiness. However, cessation of treatment for one night caused sleep quality to deteriorate despite a comparable sleep time; the deterioration in sleep quality could explain the increase in daytime sleepiness. OSA patients need to know that even short-term noncompliance with CPAP treatment significantly impairs sleep quality, leading to excessive sleepiness during monotonous tasks such as driving. Actigraphy successfully identified nights of non-compliance in treated OSA patients; but did not differentiate between the sleep of CPAP treated OSA patients and healthy controls.

Foreword

In 1978, three years after the publication of Foucault’s book Discipline and Punish, which famously introduced Bentham’s notion of the Panopticon to a wide audience, the French historian Jacques Léonard remarked that ‘it would need a squadron of competent historians to sort out the mass of interpretations’ offered by Foucault’s work. In response, Foucault said that he wanted his work to provide a workshop which would allow both himself and others to undertake further work and experiment with different approaches. He also cheerfully noted that he was encouraged by the ‘irritating effect’ that his work produced on others. The present book, which comprehensively treats the work of Bentham both in the wake of and against Foucault’s work, is a cogent testimony to the continued currency of these observations.

Ocular surface health with contact lens wear

Eye care practitioners (ECPs) would tend to agree that wearing contact lenses increases the risk for infection, but millions of patients are still fitted with lenses every year because ECPs feel that the risk is manageable and that their patients' eye health can be protected. The Fusarium and Acanthamoeba keratitis outbreaks of years past were a wake-up call to manufacturers, ECPs, and regulatory agencies that risk cannot be managed without diligence, and that the complex relationship between contact lens materials, contact lens solutions, and compliance needs to be better understood in order to optimize the efficacy of contact lens care and improve care guidelines.

Empowerment in nursing : paternalism or maternalism?

The aim of this article is to explore whether patient empowerment flourishes in the wake of current health reforms or if there is a power struggle between nursing and medicine as to what is in the patients' best interest. Shifting the balance of power from healthcare professionals to patients has become a key element of healthcare policy in England. The RCN's definition of nursing places patient empowerment as a central remit of nurses. However, achieving genuine patient empowerment is not easy and requires individuals and organizations to alter their beliefs, values and behaviours. To empower patients nurses must be in a position to share power and this may require a realignment of the traditional power base within health care. Although empowerment is often viewed on a one-to-one level between professionals and patients, for true patient empowerment to occur, issues of power and control must also be addressed at a national and political level.

Accounting for forests in Fiji : the experience of Future Forests (Fiji) Limited

"in a world which is experiencing unprecedented deforestation and widespread global environmental threats there is something intuitively right about planting a tree" (Future Forests (Fiji) Limited) The above quote demonstrates that even in the wake of global environmental crisis that hope still remains and that humans can still control their destiny. This opportunity to effect positive environmental change is one of the main aims of the South Pacific Stock Exchange’s (SPSE) most recent publicly listed company: Future Forest (Fiji) Limited. Incorporated in 2004 and listed on SPSE in 2011, the company is Fiji’s first large-scale commercial hardwood forest plantation and nursery. Future Forest (FF) is the only company listed on the SPSE with biological assets or “living assets.” The accounting standard for biological assets is IAS 41: Agriculture. This standard prescribes the use of fair value as the basis of valuation. While a more relevant method of valuation, the application of fair value accounting can be more costly and burdensome for companies in developing economies (White 2008). In line with the journal’s theme of agriculture, this article explores the issues, challenges and potential benefits involved in applying fair value accounting for biological assets in a developing economy such as Fiji using the case of Future Forest (Fiji) Limited.

Everything you do : young adult fiction and surveillance in an age of security

Espionage, surveillance and clandestine operations by secret agencies and governments were something of an East–West obsession in the second half of the twentieth century, a fact reflected in literature and film. In the twenty-first century, concerns of the Cold War and the threat of Communism have been rearticulated in the wake of 9/11. Under the rubric of ‘terror’ attacks, the discourses of security and surveillance are now framed within an increasingly global context. As this article illustrates, surveillance fiction written for young people engages with the cultural and political tropes that reflect a new social order that is different from the Cold War era, with its emphasis on spies, counter espionage, brainwashing and psychological warfare. While these tropes are still evident in much recent literature, advances in technology have transformed the means of tracking, profiling and accumulating data on individuals’ daily activities. Little Brother, The Hunger Games and Article 5 reflect the complex relationship between the real and the imaginary in the world of surveillance and, as this paper discusses, raise moral and ethical issues that are important questions for young people in our age of security.

Thermodynamic modeling of ethanol fumigation in a diesel engine

Due to rapidly diminishing international supplies of fossil fuels, such as petroleum and diesel, the cost of fuel is constantly increasing, leading to higher costs of living, as a result of the significant reliance of many industries on motor vehicles. Many technologies have been developed to replace part or all of a fossil fuel with bio-fuels. One of the dual fuel technologies is fumigation of ethanol in diesel engines, which injects ethanol into the intake air stream of the engine. The advantage of this is that it avoids any costly modification of the engine high pressure diesel injection system, while reducing the volume of diesel required and potentially increasing the power output and efficiency. This paper investigates the performance of a diesel engine, converted to implement ethanol fumigation. The project will use both existing experimental data, along with generating computer modeled results using the program AVL Boost. The data from both experiments and the numerical simulation indicate desirable results for the peak pressure and the indicated mean effective pressure (IMEP). Increase in ethanol substitution resulted in elevated combustion pressure and an increase in the IMEP, while the variation of ethanol injection location resulted in negligible change. These increases in cylinder pressure led to a higher work output and total efficiency in the engine as the ethanol substitution was increased. In comparing the numerical and experimental results, the simulation showed a slight elevation, due to the inaccuracies in the heat release models. Future work is required to improve the combustion model and investigate the effect of the variation of the location of ethanol injection.

Impact of the piston secondary motion on its slap force

A theoretical model is developed for the analysis of piston secondary motion. Based on this model, the slap force of a specific L6 diesel engine was compared when considering different boundary conditions, such as lubricating oil on cylinder liner, surface roughness, deformation of cylinder liner and piston skirt. It is concluded that it is necessary to consider the secondary motion of piston in the analysis of the inner excitation for an internal combustion engine. A more comprehensive consideration of the boundary condition (i.e., more close to the actual condition) will lead to a smaller maximum slap force, and among all boundary conditions considered in this paper, the structural deformation of the piston skirt and cylinder liner is the most influential factor. The theoretical model developed and findings obtained in this study will benefit the future analysis and design of advanced internal combustion engine structures.

Experimental and finite element analysis to identify the source of vibration of a coach

This paper presents an investigation on the cause of severe vibration problem of a coach with four-cylinder engine running at an idle state using vibration and impact hammer modal experiments to obtain the main vibration frequency components and the natural characteristics of the coach. The vibration results indicate that the main vibration component comes from the vibration transmitted from the engine to the chassis frame, which is closely related with the engine idle speed. Based on structural simulation analysis of the coach’s chassis frame and comparison with modal testing, the coach severe vibration problem was due to coupling resonance between the engine idle frequency and the fourth natural frequency of the chassis frame. The solution to eliminate the vibration problem is provided by changing the local structure stiffness of the chassis frame. The contribution of this paper lies in providing a solution to solve similar problems.

Condition monitoring and fault diagnosis of diesel engines using instantaneous angular speed analysis

Continuous monitoring of diesel engine performance is critical for early detection of fault developments in an engine before they materialize into a functional failure. Instantaneous crank angular speed (IAS) analysis is one of a few nonintrusive condition monitoring techniques that can be utilized for such a task. Furthermore, the technique is more suitable for mass industry deployments than other non-intrusive methods such as vibration and acoustic emission techniques due to the low instrumentation cost, smaller data size and robust signal clarity since IAS is not affected by the engine operation noise and noise from the surrounding environment. A combination of IAS and order analysis was employed in this experimental study and the major order component of the IAS spectrum was used for engine loading estimation and fault diagnosis of a four-stroke four-cylinder diesel engine. It was shown that IAS analysis can provide useful information about engine speed variation caused by changing piston momentum and crankshaft acceleration during the engine combustion process. It was also found that the major order component of the IAS spectra directly associated with the engine firing frequency (at twice the mean shaft rotating speed) can be utilized to estimate engine loading condition regardless of whether the engine is operating at healthy condition or with faults. The amplitude of this order component follows a distinctive exponential curve as the loading condition changes. A mathematical relationship was then established in the paper to estimate the engine power output based on the amplitude of this order component of the IAS spectrum. It was further illustrated that IAS technique can be employed for the detection of a simulated exhaust valve fault in this study.

Insurance and trust : lessons from the Christchurch Cathedral

This article examines important insurance and trust law issues that may confront trustees charged with the governance and protection of unique properties with broad community and heritage significance. Often trustee roles are assumed by community leaders without full appreciation of the potential difficulties and consequences when unforeseen circumstances arise. Three recent New Zealand court decisions in relation to the deconstruction and repair of the Christchurch Cathedral and to the interim construction of a transitional"cardboard Cathedral" highlight how difficult - and legally exposed - the role of trustee can be. The Cathedral cases go to the heart of defining the core purpose for which a Trust is created and examine the scope of discretion in fulfilling this charge its Trustees carry. Arising in the wake of the devastating Christchurch earthquakes, the Cathedral's Trustees were called upon to consider the best directions forward for a criplled and dangerous building subject to potential demolition, the wellbeing of the Cathedral's direct community, and the broader heritage and identity factors that this 'heart' of Christchurch represented. In the context of a seemingly grossly underinsured material damage cover - and faced with broader losses across the Diocese's holdings - the Trustees found that their sense of mission failed to gel with that of a community-based heritage buildings preservation trust. The High Court had to consider how monies received under the material damage policy could be applied by the Trustee in deconstructing, reinstating or repairing the Cathedral and if monies could be partly deployed to create an interim solution in the former of a transitional cathedral - all this in the context of the site-specific purpose of the Cathedral trust. The cases emphasise further the need to assess professionally the nature and quantum of cover effected to protect against various risks. In addition, in the case of historic or unusual buildings extra care must be exercised to take account additional costs associated with reinstatement so as to substantially retain the character and intrinsic value of such properties.

Parameters and equilibrium profiles for large-area surface-wave sustained plasmas

The equilibrium profiles of the plasma parameters of large-area if discharges in a finite-length metal-shielded dielectric cylinder are computed using a two-dimensional fluid code. The rf power is coupled to the plasma through edge-localized surface waves traveling in the azimuthal direction along the plasma edge. It is shown that self-consistent accounting for axial plasma diffusion and radial nonuniformity of the electron temperature can explain the frequently reported deviations of experimentally measured radial density profiles from that of the conventional linear diffusion models. The simulation results are in a good agreement with existing experimental data obtained from surface-wave sustained large-diameter plasmas. © 2002 The American Physical Society.

Microwave plasma discharge produced and sustained by the surface wave propagating along a metal wire

A theoretical model of the plasma discharge in a metal cylinder pumped by an operating gas of an arbitrary nature is presented. The ionization is carried out by the surface wave (SW) propagating along a coaxial metal wire. The model includes the local dispersion relation, the energy balance equation, and the relation between the absorbed power per unit length and the local plasma density. Two typical regimes of the discharge are analyzed. In both regimes the axial and radial profiles of the plasma density of the electromagnetic field components and of the SW intensity are obtained. The possible use of the obtained results in plasma technology are discussed.

Longitudinal change in sleep and daytime sleepiness in postpartum women

Sleep disruption strongly influences daytime functioning; resultant sleepiness is recognised as a contributing risk-factor for individuals performing critical and dangerous tasks. While the relationship between sleep and sleepiness has been heavily investigated in the vulnerable sub-populations of shift workers and patients with sleep disorders, postpartum women have been comparatively overlooked. Thirty-three healthy, postpartum women recorded every episode of sleep and wake each day during postpartum weeks 6, 12 and 18. Although repeated measures analysis revealed there was no significant difference in the amount of nocturnal sleep and frequency of night-time wakings, there was a significant reduction in sleep disruption, due to fewer minutes of wake after sleep onset. Subjective sleepiness was measured each day using the Karolinska Sleepiness Scale; at the two earlier time points this was significantly correlated with sleep quality but not to sleep quantity. Epworth Sleepiness Scores significantly reduced over time; however, during week 18 over 50% of participants were still experiencing excessive daytime sleepiness (Epworth Sleepiness Score ≥12). Results have implications for health care providers and policy makers. Health care providers designing interventions to address sleepiness in new mothers should take into account the dynamic changes to sleep and sleepiness during this initial postpartum period. Policy makers developing regulations for parental leave entitlements should take into consideration the high prevalence of excessive daytime sleepiness experienced by new mothers, ensuring enough opportunity for daytime sleepiness to diminish to a manageable level prior to reengagement in the workforce.

The effects of sleep restriction on executive inhibitory control and affect in young adults

Purpose: Young adults regularly experience restricted sleep due to a range of social, educational and vocational commitments. Evidence suggests that extended periods of sleep deprivation negatively impact affective and inhibitory control mechanisms leading to behavioural consequences such as increased emotional reactivity and impulsive behaviour. It is less clear whether acute periods of restricted sleep produce the same behavioural consequences. Methods: Nineteen young adults (m = 8, f = 12) with habitual late bed-time (after 22:30 h) and wake-time (after 06:30 h) completed a range of objective and subjective measures assessing sleepiness (Psychomotor Vigilance Task, Karolinska Sleepiness Scale), inhibitory control (Emotional Go/No-go Task and a Balloon Analog Risk Task) and affect (Positive and Negative Affective Schedule). Testing was counterbalanced across participants, and occurred on two occasions once following restricted sleep and once following habitual sleep one week apart. Results: Compared to habitual sleep, sleep restriction produced significantly slower performance on the Psychomotor Vigilance Task, and higher subjective ratings of sleepiness on the Karolinska Sleepiness Scale. Sleep restriction also caused a significant decrease in positive affect, but no change in negative affect on the Affective Schedule. Inhibitory control efficiency was significantly differentiated, with participants showing an increase in risk taking on the Balloon Analog Risk Task, but there was no evidence of increased reactivity to negative stimuli on the Emotional Go/No-go task. Conclusions: Results suggest that even acute periods of sleep loss may cause deficits in affective experiences and increase impulsive and potentially high risk behaviour in young adults.