A feasibility study of auricular therapy and self-administered acupressure for insomnia following cancer treatment

Introduction: Many cancer patients experience sleeping difficulties which can persist several years after the completion of cancer treatment. Previous research suggests that acupuncture, and variants of acupuncture (acupressure, auricular therapy) may be effective treatment options for sleep disturbance. However, current evidence is limited for cancer patients.

Methods: Feasibility study with 3 arms. Seven cancer patients with insomnia randomised to receive either auricular therapy (attaching semen vaccariae seeds to ear acupoints) (n=4), self-acupressure (n=1) or no treatment (n=2). Participants assigned to receive auricular therapy or self-acupressure stimulated the acupoints each night an hour before retiring to bed. The duration of participant involvement was 5 weeks. Subjective sleep quality was measured at baseline and post-treatment using the Pittsburgh Sleep Quality Index (PSQI). The impact of treatment on concerns of importance to the participants themselves was measured using the Measure Yourself Concerns and Wellbeing (MYCaW). Each participant also completed a treatment log book.

Results: All participants completed their treatment. All auricular therapy and self-acupressure participants recorded clinically significant improvements in global PSQI scores. In the auricular therapy arm mean global PSQI reduced from 12.5 at baseline to 8 following completion of treatment. In the self-acupressure arm PSQI reduced from 15 to 11. While in the no treatment arm the mean PSQI score was 14.5 at both baseline and follow up.

Conclusions: Despite the limited sample size, both auricular therapy and self-acupressure may represent potentially effective treatments for cancer patients with insomnia. The positive findings suggest further research is warranted into both treatment modalities.

Factors that impact on the use of mechanical ventilation weaning protocols in critically ill adults and children: a qualitative-evidence synthesis

Background:
Prolonged mechanical ventilation is associated with a longer intensive care unit (ICU) length of stay and higher mortality. Consequently, methods to improve ventilator weaning processes have been sought. Two recent Cochrane systematic reviews in ICU adult and paediatric populations concluded that protocols can be effective in reducing the duration of mechanical ventilation, but there was significant heterogeneity in study findings. Growing awareness of the benefits of understanding the contextual factors impacting on effectiveness has encouraged the integration of qualitative evidence syntheses with effectiveness reviews, which has delivered important insights into the reasons underpinning (differential) effectiveness of healthcare interventions.

Objectives:
1. To locate, appraise and synthesize qualitative evidence concerning the barriers and facilitators of the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

2. To integrate this synthesis with two Cochrane effectiveness reviews of protocolized weaning to help explain observed heterogeneity by identifying contextual factors that impact on the use of protocols for weaning critically-ill adults and children from mechanical ventilation;

3. To use the integrated body of evidence to suggest the circumstances in which weaning protocols are most likely to be used.

Search methods:
We used a range of search terms identified with the help of the SPICE (Setting, Perspective, Intervention, Comparison, Evaluation) mnemonic. Where available, we used appropriate methodological filters for specific databases. We searched the following databases: Ovid MEDLINE, Embase, OVID, PsycINFO, CINAHL Plus, EBSCOHost, Web of Science Core Collection, ASSIA, IBSS, Sociological Abstracts, ProQuest and LILACS on the 26th February 2015. In addition, we searched: the grey literature; the websites of professional associations for relevant publications; and the reference lists of all publications reviewed. We also contacted authors of the trials included in the effectiveness reviews as well as of studies (potentially) included in the qualitative synthesis, conducted citation searches of the publications reporting these studies, and contacted content experts.

We reran the search on 3rd July 2016 and found three studies, which are awaiting classification.

Selection criteria:
We included qualitative studies that described: the circumstances in which protocols are designed, implemented or used, or both, and the views and experiences of healthcare professionals either involved in the design, implementation or use of weaning protocols or involved in the weaning of critically-ill adults and children from mechanical ventilation not using protocols. We included studies that: reflected on any aspect of the use of protocols, explored contextual factors relevant to the development, implementation or use of weaning protocols, and reported contextual phenomena and outcomes identified as relevant to the effectiveness of protocolized weaning from mechanical ventilation.

Data collection and analysis:
At each stage, two review authors undertook designated tasks, with the results shared amongst the wider team for discussion and final development. We independently reviewed all retrieved titles, abstracts and full papers for inclusion, and independently extracted selected data from included studies. We used the findings of the included studies to develop a new set of analytic themes focused on the barriers and facilitators to the use of protocols, and further refined them to produce a set of summary statements. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to arrive at a final assessment of the overall confidence of the evidence used in the synthesis. We included all studies but undertook two sensitivity analyses to determine how the removal of certain bodies of evidence impacted on the content and confidence of the synthesis. We deployed a logic model to integrate the findings of the qualitative evidence synthesis with those of the Cochrane effectiveness reviews.

Main results:
We included 11 studies in our synthesis, involving 267 participants (one study did not report the number of participants). Five more studies are awaiting classification and will be dealt with when we update the review.

The quality of the evidence was mixed; of the 35 summary statements, we assessed 17 as ‘low’, 13 as ‘moderate’ and five as ‘high’ confidence. Our synthesis produced nine analytical themes, which report potential barriers and facilitators to the use of protocols. The themes are: the need for continual staff training and development; clinical experience as this promotes felt and perceived competence and confidence to wean; the vulnerability of weaning to disparate interprofessional working; an understanding of protocols as militating against a necessary proactivity in clinical practice; perceived nursing scope of practice and professional risk; ICU structure and processes of care; the ability of protocols to act as a prompt for shared care and consistency in weaning practice; maximizing the use of protocols through visibility and ease of implementation; and the ability of protocols to act as a framework for communication with parents.

Authors' conclusions:
There is a clear need for weaning protocols to take account of the social and cultural environment in which they are to be implemented. Irrespective of its inherent strengths, a protocol will not be used if it does not accommodate these complexities. In terms of protocol development, comprehensive interprofessional input will help to ensure broad-based understanding and a sense of ‘ownership’. In terms of implementation, all relevant ICU staff will benefit from general weaning as well as protocol-specific training; not only will this help secure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is in place. In order to maximize relevance and acceptability, protocols should be designed with the patient profile and requirements of the target ICU in mind. Predictably, an under-resourced ICU will impact adversely on protocol implementation, as staff will prioritize management of acutely deteriorating and critically-ill patients.

Testing the channel-based model of duration perception

The channel-based model of duration perception postulates the existence of neural mechanisms that respond selectively to a narrow range of stimulus durations centred on their preferred duration (Heron et al Proceedings of the Royal Society B 279 690–698). In principle the channel-based model could
explain recent reports of adaptation-induced, visual duration compression effects (Johnston et al Current Biology 16 472–479; Curran and Benton Cognition 122 252–257); from this perspective duration compression is a consequence of the adapting stimuli being presented for a longer duration than the test stimuli. In the current experiment observers adapted to a sequence of moving random dot patterns at the same retinal position, each 340ms in duration and separated by a variable (500–1000ms) interval. Following adaptation observers judged the duration of a 600ms test stimulus at the same location. The test stimulus moved in the same, or opposite, direction as the adaptor. Contrary to the channel-based
model’s prediction, test stimulus duration appeared compressed, rather than expanded, when it moved in the same direction as the adaptor. That test stimulus duration was not distorted when moving in the opposite direction further suggests that visual timing mechanisms are influenced by additional neural processing associated with the stimulus being timed.

The duration compression effect is mediated by adaptation of both retinotopic and spatiotopic mechanisms

The duration compression effect is a phenomenon in which prior adaptation to a spatially circumscribed dynamic stimulus results in the duration of subsequent subsecond stimuli presented in the adapted region being underestimated. There is disagreement over the frame of reference within which the duration compression phenomenon occurs. One view holds that the effect is driven by retinotopic-tuned mechanisms located at early stages of visual processing, and an alternate position is that the mechanisms are spatiotopic and occur at later stages of visual processing (MT+). We addressed the retinotopic-spatiotopic question by using adapting stimuli – drifting plaids - that are known to activate global-motion mechanisms in area MT. If spatiotopic mechanisms contribute to the duration compression effect, drifting plaid adaptors should be well suited to revealing them. Following adaptation participants were tasked with estimating the duration of a 600ms random dot stimulus, whose direction was identical to the pattern direction of the adapting plaid, presented at either the same retinotopic or the same spatiotopic location as the adaptor. Our results reveal significant duration compression in both conditions, pointing to the involvement of both retinotopic-tuned and spatiotopic-tuned mechanisms in the duration compression effect.

The "Eco" and "Low-carbon" promise: a critical review of China's experience

The scale and speed of China’s urbanization translate into major challenges for sustainability. Could the ‘eco-city’ and ‘low-carbon’ agendas, and the promotion of related pilot cities drive Chinese urban practice towards more environmentally sustainable solutions? We explore this question through a critical review of experience in China, identifying problems relating to the development of space, the treatment of scale and the pursuit of efficiency (the ‘space-scale-efficiency nexus’). China seeks sustainable solutions through eco and low-carbon agendas, but our review finds that current efforts fall short of expectations, and problematic patterns are repeated. We propose that a geo-administrative notion of functional regions could provide a strategic framework to address the range of design, physical and administrative planning problems, ensuring that eco-city and low-carbon city pilots result in comprehensive solutions that can be effectively replicated.

Motivations to participate in international trade fairs: the Portuguese experience

Motivations/barriers to participate in ITF

Social development of primary aged children through a movement education program

Unique in Canada, is a university based movement program offered to children aged 1-12 which is diverse and inclusive in its design to foster healthy physical, cognitive, affective and social development. The purpose of this study is to investigate how children's involvement in a weekly movement education program influences their social development. The primary-aged children involved in this research are participants in the university based Saturday morning program, The Children's Movement Program (CMP), in which creative dance, educational gymnastics and developmental games are employed to enhance optimal development. The 15 participants were systematically observed for 8 weeks as they naturally engaged in the program's activities. Interviews were conducted with both children and their caregivers throughout the duration of the program. Particular attention was paid to the perceptions of caregivers regarding the advantages of a program based upon principles of movement education. Results indicate that participation in the program increases children's opportunity to interact socially and address ways in which program content, pedagogy and context encourage social development. A figure was developed with these components to assist teachers in creating inclusive and meaningful movement experiences. 'Content' is referred to as the material to be learned or the desired outcome for the learner. 'Pedagogy' refers to the process in which the student will engage and 'Context' refers to the environment in which the experience occurs (eg. skating rink with playground balls). It is recommended that each is thoroughly addressed individually for its potential in lesson design.

Impacts and Detection of Design Smells

Les changements sont faits de façon continue dans le code source des logiciels pour prendre en compte les besoins des clients et corriger les fautes. Les changements continus peuvent conduire aux défauts de code et de conception. Les défauts de conception sont des mauvaises solutions à des problèmes récurrents de conception ou d’implémentation, généralement dans le développement orienté objet. Au cours des activités de compréhension et de changement et en raison du temps d’accès au marché, du manque de compréhension, et de leur expérience, les développeurs ne peuvent pas toujours suivre les normes de conception et les techniques de codage comme les patrons de conception. Par conséquent, ils introduisent des défauts de conception dans leurs systèmes. Dans la littérature, plusieurs auteurs ont fait valoir que les défauts de conception rendent les systèmes orientés objet plus difficile à comprendre, plus sujets aux fautes, et plus difficiles à changer que les systèmes sans les défauts de conception. Pourtant, seulement quelques-uns de ces auteurs ont fait une étude empirique sur l’impact des défauts de conception sur la compréhension et aucun d’entre eux n’a étudié l’impact des défauts de conception sur l’effort des développeurs pour corriger les fautes. Dans cette thèse, nous proposons trois principales contributions. La première contribution est une étude empirique pour apporter des preuves de l’impact des défauts de conception sur la compréhension et le changement. Nous concevons et effectuons deux expériences avec 59 sujets, afin d’évaluer l’impact de la composition de deux occurrences de Blob ou deux occurrences de spaghetti code sur la performance des développeurs effectuant des tâches de compréhension et de changement. Nous mesurons la performance des développeurs en utilisant: (1) l’indice de charge de travail de la NASA pour leurs efforts, (2) le temps qu’ils ont passé dans l’accomplissement de leurs tâches, et (3) les pourcentages de bonnes réponses. Les résultats des deux expériences ont montré que deux occurrences de Blob ou de spaghetti code sont un obstacle significatif pour la performance des développeurs lors de tâches de compréhension et de changement. Les résultats obtenus justifient les recherches antérieures sur la spécification et la détection des défauts de conception. Les équipes de développement de logiciels doivent mettre en garde les développeurs contre le nombre élevé d’occurrences de défauts de conception et recommander des refactorisations à chaque étape du processus de développement pour supprimer ces défauts de conception quand c’est possible. Dans la deuxième contribution, nous étudions la relation entre les défauts de conception et les fautes. Nous étudions l’impact de la présence des défauts de conception sur l’effort nécessaire pour corriger les fautes. Nous mesurons l’effort pour corriger les fautes à l’aide de trois indicateurs: (1) la durée de la période de correction, (2) le nombre de champs et méthodes touchés par la correction des fautes et (3) l’entropie des corrections de fautes dans le code-source. Nous menons une étude empirique avec 12 défauts de conception détectés dans 54 versions de quatre systèmes: ArgoUML, Eclipse, Mylyn, et Rhino. Nos résultats ont montré que la durée de la période de correction est plus longue pour les fautes impliquant des classes avec des défauts de conception. En outre, la correction des fautes dans les classes avec des défauts de conception fait changer plus de fichiers, plus les champs et des méthodes. Nous avons également observé que, après la correction d’une faute, le nombre d’occurrences de défauts de conception dans les classes impliquées dans la correction de la faute diminue. Comprendre l’impact des défauts de conception sur l’effort des développeurs pour corriger les fautes est important afin d’aider les équipes de développement pour mieux évaluer et prévoir l’impact de leurs décisions de conception et donc canaliser leurs efforts pour améliorer la qualité de leurs systèmes. Les équipes de développement doivent contrôler et supprimer les défauts de conception de leurs systèmes car ils sont susceptibles d’augmenter les efforts de changement. La troisième contribution concerne la détection des défauts de conception. Pendant les activités de maintenance, il est important de disposer d’un outil capable de détecter les défauts de conception de façon incrémentale et itérative. Ce processus de détection incrémentale et itérative pourrait réduire les coûts, les efforts et les ressources en permettant aux praticiens d’identifier et de prendre en compte les occurrences de défauts de conception comme ils les trouvent lors de la compréhension et des changements. Les chercheurs ont proposé des approches pour détecter les occurrences de défauts de conception, mais ces approches ont actuellement quatre limites: (1) elles nécessitent une connaissance approfondie des défauts de conception, (2) elles ont une précision et un rappel limités, (3) elles ne sont pas itératives et incrémentales et (4) elles ne peuvent pas être appliquées sur des sous-ensembles de systèmes. Pour surmonter ces limitations, nous introduisons SMURF, une nouvelle approche pour détecter les défauts de conception, basé sur une technique d’apprentissage automatique — machines à vecteur de support — et prenant en compte les retours des praticiens. Grâce à une étude empirique portant sur trois systèmes et quatre défauts de conception, nous avons montré que la précision et le rappel de SMURF sont supérieurs à ceux de DETEX et BDTEX lors de la détection des occurrences de défauts de conception. Nous avons également montré que SMURF peut être appliqué à la fois dans les configurations intra-système et inter-système. Enfin, nous avons montré que la précision et le rappel de SMURF sont améliorés quand on prend en compte les retours des praticiens.

Are primary and secondary provoked vestibulodynia two different entities? A comparison of pain, psychosocial and sexual characteristics.

Introduction Provoked vestibulodynia (PVD) is suspected to be the most frequent cause of vulvodynia in premenopausal women. Based on the onset of PVD relative to the start of sexual experience, PVD can be divided into primary (PVD1) and secondary PVD (PVD2). Studies comparing these PVD subgroups are inconclusive as to whether differences exist in sexual and psychosocial functioning. Aim The aim of this study was to compare the pain, sexual and psychosocial functioning of a large clinical and community-based sample of premenopausal women with PVD1 and PVD2. Methods A total of 269 women (n = 94 PVD1; n = 175 PVD2) completed measures on sociodemographics, pain, sexual, and psychosocial functioning. Main Outcome Measures Dependent variables were the 0–10 pain numerical rating scale, McGill–Melzack Pain Questionnaire, Female Sexual Function Index, Global Measure of Sexual Satisfaction, Beck Depression Inventory-II, Painful Intercourse Self-Efficacy Scale, Pain Catastrophizing Scale, State-Trait Anxiety Inventory Trait Subscale, Ambivalence over Emotional Expression Questionnaire, Hurlbert Index of Sexual Assertiveness, Experiences in Close Relationships Scale—Revised, and Dyadic Adjustment Scale-Revised. Results At first sexual relationship, women with PVD2 were significantly younger than women with PVD1 (P < 0.01). The average relationship duration was significantly longer in women with PVD2 compared with women with PVD1 (P < 0.01). Although women with PVD1 described a significantly longer duration of pain compared with women with PVD2 (P < 0.01), no significant subtype differences were found in pain intensity during intercourse. When controlling for the sociodemographics mentioned earlier, no significant differences were found in sexual, psychological, and relational functioning between the PVD subgroups. Nevertheless, on average, both groups were in the clinical range of sexual dysfunction and reported impaired psychological functioning. Conclusions The findings show that there are no significant differences in the sexual and psychosocial profiles of women with PVD1 and PVD2. Results suggest that similar psychosocial and sex therapy interventions should be offered to both subgroups of PVD.

Description and analysis of pulmonary rehabilitation care programs current state in four cities of Colombia

Purpose: there are many studies reporting the benefits of pulmonary rehabilitation, but few of them exhibit the behavior and activities of these services. This article presents the characteristics of services, parts management and training level of team members, in addition to the variables or instruments used to measure the effectiveness and impact in these programs. Method: it was made a cross sectional convenience sample which included seven pulmonary rehabilitation services in four Colombian cities (Bogotá, Medellín, Manizales and Cali), selected by the coverage, for having at least one year of experience and for being formally established and recognized nationwide. The interdisciplinary team of each service answered a survey that was validated through a pilot test and expert consensus. Participation was voluntary. Results: labor onset pulmonary rehabilitation services correspond to an average of a decade, with COPD and asthma pathologies of attention. The programs are characterized by an outpatient treatment with an average duration of eight to twelve weeks, with a frequency of an hour three times a week. Also, the director of the service is regularly a pulmonologist and the coordinator a physiotherapist (57.14%). The posgradual training of these professionals is notable, and they report to have procedural, administrative and communicative skills, but qualify regular there research skills. The physical and technological resources are well tested. 71.42% have done impact studies, but only 28.57% have been published. All have in common training in upper limbs, lower limbs, respiratory muscles, counseling, functional assessment and quality of life. The effectiveness and impact of programs is measured by the walking test, quality of life questionnaires and activities of daily living.

Infant feeding choices: experience, self-identity and lifestyle

In England 78% of mothers initiate breastfeeding and in the UK less than 1% exclusively breastfeed until 6 months, despite WHO recommendations to do so. This study investigated women’s infant feeding choices using in-depth interviews with 12 mothers of infants aged 7-18 weeks. Using content analysis, four themes emerged: (1) Information, Knowledge and Decision Making, (2) Physical Capability, (3) Family and Social Influences, (4) Lifestyle, Independence and Self-Identity. Whilst women were aware of the ‘Breast is Best’ message, some expressed distrust in this information if they had not been breastfed themselves. Women felt their own infant feeding choice was influenced by the perceived norm amongst family and friends. Women described how breastfeeding hindered their ability to retain their self-identities beyond motherhood as it limited their independence. Several second-time mothers felt they lacked support from health professionals when breastfeeding their second baby, even if they had previously encountered breastfeeding difficulties. The study indicates that experience of breastfeeding, and belief in the health benefits associated with it are important factors for initiation of breastfeeding, whilst decreased independence and self-identity may influence duration of breastfeeding. Intervention and support schemes should tackle all mothers, not just first-time mothers.

Impact of duration thresholds on Atlantic tropical cyclone counts*

Records of Atlantic basin tropical cyclones (TCs) since the late nineteenth century indicate a very large upward trend in storm frequency. This increase in documented TCs has been previously interpreted as resulting from anthropogenic climate change. However, improvements in observing and recording practices provide an alternative interpretation for these changes: recent studies suggest that the number of potentially missed TCs is sufficient to explain a large part of the recorded increase in TC counts. This study explores the influence of another factor—TC duration—on observed changes in TC frequency, using a widely used Atlantic hurricane database (HURDAT). It is found that the occurrence of short-lived storms (duration of 2 days or less) in the database has increased dramatically, from less than one per year in the late nineteenth–early twentieth century to about five per year since about 2000, while medium- to long-lived storms have increased little, if at all. Thus, the previously documented increase in total TC frequency since the late nineteenth century in the database is primarily due to an increase in very short-lived TCs. The authors also undertake a sampling study based upon the distribution of ship observations, which provides quantitative estimates of the frequency of missed TCs, focusing just on the moderate to long-lived systems with durations exceeding 2 days in the raw HURDAT. Upon adding the estimated numbers of missed TCs, the time series of moderate to long-lived Atlantic TCs show substantial multidecadal variability, but neither time series exhibits a significant trend since the late nineteenth century, with a nominal decrease in the adjusted time series. Thus, to understand the source of the century-scale increase in Atlantic TC counts in HURDAT, one must explain the relatively monotonic increase in very short-duration storms since the late nineteenth century. While it is possible that the recorded increase in short-duration TCs represents a real climate signal, the authors consider that it is more plausible that the increase arises primarily from improvements in the quantity and quality of observations, along with enhanced interpretation techniques. These have allowed National Hurricane Center forecasters to better monitor and detect initial TC formation, and thus incorporate increasing numbers of very short-lived systems into the TC database.

A Lagrangian analysis of ice-supersaturated air over the North Atlantic

Understanding the nature of air parcels that exhibit ice-supersaturation is important because they are the regions of potential formation of both cirrus and aircraft contrails, which affect the radiation balance. Ice-supersaturated air parcels in the upper troposphere and lower stratosphere over the North Atlantic are investigated using Lagrangian trajectories. The trajectory calculations use ERA-Interim data for three winter and three summer seasons, resulting in approximately 200,000 trajectories with ice-supersaturation for each season. For both summer and winter, the median duration of ice-supersaturation along a trajectory is less than 6 hours. 5% of air which becomes ice-supersaturated in the troposphere, and 23% of air which becomes ice-supersaturated in the stratosphere will remain ice-supersaturated for at least 24 hours. Weighting the ice-supersaturation duration with the observed frequency indicates the likely overall importance of the longer duration ice-supersaturated trajectories. Ice-supersaturated air parcels typically experience a decrease in moisture content while ice-supersaturated, suggesting that cirrus clouds eventually form in the majority of such air. A comparison is made between short-lived (less than 24 h) and long-lived (greater than 24 h) ice-supersaturated air flows. For both air flows, ice-supersaturation occurs around the northernmost part of the trajectory. Short-lived ice-supersaturated air flows show no significant differences in speed or direction of movement to subsaturated air parcels. However, long-lived ice-supersaturated air occurs in slower moving air flows, which implies that they are not associated with the fastest moving air through a jet stream.

Explaining sleep duration in adolescents: The impact of socio-demographic and lifestyle factors and working status

Previous studies found students who both work and attend school undergo a partial sleep deprivation that accumulates across the week. The aim of the present study was to obtain information using a questionnaire on a number of variables (e.g., socio-demographics, lifestyle, work timing, and sleep-wake habits) considered to impact on sleep duration of working (n = 51) and non-working (n = 41) high-school students aged 14-21 yrs old attending evening classes (19:00-22:30h) at a public school in the city of Sao Paulo, Brazil. Data were collected for working days and days off. Multiple linear regression analyses were performed to assess the factors associated with sleep duration on weekdays and weekends. Work, sex, age, smoking, consumption of alcohol and caffeine, and physical activity were considered control variables. Significant predictors of sleep duration were: work (p < 0.01), daily work duration (8-10h/day; p < 0.01), sex (p = 0.04), age 18-21 yrs (0.01), smoking (p = 0.02) and drinking habits (p = 0.03), irregular physical exercise (p < 0.01), ease of falling asleep (p = 0.04), and the sleep-wake cycle variables of napping (p < 0.01), nocturnal awakenings (p < 0.01), and mid-sleep regularity (p < 0.01). The results confirm the hypotheses that young students who work and attend school showed a reduction in night-time sleep duration. Sleep deprivation across the week, particularly in students working 8-10h/day, is manifested through a sleep rebound (i.e., extended sleep duration) on Saturdays. However, the different roles played by socio-demographic and lifestyle variables have proven to be factors that intervene with nocturnal sleep duration. The variables related to the sleep-wake cyclenaps and night awakeningsproved to be associated with a slight reduction in night-time sleep, while regularity in sleep and wake-up schedules was shown to be associated with more extended sleep duration, with a distinct expression along the week and the weekend. Having to attend school and work, coupled with other socio-demographic and lifestyle factors, creates an unfavorable scenario for satisfactory sleep duration.

Influence of examiner's clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

The aim of this in vitro study was to assess the influence of varying examiner's clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n=5; B, n=5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n=5; D, n=5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11-0.40), B (0.12-0.33), C (0.47-0.58), and D (0.42-0.71). Interexaminer reproducibility statistics were computed based on means +/- SD of unweighted kappa values: A (0.07 +/- 0.05), B (0.12 +/- 0.09), C (0.24 +/- 0.08), and D (0.33 +/- 0.10). Sensitivity, specificity, and accuracy were calculated at D(1) and D(3) thresholds and compared by performing McNemar test (p=0.05). D(1) sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D(3) specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman's correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner's clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.