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JOHNSON, KATE. "Treatment for Nocturnal Reflux Often Falls Short." Internal Medicine News 38, no. 22 (November 2005): 59. http://dx.doi.org/10.1016/s1097-8690(05)72398-2.
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Suman, Sanjay, Dudley Robinson, Nadia Bhal, Susannah Fraser, Angus MacCormick, Ann Williams, and Sergey Tadtayev. "Management of nocturia: overcoming the challenges of nocturnal polyuria." British Journal of Hospital Medicine 80, no. 9 (September 2, 2019): 517–24. http://dx.doi.org/10.12968/hmed.2019.80.9.517.
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Nocturia may be a multifactorial condition and should be regarded as a syndrome rather than a diagnosis, with many factors contributing to the clinical presentation. The effects of sleep deprivation can have a severely detrimental impact on the quality of life and productivity of the working age population, with considerable economic implications. Patients are unlikely to seek an appointment with their GP complaining of nocturia – they are more likely to complain of the effects of the condition, such as chronic tiredness, or injuries resulting from falls. The main criterion in deciding whether a patient should undergo further investigations into suspected nocturia is the degree to which the patient finds the condition bothersome. In some patients, lifestyle modifications may be an effective way to manage nocturia before medication is considered. As the only licensed product for all adults including those over 65 years of age, low dose desmopressin (Noqdirna® (as lyophilisate) Ferring Pharmaceuticals Ltd) is highly effective in the management of idiopathic nocturnal polyuria, producing improvements in clinical symptoms, sleep parameters and quality of life. Care should be administered as a joint enterprise between the patient's GP and colleagues in secondary care. This article outlines the findings of a roundtable discussion into the optimal management of patients with nocturnal polyuria.
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Miyajima, Shigero, Taisei Omaru, Tatsu Ishii, Hisatomi Arima, Yozo Shibata, Teruaki Izaki, and Nobuhiro Haga. "Real-World Evidence for Risk Factors of Bruises and Fractures from Falls in Patients with Overactive Bladder: A Medical Record Analysis." International Journal of Clinical Practice 2023 (December 27, 2023): 1–6. http://dx.doi.org/10.1155/2023/3701823.
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Aim. To identify the risk factors for bruises and fractures from falls in patients with overactive bladder (OAB). Methods. We evaluated 1136 patients with OAB and aged ≥50 years who visited our hospital. Age, sex, frequency of nocturnal urination, and urinary incontinence type were investigated in the 360 eligible patients. Patients were divided into three groups: those patients without falls (no-fall group), those with fall bruises (bruise group), and those with fall fractures (fracture group). The risk factors for bruises and fractures in patients with OAB were evaluated using the logistic regression analysis. In addition, association between the bruises or fractures from falls and the behavior around urination during the night was investigated. Results. The multivariate logistic regression analysis showed that female sex (odds ratio (OR) 2.888, p = 0.030) and nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.940; p = 0.040) were significantly associated with bruises. Nocturnal urination frequency ≥3 times/night (OR vs. ≤2 times/night, 2.835; p = 0.026) and urge incontinence (OR 3.415, p = 0.016) were significantly associated with fractures. Behavior around urination during the night was significantly associated with fractures (p = 0.009). Conclusion. In the real-world clinical setting, increasing nocturnal urination frequency is a common risk factor for bruises and fractures. Also, female sex and urge incontinence were the risk factors for bruises and fractures, respectively. OAB patients with urge incontinence would especially require aggressive intervention to prevent fractures during night-time voiding.
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Graf, R., S. Krishna, and H. C. Heller. "Regulated nocturnal hypothermia induced in pigeons by food deprivation." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 256, no. 3 (March 1, 1989): R733—R738. http://dx.doi.org/10.1152/ajpregu.1989.256.3.r733.
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The daily body temperature (Tb) cycle of pigeons is altered by food deprivation in that Tb falls to lower and lower levels on consecutive nights after the onset of deprivation, whereas the Tb levels during corresponding days remain nearly unchanged. Manipulations of spinal cord temperature, a major feedback parameter in the avian thermoregulatory system, reveal that episodes of nocturnal hypothermia are regulated. The spinal cord threshold temperature for inducing increases in metabolic heat production falls to progressively lower levels each night and returns to normal euthermic levels during the day.
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Stevens, David, Brianna Jackson, Jayne Carberry, James McLoughlin, Chris Barr, Sutapa Mukherjee, Aaron Oh, R. Doug McEvoy, Maria Crotty, and Andrew Vakulin. "The Impact of Obstructive Sleep Apnea on Balance, Gait, and Falls Risk: A Narrative Review of the Literature." Journals of Gerontology: Series A 75, no. 12 (February 10, 2020): 2450–60. http://dx.doi.org/10.1093/gerona/glaa014.
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Abstract Falls-related hospitalization and injury rates are steadily increasing globally due to a growth in the aging population, and the associated health problems that increase risk of falls. One such associated health problem is sleep disturbances and disorders. Recent cohort studies have shown that subjectively reported poor quality sleep is associated with an increased risk of falls. Obstructive sleep apnea (OSA) is a common sleep disorder characterized by the repetitive reductions, or cessation, of airflow. Some studies have shown that OSA impairs posture/balance and gait with nocturnal hypoxemia the likely main cause. Emerging evidence suggests that treating OSA by continuous positive airway pressure (CPAP) can improve gait, but no studies to date have examined the effect of CPAP on posture/balance. The overall control of balance relies on a complex interaction between several physiological functions including vestibular, muscle, visual, and cognitive functions. We postulate that OSA impacts balance by affecting these different systems to various degrees, with the nocturnal hypoxic burden likely playing an important role. Importantly, these impairments in balance/posture and possible falls risk may be alleviated by OSA treatment. Larger mechanistic studies are needed to properly elucidate how OSA affects falls risk and future large-scale randomized control trials are needed to determine the effectiveness of OSA treatment in reducing the risk of falls.
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Monaghan, T. F., A. S. Wagg, C. W. Agudelo, S. N. Rahman, K. P. Michelson, M. R. Epstein, K. Everaert, J. M. Lazar, J. P. Weiss, and D. L. Bliwise. "0822 Frail Older Men With Nocturia are Disproportionately Affected by Excess Nocturnal Urine Production." Sleep 43, Supplement_1 (April 2020): A313. http://dx.doi.org/10.1093/sleep/zsaa056.818.
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Abstract Introduction Nocturia is a risk factor for falls and hip fractures in older adults. We determined whether the Frailty Index (FI), incorporating comorbidities, functional performance, and physical signs, was associated with nocturia frequency and/or overnight urine production. Methods We examined nightly (24-hour) voiding diaries (men ≥65 years) in an outpatient urologic clinic demonstrating ≥2 nocturnal voids (n=158). FI calculations followed Rockwood (CMAJ 2005;173:489-95). A total of 39 conditions were assessed. Three FI groups were established: Low (≤0.077) (n=59), Intermediate (>0.077 and <0.179) (n=58), and High (≥0.179) (n=41). We compared number of nocturnal voids (NV), nocturnal urine volume (NUV) (in mL), and 24-hr total urine volume (24-hr TUV) (in mL) across groups. Results NV did not differ by group (p=0.333) (median for all groups=3). However, NUV (916 [671-1419] vs. 690 [505-942] vs. 630 [500-1050] mL) differentiated the High, Medium and Low FI groups (p<0.001 via Kruskal-Wallis with Bonferroni pairwise adjustments), respectively. Similarly, 24-hr TUV differentiated the 3 groups (2200 [1800-2550] vs. 1620 [1259-2119] vs. 1650 [1390-2517] mL, p=0.005). Differences in NUV remained significant (p=0.006) after eliminating Diabetes Mellitus cases (n=44). However, differences did not persist for 24-hr TUV (p=0.180). Conclusion Higher NUV, but not 24-hr TUV, was a robust correlate of frailty in these older men. Accounting for diabetes did not diminish the effect. Although undiagnosed sleep apnea remains a possible cause, recent chronobiologic data (Monaghan et al, Age Aging, 2020, in press) suggest that nocturia in the aged is characterized by excess free water clearance early in the sleep period. This argues against solute-driven urine production (as might be expected in sleep apnea) in accounting for the effect. Nocturia may represent a conspicuous and important change in circadian rhythm of urine production occurring in old age. Support N/A
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Croce, Alessandro, Grzegorz Bilo, Martino F. Pengo, Alice Margherita Ornago, Alice Ricco, Giuseppe Bellelli, and Gianfranco Parati. "CLINICAL SIGNIFICANCE OF NIGHTTIME BLOOD PRESSURE: EXPLORING THE ASSOCIATION OF NOCTURNAL HYPOTENSIVE PHENOTYPE AND HISTORY OF FALLS IN ELDERLY HYPERTENSIVE PATIENTS." Journal of Hypertension 42, Suppl 1 (May 2024): e41. http://dx.doi.org/10.1097/01.hjh.0001019664.42434.7e.
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Objective: falls are a major health problem in elderly, approximately 28–35% of individuals aged > 65 years’ experience falls each year. Previous studies suggested that unexplained falls may mask a syncope or pseudo-syncope in almost 50% of cases, and that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ambulatory blood pressure monitoring (ABPM), the so-called hypotensive phenotype. However, it is not clear whether hypotensive phenotype may be itself associated with falls. We investigate if hypotensive phenotype is associated with history of falls in elderly hypertensive. Design and method: a cross-sectional study that included treated hypertensive patients aged >=75 years evaluated at the Hypertension Center of Istituto Auxologico Italiano IRCCS in Milan. We excluded patients with a life expectancy of less than 6 months. All participants underwent ABPM. History of falls within the last year was recorded and multidimensional geriatric assessment to estimate frailty using Frailty accumulation index was performed. Daytime and night-time hypotensive phenotypes were defined as at least one SBP drops <90 mmHg on ABPM during daytime and night-time, respectively. The same analysis was repeated by considering cut-off of SBP <80 mmHg both during day and night-time. Results: we enrolled 105 patients, mainly females (n=80, 76%) with a mean age of 82 (± 4) years. In 74 (70%) patients day-time hypotensive phenotype was present at ABPM, while nighttime hypotensive phenotype was present in 24 of them (23%). Among participants 21 (20%) experienced a fall in the last 12 months; compared for age, sex, BMI, frailty index and BP patients with falls and not have no significant differences. Regardless of SBP cut-off, nocturnal hypotensive phenotype was associated with history of falls while daytime hypotensive phenotype was not. (Figure 1). Conclusions: In our study, nighttime but not daytime BP drops were associated with falls in treated hypertensive elderly patients. The mechanistic role of nighttime hypotensive phenotype and its association with syncope and falls will need to be evaluated in larger prospective studies to better clarify the utility of ABPM in falls prediction in elderly.
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Kario, Kazuomi, Thomas G. Pickering, Takefumi Matsuo, Satoshi Hoshide, Joseph E. Schwartz, and Kazuyuki Shimada. "Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives." Hypertension 38, no. 4 (October 2001): 852–57. http://dx.doi.org/10.1161/hy1001.092640.
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Song, Xiaowei, and Benjamin Rusak. "Acute effects of light on body temperature and activity in Syrian hamsters: influence of circadian phase." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 278, no. 5 (May 1, 2000): R1369—R1380. http://dx.doi.org/10.1152/ajpregu.2000.278.5.r1369.
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Light exposure at night causes an acute increase in human body temperature, which normally falls during the night. This change is largely attributable to the suppression by light of the nocturnal rise in melatonin levels. Little is known, however, about the effects of light on body temperature in nocturnally active mammals in which the nightly peak in melatonin secretion coincides with the circadian phase of elevated, rather than decreased, body temperature. We investigated the effects of a 1-h exposure to light on body temperature and activity of Syrian hamsters, Mesocricetus auratus, at two phases during the night and at two phases during the projected day. Brain or abdominal temperature was recorded continuously using implanted radio transmitters while locomotor activity was monitored simultaneously using a passive infrared movement detector. Responses to light exposure were strongly circadian phase dependent; light during the night caused elevations in both brain and core body temperature, whereas light during the projected day did not. Temperature increases at night could not be attributed solely to activity increases at the onset of light pulses, indicating a contribution from nonbehavioral mechanisms of thermogenesis. These results provide the first evidence for circadian modulation of acute temperature responses to light in a nocturnal mammal.
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Ballard, R. D., M. C. Saathoff, D. K. Patel, P. L. Kelly, and R. J. Martin. "Effect of sleep on nocturnal bronchoconstriction and ventilatory patterns in asthmatics." Journal of Applied Physiology 67, no. 1 (July 1, 1989): 243–49. http://dx.doi.org/10.1152/jappl.1989.67.1.243.
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To assess the effect of sleep on airflow resistance and patterns of ventilation in asthmatic patients with nocturnal worsening, 10 adult subjects (6 asthmatic patients with nocturnal worsening, 4 normal controls) were monitored overnight in the sleep laboratory on two separate occasions. During 1 night, subjects were allowed to sleep normally, whereas during the other night all sleep was prevented. The six asthmatic patients demonstrated progressive increases in lower airway resistance (Rla) on both nights, but the rate of increase was twofold greater (P less than 0.0001) during the sleep night compared with the sleep prevention night. However, overnight decrements in forced expired volume in 1 s (FEV1) were similar over the 2 nights. The asthmatic patients maintained their minute ventilation as Rla increased during sleep, demonstrating a stable tidal volume with a mild increase in respiratory frequency. We conclude that in asthmatic patients with nocturnal worsening 1) Rla increases and FEV1 falls overnight regardless of sleep state, 2) sleep enhances the observed overnight increases in Rla, and 3) sleep does not abolish compensatory ventilatory responses to spontaneously occurring bronchoconstriction.
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Magota, C., S. Ando, M. Nishizaka, K. Horikoshi, K. Tanaka, M. Miyazono, N. Hashiguchi, T. Ohkusa, and A. Chishaki. "A study on the meteorological analysis of nocturnal falls during sleep in hospital." Sleep Medicine 16 (December 2015): S200. http://dx.doi.org/10.1016/j.sleep.2015.02.1413.
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Kass-Iliyya, Antoine, and Hashim Hashim. "Nocturnal polyuria: Literature review of definition, pathophysiology, investigations and treatment." Journal of Clinical Urology 12, no. 1 (February 22, 2018): 60–71. http://dx.doi.org/10.1177/2051415818756792.
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Nocturnal polyuria (NP) is characterised by increased urine production overnight in comparison to daytime. It has significant adverse events in adults including reduced quality of life, increased risk of falls and increased mortality. Although NP can be a manifestation of other significant conditions like heart failure and sleep apnoea, there are lots of unanswered questions about NP. What is the underlying pathophysiology? Is NP a physiological manifestation of ageing? Is the circadian change of vasopressin release the primary pathology? Or is it a secondary phenomenon to a low diurnal production of urine? Is the primary pathology at the kidney level or is there another humoral, cardiac, or endovascular element? In this article, we summarise the available English-language literature on the subject of NP, including its epidemiology, pathogenesis, diagnosis and treatment. Level of evidence: Not applicable for this multicentre audit.
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Vishnu Prasanth, P., V. Sivakumar, S. Sridharan, Y. Bhavani Kumar, H. Bencherif, and D. Narayana Rao. "Lidar observations of sodium layer over low latitude, Gadanki (13.5° N, 79.2° E): seasonal and nocturnal variations." Annales Geophysicae 27, no. 10 (October 7, 2009): 3811–23. http://dx.doi.org/10.5194/angeo-27-3811-2009.
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Abstract. In this paper, we present seasonal and nocturnal variations of mesospheric sodium (Na) layer parameters observed over Gadanki (13.5° N, 79.2° E), based on 166 nights during the period from January 2005 to December 2006, for the first time. The total Na content decreases during the evening and reaches a minimum value around midnight and maximum in the early morning. The year-to-year variations illustrate that Na layers reach the peak value close to 93.5 km for the year 2005 and ~93 km for the year 2006 and falls to near zero value around 110 km. Though, seasonal variation of sodium density illustrate maximum values in September, December and March, we require a larger data base for September months to conclude the statement. The column abundance shows maximum during autumn equinox and minimum during winter. The obtained seasonal and nocturnal variation of sodium layer parameters are compared with mid-latitude observations and further possible mechanisms are discussed.
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Mcarthur, L. J., and Jeanne E. Young. "A survey of nocturnal reptiles of Robin Falls, Northern Territory: implications of Bufo marinus." Northern Territory Naturalist 18 (November 2005): 21–33. http://dx.doi.org/10.5962/p.295532.
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Pierangeli, G., F. Provini, P. Maltoni, G. Barletta, M. Contin, E. Lugaresi, P. Montagna, and P. Cortelli. "Nocturnal body core temperature falls in Parkinson's disease but not in multiple-system atrophy." Movement Disorders 16, no. 2 (2001): 226–32. http://dx.doi.org/10.1002/mds.1039.
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Parameswaran, Sajeesh, Ponnu Sankarapillai, Ajith Mohan, Anil Kumar T V, Aswin Ganesh M, and A. Marthanda Pillai. "Syncope masquerading narcolepsy- An unusual presentation." IP Indian Journal of Neurosciences 8, no. 4 (January 15, 2023): 286–88. http://dx.doi.org/10.18231/j.ijn.2022.056.
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Narcolepsy is a rare disorder of sleep wake cycle which can result in persistent excessive day time sleepiness. It is due to the deficiency of the Orexin/Hypocretin in the body. Most of these cases are reported in young adults and are difficult to diagnose early. This can lead to serious impairments in social and occupational settings if not promptly treated. Thus we are reporting an interesting case of a teenager who presented with falls. He was diagnosed with nocturnal Polysomnography followed by Multiple Sleep Latency Test (MSLT), and he significantly benefitted from treatment with Modafinil.
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Terrill, Philip Ian, Carolyn Dakin, Ian Hughes, Maggie Yuill, and Chloe Parsley. "Nocturnal oxygen saturation profiles of healthy term infants." Archives of Disease in Childhood 100, no. 1 (July 25, 2014): 18–23. http://dx.doi.org/10.1136/archdischild-2013-305708.
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ObjectivePulse oximetry is used extensively in hospital and home settings to measure arterial oxygen saturation (SpO2). Interpretation of the trend and range of SpO2values observed in infants is currently limited by a lack of reference ranges using current devices, and may be augmented by development of cumulative frequency (CF) reference-curves. This study aims to provide reference oxygen saturation values from a prospective longitudinal cohort of healthy infants.DesignProspective longitudinal cohort study.SettingSleep-laboratory.Patients34 healthy term infants were enrolled, and studied at 2 weeks, 3, 6, 12 and 24 months of age (N=30, 25, 27, 26, 20, respectively).InterventionsFull overnight polysomnography, including 2 s averaging pulse oximetry (Masimo Radical).Main outcome measurementsSummary SpO2statistics (mean, median, 5th and 10th percentiles) and SpO2CF plots were calculated for each recording. CF reference-curves were then generated for each study age. Analyses were repeated with sleep-state stratifications and inclusion of manual artefact removal.ResultsMedian nocturnal SpO2values ranged between 98% and 99% over the first 2 years of life and the CF reference-curves shift right by 1% between 2 weeks and 3 months. CF reference-curves did not change with manual artefact removal during sleep and did not vary between rapid eye movement (REM) and non-REM sleep. Manual artefact removal did significantly change summary statistics and CF reference-curves during wake.ConclusionsSpO2CF curves provide an intuitive visual tool for evaluating whether an individual's nocturnal SpO2distribution falls within the range of healthy age-matched infants, thereby complementing summary statistics in the interpretation of extended oximetry recordings in infants.
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Remmers, Neeley, Michael Anderson, and John Nelson. "829 Chronic sleep deprivation in a 75-year-old female leading to micro-sleeps with atonia causing increased falls." Sleep 44, Supplement_2 (May 1, 2021): A323. http://dx.doi.org/10.1093/sleep/zsab072.826.
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Abstract Introduction Each year, 3 million older people are treated in emergency departments for fall-related injuries. These falls can lead to serious injuries and expensive health care costs. Some have looked into the relationship between chronic sleep disturbances and falls linking chronic sleep deprivation or excessive sleep to falling. Here, we present a unique case of chronic sleep deprivation causing sleep attacks or micro-sleeps with atonia causing falls. Report of case(s) We present a 75-year-old F with a history of increased daily falls up to 4x per day that began 3 years ago. She denies any triggering events, auras, frequent tripping, loss of balance or weakness. Reportedly, she will be walking along then suddenly falls. She is aware that she is falling yet feels as though she cannot prevent/stop the fall or break her fall. No one has witnessed her fall, but is frequently found lying on the floor. She has never sustained a serious injury as a result of her falls. She has an 8 year history of restless legs syndrome treated with ropinirole and a 10 year history of obstructive sleep apnea (OSA) treated with CPAP. Her general bedtime is 2200 and wake-time is 0400 with an average 3–4 hrs of quality sleep per night for many years. She endorses severe daytime hypersomnolence and chronic hypoxemia on 3L home oxygen. We hypothesized her falls were secondary to sleep attacks or micro-sleeps where she enters REM sleep and develops atonia. Nocturnal sleep study followed by MSLT showed severe OSA with severe, persistent daytime sleeping with REM sleep and atonia. She had a mean sleep latency of 2 minutes with 1 sleep-onset REM period. We started NIPPV with supplemental oxygen treatment, and within 4 months her daytime hypersomnolence resolved, exercise intolerance improved, saturations improved to 89–90% on room air, and has <1 fall per day. Conclusion Here, we presented a unique case of a 75 yo F with recurrent falls secondary to chronic sleep deprivation causing micro-sleeps involving REM sleep and atonia. She was treated with NIPPV which improved her oxygenation and reduced her number of falls to <1 per day. Support (if any):
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Ballard, R. D., C. G. Irvin, R. J. Martin, J. Pak, R. Pandey, and D. P. White. "Influence of sleep on lung volume in asthmatic patients and normal subjects." Journal of Applied Physiology 68, no. 5 (May 1, 1990): 2034–41. http://dx.doi.org/10.1152/jappl.1990.68.5.2034.
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To assess the effect of sleep on functional residual capacity (FRC) in normal subjects and asthmatic patients, 10 adult subjects (5 asthmatic patients with nocturnal worsening, 5 normal controls) were monitored overnight in a horizontal volume-displacement body plethysmograph. With the use of a single inspiratory occlusion technique, we determined that when supine and awake, asthmatic patients were hyperinflated relative to normal controls (FRC = 3.46 +/- 0.18 and 2.95 +/- 0.13 liters, respectively; P less than 0.05). During sleep FRC decreased in both groups, but the decrease was significantly greater in asthmatic patients such that during rapid-eye-movement (REM) sleep FRC was equivalent between the asthmatic and normal groups (FRC = 2.46 +/- 0.23 and 2.45 +/- 0.09 liters, respectively). Specific pulmonary conductance decreased progressively and significantly in the asthmatic patients during the night, falling from 0.047 +/- 0.007 to 0.018 +/- 0.002 cmH2O-1.s-1 (P less than 0.01). There was a significant linear relationship through the night between FRC and pulmonary conductance in only two of the five asthmatic patients (r = 0.55 and 0.65, respectively). We conclude that 1) FRC falls during sleep in both normal subjects and asthmatic patients, 2) the hyperinflation observed in awake asthmatic patients is diminished during non-REM sleep and eliminated during REM sleep, and 3) sleep-associated reductions in FRC may contribute to but do not account for all the nocturnal increase in airflow resistance observed in asthmatic patients with nocturnal worsening.
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Urso, Daniele, Roberto De Blasi, Antonio Anastasia, Valentina Gnoni, Valentina Rizzo, Salvatore Nigro, Benedetta Tafuri, et al. "Neuroimaging Findings in a Patient with Anti-IgLON5 Disease: Cerebrospinal Fluid Dynamics Abnormalities." Diagnostics 12, no. 4 (March 30, 2022): 849. http://dx.doi.org/10.3390/diagnostics12040849.
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Anti-IgLON5 disease is a recently described autoimmune neurodegenerative disorder characterized by insidious onset, slow progression and a variety of neurological features. Neuroimaging in most patients with anti-IgLON5 disease is normal or shows nonspecific findings. Here, we report a case of anti-IgLON5 disease presenting with parkinsonism, falls, sleep problems with severe nocturnal dyspnea attacks, dysphagia, and dysautonomia. Imaging findings were initially suggestive of progressive supranuclear palsy. An altered cerebrospinal fluid dynamic was found on an MRI as well as high-convexity hyperperfusion on a brain SPECT. Further case descriptions with neuroimaging are required to characterize cerebral and cerebrospinal fluid dynamics abnormalities in this rare condition.
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OMBONI, Stefano, Adrianus A. J. SMIT, Johannes J. VAN LIESHOUT, Jos J. SETTELS, Gerard J. LANGEWOUTERS, and Wouter WIELING. "Mechanisms underlying the impairment in orthostatic tolerance after nocturnal recumbency in patients with autonomic failure." Clinical Science 101, no. 6 (October 29, 2001): 609–18. http://dx.doi.org/10.1042/cs1010609.
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In the present study, we have assessed in patients with neurogenic orthostatic hypotension the haemodynamics underlying the reduced tolerance to standing after prolonged recumbency at night. In 10 patients with neurogenic orthostatic hypotension (age 33-68 years), of which seven were being treated with fludrocortisone and/or sleeping in the 12° head-up tilt position, 24h continuous non-invasive finger blood pressure was recorded by a Portapres device. Beat-to-beat blood pressure, heart rate, stroke volume, cardiac output and total peripheral vascular resistance obtained by pulse contour analysis were assessed during 5min of standing in the evening (at 22.30 hours) and in the morning (at 06.30hours). On average, the inverse of the normal 24h blood pressure profile was found, with a large diversity in blood pressure profiles among patients. Supine blood pressure values were similar, but standing blood pressure values were lower in the morning than in the evening (P < 0.01). This resulted from larger falls in stroke volume and cardiac output upon standing in the morning compared with the evening, while total peripheral resistance did not change. There was no relationship between the decrease in body weight during the night (mean 0.9kg; range 0.2-1.6kg) and the evening-morning difference in standing blood pressure. We conclude that, in patients with neurogenic orthostatic hypotension, the impaired tolerance to standing in the morning is due to larger falls in stroke volume and cardiac output. Not only nocturnal polyuria, but also a redistribution of body fluid, are likely mechanisms underlying the pronounced decreases in stroke volume and cardiac output after prolonged recumbency at night.
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Clay, Natalie A., Donald B. Shepard, Adrian A. Garda, Daniel O. Mesquita, and Alexandre Vasconcellos. "Evidence of sodium limitation in ants and termites in a Neotropical savanna." Journal of Tropical Ecology 38, no. 2 (January 7, 2022): 71–78. http://dx.doi.org/10.1017/s0266467421000535.
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AbstractNutritional ecology of ropical ecosystems like Neotropical savannas, which are of high conservation concern, is understudied. Sodium is essential for heterotrophs but availability often falls short relative to plant consumer requirements. Savanna plant consumers like ants and termites should be sodium-limited due to high temperatures, nutrient-poor soils, and lack of oceanic sodium deposition. We tested the hypothesis that Neotropical savanna ants and termites are sodium-limited. Termites were tested by supplementing 0.25 m2 plots with H2O (control), 0.1%, 0.5%, or 1.0% NaCl and measuring termite presence and artificial substrate mass loss after 1 week. Ants were tested by collecting ants that recruited to H2O (control), 0.1%, 0.5%, and 1.0% NaCl and 1.0%, 10%, and 20% sugar baits on paired diurnal–nocturnal transects. Termites were 16 times more likely to occur on 1% NaCl than H2O plots and wood-feeding termites were most frequent. However, the decomposition rate did not differ among treatments. Ant bait use increased with increasing NaCl concentration and 1% NaCl usage was similar to sugar bait usage. Ants were 3.7 times more active nocturnally than diurnally, but contrary to predictions bait type (water, sugar or NaCl) usage did not differ between day and night. Together, these results provide strong evidence of sodium limitation in Neotropical savannas.
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Catterall, J. R., P. M. Calverley, W. MacNee, P. M. Warren, C. M. Shapiro, N. J. Douglas, and D. C. Flenley. "Mechanism of transient nocturnal hypoxemia in hypoxic chronic bronchitis and emphysema." Journal of Applied Physiology 59, no. 6 (December 1, 1985): 1698–703. http://dx.doi.org/10.1152/jappl.1985.59.6.1698.
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In five patients with hypoxic chronic bronchitis and emphysema we measured ear O2 saturation (SaO2), chest movement, oronasal airflow, arterial and mixed venous gas tensions, and cardiac output during nine hypoxemic episodes (HE; SaO2 falls greater than 10%) in rapid-eye-movement (REM) sleep and during preceding periods of stable oxygenation in non-REM sleep. All nine HE occurred with recurrent short episodes of reduced chest movement, none with sleep apnea. The arterial PO2 (PaO2) fell by 6.0 +/- 1.9 (SD) Torr during the HE (P less than 0.01), but mean arterial PCO2 (PaCO2) rose by only 1.4 +/- 2.4 Torr (P greater than 0.4). The arteriovenous O2 content difference fell by 0.64 +/- 0.43 ml/100 ml of blood during the HE (P less than 0.05), but there was no significant change in cardiac output. Changes observed in PaO2 and PaCO2 during HE were similar to those in four normal subjects during 90 s of voluntary hypoventilation, when PaO2 fell by 12.3 +/- 5.6 Torr (P less than 0.05), but mean PaCO2 rose by only 2.8 +/- 2.1 Torr (P greater than 0.4). We suggest that the transient hypoxemia which occurs during REM sleep in patients with chronic bronchitis and emphysema could be explained by hypoventilation during REM sleep but that the importance of changes in distribution of ventilation-perfusion ratios cannot be assessed by presently available techniques.
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Nakano, Shigeru, Mitsutaka Kitazawa, Shin-ichi Tsuda, Mariko Himeno, Hanae Makiishi, Atsushi Nakagawa, Toshikazu Kigoshi, and Kenzo Uchida. "INSULIN RESISTANCE IS ASSOCIATED WITH REDUCED NOCTURNAL FALLS OF BLOOD PRESSURE IN NORMOTENSIVE, NONOBESE TYPE 2 DIABETIC SUBJECTS." Clinical and Experimental Hypertension 24, no. 1-2 (January 2002): 65–73. http://dx.doi.org/10.1081/ceh-100108716.
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Xu, Weixin, Steven A. Rutledge, and Kyle Chudler. "Diurnal Cycle of Coastal Convection in the South China Sea Region and Modulation by the BSISO." Journal of Climate 34, no. 11 (June 2021): 4297–314. http://dx.doi.org/10.1175/jcli-d-20-0308.1.
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AbstractUsing 17-yr spaceborne precipitation radar measurements, this study investigates how diurnal cycles of rainfall and convective characteristics over the South China Sea region are modulated by the boreal summer intraseasonal oscillation (BSISO). Generally, diurnal cycles change significantly between suppressed and active BSISO periods. Over the Philippines and Indochina, where the low-level monsoon flows impinge on coast lines, diurnal cycles of rainfall and many convective properties are enhanced during suppressed periods. During active periods, diurnal variation of convection is still significant over land but diminishes over water. Also, afternoon peaks of rainfall and MCS populations over land are obviously extended in active periods, mainly through the enhancement of stratiform precipitation. Over Borneo, where the prevailing low-level winds are parallel to coasts, diurnal cycles (both onshore and offshore) are actually stronger during active periods. Radar profiles also demonstrate a pronounced nocturnal offshore propagation of deep convection over western Borneo in active periods. During suppressed periods, coastal afternoon convection over Borneo is reduced, and peak convection occurs over the mountains until the convective suppression is overcome in the late afternoon or evening. A major portion (>70%) of the total precipitation over the Philippines and Indochina during suppressed periods falls from afternoon isolated to medium-sized systems (<10 000 km2), but more than 70% of the active BSISO rainfall is contributed by nocturnal (after 1800 LT) broad precipitation systems (>10 000 km2). However, offshore total precipitation is dominated by large precipitation systems (>10 000 km2) regardless of BSISO phases and regions.
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Grant, Robyn A., Vicki Breakell, and Tony J. Prescott. "Whisker touch sensing guides locomotion in small, quadrupedal mammals." Proceedings of the Royal Society B: Biological Sciences 285, no. 1880 (June 13, 2018): 20180592. http://dx.doi.org/10.1098/rspb.2018.0592.
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All small mammals have prominent facial whiskers that they employ as tactile sensors to guide navigation and foraging in complex habitats. Nocturnal, arboreal mammals tend to have the longest and most densely packed whiskers, and semi-aquatic mammals have the most sensitive. Here we present evidence to indicate that many small mammals use their whiskers to tactually guide safe foot positioning. Specifically, in 11, small, non-flying mammal species, we demonstrate that forepaw placement always falls within the ground contact zone of the whisker field and that forepaw width is always smaller than whisker span. We also demonstrate commonalities of whisker scanning movements (whisking) and elements of active control, associated with increasing contact with objects of interest, across multiple small mammal species that have previously only been shown in common laboratory animals. Overall, we propose that guiding locomotion, alongside environment exploration, is a common function of whisker touch sensing in small, quadrupedal mammals.
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Yeong, K., J. Santiapillai, B. N. Arumainayagam, P. Murray, and S. Tadtayev. "63 Nocturia—An Underappreciated “Symptom” of Obstructive Sleep Apnoea?" Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.24.
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Abstract Nocturia (>2 per night) is the most frequent cause of disturbed sleep in older people. Poor sleep results in reduced health related QoL, and is linked to the development of cognitive impairment. Nocturia can result in an increase risk of falls and fractures, and is also an independent risk factor for mortality. The prevalence of norturia is high in the elderly, and it has been reported to be around 77.1% in elderly women and 93% in men. Historically, this bothersome symptom is thought to be mainly a result of bladder outflow obstruction due to prostatic hypertrophy or overactive bladder. More recently, nocturia has been associated witsh nocturnal polyuria (NPu) and obstructive sleep apnoea (OSA). The relationship between OSA and NPu is not fully understood but it is thought that the negative intrathoracic pressure generated by OSA causes an increase in Atrial Natriuretic Peptide (ANP) secretion, resulting in NPu. Nocturia is highly prevalent in patients with severe OSA. However, patients are usually unaware that they have sleep apnoea, and are therefore more likely to present to urology or geriatric services. It is important that OSA is not overlooked in these clinics as intervention with CPAP is highly effective in reducing symptoms. Here, we present the result of using the STOP-Bang questionnaire in 71 consecutive patients presenting to our urology service with nocturia. The average age was 73 years (range 34-88), male-to-female ratio 14:1 and median nocturia frequency of 4. 42 patients were at risk of undiagnosed sleep apnoea (median STOP-Bang Score of 5)—35 were referred for sleep studies, 4 patients declined and 3 patients were not referred. Overall, 31 out of 35 sleep studies (88.6%) demonstrated the presence of OSA; of these 23 (74.2%) confirmed moderate or severe OSA. All patients with OSA were seen and treated by the respiratory service. Overall, median nocturia frequency decreased from 4 to 1 across the whole cohort, from a combination of CPAP therapy, bladder outlet procedures and desmopressin. Conclusion At least a third of patients (32%) with bothersome nocturia have an undiagnosed clinically-significant OSA. Identification of OSA improves outcomes across the whole cohort, because nocturia in patients without OSA is more likely to respond to bladder outlet procedures and desmopressin.
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YONEYAMA, MITSURU, HIROSHI MITOMA, and YASUYUKI OKUMA. "ACCELEROMETRY-BASED LONG-TERM MONITORING OF MOVEMENT DISORDERS: FROM DIURNAL GAIT BEHAVIOR TO NOCTURNAL BED MOBILITY." Journal of Mechanics in Medicine and Biology 13, no. 02 (April 2013): 1350041. http://dx.doi.org/10.1142/s0219519413500413.
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Accelerometry-based motion analysis is widely recognized as a promising tool in health care and medical settings since it is unobtrusive, inexpensive, and capable of providing useful information on human movement disorders. Patients suffering from neurological diseases such as Parkinson's disease (PD) often exhibit a combination of multiple motion symptoms during everyday activities. Thus, there is a need in clinical practice to capture as many types of abnormal movements as possible with minimal instrumentation that does not interfere with the subject's usual behavioral patterns. This paper presents the prospect of total health monitoring with a single accelerometer-based technique. The behavior of a PD patient was continuously recorded for a period of 36 h using a portable device with a triaxial accelerometer worn on the waist. Data were analyzed by newly developed computer programs to extract relevant movement parameters that might underlie pathological motor performance. We found that the state of the disease could be quantified in terms of distinctive aspects such as gait force, synchronization between both legs, and falls during diurnal walking, and turnover and respiration during nocturnal sleep. Our method may be a useful and practical tool that enables refined clinical assessment of the overall health status of patients with motion disorders.
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Fanciulli, Alessandra, Fabian Leys, Cristian Falup-Pecurariu, Roland Thijs, and Gregor K. Wenning. "Management of Orthostatic Hypotension in Parkinson’s Disease." Journal of Parkinson's Disease 10, s1 (September 1, 2020): S57—S64. http://dx.doi.org/10.3233/jpd-202036.
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Orthostatic hypotension (OH) is a common non-motor feature of Parkinson’s disease that may cause unexplained falls, syncope, lightheadedness, cognitive impairment, dyspnea, fatigue, blurred vision, shoulder, neck, or low-back pain upon standing. Blood pressure (BP) measurements supine and after 3 minutes upon standing screen for OH at bedside. The medical history and cardiovascular autonomic function tests ultimately distinguish neurogenic OH, which is due to impaired sympathetic nerve activity, from non-neurogenic causes of OH, such as hypovolemia and BP lowering drugs. The correction of non-neurogenic causes and exacerbating factors, lifestyle changes and non-pharmacological measures are the cornerstone of OH treatment. If these measures fail, pharmacological interventions (sympathomimetic agents and/or fludrocortisone) should be introduced stepwise depending on the severity of symptoms. About 50% of patients with neurogenic OH also suffer from supine and nocturnal hypertension, which should be monitored for with in-office, home and 24 h-ambulatory BP measurements. Behavioral measures help prevent supine hypertension, which is eventually treated with non-pharmacological measures and bedtime administration of short-acting anti-hypertensive drugs in severe cases. If left untreated, OH impacts on activity of daily living and increases the risk of syncope and falls. Supine hypertension is asymptomatic, but often limits an effective treatment of OH, increases the risk of hypertensive emergencies and, combined with OH, facilitates end-organ damage. A timely management of both OH and supine hypertension ameliorates quality of life and prevents short and long-term complications in patients with Parkinson’s disease.
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Davies, Sarah, Ali Griffiths, and T. E. Reimchen. "Pacific Hagfish, Eptatretus stoutii, Spotted Ratfish, Hydrolagus colliei, and Scavenger Activity on Tethered Carrion in Subtidal Benthic Communities off Western Vancouver Island." Canadian Field-Naturalist 120, no. 3 (July 1, 2006): 363. http://dx.doi.org/10.22621/cfn.v120i3.329.
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The influence of pelagic carrion food falls on marine benthic scavenging communities was investigated at two depths (10 m, 50 m) in Barkley Sound, west Vancouver Island, British Columbia from 12 May to 4 June, 2003. A remotely operated vehicle (ROV) equipped with video cameras was used to monitor anchored carrion (15 kg pig leg) during daylight and darkness. The videos were subsequently analyzed for species diversity, abundance and the intensity of scavenging. At 10 m, Redrock Crab (Cancer productus) and Kelp Greenling (Hexagrammos decagrammus) dominated, while at 50 m, Spot Shrimp (Pandalus platyceros), Spotted Ratfish (Hydrolagus colliei) and Pacific Hagfish (Eptatretus stoutii) were the dominant species, most of which were nocturnal. Hagfish were the major consumers of the carrion and after 23 days, no soft tissues remained at 50 m while 40% remained at 10 m. Within 24 hours of the carrion deployment, two of eleven ratfish succumbed, probably due to the direct clogging effects of hagfish mucus on the respiratory apparatus of the ratfish. These field observations are consistent with laboratory results suggesting high efficacy of hagfish mucus in competitive interactions.
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Canevini, Maria Paola, Laura Tassi, Lucia Fusco, Anna Teresa Giallonardo, Renzo Guerrini, Roberto Mai, Guido Rubboli, Paolo Tinuper, and Federico Vigevano. "Frontal lobe seizures." Epileptic Disorders 3, no. 4 (December 2001): 223–24. http://dx.doi.org/10.1684/j.1950-6945.2001.tb00399.x.
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ABSTRACT This video teaching course presents several patterns of frontal lobe seizures recorded in a number of Italian Epilepsy Centers. The general features of frontal lobe seizures are outlined in the introduction. Sixteen vldeo‐EEG sequences involving 10 different patients are shown. A short presentation of the clinical history precedes each case report. The electroclinical characteristics of seizures implicating the frontal lobe are extremely variable. According to the literature, general characteristics allowing differentiation between seizures of different topography include: appearance of seizures in clusters; seizures predominantly nocturnal or while the patient is falling asleep; short duration of each episode (approximately 30 s); abrupt onset and end; relatively short post‐ictal phase, when present; frequent secondary generalization and falls; frequent subjective sensations, usually difficult to describe; impairment of consciousness is not a constant feature; episodes of status are frequent; differentiation from pseudo‐seizures may prove to be difficult. When confirmation of the epileptic nature of paroxysmal phenomena is needed, video‐EEG recordings may be of some help. Possible subjective manifestations are: cephalic and neuro‐vegetative (even epigastric) manifestations, as well as “pensée forcée” , fear, olfactory hallucinations, non‐lateralized visual disturbances. Motor manifestations include tonic, dystonic, postural, oculocephalic deviations and falls. Verbal and more often gestural automatisms can be complex, very brief and often violent, but elementary automatisms, such as automatic hand and mouth movements, or bimanual and pedaling movements, are also frequent. In this video teaching course, we first present seizures featuring minimal motor signs, followed by seizures with a more complex semiology. The most significant clinical and EEG features are discussed. (Published with videosequences.)
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Holtzman, E. J., L. M. Braley, G. H. Williams, and N. K. Hollenberg. "Kinetics of sodium homeostasis in rats: rapid excretion and equilibration rates." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 254, no. 6 (June 1, 1988): R1001—R1006. http://dx.doi.org/10.1152/ajpregu.1988.254.6.r1001.
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In normal humans, when sodium intake is abruptly reduced from a high to a very low level, renal sodium excretion falls exponentially (half time approximately 24 h), and several days are required to achieve external sodium balance, where intake equals excretion. Because much of our knowledge of intrarenal mechanisms comes from the rat, we studied their capacity to handle sodium. In two strains of rat, Sprague-Dawley (SD) and Wistar-Kyoto (WKY), whether the sodium load was administered intravenously, by gavage, or by spontaneous feeding, the slope relating sodium excretion to time was 8-10 times more rapid than in humans, reflecting half times of 2-3 h, and external sodium balance was achieved in hours rather than days. The combination of normal rat nocturnal feeding patterns and the rapidity of the response result in a daily spontaneous transition from an expanded state with a high or intermediate level of sodium excretion to a more contracted state, with minimal sodium excretion. Studies designed to assess sodium homeostasis in rats, and related renal and hormonal changes, must consider these rapid transitions, which are related, perhaps, to the rats' persistent and remarkably rapid growth.
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Nilsson, Göran E., Sara Östlund-Nilsson, Rose Penfold, and Alexandra S. Grutter. "From record performance to hypoxia tolerance: respiratory transition in damselfish larvae settling on a coral reef." Proceedings of the Royal Society B: Biological Sciences 274, no. 1606 (September 26, 2006): 79–85. http://dx.doi.org/10.1098/rspb.2006.3706.
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The fastest swimming fishes in relation to size are found among coral reef fish larvae on their way to settle on reefs. By testing two damselfishes, Chromis atripectoralis and Pomacentrus amboinensis , we show that the high swimming speeds of the pre-settlement larvae are accompanied by the highest rates of oxygen uptake ever recorded in ectothermic vertebrates. As expected, these high rates of oxygen uptake occur at the cost of poor hypoxia tolerance. However, hypoxia tolerance is needed when coral reef fishes seek nocturnal shelter from predators within coral colonies, which can become severely hypoxic microhabitats at night. When the larvae settle on the reef, we found that they go through a striking respiratory transformation, i.e. the capacity for rapid oxygen uptake falls, while the ability for high-affinity oxygen uptake at low oxygen levels is increased. This transition to hypoxia tolerance is needed when they settle on the reef; this was strengthened by our finding that small resident larvae of Acanthochromis polyacanthus , a damselfish lacking a planktonic larval stage, do not display such a transition, being well adapted to hypoxia and showing relatively low maximum rates of oxygen uptake that change little with age.
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Juanda, Juanda, Jannus Marpaung, Leonardus Sandy Ade Putra, Fitri Imansyah, and Redi Retiandi Yacoub. "PADDY PAST TRAP SYSTEM BASED ON LONG RANGE COMMUNICATION." Telecommunications, Computers, and Electricals Engineering Journal 1, no. 1 (June 30, 2023): 48. http://dx.doi.org/10.26418/telectrical.v1i1.69895.
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Indonesia is an agricultural country that produces rice plants. The decline in crop yields was caused by pests and had an impact on rice plants which experienced yellowing leaves, broken stems, until the rice fruit became empty. Test results data in the form of numbers in certain units will be presented in the form of tables and graphs. To find out the symptoms or behavior of the system at the time of testing, an analysis is carried out. The research was conducted for 5 nights starting at 18.00 until 06.00 WIB. The LoRa sender will send data when a pest lands on a 1000-1500 VDC wire net. In the research conducted, a total of 97 pests were found. The peak of pest attacks occurs at 19:00 to 20:00 WIB. Walang sangit attacks rice plants in all phases, so it is not surprising that this pest has the largest number, namely 87 pests. The rain that falls makes the lights dim thereby reducing the interest of the pests in the pest traps. Lamps with a wavelength of 500 nm can attract the attention of nocturnal pests that attack rice plants at night.
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Mijalković, Miloš, and Nikola Vukašinović. "Case report of Parkinson's disease and orthostatic hypotension." Praxis medica 51, no. 3-4 (2022): 61–64. http://dx.doi.org/10.5937/pramed2204061m.
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Introduction: Parkinson's disease is an idiopathic, slow progressive neurodegenerative condition with the loss of dopaminergic neurons in the substantia nigra compacta of the midbrain. Due to cardiovascular dysautonomia and impaired baroreflex function in Parkinson's disease, the development of orthostatic hypotension is most common, along with increased blood pressure variability, supine hypertension, nocturnal hypertension, etc. Orthostatic hypotension in Parkinson's disease increases the risk of developing coronary heart disease, myocardial infarction, and the risk of overall, and cardiovascular mortality. Case report: Orthostatic hypotension in Parkinson's disease is associated with an increased risk of gait disturbances, loss of balance, falls resulting in injuries and limb fractures, and mortality. In this paper, we presented a patient who had previously been treated for arterial hypertension, with the current clinical presentation of symptomatic orthostatic hypotension in Parkinson's disease. After neurological evaluation and the implementation of pharmacological and non-pharmacological therapy for orthostatic hypotension, gradual improvement and stabilization of blood pressure values are achieved, along with a reduction in orthostatic hypotension symptoms and a decrease in subjective discomfort. Conclusion: In the presence of orthostatic hypotension in Parkinson's disease, in addition to pharmacological therapy, nonpharmacological treatment measures are very important for stabilizing blood pressure values and reducing the symptoms of orthostatic hypotension.
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Wu, Peiming, Masayuki Hara, Jun-ichi Hamada, Manabu D. Yamanaka, and Fujio Kimura. "Why a Large Amount of Rain Falls over the Sea in the Vicinity of Western Sumatra Island during Nighttime." Journal of Applied Meteorology and Climatology 48, no. 7 (July 1, 2009): 1345–61. http://dx.doi.org/10.1175/2009jamc2052.1.
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Abstract Precipitation measurements from the Tropical Rainfall Measuring Mission satellite indicate that annual rainfall over the sea in the vicinity of western Sumatra Island is among the highest on the earth, and most of this rainfall occurs during nighttime. Surface meteorological observations at Tabing on the western coast of the island show frequent occurrences of sudden offshore winds accompanied by an abrupt drop in surface temperatures in the late afternoon and evening. Model simulations for a 1-month period during the rainy season of the region successfully simulate the satellite-observed regional distribution and diurnal variation of rainfall. The simulation results show that convection develops across a wide area over the mountainous areas of the island at similar times in the afternoon with the development of thermally induced local circulations. At these times of the day, convection over the sea along the western coast of the island is suppressed by the thermally and topographically induced diurnal changes in the boundary layer flow. When convection over the mountains of the island dissipates in the late afternoon and evening, a zone of cold surface outflow along the western coast results from the mountain convection breaking out to the sea. Meanwhile, the convective inhibition offshore is reduced in the evening, and the offshore flow causes regular occurrences of convection over the sea near the coast. The triggered convective systems propagate offshore and westward in multicell cluster storms during nighttime, bringing heavy rainfall over the sea off the western coast of the island. Sensitivity experiments with a flat-topography model demonstrate that the frequent occurrence of offshore flow in the late afternoon and evening on the western coast is caused by the mountainous topography of the island and its induced afternoon convection. The mountains on the island and the resultant thermally and convectively induced local circulations can play an important role in the formation of nocturnal abundant rainfall over the sea west of Sumatra Island.
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Nakagawa, Yasuhiko, Ken Kishida, Shinji Kihara, Ryoko Yoshida, Tohru Funahashi, and Iichiro Shimomura. "Nocturnal Falls of Adiponectin Levels in Sleep Apnea with Abdominal Obesity and Impact of Hypoxia-Induced Dysregulated Adiponectin Production in Obese Murine Mesenteric Adipose Tissue." Journal of Atherosclerosis and Thrombosis 18, no. 3 (2011): 240–47. http://dx.doi.org/10.5551/jat.6593.
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Schörghofer, Norbert, Steven Businger, and Matthias Leopold. "The Coldest Places in Hawaii: The Ice-Preserving Microclimates of High-Altitude Craters and Caves on Tropical Island Volcanoes." Bulletin of the American Meteorological Society 99, no. 11 (November 2018): 2313–24. http://dx.doi.org/10.1175/bams-d-17-0238.1.
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AbstractThe coldest places on the Hawaiian island chain are not on the very summits of its tallest volcanoes, Mauna Kea (19.82°N; 4,207 m) and Mauna Loa (19.48°N; 4,169 m), but within craters and caves with perennial ice. Here, we explore unique microclimates in the alpine stone deserts of two tropical island volcanoes, report new temperature extremes for Hawaii, and study the role of microclimates in the preservation of perennial ice bodies. Nocturnal cold-air pools are common in the craters and are responsible for the coldest temperature ever reported from the Hawaiian Islands (–20°C). These cold-air pools are not frequent enough to substantially affect the annual heat budget of the ground, but cold air is frequently trapped between boulders and contributes to freezing conditions in this way. Perennial ice is found beneath even warmer environments in lava tube caves. The lowest annual-mean temperature (–0.7°C) was measured at the distal end of a spectacular ice cave on Mauna Loa, where the outside air temperature averages +8°C. In the current climate, the outside temperature rarely falls below freezing, so the air’s sensible heat cannot contribute to freezing conditions. Considering the effect of recent climate warming and the buoyancy of humid air, cold air that flowed down the lava tubes in winter nights, combined with sublimation cooling, is still a plausible explanation for the perennial ice ponds found there.
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Romatschke, Ulrike, and Robert A. Houze. "Characteristics of Precipitating Convective Systems in the Premonsoon Season of South Asia." Journal of Hydrometeorology 12, no. 2 (April 1, 2011): 157–80. http://dx.doi.org/10.1175/2010jhm1311.1.
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Abstract Tropical Rainfall Measuring Mission (TRMM) Precipitation Radar (PR) data obtained over South Asia during eight premonsoon seasons (March–May) show that the precipitation is more convective in nature and more sensitive to synoptic forcing than during the monsoon. Over land areas, most rain falls from medium-sized systems (8500–35 000 km2 in horizontal area). In continental regions near the Himalayas, these medium-sized systems are favored by 500-mb trough conditions and are of two main types: 1) systems triggered by daytime heating over high terrain and growing to reach maximum size a few hours later and 2) systems triggered at night, as moist upstream flow is lifted over cold downslope flow from the mountains, and reaching maximum development upstream of the central and eastern Himalayas in the early morning hours. Systems triggered by similar mechanisms also account for the precipitation maxima in mountainous coastal regions, where the diurnal cycles are dominated by systems triggered in daytime over the higher coastal terrain. Medium-sized nocturnal systems are also found upstream of coastal mountain ranges. West-coastal precipitation systems over India and Myanmar are favored when low pressure systems occur over the upstream oceans, whereas Indian east-coastal systems occur when high pressure dominates over Bangladesh. Over the Bay of Bengal, the dominant systems are larger (>35 000 km2), and have large stratiform components. They occur in connection with depressions over the Bay and exhibit a weaker diurnal cycle.
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Libová, Ľubica, Lívia Kollárová, Ľubica Vanková, and Michal Vavro. "Prelevance of falls in seniors hospitalized on gerontopsychiatric department, their risk factors and possibilities of preventive interventions." Magyar Gerontológia 13 (December 29, 2021): 34–37. http://dx.doi.org/10.47225/mg/13/kulonszam/10579.
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Introduction:Falls and associated injuries are a serious problem for seniors in the home as well as in the medical environment. The main goal was to approach the issue of falls in the elderly in hospital facilities with regard to gerontopsychiatric issues and psychiatric treatment.Methodology:We used a questionnaire to find out the prevalence of falls in the elderly, the use of preventive measures and their effectiveness. The questionnaire had three sections that focused on demographics, medication, fall during hospitalization, a "Simple Screening Tool for Risk Assessment," and questions for nurses about the use of preventative measures. The sample consisted of 113 seniors in the age category over 65 years hospitalized in the psychiatric hospital Hronovce.Results:Based on the data obtained, there were no significant differences in the incidence of falls when comparing the age category up to 75 years and over 75 years. We can state that gerontopsychiatric patients are at risk of falling, regardless of their age. Of all participating survey respondents 46.9% fell and 53.1% did not fall during the study period, with 31% of patients falling repeatedly and 15.9% of patients fell once. In the survey sample 100% of respondents were taking psychotropic drugs, 46.9% were taking risk medication - benzodiazepines, and these respondents had a fall at least once during their hospitalization. We found out that the risk of falling is increased by almost half in patients with nocturnal disorientation, sensory disorders and dementia. In the group of respondents (56.7%) who needed help with movement, falls occurred more often than in patients without restricted movement ability, but the differences were not significant. Problems with defecation led to a higher prevalence of falls. Among seniors who fell, there were 14.2% of them who did not have a problem with defecation compared to 32.7% who had a problem with defecation or suffered from incontinence. Nurses used the most frequently some environmental adjustments in 66.4%, increased supervision of high-risk patients in 52.2%, and nurses used multiple interventions in 67.3% of cases as preventive measures against falls in the observed group of patients. Nurses considered as proven interventions: increased supervision of high-risk patients (16.0%), use of compensatory aids when walking (5.0%), suitable footwear, (14.0%), adjustments of the environment (29%) rehabilitation exercises (13.0%), adherence to a drinking regime (7.0%).Conclusion:In seniors with mental illness there was a higher incidence of falls regardless of age, the use of psychopharmacological treatment, especially in the form of benzodiazepines, led to a higher incidence of falls. Nursing staff used multiple interventions. The adjustment of the environment and the use of suitable anti-slip footwear proved to be the most effective.Contact:doc. PhDr. Ľubica Libová PhD.Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety,n.o. Bratislava; FZaSP sv. Ladislava, ul. Slovenská 11 940 52 Nové Zámky, Slovenská republika+421 903169357lubica.libova@gmail.com
PREVALENCIA PÁDOV U SENIOROV HOSPITALIZOVANÝCH NA GERONTOPSYCHIATRICKOM ODDELENÍ, ICH RIZIKOVÉ FAKTORY A MOŽNOSTI PREVENTÍVNYCH INTERVENCIÍKľúčové slová: Pády seniorov. Prevencia. Rizikové faktory.Úvod:Pády a s nimi spojené úrazy predstavujú závažný problém u seniorov v domácom ako aj v zdravotníckom prostredí. Hlavným cieľom bolo priblížiť problematiku pádov u seniorov v nemocničných zariadeniach z ohľadom na gerontopsychiatrickú problematiku a psychiatrickú liečbu.Metodika:Na zistenie prevalenciu pádov seniorov, používanie preventívnych opatrení a ich efektivitu sme použili protokol. Protokol mal tri časti, ktoré boli zamerané na demografické údaje, medikáciu, pád počas hospitalizácie, „Jednoduchý skríningový nástroj na posúdenie rizika“ a otázky pre sestry o používaní preventívnych opatrení. Výberový súbor tvorilo 113 seniorov vo vekovej kategórii nad 65 rokov hospitalizovaných v psychiatrickej nemocnici Hronovce.Výsledky:Na základe získaných údajov pri porovnaní vekovej kategórie do 75 rokov a nad 75 rokov neboli významné rozdiely vo výskyte pádu. Môžeme konštatovať, že gerontopsychiatrickí pacienti sú rizikový pre pád bez ohľadu na svoj vek. Zo všetkých zúčastnených respondentov prieskumu počas sledovaného obdobia spadlo 46,9 % a nespadlo 53,1 %, pričom 31 % pacientov spadlo opakovane, 15,9 % pacientov spadlo raz. V prieskumnej vzorke 100% respondentov užívalo psychofarmaká z nich 46,9% užívalo rizikovú medikáciu - benzodiazepíny a u týchto respondentov sa vyskytol pád počas hospitalizácie najmenej raz. Zistili sme, že riziko pádu sa zvyšuje takmer o polovicu u pacientov s nočnou dezorientáciou, zmyslovými poruchami a demenciou. V skupine respondentov (56,7%), ktorí potrebovali pomoc pri pohybe sa vyskytol pád častejšie ako u pacientov bez obmedzeného pohybu ale rozdiely neboli významné. Problémy s vyprázdňovaním viedli k vyššej miere prevalencie pádov. Spadlo 14,2 % seniorov, ktorí nemali problém s vyprázdňovaním oproti 32,7%, ktorí mali problém s vyprázdňovaním alebo trpeli inkontinenciou. Najčastejšie sestry používali ako preventívne opatrenia voči pádom v skúmanom súbore pacientov úpravu prostredia v 66,4 % , zvýšený dohľad nad rizikovými pacientmi v 52,2 %, viacnásobné intervencie používali v 67,3 % prípadov. Pričom ako osvedčené intervencie považovali sestry: zvýšený dohľad/dozor nad rizikovými pacientmi (16,0 %), používanie kompenzačných pomôcok pri chôdzi (5,0 %), vhodnú obuv, (14,0 %), úpravu prostredia ( 29%) rehabilitačné cvičenie (13,0 %), dodržiavanie pitného režimu (7,0 %).Záver:U seniorov s duševným ochorením bol vyšší výskyt pádov bez ohľadu na vek, užívanie psychofarmakologickej liečby najmä vo forme benzodiazepínov viedlo k väčšiemu výskytu pádov. Ošetrujúci personál používal viacnásobné intervencie. Ako najúčinnejšie sa osvedčilo upravenie prostredia a používanie vhodnej protišmykovej obuvi.Korešpondujúci autor:doc. PhDr. Ľubica Libová PhD.Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety,n.o. Bratislava; FZaSP sv. Ladislava, ul. Slovenská 11 940 52 Nové Zámky, Slovenská republika+421 903169357lubica.libova@gmail.comZber dát prebiehal so súhlasom etickej komisie zdravotníckeho zariadenia a s informovaným súhlasom respondentov.
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Zahorka, Herwig. "Animism is Applied Ethnobotany: A Shamanic Healing Ritual with the Dayak Benuaq Ohookng / East Kalimantan." Journal of Tropical Ethnobiology 3, no. 1 (January 30, 2020): 57–68. http://dx.doi.org/10.46359/jte.v3i1.8.
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The Dayak Benuaq Ohookng people believe in many and diverse territorial ghosts/spirits (wook) who exist in the environment, some of which have the power to remove the soul (juus) of a human body part or organ and, at the same time, implant disease. Consequently, this body part or organ gets sick. The mission of the shamans (pembeliatn), as mediums to the spiritual world, is to identify the ghost/spirit responsible during nocturnal rituals and to submit all of the diverse ritual offerings possible, including making an exchange of a “soul” (kelakar) made from ironwood (Eusideroxylon zwageri). To get rid of the disease, the patient smears some of his/her own saliva onto a carved statue (sepatukng silih), depicting the ghost/spirit concerned, after the shaman activated it. Later, this statue is taken to the forest. The shaman can also extract the disease from the sick body part by help of a thinly spliced banana leaf (telolo). The disease can also be attached to the statue or put into the blood of sacrificial animals. In order to finally find and identify the lost soul of the patient’s sick body part, the shaman performs a vigorous dance and then falls into a trance, during which he receives a message about where to catch the soul. To discover the soul and capture it, he uses a bamboo stick filled with boiled rice (tolakng tintikng). The captured soul is then massaged into the sick body part of the patient. To perform this ritual, a great number of traditional and institutionalized plants are essential. They are arranged around the altar (balai sianca jadi) and used for ritual objects. White rice and rice colored with black, red, yellow and green dyes plays an important role in attracting and satisfying the ghosts.
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Teo, Angelene, Arturo Vilches-Moraga, and John Staniland. "140 Midodrine Hydrochloride in the Management of Elderly Patients with Neurocardiogenic Syncope: A Prospective Observational Study." Age and Ageing 48, Supplement_4 (December 2019): iv34—iv39. http://dx.doi.org/10.1093/ageing/afz164.140.
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Abstract Background Midodrine hydrochloride is an alpha-1 agonist that has been used in the management of syncope in patients with orthostatic hypotension, vasovagal syncope and vasodepressor carotid sinus syndrome when non-pharmacological means have failed. However, there are very limited information about its use, tolerability and side effects among the elderly population. Objectives We aim to document effectiveness of Midodrine in patients who have been diagnosed with neurocardiogenic syncope assessed and managed at a specialist falls and syncope outpatient unit. We monitored for changes in patients' symptoms, adverse reactions reported and optimum drug dosages that have shown benefit in this cohort of patients. Methods A prospective observational study of 33 subjects aged between 68 and 94 (mean age 79) who have been started on Midodrine therapy following positive tilt table test or confirmed diagnosis of symptomatic orthostatic hypotension despite conservative managements. They have been followed up for a mean of 2.9 years. Results 81% of patients( n=27) reported significant improvement in their symptoms. Although 7 patients reported adverse reactions to Midodrine, the majority of the patients tolerated the therapy well and continued on the treatment except for one patient who experienced gastrointestinal discomfort and withdrew completely. Commonest side effects are pruritus and piloerection, but they are not amenable to treatment due to underlying mechanism of action of Midodrine on hair follicles. The dosage varies from 2.5mg to 10mg, taken at 8am, 12pm and 5pm due to risk of nocturnal supine hypertension. Higher dose did not correlate with higher possibility of experiencing side effects. Conclusion Midodrine appears to be effective, safe and well tolerated among the elderly population. It should be considered in the management of patients with neurocardiogenic syncope when non-pharmacological means have failed, irrespective of age. This observational study requires further confirmation by randomised control studies with larger sample size.
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Kelly, Richard, Stephen Richards, Louise Arnold, Gemma Valters, Matthew Cullen, Anita Hill, and Peter Hillmen. "A Spontaneous Reduction of Clone Size in Paroxysmal Nocturnal Hemoglobinuria Patients Treated with Eculizumab for Greater Than 12 Months." Blood 114, no. 22 (November 20, 2009): 1992. http://dx.doi.org/10.1182/blood.v114.22.1992.1992.
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Abstract Abstract 1992 Poster Board I-1014 Paroxysmal Nocturnal Hemoglobinuria (PNH) is an acquired clonal disorder of hemopoietic stem cells that is characterized by bone marrow failure, intravascular hemolysis and venous thrombosis. Eculizumab is a humanized monoclonal antibody that specifically binds to the complement protein C5 preventing its cleavage thereby inhibiting the formation of the terminal components of the complement cascade. Eculizumab was approved by the FDA in 2007 after clinical trials showed it was efficacious in treating patients with hemolytic PNH. Prior to eculizumab therapy treatment options were mainly supportive in nature. Historical data shows that a third of patients who survive greater than 10 years undergo spontaneous recovery. We present data on 38 patients with hemolytic PNH treated at a single centre with eculizumab for 12 months or longer. Thirty six of these patients were treated with a loading dose of 600mg every week for 4 doses followed by 900mg the following week and then a maintenance dose of 900mg dose every 14 day. The other 2 patients required a higher maintenance dose of eculizumab, 1200mg every 14 days, due to symptomatic intravascular hemolysis on the standard regime. All our patients had a high PNH granulocyte clone size at the initiation of eculizumab treatment from 52.90% to 99.95% with a median of 96.38%. The duration of eculizumab therapy varied from 12 to 84 months with a median treatment duration of 50 months. Granulocyte clone size was used as it is not subject to as much variation as the erythrocyte clone size which changes both due to blood transfusions and to the extent of intravascular hemolysis present. The proportion of PNH granulocytes probably most accurately reflects the true size of the PNH clone. Seven out of these 38 patients (18.4%) have had a 10% or greater reduction in their granulocyte clone size during the course of their eculizumab treatment. These patients have had a steady and continued decline in their granulocyte clone size throughout their treatment with eculizumab. This may actually be due to an increase in the residual normal cells in some patients (see Table). Two of these patients (U.P.N. 5 and 7) have had such a dramatic reduction in their clone size that they have been able to stop their eculizumab treatment without any observed detriment to their health.TableChange in PNH clones in patients on eculizumabU.P.N.Months on eculizumabNeutrophils PNH clone size (%)Normal neutrophils (%)Pre-treatmentMost recent on treatmentPre-treatmentMost recent on treatment15097.242.82.85724878.063.222.036.335596.484.13.615.941592.577.07.523.051261.732.438.367.664788.362.511.737.578552.98.547.191.5 Two of these 7 patients were treated with ciclosporin for underlying aplasia as compared to 3 of the 31 of those who haven't had a decrease in their clone size. There was no difference in the white cell or platelet count in these 7 patients from when they started eculizumab treatment to the present day indicating that the degree of bone marrow failure present has not changed dramatically during this time course. 5 of the 7 patients had neutrophil clone sizes of less than the median perhaps indicating that recovery requires a certain number of residual normal stem cells to be present. There were no other observed differences to distinguish between patients whose clone size fell and those that did not. It is unlikely that eculizumab has a direct effect on clone size in hemolytic PNH. A more probable hypothesis is that the immune selection in favour of the PNH clone expires over time allowing normal hemopoietic stem cells to repopulate the bone marrow. Whether eculizumab has any influence on this rather than just allowing patients to survive and remain well until recovery occurs is not clear. Our data suggests that there needs to be some normal hematopoietic activity in order for the normal marrow cells to expand and clone size under 95% predicts for recovery. In conclusion, a significant minority of patients with PNH on eculizumab have a progressive reduction in the size of their PNH clone during therapy and in some of these patients the clone falls to a level at which eculizumab can safely be stopped. Disclosures: Kelly: Alexion Pharmaceuticals: Honoraria. Richards:Alexion Pharmaceuticals: Honoraria. Hill:Alexion: Honoraria. Hillmen:Alexion Pharmaceuticals: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Srojidinova, Nigora, Aziza Duysenbaeva, Lola Khafizova, and Ravshan Urishbaev. "RELATIONSHIP OF DAILY BLOOD PRESSURE PROFILE AND ARTERIAL STIFFNESS." Journal of Hypertension 42, Suppl 1 (May 2024): e69-e70. http://dx.doi.org/10.1097/01.hjh.0001019936.94896.67.
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Objective: To study the blood pressure daily profile in patients with hypertension (HNT) depending on the pulse wave velocity (PWV). Design and method: We studied 88 treated patients with HNT. The ambulatory BP monitoring (ABPM) was recorded with a Medicom-combi device (Russia) using the oscillometric method. PWV was determined using the SphygmoCor (AtCor Medical Pty Ltd, Australia). Statistical analysis was performed using the SPSS 24.0 software package. Results: Patients were divided into 2 groups depending on PWV level: the first group had a PWV < 10 m/s, and the second group had a PWV > 10 m/s. The mean PWV in the groups was 7.79±1.38 vs. 14.13±1.85 m/s, respectively (p<0.007). Office SBP and DBP didn’t differ between groups. Patients of the second group had significantly higher mean daily SBP (113.64±16.64 vs 128.23±16.91 mm Hg, p=0.0001), mean daytime SBP (116.77±8.99 vs 129.36±7.8 mm Hg, p=0.0001), and mean nighttime DBP (66.26±9.7 vs 71.64±7.1 mm Hg, p=0.04). The load index (LI) of daytime and nighttime SBP was higher in patients with PWV > 10 m/s. LI of SBP daytime: 9.72±15.82% vs. 27.74±35.24%, respectively, p = 0.001. LI of SBP nighttime: 18.34±26.44% vs. 44.2±38.81%, respectively, p = 0.001. Variability and nocturnal falls of SBP and DBP also didn’t differ between the groups. The number of dippers by SBP and DBP was higher in patients with normal PWV, but not significantly: 18% and 12% vs. 13% and 9%, SBP: χ2 = 0.04, p = 0.83; DBP: χ2 = 0.19, p = 0.45. The number of non-dippers by SBP and DBP was significantly higher in the first group: 65% and 66% vs. 50% and 50%; SBP: χ2 = 4.6, p = 0.032; and DBP: χ2 = 5.25, p > 0.05. However, the number of night-pickers by SBP and DBP significantly prevailed in the second group: 17% and 19% vs. 36.4% and 32%, respectively; SBP: χ2 = 9.2, p = 0.003, DBP: χ2 = 5.58, p = 0.019. There were no over-dippers in both groups. Conclusions: Hypertensive patients with high PWV values had more pronounced disorders in their daily blood pressure profile.
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Chapple, C., and A. Mangera. "Nocturia and the danger of falls." International Journal of Clinical Practice 64, no. 5 (April 2010): 527–28. http://dx.doi.org/10.1111/j.1742-1241.2010.02356.x.
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Adirim, Zachary, Yulu Pan, Margaret Doyle, Melissa Knauert, Henry Yaggi, and Brienne Miner. "0680 Body Clock and Aging: Relationships of Circadian Rhythm with Sleep Quality, Mental Health and Geriatric Conditions." SLEEP 47, Supplement_1 (April 20, 2024): A291. http://dx.doi.org/10.1093/sleep/zsae067.0680.
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Abstract Introduction Circadian rhythm is associated with sleep quality and mental health. Research to date has been primarily focussed on adolescent and general adult populations, with little inquiry in older adults, whom have relatively earlier circadian phases. We sought to clarify correlates of circadian function with sleep quality and mental health, in addition to geriatric conditions to further explore these relationships in an older adult population. Methods We undertook a cross-sectional study of 67 community-dwelling older adults (≥60yrs) with self-reported sleep complaints. Circadian rhythm was assessed with 7-day actigraphy, to derive sleep midpoint and variables of circadian strength (interdaily stability (IS), intradaily variability (IV), amplitude, and MESOR), calculated using non-parametric or cosinor analysis. Assessments evaluated outcome measures of subjective sleep quality (Insomnia Severity Index [ISI], Pittsburgh Sleep Quality Index [PSQI], Epworth Sleepiness Scale [ESS]), objective sleep physiology (nocturnal polysomnography parameters), mental health (prior psychiatric diagnosis [depression, bipolar anxiety, PTSD], Patient Health Questionnaire of depressive symptoms [PHQ8], Generalized Anxiety Disorder Questionnaire [GAD2]), geriatric conditions (age, frailty [Fried phenotype], cognition with Montreal Cognitive Assessment [MOCA], falls (≥1 in past year), multimorbidity [≥3 chronic conditions], and polypharmacy [≥5 medications]). Pearson correlation coefficients were employed to investigate relationships. Results Circadian rhythm markers (lower amplitude, MESOR) were associated with daytime sleepiness (r=0.25-0.29, p values < 0.05). Later sleep midpoint was correlated with reduced total sleep time on PSG (r=0.36, p< 0.05), and lower ISI severity (r=0.29, p< 0.05). Measures of circadian weakness (lower IS, higher IV) were associated with mental health diagnoses (r=0.25-0.30; p values < 0.05), though no significant associations were seen with psychiatric symptoms. Earlier sleep midpoint was correlated with increasing age (r=0.41, p< 0.05). Parameters of circadian weakness (low IS, high IV, low amplitude) were associated with lower cognitive scores (r=0.32-0.44, p values < 0.05) and multimorbidity (r=0.30-0.36, p values < 0.05). Conclusion Our data strengthens links between circadian rhythm characteristics with sleep quality and mental health conditions, demonstrating generalizability to older adult populations. Markers of weaker circadian rhythm were associated with cognitive dysfunction and multimorbidity. Future research should examine the association of circadian markers with incident geriatric illness longitudinally. Support (if any) NIA (K76AG0749505, P30AG021342)
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&NA;. "Impaired nocturnal BP fall possible in secondary hypertension." Inpharma Weekly &NA;, no. 929 (March 1994): 14. http://dx.doi.org/10.2165/00128413-199409290-00030.
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Wrede, Christian, Annemarie Braakman-Jansen, and Lisette van Gemert-Pijnen. "Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers." JMIR Aging 4, no. 2 (April 12, 2021): e26875. http://dx.doi.org/10.2196/26875.
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Background Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. Objective The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. Methods A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-Kåreborn. Results Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. Conclusions Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care.
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Roggeman, Saskia, Jeffrey P. Weiss, Erik Van Laecke, Johan Vande Walle, Karel Everaert, and Wendy F. Bower. "The role of lower urinary tract symptoms in fall risk assessment tools in hospitals: a review." F1000Research 9 (April 3, 2020): 236. http://dx.doi.org/10.12688/f1000research.21581.1.
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A large number of falls in hospitals occur on the way to the toilet. Accordingly, a literature search was conducted in Web of Science, PubMed, Embase, and the Cochrane Library to identify fall risk screening and assessment metrics published between 1980 and 2019 and to study the inclusion of lower urinary tract symptoms (LUTS) and their related parameters in these screening tools. In addition, the literature was searched to explore the relationship between toilet-related falls and LUTS. In total, 23 fall risk scales were selected, from which 11 were applicable for in-hospital patients. In nine of the 11 scales for in-hospital patients, a LUTS or LUTS-related parameter was included. In the 12 risk assessment tools for community-dwelling older people, there were no LUTS included. Frequency, urinary incontinence, and nocturia were mostly reported in the literature as a potential fall risk parameter. It is recommended to create greater awareness of nocturia and other LUTS among caregivers of hospitalized patients to prevent falls.
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Bursztyn, M. "Blunted nocturnal fall in blood pressure in hypertensive women." Circulation 89, no. 4 (April 1994): 1912. http://dx.doi.org/10.1161/01.cir.89.4.1912.
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