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Data on the prevalence of sleep-disordered breathing (SDB) in people with HIV are limited. Moreover, whether the associations between SDB and age or BMI differ by HIV status is unknown.Is SDB more prevalent in men with HIV than those without HIV, and do the predictors of SDB differ between the two groups?Home polysomnography was used in the Multicenter AIDS Cohort Study to assess SDB prevalence in men with (n = 466; 92% virologically suppressed) and without (n = 370) HIV. SDB was defined using the oxygen desaturation index (ODI) and the apnea-hypopnea index (AHI), using four definitions: ≥ 5 events/h based on an ODI with a 3% (ODISDB prevalence was similar in men with and without HIV using the ODISDB prevalence was high overall but greater in men with than without HIV using the ODI

Examine the associations of sleep measures with kidney function changes over time among individuals from a community-based study.The sample includes 1657 participants (287 with chronic kidney disease [CKD]) in the Multi-Ethnic Study of Atherosclerosis Sleep Cohort (mean age: 57.7 years, male: 46.0%). We examined associations between a large set of sleep variables (polysomnography, actigraphy, and questionnaires) and cardiovascular disease risk factors and changes in estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio over approximately 5 years using high-dimensional regression. We investigated the modifying effect of sleep on the associations between cardiovascular disease risk factors and kidney function.Sleep metrics predicted kidney function decline only among individuals with baseline CKD. Among this group, eGFR decline was associated with decreased stage N3 sleep (0.32 mL/min/1.73 mReduced deep sleep, daytime napping, increased wake bouts, delayed sleep rhythms, and overnight hypoxemia are associated with longitudinal kidney function decline, with effects most apparent in individuals with CKD. Deep sleep, napping, and sleep timing modified the association between hemoglobin A1C and kidney function.

Bacteria are associated with the human body and colonize the gut, skin, and mucous membranes. These associations can be either symbiotic or pathogenic. In either case, bacteria derive more benefit from their host. The ability of bacteria to enter and survive within the human body can be exploited for human benefit. They can be used as a vehicle for delivering or producing bioactive molecules, such as toxins and lytic enzymes, and eventually for killing tumor cells. Clostridium and Salmonella have been shown to infect and survive within the human body, including in tumors. There is a need to develop genetic circuits, which enable bacterial cells to carry out the following activities: (i) escape the human immune system, (ii) invade tumors, (iii) multiply within the tumorous cells, (iv) produce toxins via quorum sensing at low cell densities, and (v) express suicide genes to undergo cell death or cell lysis after the tumor has been lysed. Thus, bacteria have the potential to be exploited as anticancer agents.

To assess vision in pseudophakic eyes with Fuchs' endothelial corneal dystrophy (FECD) before the onset of clinically detectable corneal edema.Cross-sectional study.Sixty-one otherwise healthy pseudophakic eyes of 38 subjects with FECD (without clinically detectable edema) and 17 otherwise healthy pseudophakic eyes of 9 subjects with normal corneas. Subjects underwent clinical examination to determine the morphologic distribution of guttae (severity grading). Standardized best-corrected high-contract and low-contrast (photopic and mesopic) visual acuity (HCVA, LCVA) and straylight were measured. Scheimpflug tomography posterior elevation and pachymetry maps were interpreted for 3 tomographic features of subclinical edema: loss of regular isopachs, displacement of the thinnest point of the cornea, and presence of posterior surface depression.In FECD without tomographic features of edema (ie, normal tomography patterns), HCVA, LCVA, and straylight did not differ from that of eyes with normal corneas (P ≥ .09); these eyes encompassed the full range of severity grading of guttae. In FECD with all 3 tomographic features of edema, the same parameters were worse compared with eyes with normal corneas (P ≤ .02). In FECD with 1 or 2 tomographic abnormalities, mesopic LCVA (P = .04) and straylight (P = .003) were worse compared with eyes with normal corneas.Impairment of vision was associated with the presence of tomographic edema in eyes with FECD. When tomography patterns were normal in FECD (ie, guttae were present without tomographic edema), visual acuity and straylight were normal, and therefore corneal surgical intervention would not typically be indicated to improve vision.

To determine the root causes of patient safety events in a high-volume intravitreal injection clinic and to assess the effect of interventions to reduce the rate of events.Quality improvement study.All cases of intravitreal injection in a designated injection clinic between January 1, 2016, and December 31, 2019.The injection clinic model involved an injecting physician, who usually differed from a prescribing physician. The procedural injection area was also physically separate from the retina outpatient clinic. A root cause analysis was used to determine the factors that contributed to possible patient safety events in an institutional quality improvement project. Specific interventions were implemented to address each specific root cause. The rates of patient safety events (never events and near misses), whether associated with patient harm or not, were compared before and after the intervention.Frequency (%) of patient-safety-related intravitreal injection events before (January 1, 2016, to December 31, 2018) and after (January 1, 2019, to December 31, 2019) intervention.The root cause analysis included complex treatment plans that could be difficult to interpret, insufficient time to adequately review the designated treatment plans, and the risk of human error given the pace and volume of scheduled injections. Quality improvement strategies included revising the standardized treatment plan documentation template, scheduling block time for injecting physicians to review treatment plans within 24 hours of the injection clinic, and requiring agreement between dual, independent, site, and medication verifications of the treatment plan by the injecting physician and an allied health coordinator before site marking. The rate of events was 0.1% (28 in 27 400, or 9.3 events per year) before intervention and decreased to 0.01% (1 in 9375, or 1 event per year) after intervention (P = 0.01). Most events were classified as near misses, and there were no instances of patient harm.A high level of patient safety can be achieved in a complex, high-volume intravitreal injection practice by recognizing potential safety issues and root causes and implementing relevant quality improvements. Although most events were near misses and no patients were harmed, reducing near misses can reduce the likelihood of harm associated with never events.

Sleep disturbances are highly prevalent in patients with predialysis chronic kidney disease, end-stage kidney disease, and after a kidney transplant. They contribute to impairment in daily function and are associated with a high burden of physical and psychiatric symptoms, decreased quality of life, and increased morbidity and mortality. Sleep disturbances also may precipitate and accelerate kidney disease progression. They often evolve across the spectrum of kidney dysfunction and may persist or re-emerge in kidney transplant recipients. Investigation into the multifaceted and dynamic relationships between sleep disturbance and chronic kidney disease requires consideration of myriad contributors including the progression of kidney disease itself, the role of treatment via dialysis and kidney transplant, psychosocial factors, and underlying sleep disorders. Despite sleep disturbance being identified as a priority to address by patients and caregivers, sleep disorders including insomnia, sleep apnea, and restless leg syndrome remain under-recognized and undertreated, and innovation in their management remains modest. In this article, we review the relationships between sleep disturbance and kidney disease, the impact of sleep disturbance and sleep disorders on symptom burden and mental health, and treatment opportunities that may address overlapping symptoms across the spectrum of kidney disease and that could improve patient-related and clinical outcomes.

Disparities in sleep health are important but underrecognized contributors to health disparities. Understanding the factors contributing to sleep heath disparities and developing effective interventions are critical to improving all aspects of heath. Sleep heath disparities are impacted by socioeconomic status, racism, discrimination, neighborhood segregation, geography, social patterns, and access to health care as well as by cultural beliefs, necessitating a cultural appropriateness component in any intervention devised for reducing sleep health disparities. Pediatric sleep disparities require innovative and urgent intervention to establish a foundation of lifelong healthy sleep. Tapping the vast potential of technology in improving sleep health access may be an underutilized tool to reduce sleep heath disparities. Identifying, implementing, replicating, and disseminating successful interventions to address sleep disparities have the potential to reduce overall disparities in health and quality of life.

Background CPAP effectiveness is limited by suboptimal adherence. Prior studies of adherence have focused on middle-aged men. Research Question Does CPAP adherence vary by age and sex? Study Design and Methods Telemonitoring data from a CPAP manufacturer database were used to assess adherence in patients initiating CPAP therapy between November 2015 and October 2018. Analyses were restricted to patients in the United States aged 18 to 90 years. Results Across 789,260 patients initiated on CPAP (mean age, 55 ± 14 years; 58.2% male), overall adherence by US Centers of Medicare & Medicaid Services criteria was 72.6%, but it varied dramatically by age and sex, ranging from 51.3% in 18- to 30-year-old women to 80.6% in 71- to 80-year-old men. Patterns of use over the first 90 days demonstrated that younger age groups had peak CPAP use by the 2nd night, with a subsequent decay in use, including abandonment of CPAP, which was greatest among 18- to 30-year-old women. In contrast, older patients steadily increase use, taking more than a week to maximize usage, and then they have much slower decays in use over time. Younger, but not older, patients have lower use of CPAP on weekends compared with weekday nights. Interpretation CPAP adherence rates vary substantially by demographics, with 18- to 30-year-old women having the lowest adherence. The pattern of use over the first 90 days also varies substantially by age and sex. Further research to understand and address the causes of disparities will be crucial to maximizing the benefits of CPAP therapy.

SARS-CoV-2, the etiologic agent of COVID-19, is a global pandemic with substantial mortality dominated by acute respiratory distress syndrome. We systematically evaluated lungs of 68 autopsies from 3 institutions in heavily hit areas (2 USA, 1 Italy). Detailed evaluation of several compartments (airways, alveolar walls, airspaces, and vasculature) was performed to determine the range of histologic features. The cohort consisted of 47 males and 21 females with a median age of 73 years (range 30-96). Co-morbidities were present in most patients with 60% reporting at least three conditions. Tracheobronchitis was frequently present, independent from intubation or superimposed pneumonia. Diffuse alveolar damage (DAD) was seen in 87% of cases. Later phases of DAD were less frequent and correlated with longer duration of disease. Large vessel thrombi were seen in 42% of cases but platelet (CD61 positive) and/or fibrin microthrombi were present at least focally in 84%. Ultrastructurally, small vessels showed basal membrane reduplication and significant endothelial swelling with cytoplasmic vacuolization. In a subset of cases, virus was detected using different tools (immunohistochemistry for SARS-CoV-2 viral spike protein, RNA in situ hybridization, lung viral culture, and electron microscopy). Virus was seen in airway epithelium and type 2 pneumocytes. IHC or in situ detection, as well as viable form (lung culture positive) was associated with the presence of hyaline membranes, usually within 2 weeks but up to 4 weeks after initial diagnosis. COVID-19 pneumonia is a heterogeneous disease (tracheobronchitis, DAD, and vascular injury), but with consistent features in three centers. The pulmonary vasculature, with capillary microthrombi and inflammation, as well as macrothrombi, is commonly involved. Viral infection in areas of ongoing active injury contributes to persistent and temporally heterogeneous lung damage.

Ancillary testing during the initial workup of acute myeloid leukemia (AML) is largely performed using aspirated materials. We utilized multiplex immunofluorescence (MIF) imaging with digital image analysis to perform an in situ analysis of the microenvironment in NPM1-mutated AML using diagnostic bone marrow biopsy tissues (N = 17) and correlated these findings with diagnostic next-generation sequencing (NGS, N = 17), flow cytometry (FC, N = 14), and first remission (CR1) NPM1-specific molecular MRD (n = 16) data. The total CD3-positive T-cell percentages correlated positively between FC and MIF (r = 0.53, p = 0.05), but were significantly lower by MIF (1.62% vs. 3.4%, p = 0.009). The percentage of mutant NPM1-positive (NPM1c+) cells ranged from 9.7 to 90.8% (median 45.4%) and did not correlate with the NPM1 mutant allele fraction by NGS (p > 0.05). The percentage of CD34+/NPM1c+ cells ranged from 0 to 1.8% (median 0.07%). The percentage of NPM1c+ cells correlated inversely (34% vs. 62%, p = 0.03), while the percentages of CD3−/NPM1c− cells (64% vs. 35%, p = 0.03), and specifically CD3−/CD4−/NPM1c− cells (26% vs. 13%, p = 0.04), correlated positively with subsequent MRD. Discordances between MIF and FC/NGS data suggest that aspirate materials are likely an imperfect reflection of the core biopsy tissue. Furthermore, increased numbers of NPM1 wild-type cells within the microenvironment at diagnosis correlate with the subsequent presence of MRD.

Objectives The objective of this study is to test the hypothesis that short sleep duration is associated with fewer minutes of transportation, work, and leisure physical activity (PA). Design This is a cross-sectional study conducted from 2008 to 2011. Setting The study setting included four sites across the U.S. (Bronx, NY; Chicago, IL; Miami, FL; San Diego, CA). Participants A total of 14,653 Hispanic/Latino adults aged 18–74 years were enrolled as participants for the study. Measurements Respondents reported sleep duration and transportation (including walking and cycling), work (including volunteering, paid work, and household chores), and leisure (including sports) PA domains and sociodemographic characteristics, other sleep characteristics, cardiometabolic health, health behaviors, and depressive symptoms. Results In analyses weighted to reflect the Hispanic/Latino population of the four cities sampled, 61% had sleep duration 7–9 hours, 19% each had sleep duration 9 hours. Those sleeping Conclusions Short sleep duration is associated with more work-related PA, both in the overall sample and among those employed. Individuals with higher work-related PA may face multiple demands and stressors that negatively influence sleep duration.

BACKGROUND: The Patient-Reported Outcomes Measurement Information System (PROMIS) includes two instruments to quantify sleep symptoms (sleep disturbance [SDA] and sleep-related impairment [SRI]) in diverse populations across a wide symptom spectrum. However, the responsiveness of PROMIS measures to treatment of sleep disorders is unknown. We examined the responsiveness of the PROMIS sleep scales to the treatment of OSA. METHODS: We collected SDA, SRI, and Epworth Sleepiness Scale (ESS) before and after initiation of positive airway pressure (PAP) in patients with type 2 diabetes newly diagnosed with OSA. To compare responsiveness, we compared effect sizes and classifications of symptom improvement using both the reliable change method and thresholds of minimum important difference (MID). RESULTS: A total of 103 patients completed assessments pre- and post-PAP. SDA, SRI, and ESS scores all declined significantly with PAP therapy. We observed the largest effect size for SDA (−0.64; 95% CI, −0.86 to −0.42), followed by SRI (−0.43; 95% CI, −0.63 to −0.23), and ESS (−0.28; 95% CI, −0.42 to −0.15). More patients experienced the reliable change category of symptom remission categorized by the PROMIS measures (SDA: 23.3%; SRI: 31.1%) relative to the ESS (5.8%) (P < .001 for both). Using the MID, SDA and SRI also classified more patients as improved (SDA: 54.4%; SRI: 49.5%) relative to the ESS (35.0%) (P < .001 for both pairwise comparisons). CONCLUSIONS: PROMIS sleep measures were more likely than the ESS to detect an improvement with PAP therapy. Incorporating PROMIS measures into research and clinical care may provide a more sensitive assessment of symptomatic response to OSA treatment.

Purpose To determine if Scheimpflug tomography pachymetry map and posterior elevation map patterns, central corneal thickness (CCT), and corneal backscatter can predict the prognosis of Fuchs endothelial corneal dystrophy (FECD). Design Cross-sectional study with follow-up of outcomes. Participants Ninety-six eyes (56 subjects) with a range of severity of FECD. Methods Corneas were graded by cornea specialists according to the area and confluence of guttae and the presence of clinically definite edema. Masked and randomized Scheimpflug imaging pachymetry map and posterior elevation map patterns were assessed by 1 observer for loss of regular isopachs, displacement of the thinnest point of the cornea, and the presence of posterior surface depression. The prognosis of eyes over a 5-year (median) follow-up period was determined based on FECD progression (new onset of clinically definite edema or ≥5% increase in CCT) or intervention by endothelial keratoplasty. Cumulative probabilities of progression and intervention were estimated from survival analyses, with risk factors determined by using Cox proportional hazards models. Main Outcome Measures Pachymetry map and posterior elevation map patterns, corneal backscatter, and CCT (ultrasonic pachymetry). Results In univariate analyses, loss of regular isopachs (hazard ratio [HR], 18.00) displacement of the thinnest point (HR, 11.53), focal posterior surface depression (HR, 10.21), and anterior corneal backscatter (HR, 1.22, per 1-grayscale unit increment), were risk factors for progression or intervention (P Conclusions Three Scheimpflug tomography pachymetry map and posterior elevation map patterns can predict FECD prognosis independent of CCT. The risk of FECD progression and intervention, including after uncomplicated cataract surgery, increases according to the number of parameters present.

To perform a randomized controlled trial of positive airway pressure (PAP) treatment for obstructive sleep apnea (OSA) in pregnancy.Participants with a BMI ≥30 kg/m241 participants completed visit 1, 89 (37%) had an AHI between 5 and 50. Fifty-one participants were randomized in Phase 1, 38 in Phase 2. There was no significant difference in our primary outcome by treatment group. In secondary analyses, UAD-PI was lower in participants on APAP compared to sleep hygiene. Otherwise, there were no differences in MAP, angiogenic markers or metabolic markers in Phase 1, Phase 2 or across the entire study. Overall adherence to APAP therapy was low, but mean use was greater in Phase 2 (0.3 ± 0.6 hours/night vs. 1.3 ± 2.3 hours/night, p=0.10). For those on active therapy, fasting glucose values decreased as adherence increased.This RCT of APAP in pregnancy did not find any differences in a composite primary cardiometabolic risk profile by treatment group. Higher APAP adherence was associated with lower fasting glucose levels. The use of a sham-PAP control arm in Phase1 may have negatively impacted adherence to active treatment.

Biowaste-derived sugars or greenhouse gases, such as methane (CH

Average arterial oxyhemoglobin saturation during sleep (AvSpO(2)S) is a clinically relevant measure of physiological stress associated with sleep-disordered breathing, and this measure predicts incident cardiovascular disease and mortality. Using high-depth whole-genome sequencing data from the National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) project and focusing on genes with linkage evidence on chromosome 8p23,1, 2 we observed that six coding and 51 noncoding variants in a gene that encodes the GTPase-activating protein (DLC1) are significantly associated with AvSpO(2)S and replicated in independent subjects. The combined DLC1 association evidence of discovery and replication cohorts reaches genome-wide significance in European Americans (p = 7.9 × 10(−7)). A risk score for these variants, built on an independent dataset, explains 0.97% of the AvSpO(2)S variation and contributes to the linkage evidence. The 51 noncoding variants are enriched in regulatory features in a human lung fibroblast cell line and contribute to DLC1 expression variation. Mendelian randomization analysis using these variants indicates a significant causal effect of DLC1 expression in fibroblasts on AvSpO(2)S. Multiple sources of information, including genetic variants, gene expression, and methylation, consistently suggest that DLC1 is a gene associated with AvSpO(2)S.

In this study, we apply a short-term voltage (0.2–0.8 V) to both crude glycerol (CG) and an anaerobic digestion (AD) effluent in a single-chamber microbial fuel cell (MFC) for power production. This improves the bioelectrogenesis in both CG (in MFC-1) and the AD effluent (in MFC-2), but higher power generation is attained in MFC-2. The use of domestic and synthetic wastewaters in the AD process leads to the generation of 195 and 350 mL H2/L-medium, respectively. MFC-2 performs better than MFC-1 in terms of both voltage generation and chemical oxygen demand (COD) reduction. The application of 0.8 V yields a power density of 311 mW/m2 (1.94 times higher than that of the control (160 mW/m2)). In addition, MFC-2 exhibits a 70% COD removal at 0.8 V, which decreases to 56% at 0.2 V. Thus, the application of a short-term voltage in MFC can stimulate both bioelectrogenesis and COD removal.

Background Short sleep may be a risk factor for atrial fibrillation. However, previous investigations have been limited by lack of objective sleep measurement and small sample size. We sought to determine the association between objectively measured sleep duration and atrial fibrillation. Methods All 31,079 adult patients undergoing diagnostic polysomnography from 1999 to 2015 at multiple sites within a large hospital network were identified from electronic medical records. Prevalent atrial fibrillation was identified by continuous ECG during polysomnography. Incident atrial fibrillation was identified by diagnostic codes and 12-lead ECGs. Logistic regression and Cox proportional hazards modeling were used to examine the association of sleep duration and atrial fibrillation prevalence and incidence, respectively, adjusting for age, sex, BMI, hypertension, coronary artery disease, cerebrovascular disease, peripheral vascular disease, heart failure, and sleep apnea severity. Results We identified 404 cases of prevalent atrial fibrillation among 30,061 individuals (mean age ± SD, 51.0 ± 14.5 years; 51.6% women) undergoing polysomnography. After adjustment, each 1-h reduction in sleep duration was associated with a 1.17-fold (95% CI, 1.11-1.30) increased risk of prevalent atrial fibrillation. Among 27,589 patients without atrial fibrillation at baseline, we identified 1,820 cases of incident atrial fibrillation over 4.6 years median follow-up. After adjustment, each 1-h reduction in sleep duration was associated with a 1.09-fold (95% CI, 1.05-1.13) increased risk for incident atrial fibrillation. Conclusions Short sleep duration is independently associated with prevalent and incident atrial fibrillation. Further research is needed to determine whether interventions to extend sleep can lower atrial fibrillation risk.

Objective: To demonstrate the potential of an MF59-adjuvanted inactivated trivalent seasonal influenza vaccine (aIIV3; Fluad™) to improve the immune response in young children, we review the immunogenicity, efficacy, and safety/tolerability of aIIV3 from a comprehensive clinical development program in a pediatric population with a specific need for improved influenza vaccines. Methods: Data were analyzed from a series of 1 phase Ib, 3 phase II, and 2 phase III studies involving 11,942 children aged 6 months through 5 years. Results: The clinical data showed that aIIV3 had statistically significantly greater immunogenicity and efficacy in the prevention of influenza compared to conventional inactivated trivalent seasonal influenza vaccines (IIV3s). The safety profile of aIIV3 was generally similar to that of nonadjuvanted IIV3, apart from an increased frequency of solicited adverse events (AEs) following vaccination. The majority of solicited AEs were mild or moderate in severity and resolved within 1 to 3 days. Conclusions: aIIV3 was well tolerated, with immunogenicity and efficacy exceeding that of conventional IIV3 in children 6 months through 5 years of age. The MF59-adjuvanted vaccine has the potential to fulfill an unmet clinical need in the prevention of seasonal influenza in this age group. Keywords: Children, Influenza, Vaccine, Adjuvant, MF59

Objective: To assess the safety and immunogenicity of the MF59-adjuvanted seasonal trivalent inactivated influenza vaccine (aIIV3; Fluad) in children aged 6 months through 5 years who are at risk of influenza complications. Methods: A retrospective analysis was performed to examine unsolicited adverse events (AEs) in an integrated dataset from six randomized clinical studies that compared aIIV3 with non-adjuvanted inactivated influenza vaccines (IIV3). The integrated safety set comprised 10 784 children, of whom 373 (3%) were at risk of influenza complications. Results: The at-risk safety population comprised 373 children aged 6 months through 5 years: 179 received aIIV3 and 194 received non-adjuvanted IIV3 (128 subjects received a licensed IIV3). The most important risk factors were respiratory system illnesses (62–70%) and infectious and parasitic diseases (33–39%). During the treatment period, unsolicited AEs occurred in 54% of at-risk children and 55% of healthy children who received aIIV3; of those receiving licensed IIV3, 59% of at-risk and 62% of healthy subjects reported an unsolicited AE. The most common AEs were infections, including upper respiratory tract infection. Serious AEs (SAEs) were reported in

Introduction False beliefs about sleep can persist despite contradicting scientific evidence, potentially impairing population health. Identifying commonly held false beliefs lacking an evidence base (“myths”) can inform efforts to promote population sleep health. Method We compiled a list of potential myths using Internet searches of popular press and scientific literature. We used a Delphi process with sleep experts (n = 10) from the fields of sleep medicine and research. Selection and refinement of myths by sleep experts proceeded in 3 phases, including focus groups (Phase 1); email-based feedback to edit, add, or remove myths (Phase 2); and closed-ended questionnaires (Phase 3) where experts rated myths on 2 dimensions, falseness and public health significance, using 5-point Likert scale from 1 (“not at all”) to 5 (“extremely false”). Results The current study identified 20 sleep myths. Mean expert ratings of falseness ranged from 5.00 (SD = 0.00) for the statement “during sleep the brain is not active” to 2.50 (SD = 1.07) for the statement “sleeping in during the weekends is a good way to ensure you get adequate sleep.” Mean responses to public health significance ranged from 4.63 (SD = 0.74) for debunking the statement that “many adults need only 5 or less hours of sleep for general health” to 1.71 (SD = 0.49) for the statement that “remembering your dreams is a sign of a good night's sleep.” Conclusion The current study identified commonly held sleep myths that have a limited or questionable evidence base. Ratings provided by experts suggest areas that may benefit from public health education to correct myths and promote healthy sleep.

Background The relationship of poor sleep patterns to the increased risk of obesity has been reported, but the results are variable. This study evaluated the association between objectively measured sleep patterns and obesity in a representative adult population of Hispanic/Latino subjects living in the United States. Methods This cross-sectional study was an analysis of a multicenter, community-based cohort of 2,156 participants aged 18 to 64 years from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Recruitment was conducted in San Diego, California; Chicago, Illinois; Bronx, New York; and Miami, Florida. Models were controlled for age, sex, ethnic background, site, income, education, and apnea-hypopnea index. Seven days of wrist actigraphy data were collected. Obesity was defined as BMI ≥ 30 kg/m2, and abdominal obesity was defined as waist circumference ≥ 88 cm in women and ≥ 102 cm in men. Napping was defined as more than one 15-min nap per week. Results An inverse linear relationship was found between sleep duration and prevalence of obesity (P linear trend ≤ 0.01). A reduction of 1 h sleep increased obesity prevalence by 4.1% (95% CI, 1.6-6.6; P = .002) and abdominal obesity prevalence by 3.6% (95% CI, 1.1-6.1; P = .007). Daytime napping increased obesity prevalence by 10.4% (95% CI, 3.5-17.3; P = .004) and abdominal obesity prevalence by 7.1% (95% CI, 1.0-13.2; P = .02). Conclusions In a population of young to older adult Hispanic/Latino subjects, we found an inverse linear association between sleep duration and the prevalence of obesity. Daytime napping was strongly associated with greater adiposity. Interventional and longitudinal studies are needed to better understand how abnormal sleep patterns contribute to the obesity epidemic.

PURPOSE: To determine whether preoperative endothelial cell density (ECD) and/or postoperative ECD after Descemet stripping automated endothelial keratoplasty (DSAEK) are associated with late endothelial graft failure (LEGF) in the Cornea Preservation Time Study (CPTS). DESIGN: Cohort study within multicenter randomized clinical trial. PARTICIPANTS: 1,007 individuals (1,223 study eyes), mean age 70 years, undergoing DSAEK for Fuchs’ dystrophy (94% of eyes) or pseudophakic/aphakic corneal edema (PACE) (6% of eyes) and followed for up to 5 years. METHODS: Central ECD was determined by a central image analysis reading center. Preoperative ECD was determined for 1209 eyes that did not fail and 14 eyes that experienced LEGF. ECD at 6 and 12 months after DSAEK, the change in ECD from preoperative to 6 and 12 months, surgeon-reported operative complications, and postoperative graft dislocation, were investigated for an association with LEGFs unrelated to other postoperative events. Univariable and multivariable Cox proportional hazards regression models were used to assess associations. RESULTS: The cumulative probability of LEGF was 1.3% (95% CI 0.8% to 2.4%). Median (IQR) preoperative ECDs were similar for eyes with LEGF (2523 (2367, 3161) cells/mm(2)) and eyes without failure (2727 (2508, 2973) cells/mm(2)) (p=0.34). ECD at 6 months was associated with LEGF (p

Noble-metal hybrid nanostructures have gained tremendous attention due to their potential roles in biomedical and catalytic applications. In this study, for the synthesis of silver nanoparticles (Ag NPs)–silica (SiO2) NPs, a novel green chemistry approach was employed, in which green tea biomolecule–encapsulated SiO2 nanostructures were used for the reduction of silver ions to produce hybrid nanostructures within 300 s. The high-resolution transmission electron microscopy (HrTEM) revealed the formation of uniform ultrafine spherical Ag NPs that were evenly distributed in the nanostructures. The formed nanohybrid structures showed efficient catalytic activity for the formation of derivatives of dihydroquinoline, and retained 91% of their reusability capacity, even after 5 repeated cycles. Hence, this work provides a novel synthesis method not only for the synthesis of biomolecule-entrapped SiO2 nanostructures, but also for the rapid formation of catalytically active hybrid nanostructures.

Thermal dewatering using spray dryers is an energy-intensive process, which recently, applied for removal of water from industrial effluents by evaporation. Reduction of energy consumption is vital to reduce operating cost in addition to sustainable development. In this paper, the modern integrated energy savings scheme is proposed in four parts. (i) An advanced energy saving configuration named as a hybrid heat recovery system for a spray dryer, (ii) Developed rigorous but simple mathematical model for direct and hybrid heat recovery system, (iii) A generalized performance indicator for investigation of environmental impact on energy recovery called as ‘Sustainability Index’ is proposed for thermal systems and demonstrated for spray dryer, and finally (iv) The proposed methods are explained with the help of an illustrative example taken from the literature. Up to 80% recirculation ratio, performance enhancement, and Sustainability Index are significantly higher for the hybrid heat recovery system than the direct heat recovery system, while for higher than 80% recirculation ratio, both are approaching towards nearly same value. Furthermore, with increasing recirculation ratio, moisture recirculation into the drying chamber also increases, which reduces the requirement of the mass flow rate of dry hot air due to the higher heat capacity of recirculated moisture. A reduction in hot air requirement reduces the high-grade blower power in addition to net heat supplied. Dryer efficiency and sustainability index, both show a strong dependency on the amount of heat recovery for spray dryer.

Novel mesoporous SiO2 microparticles were synthesized by spray pyrolysis using multiwalled carbon nanotubes (MCNTs) as a template. The synthesized multicompartment structure with uniform pores of 12.0 nm was used to immobilize lipase from Thermomyces lanuginosus. The total surface area of mesoporous SiO2 microparticles prepared from silica colloidal solution was increased by 26-folds compared to that of dense SiO2 particles (494 vs 19.0 m2 g−1, respectively). Mesoporous SiO2 particles showed 236% higher protein loading for lipase, than dense SiO2 particles. The maximum velocity (Vmax) and catalytic efficiencies of immobilized lipase were 3.80 and 5.90 folds higher than that of free enzyme. Contact angle analysis revealed increased hydrophobicity of the mesoporous particles, which is advantageous for lid opening at the active center, and increased activity after immobilization. We next developed a lipase/SiO2/glassy carbon electrode (GCE) biosensors. Cyclic voltammetric results showed linear responses of the lipase/SiO2/GCE bioelectrode towards tributyrin (50–300 mg dL−1) as a surface-limited reaction in Tris-HCl buffer. After 12 repetitive uses, dense SiO2- and mesoporous SiO2-bound lipase retained 74.2 and 95.4% of its original activities, respectively. Thus, given their desirable characteristics and industrial utility, greatly porous SiO2 particles may provide an excellent support for enzyme immobilization in biosensor development or biocatalysis in organic media.

Pyridine nucleotide cofactors play important roles in biocatalytic processes that generate value-added chemicals for the pharmaceutical and food industries. Because of the high price of these pyridine cofactors, cofactor regeneration is highly desirable. However, recycling the oxidized form of cofactors, especially NADP+, remains a challenge. Here, we cloned and characterized an NADH oxidase from Lactobacillus reuteri (LreNox) which can oxidize both NADH and NADPH. Unlike many other Noxs, LreNox showed equal catalytic efficiency towards NADH and NADPH. To the best our knowledge, LreNox has the highest activity towards NADPH as a substrate compared to other wild type Noxs. Homology modeling and substrate docking studies provided insights into the dual substrate specificity of LreNox. Gly155, Ser179, and His184 in the LreNox substrate binding pocket, which are absent in other Noxs structures, are crucial for NADPH recognition, providing more space for interactions with the additional phosphate group present in NADPH. We also explored the utility of LreNox for NADP+ regeneration in l-sorbose production by coupling it with a sorbitol dehydrogenase. The turn over number (TTN) improved ~53-fold after using LreNox as the NADP+ recycling enzyme. This study demonstrates that LreNox could potentially be used for the regeneration of NAD(P)+ in commercial applications.

With the fast development of IoTs, the usage of varied smart applications like smart home, ,smart traffic, smart healthcare, smart cities are increased exponentially. Data in large volume is generated, processed and transmitted by smart devices in IoT. In advent to fulfil the unsupported features for some IoT applications (e.g., low latency, geographic distribution, location awareness) fog computing is consolidated with IoTs to come up with storage, networking and computing resources at the extremity of network that is near the device. Security of the data in transit and at rest is the major area of concern in IoT. As the IoT devices comprised of limited resources (i.e., less storage capacity, low processing power) the security mechanisms of cloud are not directly applicable to IoT. Lightweight cryptographic functions are proposed and proved to overcome many issues of conventional encryption. They are proved to be suitable for resource constrained devices. In last few years, a broad range of lightweight cryptography methods lightweight cryptography methods have been proposed. Also, the security capacities and functions, for example, cryptography can be offloaded to all the more remarkable fog nodes.

The relationship between sleep disruption, independent of obstructive sleep apnea (OSA), and atrial fibrillation (AF) is unknown.The purpose of this study was to determine whether poor sleep itself is a risk factor for AF.We first performed an analysis of participants in the Health eHeart Study and validated those findings in the longitudinal Cardiovascular Health Study, including a subset of patients undergoing polysomnography. To determine whether the observed relationships readily translated to medical practice, we examined 2005-2009 data from the California Healthcare Cost and Utilization Project.Among 4553 Health eHeart participants, the 526 with AF exhibited more frequent nighttime awakening (odd ratio [OR] 1.47; 95% confidence interval [CI] 1.14-1.89; P = .003). In 5703 Cardiovascular Health Study participants followed for a median 11.6 years, frequent nighttime awakening predicted a 33% greater risk of AF (hazard ratio [HR] 1.33; 95% CI 1.17-1.51; P.001). In patients with polysomnography (N = 1127), every standard deviation percentage decrease in rapid eye movement (REM) sleep was associated with a 18% higher risk of developing AF (HR 1.18; 95% CI 1.00-1.38; P = .047). Among 14,330,651 California residents followed for a median 3.9 years, an insomnia diagnosis predicted a 36% increased risk of new AF (HR 1.36; 95% CI 1.30-1.42; P.001).Sleep disruption consistently predicted AF before and after adjustment for OSA and other potential confounders across several different populations. Sleep quality itself may be important in the pathogenesis of AF, potentially representing a novel target for prevention.

Objective Drowsy driving is a significant cause of traffic accidents and fatalities. Although previous reports have shown an association between race and drowsy driving, the reasons for this disparity remain unclear. Study design A cross-sectional analysis of responses from 193,776 White, Black, and Hispanic adults participating in the US Behavioral Risk Factor Surveillance System from 2009 to 2012 who answered a question about drowsy driving. Measurements Drowsy driving was defined as self-reporting an episode of falling asleep while driving in the past 30 days. All analyses were adjusted for age, sex, and medical comorbidities. Subsequent modeling evaluated the impact of accounting for differences in health care access, alcohol consumption, risk-taking behaviors, and sleep quality on the race–drowsy driving relationship. Results After adjusting for age, sex, and medical comorbidities, the odds ratio (OR) for drowsy driving was 2.07 (95% confidence interval [CI] 1.69-2.53) in Blacks and 1.80 (95% CI 1.51-2.15) in Hispanics relative to Whites. Accounting for health care access, alcohol use, and risk-taking behaviors had little effect on these associations. Accounting for differences in sleep quality resulted in a modest reduction in the OR for drowsy driving in Blacks (OR = 1.55, 95% CI 1.27-1.89) but not Hispanics (OR = 1.74, 95% CI 1.45-2.08). Conclusion US Blacks and Hispanics have approximately twice the risk of drowsy driving compared to whites. Differences in sleep quality explained some of this disparity in Blacks but not in Hispanics. Further research to understand the root causes of these disparities is needed.

Recent evidence has highlighted the health inequalities in sleep behaviors and sleep disorders that adversely affect outcomes in select populations, including African-American and Hispanic-American subjects. Race-related sleep health inequalities are ascribed to differences in multilevel and interlinked health determinants, such as sociodemographic factors, health behaviors, and biology. African-American and Hispanic-American subjects are admixed populations whose genetic inheritance combines two or more ancestral populations originating from different continents. Racial inequalities in admixed populations can be parsed into relevant groups of mediating factors (environmental vs genetic) with the use of measures of genetic ancestry, including the proportion of an individual's genetic makeup that comes from each of the major ancestral continental populations. This review describes sleep health inequalities in African-American and Hispanic-American subjects and considers the potential utility of ancestry studies to exploit these differences to gain insight into the genetic underpinnings of these phenotypes. The inclusion of genetic approaches in future studies of admixed populations will allow greater understanding of the potential biological basis of race-related sleep health inequalities.

BACKGROUND: Although excessive daytime sleepiness (EDS) is a common symptom of obstructive sleep apnea (OSA), and both EDS and OSA have separately been associated with increased risk of cardiovascular disease (CVD), their joint association with CVD risk is unknown METHODS: Among 3,874 Sleep Heart Health Study (SHHS) participants without prevalent CVD, moderate to severe OSA was defined by an apnea hypopnea index (AHI) ≥ 15 on an in-home polysomnography. EDS was defined as an Epworth Sleepiness Scale score ≥ 11. Incident CVD events included total CVD events (coronary heart disease (CHD) and stroke), as well as CHD and stroke separately. Cox proportional hazards models adjusted for age, sex, alcohol, smoking, and body mass index. RESULTS: Compared to those with AHI

The structural morphology and composition of a support play a key role in the performance of nanoparticle-based enzymatic biosensors. In the present study, the influence of different functional groups, including glutaraldehyde, 3-aminopropyltriethoxysilane, carbodiimide, cyano, and polyethyleneimine for the immobilization of laccase on synthesized Fe2O3 yolk-shell and commercially available Fe2O3, SrFe12O19, and Y3Fe5O12 particles was analyzed. Glutaraldehyde-activated particles showed higher laccase activity after immobilization and higher relative detection currents for 2,6-dimethoxyphenol (2,6-DMP). The multi-shelled structural morphology of Fe2O3 yolk-shell particles significantly improved the biosensing properties of immobilized laccase compared to that of spherical pure Fe2O3 and composite SrFe12O19 and Y3Fe5O12 particles. The prepared biosensors showed high selectivity towards 2,6-DMP, with a sensitivity of 452 μA/mM/cm2. Under optimum conditions, the linear ranges of detection were as follows: 2,6-DMP (0.025–750 μM), guaiacol (0.10–250 μM), pyrogallol (0.25–250 μM), and 3,4-dihydroxy- l -phenylalanine (1.0–125 μM), with limit of detection values of 0.010, 0.052, 0.093, and 0.273 μM, respectively. Laccase immobilized on bio-friendly multi-shelled Fe2O3 yolk-shell particles showed a broad linear range of detection, the lowest limit of detection, high sensitivity and stability, good reproducibility, anti-interference and recovery, and insignificant inhibition by laccase inhibitors.

Characterizing the tumor immune microenvironment enables the identification of new prognostic and predictive biomarkers, the development of novel therapeutic targets and strategies, and the possibility to guide first-line treatment algorithms. Although the driving elements within the tumor microenvironment of individual primary organ sites differ, many of the salient features remain the same. The presence of a robust antitumor milieu characterized by an abundance of CD8+ cytotoxic T-cells, Th1 helper cells, and associated cytokines often indicates a degree of tumor containment by the immune system and can even lead to tumor elimination. Some of these features have been combined into an ‘Immunoscore’, which has been shown to complement the prognostic ability of the current TNM staging for early stage colorectal carcinomas. Features of the immune microenvironment are also potential therapeutic targets, and immune checkpoint inhibitors targeting the PD-1/ PD-L1 axis are especially promising. FDA-approved indications for anti-PD-1/PD-L1 are rapidly expanding across numerous tumor types and, in certain cases, are accompanied by companion or complimentary PD-L1 immunohistochemical diagnostics. Pathologists have direct visual access to tumor tissue and in-depth knowledge of the histological variations between and within tumor types and thus are poised to drive forward our understanding of the tumor microenvironment. This review summarizes the key components of the tumor microenvironment, presents an overview of and the challenges with PD-L1 antibodies and assays, and addresses newer candidate biomarkers, such as CD8+ cell density and mutational load. Characteristics of the local immune contexture and current pathology-related practices for specific tumor types are also addressed. In the future, characterization of the host antitumor immune response using multiplexed and multimodality biomarkers may help predict which patients will respond to immune-based therapies.

Background The aim of this study was to evaluate the association between actigraphy-based measures of sleep and prevalent hypertension in a sample of US Latinos. Methods We analyzed data from 2,148 participants of the Sueno Sleep Ancillary Study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), who underwent 1 week of wrist actigraphy to characterize sleep duration, sleep efficiency, sleep fragmentation index, and daytime naps. Insomnia was defined as an Insomnia Severity Index ≥ 15. Hypertension was defined based on self-reported physician diagnosis. Survey linear regression was used to evaluate the association of sleep measures with hypertension prevalence. Sensitivity analyses excluded participants with an apnea-hypopnea index (AHI) ≥ 15 events/h. Results The mean age was 46.3 ± 11.6 years, and 65% of the sample consisted of women. The mean sleep duration was 6.7 ± 1.1 hours. Thirty-two percent of the sample had hypertension. After adjusting for age, sex, ethnic background, site, and AHI, each 10% reduction in sleep efficiency was associated with a 7.5% (95% CI, –12.9 to –2.2; P = .0061) greater hypertension prevalence, each 10% increase in sleep fragmentation index was associated with a 5.2% (95% CI, 1.4-8.9; P = .0071) greater hypertension prevalence, and frequent napping was associated with a 11.6% greater hypertension prevalence (95% CI, 5.5-17.7; P = .0002). In contrast, actigraphy-defined sleep duration ( P = .20) and insomnia ( P = .17) were not associated with hypertension. These findings persisted after excluding participants with an AHI ≥ 15 events/h. Conclusions Independent of sleep-disordered breathing, we observed associations between reduced sleep continuity and daytime napping, but not short sleep duration, and prevalent hypertension.

Inefficient waste management and associated environmental pollution are exhausting societies’ precious renewable resources. Moreover, their effects on human health adversely affect the global economic scenario. These adverse effects are a constant cause of concern for environmental and health management. This review presents alternatives to uneconomical and non-eco-friendly methods for waste management and treatment. The multistep microbial anaerobic digestion (AD) process has the potential to metabolize up to 95% of organic matter to energy-rich methane (CH4) and carbon dioxide. The intermediates of AD can be transformed into value-added products, such as hydrogen (H2), polyhydroxyalkanoates (PHAs), and CH4. The unique feature of these value-added products is their eco-friendly nature (non-polluting and biodegradable). The use of biowaste as feed makes the process economical. A few limiting factors that must be circumvented include (i) the slow metabolic rates of methanogens, (ii) high susceptibility to oxygen concentrations, and (iii) the complexity of biowaste. Here, we focus on using biowaste as a feed for integrating dark-fermentative H2 production processes with those of i) photo-fermentative H2, ii) PHAs, and (iii) CH4. This strategy could encourage a transition to an economy based on sustainable waste management and energy generation.

Purpose To report a case of recurrent iris post-transplant lymphoproliferative disorder (PTLD) treated with ultra-low-dose (boom-boom) radiotherapy (RT). Observations A 12-year-old Caucasian male with a history of bilateral, recurrent iris PTLD of the extranodal marginal zone lymphoma (MALT) type presented with persistent bilateral anterior chamber cellular infiltration, which was incompletely controlled on topical corticosteroids, and with elevated intraocular pressure (IOP) in the right eye secondary to steroid response. The patient was diagnosed with PTLD recurrence and was successfully treated with ultra-low-dose RT to both eyes in 2 fractions of 2 Gy. At 15 month follow-up the patient maintained complete disease control with normal IOP off all topical ophthalmic medications. Conclusions and Importance: Ultra-low-dose RT for ocular PTLD of the MALT subtype represents a novel therapeutic approach that may provide a durable treatment response and could be considered as either primary or adjuvant therapy for this rare condition.

Biohythane may be used as an alternative feed for methanol production instead of costly pure methane. In this study, methanol production potential of Methylocella tundrae immobilized through covalent immobilization, adsorption, and encapsulation was evaluated. Cells covalently immobilized on groundnut shells and chitosan showed a relative methanol production potential of 83.9 and 91.6%, respectively, compared to that of free cells. The maximum methanol production by free cells and cells covalently immobilized on groundnut shells and chitosan was 6.73, 6.20, and 7.23 mM, respectively, using simulated biohythane as a feed. Under repeated batch conditions of eight cycles, cells covalently immobilized on chitosan and groundnut shells, and cells encapsulated in sodium-alginate resulted in significantly higher cumulative methanol production of 37.76, 31.80, and 25.58 mM, respectively, than free cells (18.57 mM). This is the first report on immobilization of methanotrophs on groundnut shells and its application in methanol production using biohythane as a feed.

Objective The majority of adults sleep with a partner, making sleep a dyadic experience. However, interventions to improve sleep have primarily focused on individuals. This qualitative analysis used a dyadic approach to identify facilitators and barriers to successful treatment of one of the most common sleep disorders, obstructive sleep apnea, with continuous positive airway pressure (CPAP). Methods Twenty joint qualitative interviews were conducted with couples, one couple at a time, with a sample of 20 patients with obstructive sleep apnea and their partners to develop an understanding of couples' experiences with CPAP use. Interviews were audio recorded and transcribed. Conventional qualitative content analysis was used to analyze the interview data. Results Facilitators of CPAP use were the following: the partner aiding diagnosis and treatment, couples working together using CPAP, the perceived benefits of CPAP for both partners, the patient being motivated to use CPAP for the benefit of the partner, and various types of support provided by the partner to encourage CPAP use. Major barriers to CPAP use were the following: anxiety related to CPAP use particularly in the beginning of therapy, bothersome equipment causing disruptions in sleep and bedtime routine, interruptions to intimacy, and concern about image change while wearing CPAP. Conclusions Findings from this study suggest that couple-directed interventions that advocate for a mutually engaging perspective and promote supportive relationships and positive dyadic coping may be targets for improving CPAP adherence. Further research evaluating the potential of couple-focused interventions to improve sleep health is warranted.

Sleep is a state of consciousness that is preserved across animal species whose exact function is not yet clear but which has a vital impact on health and well-being. Epidemiological evidence suggests sleep duration in both children and adults has been decreasing over the past half-century, while at the same time, rates of overweight and obesity have been increasing. Short sleep duration along with other dimensions of poor sleep have been associated with obesity both cross-sectionally and longitudinally. These data suggest a potential causal relationship between poor sleep and greater rates of weight gain that may be related to effects of sleep on dietary intake or physical activity. However, there is also potential for reverse causation as obesity leads to many co-morbidities including sleep apnea that can disrupt sleep. Medium and long term interventional studies are needed to evaluate the potential for healthy sleep interventions to help combat the epidemic of obesity.

The design of thin-film multilayered anti-reflection (AR) coating is quite an intricate task due to highly nonlinear and complex dimensional search space, which includes many local minima. In this paper, a novel teaching-learning based optimization (TLBO) approach is employed to design ultra-low reflective coating over a broad wavelength-band using multilayer thin-film structures for optoelectronic devices. The algorithm is implemented using LabVIEW as a programming tool. Various design specific input parameters such as scanning range of wavelengths, step-size, angle of incidence, number of layers, the name and sequence of coating materials etc. are required to be fed by the user on the graphical user interface. The algorithm minimizes the average reflectivity computed over given wavelength range by tuning the thickness of layers in the multilayer stack. The reliability and evolution of design solution with iterations have been systematically investigated for different learner-sizes. Finally, using the optimized learner size and desired number of iterations, the optimum AR design is obtained in terms of the thickness of each layer for the multilayer AR coating. The effectiveness of the TLBO approach has been compared with that of an established algorithm, i.e. genetic algorithm (GA), by means of Wilcoxon singed ranked test. It is concluded that the TLBO can be a very efficient, simpler and relatively faster approach to address complex optimization problems such as broad-band AR coating designs.

Although disorganized, chaotic households have been linked to poorer sleep outcomes, how household chaos actually manifests itself in the behaviors of others around the bedtime of a child or adolescent is not well understood.To determine whether household chaos was associated with specific, nightly sleep-disturbing activities of adolescents' family members.Longitudinal study.Twenty-six African American or multiethnic early adolescent (ages 11-12 years) and parent dyads, recruited from local schools and social-service agencies in greater Cleveland, OH.Over 14 days, each night at bedtime, adolescents identified family-member activities keeping them awake or making it difficult to sleep by using a smart phone-administered survey. Household organization was assessed via parent-completed, validated instruments. A generalized linear mixed model examined associations between each activity and household-organization measures.Adjusted for the effect of school being in session the next day, an increasingly chaotic household was associated with increased odds of household members disturbing adolescents' efforts to fall asleep by watching TV/listening to music (odds ratio [OR]=1.8, 95% confidence interval [CI]=1.2-3.2), phoning/texting (OR=1.7, 95% CI =1.2-2.9), or having friends/relatives over visiting at the home (OR=1.6, 95% CI =1.0-3.0). Conversely, a more chaotic household was associated with decreased odds of adolescents reporting that "nothing" was keeping them awake or making it more difficult to sleep (OR=0.6, 95% CI =0.4-0.8). Enforced sleep rules were inconsistently associated with sleep-disturbing behaviors.Improving early-adolescent sleep may benefit from considering the nighttime behavior of all household members and encouraging families to see that improving early-adolescent sleep requires the household's participation.

Most of the part of the land is covered by saline water where fresh water is available in less proportion and also the demand of fresh water for drinking use is increasing rapidly day after day due to increase in the population. Hence, solar desalination is a feasible alternative to sweep over this massive difficulty. The process by which impure water is converted into clean water is called soar desalination and instrument which is used for it is known as solar still. A lot of investigation has been done by various researchers to inspect the parameters which affect the efficiency of solar still and thereby to improve its performance. In this review paper different design and climate parameters are reviewed which affects the yield of a solar still.