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Objective: Seizures and electroencephalographic (EEG) abnormalities have been associated with unfavorable stroke functional outcome. However, this association may depend on clinical and imaging stroke severity. We set out to analyze whether epileptic seizures and early EEG abnormalities are predictors of stroke outcome after adjustment for age and clinical/imaging infarct severity., Methods: A prospective study was made on consecutive and previously independent acute stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 on admission and an acute anterior circulation ischemic lesion on brain imaging. All patients underwent standardized clinical and diagnostic assessment during admission and after discharge, and were followed for 12 months. Video-EEG (<60 min) was performed in the first 72 h. The Alberta Stroke Program Early CT Score quantified middle cerebral artery infarct size. The outcomes in this study were an unfavorable functional outcome (modified Rankin Scale [mRS] ≥ 3) and death (mRS = 6) at discharge and 12 months after stroke., Results: Unfavorable outcome at discharge was independently associated with NIHSS score (p = 0.001), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Unfavorable outcome 1 year after stroke was independently associated with age (p = 0.001), NIHSS score (p < 0.001), remote symptomatic seizures (p = 0.046), EEG background activity slowing (p < 0.001), and asymmetry (p < 0.001). Death in the first year after stroke was independently associated with age (p = 0.028), NIHSS score (p = 0.001), acute symptomatic seizures (p = 0.015), and EEG suppression (p = 0.019)., Significance: Acute symptomatic seizures were independent predictors of vital outcome and remote symptomatic seizures of functional outcome in the first year after stroke. Therefore, their recognition and prevention strategies may be clinically relevant. Early EEG abnormalities were independent predictors and comparable to age and early clinical/imaging infarct severity in stroke functional outcome discrimination, reflecting the concept that EEG is a sensitive and robust method in the functional assessment of the brain.

Introduction: Although uncommon, major vessel hemorrhage is the most feared complication of mediastinoscopy. Our goal was to determine the optimal management strategy and to develop a simple and accessible protocol for optimizing care in these situations., Methods: Data collection after reviewing the relevant literature. A literature review was conducted using the following databases: PubMed, Medline, Embase and ScienceDirect., Results: The protocol consists of three distinct parts - initial checklist, considerations in minor bleeding and performance in major bleeding. In this last section we propose an initial approach based mainly on fluid resuscitation and immediate surgical correction if the former has not been successful., Conclusion: Mediastinoscopy continues to be an important and effective diagnostic tool. However, it can cause important iatrogenic lesions which the anesthesiologist and surgical team must be prepared to diagnose early and treat properly.

Introduction: Duchenne muscular dystrophy (DMD) is an x linked recessive disorder. Long term prognosis is ominous, with development of respiratory distress and cardiomyopathy in advanced stage of the disease and expected death in the teens-to-mid 20s due to respiratory or cardiac failure. Peri-operative management of this patients is challenging due to difficult airway anatomy (macroglossia, limited neck and mandibular mobility). Additionally, they are at risk of developing malignant hyperthermia, rhabdomyolysis and hyperkalemic cardiac arrest when exposed to halogenated inhalational anaesthetics and depolarizing muscle relaxants., Methods: We describe a case of DMD proposed to a thoracotomy for treatment of recurrent pneumothorax and its anaesthetic approach., Results: A 22-year-old male patient with DMD presented at emergency department due dyspnoea starting at 3 days associated with right scapular pain, enhanced by breathing. The patient already presents with mild cardiomyopathy (ejection fraction of 55%, mild mitral and tricuspid regurgitation), severe restrictive respiratory defect, requiring continuous BiPAP. The patient was markedly denourished (BMI of 12 kg/m2) and presented with nearly absent breathing sounds on the right side. Chest radiography showed large pneumothorax on the right side with no signs of tension. Drainage was performed. Despite initial success, recurrence of pneumothorax occurred on the several attempts of clamping. A bronchopleural fistula was suspected and operative treatment was considered. Considering the comorbidities, he was graded ASA IV with a difficult airway due to macroglossia, limited neck and mandibular mobility. Oro-tracheal intubation was performed with slight sedation (propofol, without neuromuscular blocks). Difficult airway anatomy (direct laryngoscopy - Cormack 4) successfully approached with a bougie and Mccoy blade. Fibreoptic intubation approach was immediately available in the operating room, if required. Total intravenous anaesthesia was decided (remifentanil and propofol, administered by continuous infusion, without neuromuscular blockers). Volume controlled protective ventilation as used (tidal volume 6-8ml/kg, respiratory frequency of 14-16/ min; FiO2: 0,5). No bronchopleural fistula was detected and pleurodesis was performed with biologic glue. Patient remained intubated and was transferred to the ICU for monitoring, having been discharged on the 2nd day to the ward. Despite this, pneumothorax recurrence occurred, and surgery was performed again, using the same anaesthetic approach, this time with successful closure of the bronchopleural fistula., Conclusion: Total intravenous anaesthesia, without neuromuscular blockers, is a safe and effective option for DMD patients. Anaesthesiologists must consider the possibility of cardio-pulmonary disabilities, difficult airway management, as well as the high risk of malignant hyperthermia in these patients.

Background: Sleep and fatigue management is one of the main challenges in airline operations scheduling. Our aim was to compare the differences regarding fatigue, sleep, and labor specificities between the two most common types of flight, short/medium haul (SM-H) and long haul (L-H), in a large sample of airline pilots., Methods: A self-report questionnaire was developed, composed of socio-economic and labor questions, and psychological assessment scales for fatigue and sleep. Associations of these variables and type of flight were tested., Results: Of the total sample of Portuguese airline pilots (N = 435), 313 (72%) were from SM-H and 122 (28%) were from L-H. For SM-H, the values obtained for sleep complaints were 34.2%, daytime sleepiness 61.6%, and fatigue 93.0%. For L-H, 36.9%, 53.3%, and 84.4%, respectively. Looking at labor variables, the differences between the two types of flights were evident, with SM-H pilots' having statistically significant higher mean values of duty and flight hours, numbers of sectors, and early mornings. Only the mean number of night periods was higher in L-H pilots. All values were reported for 28 consecutive scheduling days., Conclusion: Night periods and time-zone crossing may explain higher prevalence levels of sleep disturbances in L-H pilots. However, the values for daytime sleepiness were higher in SM-H pilots, which may be attributed to diminished sleep caused by a combination of frequent early starts and long duty periods. Taking into account the large differences between the two types of flights, different regulatory limits should be considered by aviation authorities. Reis C, Mestre C, Canhão H, Gradwell D, Paiva T. Sleep and fatigue differences in the two most common types of commercial flight operations. Aerosp Med Hum Perform. 2016; 87(9):811-815.

Narcolepsy with cataplexy is a rare disease with an estimated prevalence of 0.02% in European populations. Narcolepsy shares many features of rare disorders, in particular the lack of awareness of the disease with serious consequences for healthcare supply. Similar to other rare diseases, only a few European countries have registered narcolepsy cases in databases of the International Classification of Diseases or in registries of the European health authorities. A promising approach to identify disease-specific adverse health effects and needs in healthcare delivery in the field of rare diseases is to establish a distributed expert network. A first and important step is to create a database that allows collection, storage and dissemination of data on narcolepsy in a comprehensive and systematic way. Here, the first prospective web-based European narcolepsy database hosted by the European Narcolepsy Network is introduced. The database structure, standardization of data acquisition and quality control procedures are described, and an overview provided of the first 1079 patients from 18 European specialized centres. Due to its standardization this continuously increasing data pool is most promising to provide a better insight into many unsolved aspects of narcolepsy and related disorders, including clear phenotype characterization of subtypes of narcolepsy, more precise epidemiological data and knowledge on the natural history of narcolepsy, expectations about treatment effects, identification of post-marketing medication side-effects, and will contribute to improve clinical trial designs and provide facilities to further develop phase III trials., (© 2016 European Sleep Research Society.)

Sediments may be a repository of contaminants in freshwater ecosystems. One way to assess the quality of this compartment, in terms of potentially bioavailable metals, is by the analysis of acid-volatile sulfide (AVS) and simultaneously extracted metals (SEM). In order to investigate the bioavailability, toxicity, and compartmentalization of different metals (Cd, Cr, Cu, Ni, Pb, Zn), sampling of surface sediments was performed at nine stations along the Paiva Castro reservoir (São Paulo, Brazil). The metals were analyzed using atomic absorption spectroscopy. Sediment organic matter (OM), organic carbon (OC), and grain size were also measured. The parameters pH, EH, temperature, and dissolved oxygen were determined at the sediment-water interface. Chronic and acute toxicological tests were performed with sediments from the area where water was extracted for the public water supply. Low levels of OM, associated with loss of stratification in the water column, explained the relatively low AVS values. The molar ratio ∑[SEM]-[AVS]/fOC was less than 130 mmol/kg(-1) for all the sampling stations, indicating that the metals were not bioavailable. With the exception of Cd, metal levels were in accordance with background concentrations and the threshold effect level (TEL) established by the Canadian Council of Ministers of the Environment. The ecotoxicological tests confirmed the absence of toxic effects to biota. Application of principal component analysis indicated the presence of four compartments along the reservoir: (1) a riverine zone, potentially threatened by contamination with Cd; (2) an intermediate zone; (3) a limnic area; and (4) the area where water was taken for the public water supply.

This work aimed to determine daytime sleepiness and sleep complaints prevalence and the corresponding influence on perceived fatigue and to evaluate the influence of sociodemographic parameters and labour variables on sleep complaints, sleepiness and fatigue. A questionnaire was developed including socio-economic and labour issues and instruments, focused in sleep and fatigue. The response rate was 32% and the final sample had 435 pilots. The prevalence of sleep complaints was 34.9%, daytime sleepiness 59.3% and fatigue 90.6%. The high prevalence of sleep complaints, sleepiness and fatigue was disclosed in pilots, with those who fly short/medium having an added risk of fatigue.

The occurrence of seizures in specific types of epilepsies can follow a 24-hour nonuniform or nonrandom pattern. We described the 24-hour pattern of clinical seizures in patients with focal refractory epilepsy who underwent video-electroencephalography monitoring. Only patients who were candidates for epilepsy surgery with an unequivocal seizure focus were included in the study. A total of 544 seizures from 123 consecutive patients were analyzed. Specific time of seizures were distributed along 3- or 4-hour time blocks or bins throughout the 24-hour period. The mean age of the subjects was 37.7 years, with standard deviation of 11.5 years, median of 37. The majority were females (70/56%). The majority of patients had a seizure focus located in the mesial temporal lobe (102/83%) and in the neocortical temporal lobe (13/11%). The remaining patients had a seizure focus located in the extratemporal lobe (8/6%). The most common etiology was mesial temporal sclerosis (86/69.9%). Nonuniform seizure distribution was observed in seizures arising from the temporal lobe (mesial temporal lobe and neocortical temporal lobe), with two peaks found in both 3- and 4-hour bins: 10:00-13:00/16:00-19:00 and 08:00-12:00/16:00-20:00 respectively (p=0.004). No specific 24-hour pattern was identified in seizures from extratemporal location. The 24-hour rhythmicity of seizure distribution is recognized in certain types of epilepsy, but studies on the topic are scarce. Their replication and validation is therefore needed. Our study confirms the bimodal pattern of temporal lobe epilepsy independently of the nature of the lesion. However, peak times differ between different studies, suggesting that the ambient, rhythmic exogenous factors or environmental/social zeitgebers, may modulate the 24-hour rhythmicity of seizures. Characterization of these 24-hour patterns of seizure occurrence can influence diagnosis and treatment in selected types of epilepsy, such as the case of temporal lobe epilepsy, the most common drug-resistant epilepsy., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objectives: The aim is to evaluate the mutual influences between sleep duration/sleep deprivation (SD) and the sleep stealers/adolescent risk behaviours., Methods: The national survey is a component of the Health Behaviour in School-Aged Children (HBSC) study, it is based on a school-based self-completed questionnaire; 3476 students were randomly selected from 139 randomly chosen Portuguese schools using as an unit the class, 53.8% were girls; 45.9% attended the 8th grade and 54.1% the 10th grade; the mean age was 14.9 years. The measured variables were: 1) gender and age; 2) sociodemographics; 3) sleep duration during the week and during weekends and computed SD; 4) screen time (computer use during the week and during the week end (PC use); watching TV and mobile phone use; 5) earlier sexual behaviour; 6) violent behaviours: fights, use of weapons; 7) use of tobacco, alcohol and drugs. The statistical analysis included Pearson chi-square tests and logistic regression., Results: Excessive use of mobile phone, of computer use during weekdays, and internet facilities; substance use; violence and earlier sexual relations had significantly higher prevalence in sleep deprived adolescents. By logistic regression only using PC during weekdays, tobacco, drugs and weapons were associated to SD, while SD was associated to PC use during weekdays, tobacco use and drugs' use. Computer uses tend to be associated among themselves. Mobile phone is associated with computer practices and with alcohol and tobacco use. Tobacco is associated with most risk behaviours. Alcohol use is associated with other substance use, computer use and violent behaviours. Violence behaviours, earlier sex and drugs use tend to be associated among themselves., Conclusions: Sleep stealers use and risk behaviours are more prevalent in sleep deprived adolescents, but, in spite of significant individual associations, models of risk behaviours are still lacking.

Objectives: The present study aimed to evaluate the influences of sleep duration, sleep deprivation, and weekend variability of sleep upon other adolescents' features, namely those related to health and health-related quality of life., Methods: The Health Behaviour in School-Aged Children (HBSC) survey is based on a self-completed questionnaire. The participants in the present study were 3476 students (53.8% were girls) in the 8th and 10th grades at school; the mean age was 14.9 years (range 12.5-19.0). Subjective sleep duration during the weeknights and weekends was collected; sleep deprivation (SD) was considered whenever the difference was greater than 3 h. Health complaint frequency and health-related quality of life (with the Kidscreen 10) were collected., Results: Sleep deprivation was present in 18.9% of the students. It was negatively correlated with sleep duration on weeknights. There were no gender differences, but SD increased with age and grade. Higher school grades were mainly associated with fatigue. A considerable number of adolescents had sleep problems (37.2%); 25.5% had difficulties in sleep initiation, which was more prevalent in adolescents with SD. The sleep duration on weeknights was decreased in the SD group. The average health-related quality of life was reduced in adolescents with SD. The frequency of health complaint was higher is adolescents with SD. Girls had significantly more health complaints than boys, with special focus on headaches., Conclusions: Sleep deprivation is associated with the perception of health-related quality of life and perceived physical and mental health., (Copyright © 2014. Published by Elsevier B.V.)

Background: Poor sleep contributes to the developmental problems seen in preterm infants. We evaluated sleep problems in preterm infants 6 months of post-gestational age using the subjective Brief Infant Sleep Questionnaire (BISQ) and objective sleep tests. We also compared the sleep of premature infants with that of full-term infants., Methods: The study included 68 6-month-old full-term healthy infants and 191 premature infants born at <37 weeks gestation. All parents completed the BISQ-Chinese version and sleep diaries. At the same time, all premature infants were submitted to one night of polysomnography (PSG) in the sleep laboratory and also were set up with an actigraph kept for 7 days. Statistical analyses were performed using correlation coefficients and the t-test with SPSS version 18 to compare questionnaire responses with other subjective and objective measures of sleep., Results: The sleep problems indicated in the subjective questionnaire for the premature infants, particularly: "the nocturnal sleep duration, number of night awakenings, daytime sleep duration, duration of time with mouth breathing, and loud-noisy breathing" had significant correlations with sleep diaries, actigraphy and PSG results. The BISQ showed that duration of infant's sleeping on one side, nocturnal sleep duration, being held to fall asleep, number of nighttime awakenings, daytime sleep duration, subjective consideration of sleep problems, loud-noisy breathing, and duration spent crying during the night were significantly different between the premature infants and the term infants. PSG confirmed the presence of a very high percentage (80.6%) of premature infants with AHI > 1 event/hour as indicated by the questionnaire., Conclusion: Premature infants have more sleep problems than full-term infants, including the known risk of abnormal breathing during sleep, which has been well demonstrated already with the BISQ-Chinese (CBISQ).

Objectives: The present study aims to test the factor structure of two sleep questionnaires and their internal consistency in a sample of adolescents and their respective parents and to evaluate the validity and robustness of a three-dimensional model about sleep, addressing nine subcategories related to sleep habits, personal and environmental factors., Methods: Participants were 654 adolescents from Portuguese schools, who completed "My Sleep and I" questionnaire, and 664 parents who completed "My child׳s sleep" questionnaire; to them confirmatory factor analysis was applied., Results: Confirmatory factor analysis indicate that a nine-factor model has better fit indices compared with the others tested models for both samples (adolescents: χ (2)/df (Chi-square/degrees of freedom)=2.59, Comparative Fit Index (CFI)=.82, Goodness-of-Fit Index (GFI)=.92, Root Mean Square Error of Approximation (RMSEA)=.049, Expected Cross-Validation Index (ECVI)=1.416; Parents: χ (2)/df=2.89, CFI=.85, GFI=.91, RMSEA=.053, ECVI=1.528). Moreover, the comparison of the models through Δχ (2) index (chi-square difference between rival models) indicates a better fit for this model, Δχ (2) (24)=186.5, p<.001 for adolescents and Δχ (2) (24)=209, p<.001 for parents. Also, the three second-order factors have good internal consistency, convergent and discriminant validity for all factors in both samples., Conclusions: Results postulate that the three factors and their nine subcategories account for correlations between sleep habits, self-perceptions and knowledge about sleep.

The automatic computation of the hypnogram and sleep Parameters, from the data acquired with portable sensors, is a challenging problem with important clinical applications. In this paper, the hypnogram, the sleep efficiency (SE), rapid eye movement (REM), and nonREM (NREM) sleep percentages are automatically estimated from physiological (ECG and respiration) and behavioral (Actigraphy) nocturnal data. Two methods are described; the first deals with the problem of the hypnogram estimation and the second is specifically designed to compute the sleep parameters, outperforming the traditional estimation approach based on the hypnogram. Using an extended set of features the first method achieves an accuracy of 72.8%, 77.4%, and 80.3% in the detection of wakefulness, REM, and NREM states, respectively, and the second an estimation error of 4.3%, 9.8%, and 5.4% for the SE, REM, and NREM percentages, respectively.

Sleep medicine is evolving globally into a medical subspeciality in its own right, and in parallel, behavioural sleep medicine and sleep technology are expanding rapidly. Educational programmes are being implemented at different levels in many European countries. However, these programmes would benefit from a common, interdisciplinary curriculum. This 'catalogue of knowledge and skills' for sleep medicine is proposed, therefore, as a template for developing more standardized curricula across Europe. The Board and The Sleep Medicine Committee of the European Sleep Research Society (ESRS) have compiled the catalogue based on textbooks, standard of practice publications, systematic reviews and professional experience, validated subsequently by an online survey completed by 110 delegates specialized in sleep medicine from different European countries. The catalogue comprises 10 chapters covering physiology, pathology, diagnostic and treatment procedures to societal and organizational aspects of sleep medicine. Required levels of knowledge and skills are defined, as is a proposed workload of 60 points according to the European Credit Transfer System (ECTS). The catalogue is intended to be a basis for sleep medicine education, for sleep medicine courses and for sleep medicine examinations, serving not only physicians with a medical speciality degree, but also PhD and MSc health professionals such as clinical psychologists and scientists, technologists and nurses, all of whom may be involved professionally in sleep medicine. In the future, the catalogue will be revised in accordance with advances in the field of sleep medicine., (© 2013 European Sleep Research Society.)

Wrist actigraphy (ACT) is a low-cost and well-established technique for long-term monitoring of human activity. It has a special relevance in sleep studies, where its noninvasive nature makes it a valuable tool for behavioral characterization and for the detection and diagnosis of some sleep disorders. The traditional sleep/wakefulness state estimation algorithms from the nocturnal ACT data are unbalanced from a sensitivity and specificity points of view since they tend to overestimate sleep state, with severe consequences from a diagnosis point of view. They usually maximize the overall accuracy that does not take into account the highly unbalanced state distribution. In this paper, a method is proposed to appropriately deal with this unbalanced problem, achieving similar sensitivity and specificity scores in the state estimation process. The proposed method combines two linear discriminant classifiers, trained with two different criteria involving movement detection to generate a first state estimate. This result is then refined by a Hidden Markov Model-based algorithm. The global accuracy, the sensitivity, and the specificity of the method are 77.8%, 75.6%, and 81.6%, respectively, performing better than the tested algorithms. If the performance is assessed only for movement periods, this improvement is even higher.

Obstructive sleep apnea syndrome (OSAS) is a common disorder characterized by repetitive episodes of breathing cessation due to complete or partial collapse of the upper airway therefore affecting ventilation. It is quite common, with a prevalence of about 2-4%, has a strong genetic component, and creates a proinflammatory state with elevated TNFα and other cytokines. If untreated, OSA can lead to significant neurological problems that include stroke, cognitive decline, depression, headaches, peripheral neuropathy, and nonarteritic ischemic optic neuropathy (NAION). Treatment reverses some of these neurological problems. Treatment includes continuous positive airway pressure and its variants, oral appliances, weight loss, upper airway surgery, and rarely maxillofacial procedures. Other sleep breathing disorders such as hypoventilation, central sleep apnea, complex sleep apnea, and Cheyne-Stokes respiration are less common and are sometimes associated with neuromuscular disorders causing diaphragmatic paralysis, but can also be seen in opiate exposure and severe obesity., (© 2014 Elsevier B.V. All rights reserved.)

The present study evaluated the toxic potential and physicochemical characteristics of waste water generated in nitrocellulose production, including effluents from delignification, bleaching, nitration and mixture (composed of these three effluents), from a plant in the Paraiba Valley, São Paulo, Brazil. The test organisms used for toxicity assays were Daphnia similis, Danio rerio, Escherichia coli, Pseudomonas putida and Pseudokircheneriella subcaptata. The results showed that the effluents analyzed present acute and chronic toxicity for the organisms tested. Nitration effluent was the least toxic, while delignification and bleaching effluents were the most toxic. The naturally occurring pollutants in wood fiber and cotton, like lignin, probably contributed to effluents toxicity, in addition to higher concentrations of total dissolved solids, which are in non-compliance with Brazilian legislation, conductivity, chemical oxygen demand and color. The discharge of nitrocellulose effluent into an aquatic environment should only occur after appropriate treatment, due to their toxic characteristics.

Explosives industries are a source of toxic discharge. The aim of this study was to compare organisms sensitivity (Daphnia similis, Danio rerio, Escherichia coli and Pseudomonas putida) in detecting acute toxicity in wastewater from two explosives, 2,4,6-TNT (TNT) and nitrocellulose. The samples were collected from an explosives company in the Paraiba Valley, São Paulo, Brazil. The effluents from TNT and nitrocellulose production were very toxic for tested organisms. Statistical tests indicated that D. similis and D. rerio were the most sensitive organisms for toxicity detection in effluents from 2,4,6-TNT and nitrocellulose production. The P. putida bacteria was the organism considered the least sensitive in indicating toxicity in effluents from nitrocellulose.

Objective: To evaluate the perception of health-related quality of life (HRQoL) in Portuguese patients with narcolepsy, and to compare the results to normative data., Methods: Fifty-one narcoleptic adults (26M, 25F), aged between 18 and 80 years (mean=43.35, SD=15.32), were included in the final analysis of a multicentric cross-sectional study. The Medical Outcome Study--36 Item Short-Form Survey (SF-36) was used to assess quality of life, and the Beck Depression Inventory (BDI) was used for self-assessment of depression., Results: Several HRQoL domains were significantly lower than National surveys, except physical function and bodily pain (p between 0.000 and 0.006). SF-36 presented the lowest score in vitality (39.93). Deterioration was significantly higher in role physical (p=0.006), vitality (p=0.011), and mental health (p=0.008) in women, and in physical function (p=0.003) and bodily pain (p=0.045) in elderly subjects. Those with higher literacy had better physical function (p=0.046)., Conclusion: HRQoL is significantly deteriorated in narcoleptics, affecting all dimensions (except physical function and bodily pain) when compared with the general Portuguese population. The results are consistent with studies of narcolepsy in other countries in demonstrating the profound impact of this disorder on quality of life., (Copyright © 2011 Elsevier B.V. All rights reserved.)

During the manufacture of explosives, large amounts of water are used to remove unwanted by-products generated. This water in turn, ends up in wastewater treatment plants or water bodies. The aim of this study was to evaluate the toxic potential of effluent generated by 2.4.6-Trinitrotoluene (TNT) production, yellow water, red water and mixture of yellow and red water, produced from a plant located in the Paraíba Valley, São Paolo state, Brazil. Daphnia similis, Danio rerio, Escherichia coli, Pseudomonas putida and Pseudokircheneriella subcaptata were used as test organisms. Physicochemical parameters such as color, pH, conductivity, total dissolved solids, dissolved oxygen, chemical oxygen demand (COD) and biochemical oxygen demand (BOD) were evaluated. Effluent from 2.4.6-TNT production was extremely toxic to all test organisms. The physicochemical parameters evaluated showed high levels of conductivity (from 41.533 to 42.344 μS /cm) and chemical oxygen demand (COD of 8471 to 27.364 mg/L) for the effluents analyzed.

Wrist actigraphy is a well established procedure to monitor human activity. Among other areas, it has a special relevance in sleep studies where its lightweight and non-intrusive nature make it a valuable tool to access the circadian cycle. While there are several methods to extract information from the data, the differentiation between sleep and wakefulness states is still an open discussion. In this paper, the characteristics of the movements in the different states are assumed to be intrinsically different. These differences are not simply related with magnitude and movement counting, but due to real differences on the statistical distributions describing the actigraphy data. Thus it is possible to refine the discrimination level when detecting these states. The proposed methodology to characterize the actigraphy data is based on a mixture of three canonical distributions; i)Exponential, ii)Rayleigh and iii)Gaussian. It is shown that the weights and parameters estimated in each state are organized into almost separable clusters on the feature space. This suggests the ability of the method to discriminate these states based only on the movements recorded on actigraphy data.

Introduction: Functional magnetic resonance imaging studies enable the investigation of neural correlates underlying behavioral performance. We investigate the effect of active and sham Continuous Positive Airway Pressure (CPAP) treatment on working memory function of patients with Obstructive Sleep Apnea Syndrome (OSAS) considering Task Positive and Default Mode networks (TPN and DMN)., Methods: An experiment with 4 levels of visuospatial n-back task was used to investigate the pattern of cortical activation in 17 men with moderate or severe OSAS before and after 2 months of therapeutic (active) or sub-therapeutic (sham) CPAP treatment., Results: Patients with untreated OSAS had significantly less deactivation in the temporal regions of the DMN as compared to healthy controls, but activation within TPN regions was comparatively relatively preserved. After 2 months of treatment, active and sham CPAP groups exhibited opposite trends of cerebral activation and deactivation. After treatment, the active CPAP group demonstrated an increase of cerebral activation in the TPN at all task levels and of task-related cerebral deactivation in the anterior midline and medial temporal regions of the DMN at the 3-back level, associated with a significant improvement of behavioral performance, whereas the sham CPAP group exhibited less deactivation in the temporal regions of Default Mode Network and less Task Positive Network activation associated to longer response times at the 3-back., Conclusion: OSAS has a significant negative impact primarily on task-related DMN deactivation, particularly in the medial temporal regions, possibly due to nocturnal hypoxemia, as well as TPN activation, particularly in the right ventral fronto-parietal network. After 2 months of active nasal CPAP treatment a positive response was noted in both TPN and DMN but without compete recovery of existing behavioral and neuronal deficits. Initiation of CPAP treatment early in the course of the disease may prevent or slow down the occurrence of irreversible impairment.

Individuals with Parkinson's disease (PD) and temporal lobe epilepsy (TLE) have hallucinations and mild cognitive dysfunction. The objective of this work was to study dreams in PD and TLE patients using a common functional model of dream production involving the limbic and paralimbic structures. Dreams were characterised in early-stage PD (19 males) and TLE patients (52) with dream diaries classified by the Hall van de Castle system and were compared with matched controls. In PD, there were significant differences between patients' dreams and those of controls: animals, physical aggression, and a befriender were more common in patients, and aggressor and bodily misfortunes were less common. The dreams of patients with frontal dysfunction showed more aggressive features. TLE patients had lower recall than PD patients and a higher proportion of dreams involving family and familiar settings, lower proportions involving success, and a higher incidence of frontal dysfunction. The dreams of PD and TLE patients share important features., (Copyright © 2011. Published by Elsevier Inc.)

Purpose: To evaluate morning dream recall frequency and content in patients with temporal lobe epilepsy (TLE)., Methods: Fifty-two patients with pharmacoresistant TLE submitted to a written dream diary during five consecutive days and continuous video-electroencephalographic (video-EEG) monitoring. A matched control group of 41 healthy subjects completed the same diary at home. The number of recalled dreams (including long dreams) and nonrecalled dream mentation were collected, and the Dream Recall Rate (DRR) was calculated. Hall and Van de Castle dream content analysis was performed., Key Findings: Greater than 70% of patients with TLE (37 of 52) recall their dreams, but DRR rate in these patients is lower than in controls (p ≤ 0.001). Dream recall does not appear to be influenced by the presence of neuropsychological deficits nor seizure frequency. In dreams descriptions, TLE patients (vs. controls) have a higher percentage of familiarity in settings and fewer dreams with at least one success., Significance: Onirical activity of patients with TLE is different from that of healthy subjects. Our results support the role of mesial and neocortical temporal structures in dream experience. The selective activation of dysfunctional mesial structures may be responsible for some of the observed variability. However, dream content changes can also mirror social and psychological comorbidities of patients with epilepsy., (Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.)

Wastewater containing several dyes, including sulfur black from the dyeing process in a textile mill, was treated using a UV/H2O2 process. The wastewater was characterized by a low BOD/COD ratio, intense color and high acute toxicity to the algae species Pseudokirchneriella subcaptata. The influence of the pH and H2O2 concentration on the treatment process was evaluated by a full factorial design 22 with three replicates of the central experiment. The removal of aromatic compounds and color was improved by an increase in the H2O2 concentration and a decrease in pH. The best results were obtained at pH 5.0 and 6 g L(-1). With these conditions and 120 min of UV irradiation, the removal of the color, aromatic compounds and COD were 74.1, 55.1 and 44.8%, respectively. Under the same conditions, but using a photoreactor covered with aluminum foil, the removal of the color, aromatic compounds and COD were 92.0, 77.6 and 59.4%, respectively. Moreover, the use of aluminum foil reduced the cost of the treatment by 40.8%. These results suggest the potential application of reflective materials as a photoreactor accessory to reduce electric energy consumption during the UV/H2O2 process.

Human activity can be measured with actimetry sensors used by the subjects in several locations such as the wrists or legs. Actigraphy data is used in different contexts such as sports training or tele-medicine monitoring. In the diagnosis of sleep disorders, the actimetry sensor, which is basically a 3D axis accelerometer, is used by the patient in the non dominant wrist typically during an entire week. In this paper the actigraphy data is described by a weighted mixture of two distributions where the weight evolves along the day according to the patient circadian cycle. Thus, one of the distributions is mainly associated with the wakefulness state while the other is associated with the sleep state. Actigraphy data, acquired from 20 healthy patients and manually segmented by trained technicians, is used to characterize the acceleration magnitude during sleep and wakefulness states. Several mixture combinations are tested and statistically validated with conformity measures. It is shown that both distributions can co-exist at a certain time with varying importance along the circadian cycle.

The accurate measure of the central temperature is a very important physiologic indicator in several clinical applications, namely, in the characterization and diagnosis of sleep disorders. In this paper a simple system is described to continuously measure the body temperature at the ear. An electronic temperature sensor is coupled to the microphone of a common commercial auricular Bluetooth device that sends the temperature measurements to a mobile phone to which is paired. The measurements are stored at the mobile phone and periodically sent to a medical facility by email or SMS (short messaging service).

The diagnosis of Sleep disorders, highly prevalent in the western countries, typically involves sophisticated procedures and equipments that are intrusive to the patient. Wrist actigraphy, on the contrary, is a non-invasive and low cost solution to gather data which can provide valuable information in the diagnosis of these disorders. The acquired data may be used to infer the Sleep/Wakefulness (SW) state of the patient during the circadian cycle and detect abnormal behavioral patterns associated with these disorders. In this paper a classifier based on Autoregressive (AR) model coefficients, among other features, is proposed to estimate the SW state. The real data, acquired from 23 healthy subjects during fourteen days each, was segmented by expert medical personal with the help of complementary information such as light intensity and Sleep e-Diary information. Monte Carlo tests with a Leave-One-Out Cross Validation (LOOCV) strategy were used to assess the performance of the classifier which achieves an accuracy of 96%.

The environmental impact caused by the production of explosives made from nitroaromatic compounds such as 2,4,6-trinitrotoluene (TNT) is currently a major concern, mainly due to their toxic nature, a fact that makes these compounds highly harmful. This work evaluated a continual system treatment reactor (CSTR) consisting of column zero-valent iron and a system to promote a fenton reaction in order to create possible definitive routines for treating effluents originating from the TNT production process. The spectrophotometric results demonstrated that this combination of processes was highly efficient in promoting the removal of all the absorbed species at 290 nm and the visible region of the specter. The results also revealed that the combination of treatments was significantly efficient in terms of correcting the effluent's main parameters of relevance, mainly COD (95.5% reduction) and TNT concentration, whose total was converted into nitrous and phenolic compounds and, additionally, the acute toxicity was also significantly reduced (95%). These results indicate that the strategy can serve as an efficient option for effluent treatment, for release into the receiving body, or eventually for use as industrial reuse water.

The objective of this work was to characterize the effluent originating from a Brazilian TNT production industry. Analyses were performed using physical, chemical, spectroscopic and ecotoxicological assays, which demonstrated that the effluent had a significant pollution potential, mainly due to the low pH and high concentration of TNT (156+/-10mgL(-1)). The results also demonstrated that the effluent presented significant acute toxicity, and could cause countless damages if released into the receiving body without being adequately treated first. The observed pollution potential justifies studies to evaluate treatment technologies or recover the residue generated in the TNT industry.

The objective of this work was to characterize the delignification effluent originating from the delignification industry and evaluate the combination of the fungus and photocatalytic process (TiO(2)/UV system) for the treatment of this effluent. The delignification effluent has proven harmful to the environment because it presents high color (3516 CU), total phenol (876 mg/L) and TOC (1599 mg/L) and is also highly toxic even in a low concentration. The results of photocatalysis were 11%, 25% and 13% higher for reductions in color, total phenol and TOC, respectively. The combined treatments presented benefits when compared to the non-combined treatments. Fungus and photocatalysis in combination proved to be the best treatment, reducing the color, total phenol, toxicity (inhibition of Escherichia coli growth) and TOC by 94.2%, 92.6%, 4.9% and 62%, respectively.

A new web based network aims at the improvement of health care in Europe by integrating advanced e-learning and e-publishing technologies for the training of medical doctors, nurses, and students. The field of application is sleep physiology and sleep medicine. Based on a multilingual, multimedia communication system, ENN-ICS Centre offers direct access to medical information for users, i.e healthcare professionals and citizens, in Europe and worldwide. The use of XML supports the development of media independent contents for multiple target groups. Editorial and distributive processes are supported by customized central editorial, content management and learning management systems (CMS, LMS). ENN-ICS e-health services are evaluated by selected user groups in North, Middle and Southern Europe using reliable and scientifically accepted validation instruments. The compliance with essential quality requirements and criteria is tested and verified by using online questionnaires based on the DISCERN questionnaire for evaluating patient information, the HON principles for health-related websites and the GMDS catalogue of quality criteria for electronic publications in medicine. The system architecture and its exemplary applications can be used as a model for future e-health services dealing with neurological and other medical topics.

Twelve strains of filamentous fungi, most of them belonging to the Deuteromycetes class, were isolated from activated sludge adapted to the delignification effluent from a nitrocellulose industry and screened to be used in the treatment of the effluent. The screening experiment was carried out using the effluent without co-substrate, treated for 120 h and pH 5. Aspergillus 2BNL1, Aspergillus 1AAL1 and Lentinus edodes UEC 2019 showed the highest effluent color reduction rates between 83% and 95%. The white-rot fungus L. edodes UEC 2019 was used as the control for the decolorization. In addition to color reduction, total phenol was also reduced in 56% and 79% by Aspergillus 2BNL1 and L. edodes UEC 2019, respectively. A kinetic experiment showed that Aspergillus 2BNL1 and Aspergillus 1AAL1 reduced the effluent color in the range of 81-95% at the first 24 h while L. edodes required 72 h to achieve a similar result. UV/Visible spectra revealed that all fungi treatments were able to decrease the chromophore compounds present in the effluent, except Aspergillus 1AAL1 that increased the UV absorptions. The molar weight distribution analysis showed that the three fungi were able to change the pattern of the effluent chromatogram, probably by degradation of the high molecular weight compounds.

Background and Purpose: This study examines the prevalence and associated factors of insomnia symptoms and sleep dissatisfaction in the general population of Portugal., Patients and Methods: We interviewed by telephone 1858 participants aged 18 years or older and representative of the general population of Portugal using the Sleep-EVAL system. Participation rate was 83%. The questionnaire included the assessment of sleep habits, insomnia symptomatology according to DSM-IV and ICSD classifications, associated and sleep/mental disorders and daytime consequences., Results: Insomnia symptoms occurring at least 3 nights per week were reported by 28.1% of the sample and global sleep dissatisfaction (GSD) by 10.1%. Difficulty maintaining sleep was the most frequent symptom (21.0%); 29.4% of subjects with insomnia symptoms reported GSD. Daytime consequences, medical consultations for sleep and use of sleep medication were at least 2 times more frequent among subjects with insomnia symptoms and GSD compared to subjects with insomnia symptoms without GSD; insomnia diagnoses were also more frequent in the GSD group., Conclusions: The results show a severity gradation among subjects with only 1 insomnia symptom, those with 2 or 3 insomnia symptoms but without GSD and those with at least 1 insomnia symptom and GSD. Specific sleep or psychiatric disorders were identified for the majority of GSD subjects (86%); this rate dropped to 50.6% when only 1 insomnia symptom without GSD was reported. GSD appeared to be a good indicator of the presence of a sleep or psychiatric disorder and a good discriminator of the severity of sleep disturbances among subjects with insomnia symptoms.

It is currently claimed that congenitally blind do not have visual imagery and are therefore unable to present visual contents in their dreams. The aim of our study was to quantitatively evaluate the existence of visual imagery in born-blind dreams and to correlate it with objective measures, such as sleep EEG frequency components, namely with alpha attenuation (regarded as an indicator of visual activity), and graphical analysis of dream pictorial representations. The investigation was carried out via simultaneous recordings of dream reports and polysomnography, during nocturnal sleep at volunteers' homes; scheduled regular awakenings during the night provided the data for dream and EEG analysis. In the morning, subjects were asked to make a drawing of their dream images. Congenitally blind (n=10) were comparable to normal sighted subjects (n=9): the two groups presented equivalent visual activity indices, and no differences in the analysis of graphical representation of dreaming imagery. However, blind subjects presented a lower rate of dream recall than sighted (27% versus 42%). Both groups had significant negative correlation between Visual Activity Index (VAI) and alpha power in the central and occipital O2 derivations (blind: C4: r=-0.615, P<0.005; O2: r=-0.608, P<0.006; sighted: C4: r=-0.633, P<0.01; O2: r=-0.506, P<0.05). This correlation was weaker for the blind in O1 (r=-0.573, P<0.05) and non-existent for the sighted. Blind individuals have significantly lower alpha activity in the central derivation. In conclusion, the congenitally blind have visual content in their dreams and are able to draw it and, as expected, their VAI is negatively correlated with EEG alpha power.