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Environmental epidemiology has proven critical to study various associations between environmental exposures and adverse human health effects. However, there is a perception that it often does not sufficiently inform quantitative risk assessment. To help address this concern, in 2017, the Health and Environmental Sciences Institute initiated a project engaging the epidemiology, exposure science, and risk assessment communities with tripartite representation from government agencies, industry, and academia, in a dialogue on the use of environmental epidemiology for quantitative risk assessment and public health decision making. As part of this project, four meetings attended by experts in epidemiology, exposure science, toxicology, statistics, and risk assessment, as well as one additional meeting engaging funding agencies, were organized to explore incentives and barriers to realizing the full potential of epidemiological data in quantitative risk assessment. A set of questions was shared with workshop participants prior to the meetings, and two case studies were used to support the discussion. Five key ideas emerged from these meetings as areas of desired improvement to ensure that human data can more consistently become an integral part of quantitative risk assessment: 1) reducing confirmation and publication bias, 2) increasing communication with funding agencies to raise awareness of research needs, 3) developing alternative funding channels targeted to support quantitative risk assessment, 4) making data available for reuse and analysis, and 5) developing cross-disciplinary and cross-sectoral interactions, collaborations, and training. We explored and integrated these themes into a roadmap illustrating the need for a multi-stakeholder effort to ensure that epidemiological data can fully contribute to the quantitative evaluation of human health risks, and to build confidence in a reliable decision-making process that leverages the totality of scientific evidence.

STUDY OBJECTIVES: Restless sleep is a very common parental complaint in children with attention-deficit/hyperactivity disorder (ADHD), but restless sleep has been seen in association with other comorbidities such as restless legs syndrome and obstructive sleep apnea. Restless sleep disorder (RSD) needs to be identified from other disorders when evaluating children with ADHD. In this study we aim to identify the prevalence of RSD in children with ADHD referred to our sleep center. METHODS: This is a retrospective study of children with ADHD who underwent polysomnography. The following diagnostic and descriptive data were obtained for each patient: age, sex, presence/absence of RSD, other sleep disorders, psychiatric comorbidities, and medications. RSD was diagnosed per diagnostic criteria. RESULTS: There were 66 children with ADHD. All of them underwent polysomnography, 17 were females, and 49 were males. Mean age was 11.6 years (± 3.6 standard deviation). The complaint of restless sleep was reported by the parents of 54 (81.1%) of the children; however, only 6 of them (9.1%) were diagnosed with RSD. Seventy-one percent had obstructive sleep apnea and 19.7% had restless legs syndrome. A significant number of patients had psychiatric comorbidities and were on various medications. CONCLUSIONS: Although restless sleep is a common complaint reported in 81.1% of children with ADHD, only 9.1% had RSD. Most causes of restless sleep are secondary and associated with other sleep disorders, psychiatric comorbidities, or medication use.

Diagrammatic formats are useful for summarizing the processes of evaluation and comparison of forecasts in plant pathology and other disciplines where decisions about interventions for the purpose of disease management are often based on a proxy risk variable. We describe a new diagrammatic format for disease forecasts with two categories of actual status and two categories of forecast. The format displays relative entropies, functions of the predictive values that characterize expected information provided by disease forecasts. The new format arises from a consideration of earlier formats with underlying information properties that were previously unexploited. The new diagrammatic format requires no additional data for calculation beyond those used for the calculation of a receiver operating characteristic (ROC) curve. While an ROC curve characterizes a forecast in terms of sensitivity and specificity, the new format described here characterizes a forecast in terms of relative entropies based on predictive values. Thus it is complementary to ROC methodology in its application to the evaluation and comparison of forecasts.

Nearly 20 years have elapsed since the first clinical trial investigated the impact of interval training on patients with cardiovascular disease (CVD). This clinical corner discusses the health outcomes of systematic reviews and meta-analyses and appropriately powered randomized clinical trials which have tested these interval training programs across various CVDs (i.e., coronary artery disease, heart failure, atrial fibrillation, peripheral arterial disease, and cardiac implantable electronic devices). The publications included in this clinical corner have shown that interval training leads to similar or superior improvements in peak oxygen uptake (V̇O2peak), functional capacity, pain free walking, quality of life, anxiety, depression, and endothelial function, but the magnitude of improvements across varying protocols (e.g., length and number of work periods, intensities of work periods, duration of exercise sessions, frequency of exercise sessions, and duration of program) and optimal dosage for males and females are unclear across CVD conditions. The heterogeneity in protocols, physical and mental health outcome measures, and lack of sex- and gender-based analyses calls for more high-quality research in this area. [ABSTRACT FROM AUTHOR]

Disabling atrial fibrillation (AF)-related symptoms and different testing settings may influence day-to-day cardiopulmonary exercise testing (CPET) measurements, which can affect exercise prescription for high-intensity interval training (HIIT) and moderate-to-vigorous intensity continuous training (M-VICT) and their outcomes. This study examined the reliability of CPET in patients with AF and assessed the proportion of participants achieving minimal detectable changes (MDC) in peak oxygen consumption (V̇O2peak) following HIIT and M-VICT. Participants were randomized into HIIT or M-VICT after completing two baseline CPETs: one with cardiac stress technologists (CPETdiag) and the other with a research team of exercise specialists (CPETresearch). Additional CPET was completed following 12 weeks of twice-weekly training. The reliability of CPETdiag and CPETresearch was assessed by intraclass correlation coefficient (ICC) and dependent t tests. The MDC score was calculated for V̇O2peak using a reliable change index. The proportion of participants achieving MDC was compared between HIIT and M-VICT using chi-square analysis. Eighteen participants (69 ± 7 years, 33% females) completed two baseline CPETs. The ICCs were significant for all measured variables. However, peak power output (POpeak: 124 ± 40 vs. 148 ± 40 watts, p < 0.001) and HR (HRpeak: 136 ± 22 vs. 148 ± 30 bpm, p = 0.023) were significantly greater in CPETresearch than CPETdiag. Few participants achieved MDC in V̇O2peak (5.6 mL/kg/min) with no difference between HIIT (0%) and M-VICT (10.0%, p = 0.244). POpeak and HRpeak differed significantly in patients with AF when CPETs were repeated under different settings. Caution must be practised when prescribing exercise intensity based on these measures as under-prescription may increase the number of exercise non-responders. [ABSTRACT FROM AUTHOR]

The marine bacterium Vibrio fischeri is the monospecific symbiont of the Hawaiian bobtail squid, Euprymna scolopes, and the establishment of this association involves a number of signaling pathways and transcriptional responses between both partners. We report here the first full RNA-Seq dataset representing host-associated V. fischeri cells from colonized juvenile E. scolopes, as well as comparative transcriptomes under both laboratory and simulated marine planktonic conditions. These data elucidate the broad transcriptional changes that these bacteria undergo during the early stages of symbiotic colonization. We report several previously undescribed and unexpected transcriptional responses within the early stages of this symbiosis, including gene expression patterns consistent with biochemical stresses inside the host, and metabolic patterns distinct from those reported in associations with adult animals. Integration of these transcriptional data with a recently developed metabolic model of V. fischeri provides us with a clearer picture of the metabolic state of symbionts within the juvenile host, including their possible carbon sources. Taken together, these results expand our understanding of the early stages of the squid-vibrio symbiosis, and more generally inform the transcriptional responses underlying the activities of marine microbes during host colonization.