When Public Will Meets Legislative Resistance: Five Lessons from Ohio's Issue 2 Cannabis Legalization Controversy

In this paper, I explore the challenges of legalizing cannabis in Ohio, focusing on the passing of the Issue 2 Bill, legislative resistance, and public response. I propose five strategies for effective policy change: persistent advocacy post policy change success, establishing strong coalitions, empowering grassroots movements, promoting rigorous data-driven research, and launching public education campaigns. I offer a detailed analysis of the interaction between public opinion and legislative action in cannabis legalization and its implications for substance-related policy change.

Development of the Enthusiastic Substance Use Attitudes Scale: Preliminary Evidence of a Novel Maintenance Factor

Background: Expectancies, motives, and attitudes toward substances are cognitive factors that partially account for substance use; however, existing measures tend to have monotonous phrasing, diverging from the enthusiastic attitude toward the perceived benefits of substance use exhibited by those who use substances regularly in informal settings. Objective: I aimed to characterize a new cognitive maintenance factor that precedes substance use by creating a brief, multidimensional measure to capture this tone nuance, which I called the Enthusiastic Substance Use Attitudes Scale (ESUAS). Method: Undergraduate students (n = 198) between ages 18 and 62 (M = 19.15, SD = 3.65; 66.2% women; 71.71% White) completed the study for course credit. Results: I used exploratory and confirmatory factor analyses to reduce a 90-item item pool based on a comprehensive qualitative thematic analysis of social media, traditional media, and the scientific literature to an 18-item hierarchical bifactor model. This model contained nine specific factors, which are (1) sociability, (2) enjoyment, (3) physical health, (4) mental health, (5) relaxation, (6) personal growth, (7) performance enhancement, (8) boredom, and (9) life processing; two general factors, which are (1) substance-induced emotion regulation and (2) substance-based assistance; and a higher-order single factor above the nine specific factors - resulting in twelve highly internally consistent, empirically supported scales. Further, the ESUAS demonstrated excellent structural, convergent, divergent, incremental, and diagnostic validity. The degree of enthusiasm towards substance use positively related to substance use disorder symptomology, polysubstance use, neuroticism, and difficulty with regulating emotions while negatively relating to one's psychological quality of life and agreeableness. Conclusion: The ESUAS may be an effective tool for professionals to characterize these enthusiastic attitudes further and measure a more ecologically valid view of the perceived benefits of substance use among those who use substances, thereby developing a more compassionate, non-stigmatizing understanding within the general public, advancing medicinal uses of illicit substances, and improving conceptualizations and treatments.

Effects of nicotine patches on early and late attentional bias to smoking cues: We may know less than we think

In contrast to overnight deprivation versus satiety studies, a small number of placebo-controlled studies have failed to find that nicotine administration reduces attentional bias (AB) to smoking cues. To assess the reliability of this failure and to address the duration and salience of AB in smokers versus never-smokers, we used a longer-than-typical (i.e., 3,000 ms) smoking cue-presentation time in a placebo-controlled trial of smokers and never-smokers. We aimed to assess whether a nicotine patch (i.e., active vs. placebo) attenuates continuously assessed eye gaze-measured AB to smoking cues across 3,000 ms in 32 habitual, overnight-deprived smokers and smoker-nonsmoker differences compared to 32 never-smokers. We presented a series of picture pairs (i.e., one smoking-related and one affectively neutral control picture) simultaneously to assess AB. Participants attended a 14 mg nicotine patch and a placebo patch session in a randomized order. The habitual smokers were 12-18 hr nicotine-deprived during both sessions. Smokers demonstrated a stronger AB toward smoking cues than never-smokers across the entire 3,000 ms cue-presentation time. Nicotine did not significantly reduce the AB to smoking cues but the AB was strongly and positively related to deprivation-associated cravings in smokers. Patch-delivered nicotine did not reduce AB to smoking cues presented for up to 3,000 ms, even though smoker-nonsmoker differences in bias remained. Assessments of longer cue presentations and more subtle cues may provide nuance not currently captured by existing studies, because of potential demand effects in designs that contrast overnight versus sated state effects on AB. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Researcher degrees of freedom in statistical software contribute to unreliable results: A comparison of nonparametric analyses conducted in SPSS, SAS, Stata, and R

Researcher degrees of freedom can affect the results of hypothesis tests and consequently, the conclusions drawn from the data. Previous research has documented variability in accuracy, speed, and documentation of output across various statistical software packages. In the current investigation, we conducted Pearson's chi-square test of independence, Spearman's rank-ordered correlation, Kruskal-Wallis one-way analysis of variance, Wilcoxon Mann-Whitney U rank-sum tests, and Wilcoxon signed-rank tests, along with estimates of skewness and kurtosis, on large, medium, and small samples of real and simulated data in SPSS, SAS, Stata, and R and compared the results with those obtained through hand calculation using the raw computational formulas. Multiple inconsistencies were found in the results produced between statistical packages due to algorithmic variation, computational error, and statistical output. The most notable inconsistencies were due to algorithmic variations in the computation of Pearson's chi-square test conducted on 2 × 2 tables, where differences in p-values reported by different software packages ranged from .005 to .162, largely as a function of sample size. We discuss how such inconsistencies may influence the conclusions drawn from the results of statistical analyses depending on the statistical software used, and we urge researchers to analyze their data across multiple packages to check for inconsistencies and report details regarding the statistical procedure used for data analysis.

Is it time for a cannabis harm reduction approach? Commentary on Sherman et al. (2022) and Borodovsky et al. (2022)

OBJECTIVE

Recent research suggests potential therapeutic benefits of cannabis-derived products, a lower risk profile than other illicit substances, and significant functional improvement from reduced use. Likewise, low abstinence rates and low motivation to achieve abstinence among those with cannabis use disorder (CUD) are the norm. As such, the harm reduction model has gained traction among substance use scientists and health care professionals as a viable alternative approach. Yet, to date no formal definition of cannabis harm reduction has been proposed.

METHOD

We reviewed the literature, including two recent empirical papers published in the Psychology of Addictive Behaviors, Sherman et al. (2022) and Borodovsky et al. (2022), which demonstrate that harm reduction is sufficient to achieve functional improvement. We then propose and define a harm reduction approach for cannabis use research and treatment, and argue why this approach is a timely, necessary discussion.

RESULTS

We suggest that a cannabis harm reduction approach includes treatment, research, and education initiatives that reduce the public health burden of cannabis use. This approach includes interventions that reduce functional impairment and risk from cannabis, reduced or managed use, and sometimes, but not necessarily, abstinence. Psychoeducation for treatment providers, legislative barriers, and research recommendations are also discussed.

CONCLUSIONS

Research and treatment for CUD has historically focused on cannabis abstinence. Treatment trials rarely yield durable abstinence rates, and reduction has recently been tied to functional improvement. We comment on Sherman et al. (2022) and Borodovsky et al. (2022) and propose a shift toward a cannabis harm reduction approach. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emotional fear of COVID-19, but not physiological expressions of fear, explains variability in COVID-19's impact on individuals' lives

The COVID-19 pandemic has had a profound and robust impact on individuals' lives and has particularly negatively affected individuals' experiences with fear of catching COVID-19. To measure this fear, researchers created the unidimensional Fear of COVID-19 Scale (FCV-19S). However, some exploratory factor analysis studies suggested the presence of two factors, which are 1) emotional fear and 2) physiological expressions of fear. In the current exploratory study, we aimed to confirm this factor structure using confirmatory factor analysis and to examine how these two new factors of the FCV-19S explain variability in the impacts of COVID-19 on nine life domains (i.e., finances, loved ones, job, safety, school, mental health, physical health, social activities, and quality of life). Participants were undergraduate students (n = 224) from a Midwestern University (White: 60.7%; Male: 48.0%) who participated in the study for course credit. The results revealed that the two-factor model had an excellent fit for the FCV-19S, both subscales had excellent psychometric properties, and the emotional fear subscale significantly explained variability in all nine life domains (7% to 54%). However, the physiological fear subscale only significantly explained variability in the physical health domain along with emotional fear (28%). The findings suggested that emotional fear of COVID-19 may explain more variability in the impact of COVID-19 across life domains, while physiological fear may only explain the effects of COVID-19 on physical health. We further discussed implications, limitations, and future directions.

The War on Drugs has Unduly Biased Substance Use Research

After working in the substance use field for several years and conducting research on substance use, it has come to my attention how deeply ingrained the War on Drugs propaganda is in substance use research. The lines of research demonstrating the potential benefits of substance use (including illicit substances), delineation of harm from stigma, and the societal impact of the War on Drugs is rather weak and lacking, despite numerous recent studies showing the benefits of certain substances and reports of individuals in therapy and online suggesing that illicit substances help them in some respects. There are numerous critical implications of this bias in substance use research. Suppose the field primarily produces studies that show that all substances are harmful in almost any circumstance and that substance use disorders (SUDs) are primarily driven by psychological deficits (e.g., willpower). In that case, we, as researchers, would be feeding into the War on Drugs, which is known for marginalizing individuals, promoting organized crime, exacerbating SUDs, feeding into a police and prison state, and killing individuals due to tainted substances. Substance use researchers and clinicians are among the first to recognize that the War on Drugs has failed. Yet, despite this belief, we seem to have not quite fully noticed how the propaganda has influenced how we conduct our jobs and the research we produce. In the current letter, I inform researchers who study substance use and clinicians who treat SUDs to acknowledge their own learned biases against substances and those who use substances; to be more cautious when interpreting substance use data in the future.

The Pathogenesis of Borderline Personality Disorder: Evolution of Evidence and Treatment Implications for Two Prominent Models

Since Stern first started his work in 1938, the field has recognized several empirically supported models of the etiology of borderline personality disorder (BPD). Two such models are the Tripartite Model of the Development of BPD and the Biosocial Development Model of BPD. The Tripartite Model of the Development of BPD suggests that it is a combination of a hyperbolic temperament, traumatic childhood experiences, and an event or series of events that trigger the onset of BPD. Whereas the Biosocial Development Model of BPD elaborates on the work of Linehan's Biosocial Theory. This model suggests a combination of an emotionally vulnerable temperament and an invalidating environment cause BPD. Over 70 years of research support these models. This article covers a detailed description of each of these models, the decades of research supporting these models, similarities, differences, treatment implications, the latest research, and future directions.

The explanatory ability of COVID-19 life changes on quality of life: A comparison of those who have had and not had COVID-19

The COVID-19 pandemic has undoubtedly negatively affected individuals' quality of life through multiple means such as social isolation, exacerbated mental health conditions, and financial instability. Multiple studies have demonstrated that one of the negative correlates of quality of life is the perceived danger of COVID-19 (i.e., fear of and anxiety about COVID-19). The current study addresses limitations in the literature by testing how life changes from COVID-19 explain the direct effect of the perceived danger of COVID-19 on quality of life using a United States sample between those who have had COVID-19 compared to those who have not had COVID-19. Undergraduate students (n = 196) from a Midwestern University in the United States participated in this study for course credit (White: n = 109; 55.61%; Male: n = 94; 48.0%). Participants completed this study online and at home where they responded to a demographic form and several measures of the effects of COVID-19 and quality of life. The results suggest that COVID-19 life changes fully explain the negative relationship between the perceived danger of COVID-19 and quality of life, but only in those who have had COVID-19. In the group that has never had COVID-19, the only significant relationship was the positive relationship between the perceived danger of COVID-19 on COVID-19 life changes. The results suggest that researchers may consider steering research away from the perceived danger of COVID-19 and onto remedying life changes from COVID-19 to improve individuals' quality of life. I further discuss the theoretical findings, implications, limitations, and future directions.

Anhedonia in Nicotine Dependence

Prior findings indicate that trait anhedonia enhances the likelihood of becoming a tobacco smoker, and preliminary evidence suggests that smoking abstinence leads to anhedonic states in some individuals and situations, and nicotine administration reduces anhedonic states. Nevertheless, many vital questions exist concerning relationships between anhedonia and nicotine dependence, including situational and individual difference factors that may moderate the strength of these associations. This chapter provides a critical review of the literature assessing relationships of anhedonia to nicotine dependence and the effects of acute nicotine through the lenses of the Research Domain Criteria's (RDoC) Positive Valence Systems (NIMH, RDoC changes to the matrix (CMAT) workgroup update: proposed positive valence domain revisions. A report by the national advisory mental health council workgroup on changes to the research domain criteria matrix, 2018) and the Situation x Trait Affective Response (STAR) model of nicotine's effects and nicotine dependence (Gilbert, Smoking individual differences, psychopathology, and emotion. Taylor and Francis, Washington, DC, 1995; Gilbert, Hum Psychopharmacol Clin Exp 12:S89-S102, 1997). The effects of nicotine and nicotine withdrawal on subjective, behavioral, and brain indices vary across the three RDoC Positive Valences Systems (Reward Responsiveness, Reward Learning, and Reward Valuation) in a manner that supports the research and potential clinical utility of using RDoC criteria and the STAR model to guide research and clinical innovation. We provide a revision of the STAR model that incorporates the three RDoC Positive Valence Systems with evidence that nicotine's effects on hedonic and affective processes vary as a function of the dominance/salience of (1) situational hedonic and affective cues and task/active coping cues, and (2) state executive functioning level/capacity and state reward sensitivity such that these effects of nicotine are maximal during states of suboptimal cognitive functioning and reward sensitivity, combined with low situational stimulus salience and low task-related cues/demands.

The Ethical Use of Fit Indices in Structural Equation Modeling: Recommendations for Psychologists

Fit indices provide helpful information for researchers to assess the fit of their structural equation models to their data. However, like many statistics and methods, researchers can misuse fit indices, which suggest the potential for questionable research practices that might arise during the analytic and interpretative processes. In the current paper, the author highlights two critical ethical dilemmas regarding the use of fit indices, which are (1) the selective reporting of fit indices and (2) using fit indices to justify poorly-fitting models. The author highlights the dilemmas and provides potential solutions for researchers and journals to follow to reduce these questionable research practices.

Effect of diazepam and fosazepam (a soluble derivative of diazepam) on sleep in man

The effect of diazepam (5 mg and 10 mg), and fosazepam (60 mg and 80 mg), a soluble derivative of diazepam, on sleep was studied in six healthy adult males using electroencephalography for sleep measures, and analogue scales for subjective assessments of well-being and sleep quality. The effect of diazepam was limited to the night of ingestion, but the effect of fosazepam was carried over to the next night and so modified sleep for about 30 h after ingestion. Effects on total sleep time were limited to the night of ingestion. There were increases with diazepam (10 mg) (P = 0.05), and with fosazepam (60 mg and 80 mg) (P = 0.001). For the night of ingestion sleep onset latencies were shortened, and awakenings were reduced by both drugs. The latency to stage 3 was shortened by fosazepam (60 mg and 80 mg) (P = 0.05). The low and high dose of each drug reduced the duration (min) of stage 0 sleep (P = 0.01), but fosazepam also reduced the duration (min) of stage 1 sleep (P = 0.001), and there was an increase in stage 2 sleep (P = 0.01). With fosazepam there were carry over effects to the next night with reduction of stage 1 sleep (P = 0.05). There were no effects on the duration of stage 3, but there was evidence that stage 4 activity was reduced during the recovery night after ingestion of fosazepam (80 mg). No effects were observed on REM sleep. Subjects reported an improved sense of well-being during the day after ingestion of diazepam and fosazepam, and with fosazepam they reported improved sleep. Correlations were calculated for sleep measures and subjective assessments.

Effect of a metabolite of diazepam, 3-hydroxydiazepam (temazepam), on sleep in man

The effect of 3-hydroxydiazepam (temazepam, 10 mg and 20 mg) on sleep was studied in six healthy adult males using electroencephalography for sleep measures, and analogue scales for subjective assessments of well-being and sleep quality. The effects were compared with diazepam (5 mg and 10 mg). Effect on total sleep time was restricted to the night of ingestion. There was no change in total sleep time after temazepam (10 mg), but with 20 mg total sleep time was increased (P = 0.01). Sleep onset latencies and awakenings were markedly reduced. Temazepam reduced the duration (min) of stage 0 (P = 0.05) and stage 1 (P = 0.01) sleep, and the effect on stage 1 was seen during each two hourly interval of sleep (P = 0.05). No effects were observed with stage 3, 3+4 and REM sleep, except that the appearance of the first REM period was delayed with temazepam (20 mg) (P = 0.001). The subjects, as a group, reported improved sleep, but subjective assessments of well-being were not altered. Correlations were calculated for sleep measures and subjective assessments.

Myofibroblastic fibrosarcoma with multifocal osseous metaplasia at the site of equine influenza vaccination

We describe a fibrosarcoma in a 12-year-old Quarterhorse x Arabian gelding as a sequela to equine influenza vaccination. Shortly after the second vaccination, swelling at the site was noticed by the owner and it continued to increase in size over the following 6 months. Biopsy of the mass indicated a fibrosarcoma had developed at the vaccination site. It was approximately 20 cm in diameter and elevated well above the level of the skin. There was no clinical evidence of metastases to the lungs or local lymph nodes. Surgical resection of the mass was performed and the wound healed by first and second intention. Histopathological examination and immunohistochemical staining confirmed a myofibroblastic fibrosarcoma with multifocal osseous metaplasia. To the authors' knowledge, this is the first equine case of a vaccine-associated fibrosarcoma.

Antihypertensive therapy in critical occupations: studies with an angiotensin II antagonist

OBJECTIVE

This study was performed to establish whether an angiotensin II antagonist modulates daytime sleepiness or performance.

METHODS

The central effects of losartan (50 and 100 mg), as well as amlodipine (5 and 10 mg) and promethazine (10 mg), were studied in six healthy volunteers (aged between 20 and 27 (mean 24) yr). Digit symbol substitution, tracking, vigilance, immediate and short-term memory recall, complex reaction time, together with objective (daytime sleep latencies) and subjective measures of sleepiness, were measured 1.0 h before and 0.5, 2.0, 3.5, 5.0, 6.5, and 8.0 h after ingestion. The study was placebo-controlled and double-blind with a six-way crossover design.

RESULTS

No changes in performance or in measurements related to sleepiness were observed with losartan (50 and 100 mg). Amlodipine (10 mg) impaired immediate memory and increased subjective sleepiness at 8.0 h (p < 0.05). Promethazine (10 mg) impaired vigilance and immediate memory recall and increased reaction time (basic and complex) from 2.0 to 6.5 h after ingestion, impaired tracking from 3.5 to 6.5 h and increased subjective sleepiness from 2.0 to 8.0 h (p < 0.05).

CONCLUSION

The study suggests that an angiotensin II antagonist could prove useful for the treatment of hypertension in aircrew.

Hypnotic activity of melatonin

OBJECTIVE

To establish the effect of melatonin upon nocturnal and evening sleep.

METHODS

Experiment I: The effect of melatonin (0.1, 0.5, 1.0, 5.0, and 10 mg), ingested at 23:30, was studied on nocturnal sleep (23:30-07:30) and core body temperature in 8 healthy volunteers. Performance was measured 8.5 h post-ingestion. On completion of the experiment dim light melatonin onsets (DLMO) were determined. Experiment II: The effect of melatonin (0.5, 1.0, 5.0, and 10 mg), ingested at 18:00, was studied on evening sleep (18:00-24:00) and core body temperature in 6 healthy volunteers. Performance was measured 6.5 h post-ingestion. Each experiment was placebo-controlled and double-blind with a cross-over design with temazepam (20 mg) as an active control.

RESULTS

Experiment I: Melatonin (5 mg) reduced the duration of stage 3 in the first 100 min of sleep. Melatonin (0.1 mg) reduced body temperature 6.5 to 7 h post-ingestion. Temazepam increased stage 2, reduced wakefulness and stage 1, and increased the latency to REM sleep. Temazepam reduced body temperature 4.5 to 6.5 h post-ingestion. There were no changes in performance compared with placebo. DLMO occurred between 20:40 and 23:15. Experiment II: Melatonin (all doses) increased total sleep time (TST), sleep efficiency index (SEI) and stage 2, and reduced wakefulness. Temazepam increased TST, SEI, stage 2 and slow-wave sleep, and reduced wakefulness. There were no changes in body temperature or performance compared with placebo.

CONCLUSION

Melatonin given at 23:30 has no significant clinical effect on nocturnal sleep in healthy individuals. Hypnotic activity of melatonin when given in the early evening (presumably in the absence of endogenous melatonin) is similar to 20 mg temazepam.

Antihistamines and aircrew: usefulness of fexofenadine

INTRODUCTION

The aim of this study was to establish whether fexofenadine hydrochloride, an antihistamine, modulates daytime sleepiness or performance.

METHODS

The effects of fexofenadine (120, 180, and 240 mg) on digit symbol substitution, tracking, and vigilance tasks, and on objective (multiple sleep latency test) and subjective sleepiness, were studied in six healthy volunteers (two males, four females, aged 20-34 [mean 26.5] yr) from 1 h pre-ingestion to 8 h post-ingestion. The study was placebo-controlled and double-blind with a six-way cross-over design. The centrally acting antihistamine, promethazine (10 mg), was used as an active control to confirm the sensitivity of the experimental procedures.

RESULTS

There were no changes in performance or sleepiness with any dose of fexofenadine at any time, compared with placebo. Promethazine, compared with both placebo and fexofenadine, impaired performance on the digit symbol substitution task (2.5 h post-ingestion), vigilance task (2.5-5h post-ingestion) and tracking task (2.5-3.5 h post-ingestion), increased objective sleepiness (1.5-2.5 h post-ingestion) and subjective sleepiness (1.5-8h post-ingestion).

CONCLUSION

Consideration may be given to the clinical use of currently licensed doses of fexofenadine (120-180 mg) by individuals involved in skilled activity. Fexofenadine may be potentially useful for aircrew.

Making the health care delivery system accountable

Accountability has become the fact of life for the health care provider and the delivery system. Until recently, accountability has been viewed primarily through the judicial process as issues of fraud and liability, or by managed care entities through evaluation of the financial bottom line. It is this second consideration and its ramifications that will be explored in this article. Appropriate measurement tools are needed to evaluate services, delivery, performance, customer satisfaction, and outcomes assessment. Measurement tools will be considered in light of the industry's unique considerations and realities. All participants, including insurers, employers, management, and health care providers and recipients, bear responsibilities which necessitate assessment and analysis. However, until the basic question, "Who is the customer?" is resolved, accountability issues remain complex and obscured. Accountability costs and impacts must be evaluated over time. They go way beyond bottom line cost containment and reduction. Accountability will be accomplished when the health care industry implements quality and measurement concepts that yield the highest levels of validity and appropriateness for health care delivery.

Complex effects of melatonin on human circadian rhythms in constant dim light

In humans, the pineal hormone melatonin can phase shift a number of circadian rhythms (e.g., "fatigue", endogenous melatonin, core body temperature) together with the timing of prolactin secretion. It is uncertain, however, whether melatonin can fully entrain all human circadian rhythms. In this study, the authors investigated the effects of daily melatonin administration on sighted individuals kept in continuous very dim light. A total of 10 normal, healthy males were maintained in two separate groups in partial temporal isolation under constant dim light (< 8 lux) with attenuated sound and ambient temperature variations but with knowledge of clock time for two periods of 30 days. In these circumstances, the majority of individuals free run with a mean period of 24.3 h. In a double-blind, randomized crossover design, subjects received 5 mg melatonin at 20:00 h on Days 1 to 15 (Melatonin 1st) followed by placebo on Days 16 to 30 (Placebo 2nd) or vice versa (Placebo 1st, Melatonin 2nd) during Leg 1 with treatment reversed in Leg 2. The variables measured were melatonin (as 6-sulphatoxymelatonin), rectal temperature, activity, and sleep (actigraphy and logs). In the experiment, 9 of the 10 subjects free ran with Placebo 1st, whereas Melatonin 1st stabilized the sleep-wake cycle to 24 h in 8 of 10 individuals. In addition, 2 individuals showed irregular sleep with this treatment. In some subjects, there was a shortening of the period of the temperature rhythm without synchronization. Melatonin 2nd induced phase advances (5 of 9 subjects), phase delays (2 of 9 subjects), and stabilization (2 of 9 subjects) of the sleep-wake cycle with subsequent synchronization to 24 h in the majority of individuals (7 of 9). Temperature continued to free run in 4 subjects. Maximum phase advances in core temperature were seen when the first melatonin treatment was given approximately 2 h after the temperature acrophase. These results indicate that melatonin was able to phase shift sleep and core temperature but was unable to synchronize core temperature consistently. In the majority of subjects, the sleep-wake cycle could be synchronized.

Promoting sleep in shiftworkers and intercontinental travelers

A number of techniques and treatments can be used to alleviate the sleep disturbance associated with both shiftwork and transmeridian travel. Optimization of the sleeping environment and avoidance of substances such as caffeine and alcohol before sleep are the best initial approach. Timing sleep to coincide with some of the normal sleep period where possible will improve sleep quality in shiftworkers. Similarly, following transmeridian flight, restricting sleep to the nocturnal period in the new time zone will assist adaptation. Hypnotic drugs may be of benefit to alleviate sleep disturbance experienced by shiftworkers or transmeridian travelers. Selection of the most appropriate medication must take into account required duration of action and possible residual effects of the drug on alertness. Hypnotics may be useful, particularly in middle-aged individuals who already have disturbed sleep, on those occasions when poor sleep is anticipated, for example following an eastward flight or after the initial change to night duty. Over-the-counter preparations should be avoided whenever possible unless it is known that they are not associated with residual sequelae.

Human circadian rhythms in constant dim light (8 lux) with knowledge of clock time

The light/dark (L/D) cycle is a major synchronizer of human circadian rhythms. In the absence of a strong L/D cycle, synchrony with 24 hours can nevertheless be maintained in a socially structured environment, as shown in Polar regions (Broadway et al. 1987) and by some blind subjects (Czeisler et al. 1995a). The relative contribution of other time cues to entrainment in dim light has not been fully explored. The present study investigated the behaviour of melatonin (assessed as 6-sulphatoxymelatonin); rectal temperature; activity and sleep (actigraphy and logs) in constant dim light (L/ L) with access to a digital clock. 6 normal healthy males were maintained as a group in partial temporal isolation with attenuated sound and ambient temperature for 21 days. All 6 subjects showed free-running periodicity for 6-sulphatoxymelatonin and 5/6 subjects for temperature, activity and sleep offset. The average period (tau) was 24.26 +/- 0.049, substantially shorter than in previous experiments with a self selected L/D cycle but similar to a recent study conducted in very dim light. One subject maintained a rigid sleep/wake cycle throughout whilst his 6-sulphatoxymelatonin rhythm free-ran. Total sleep time, from actigraph data, did not change but sleep efficiency decreased during the experiment. The subjects did not show group synchronization. These results confirm previous data indicating the importance of the L/D cycle in human entrainment and underline the lesser role of social cues and knowledge of clock time. This particular approach will permit the administration of timed medication to sighted humans under free-running conditions.

Psychophysiological correlates of dynamic imagery

Brain Electrical Activity Maps were recorded from 20 subjects whilst performing: (a) the Vandenberg & Kuse Mental Rotation Test (MRT) and: (b) the Isaac, Marks & Russell Vividness of Movement Imagery Questionnaire (VMIQ), and under control conditions. Subjects were classified as good or poor imagers, first on the basis of their VMIQ scores, and secondly on their MRT scores. Alpha, beta 1 and beta 2 at different cortical regions were compared between groups and between task performance and control conditions. During MRT significant reductions in alpha amplitude were found over both right and left parietal areas and over the left frontal region. In beta 1 non-significant trends in the same direction were observed in the same regions found to be significant in alpha. Non-significant trends in beta 2 were observed over the right parietal and frontal regions. No differences in amplitude at any frequency band were found between good and poor VMIQ scorers but subjects with high MRT scores showed greater alpha amplitude at many sites in the parietal, parieto-occipital and frontal areas than subjects with low MRT scores. During VMIQ testing the VMIQ high imagers showed a non-significant trend towards higher alpha amplitude at frontal regions and some scattered parietal and occipital sites and significantly higher levels of beta 2 in the left frontal region. However, no differences were found between imagery and control conditions. The results confirm the involvement of motor as well as spatial processes in dynamic imagery.

Influence of polar route schedules on the duty and rest patterns of aircrew

The duty and rest periods of aircrew operating the polar route from London via Anchorage were recorded during five schedules which involved 1-, 2- or 3-day sojourns in Japan. Sleep throughout each schedule was fragmented, with naps before duty and short sleeps after arrival at a new location. Sleep disturbance rather than cumulative sleep loss appeared to be the overriding problem, and the shorter schedules had the most marked disturbances in sleep during the trip and during the immediate recovery period. Electroencephalographic studies are necessary to confirm these observations, and information on circadian rhythmicity is needed to define the circumstances which lead to persistence of sleep disturbance on return to Europe.

Sleep of Andean high altitude natives

The structure of sleep in lowland visitors to altitudes greater than 4000 m is grossly disturbed. There are no data on sleep in long-term residents of high altitudes. This paper describes an electroencephalographic study of sleep in high altitude dwellers who were born in and are permanent residents of Cerro de Pasco in the Peruvian Andes, situated at 4330 m. Eight healthy male volunteers aged between 18 and 69 years were studied. Sleep was measured on three consecutive nights for each subject. Electroencephalographs, submental electromyographs and electro-oculograms were recorded. Only data from the third night were used in the analysis. The sleep patterns of these subjects resembled the normal sleep patterns described by others in lowlanders at sea level. There were significant amounts of slow wave sleep in the younger subjects and rapid eye movement sleep seemed unimpaired.

Circadian rhythmicity and sleep of aircrew during polar schedules

Sleep and circadian rhythms of aircrew were studied during a 7-d polar schedule operated between London and Tokyo. Sleep, rectal temperature, and subjective alertness were recorded for 2 d before departure during the schedule, and for 10 d after the return. Changes in sleep during the early part of the trip were due to sleep loss on the outward journey, but later these changes were related to the displacement of the circadian rhythm. The acrophases of the circadian rhythms of temperature were delayed by the outward journey, and amplitudes were reduced throughout the trip. During the return, aircrew reported high levels of tiredness which persisted until the second recovery night. Though the amounts of sleep obtained during the schedule were satisfactory for the aircrew as a group, some crewmembers experienced difficulties. Realignment of circadian rhythms was attained by an advance of the circadian phase in eight aircrew and by a delay in three, and resynchronization was achieved in all cases within 6 d.

Combined optical second harmonic generation/quartz crystal microbalance study of underpotential deposition processes: copper electrodeposition on polycrystalline gold

Optical second harmonic generation and quartz crystal microbalance techniques are used as in situ probes of copper underpotential deposition on polycrystalline gold surfaces in sulfuric acid electrolyte. The second harmonic signal from a polished bulk gold substrate is observed to decrease by >60% as a result of copper underpotential deposition on gold. Also, the mass of an underpotentially deposited copper adlayer is monitored in situ by an oscillating quartz crystal microbalance, yielding an estimated coverage of ~8.0 x 10(-10) mol cm(-2) and an electrosorption valency of 1.5 for a copper adlayer on the surface of vapor-deposited polycrystalline gold.

Performance and quality of sleep wearing NBC protective clothing

Two separate studies were carried out to investigate the effect of wearing nuclear-biological-chemical aircrew equipment assembly (NBC AEA) protective clothing on performance and on overnight sleep. Performance at a series of tasks was measured, in six male subjects, during the day (0800-2000 hours) and at night (2000-0800 hours). Wearing the NBC assembly did not lead to significant decrements in performance compared with the normal aircrew equipment assembly (AEA). The sleep of six male volunteers was recorded electroencephalographically on two consecutive nights when NBC protective clothing was worn. Sleep was both shortened and disturbed, compared with overnight control sleep. There were some improvements on the second night, suggesting that individuals may adapt to wearing the NBC assembly.

Altitude insomnia: studies during an expedition to the Himalayas

During an expedition to the Himalayas, we studied the sleep and respiration of six climbers. Three ingested acetazolamide (500 mg) daily throughout the climb and the other three ingested placebo. At high altitude (4,150-4,846 m), each subject ingested temazepam (10 mg) for one night and placebo for another. Acetazolamide improved sleep above 2,750 m, but it is uncertain whether this was due to sedation or to improvements in arterial oxygen saturation. Sleep was markedly disturbed in all subjects above 4,000 m. Temazepam improved sleep, and in subjects taking acetazolamide, it reduced sleep-onset latencies and increased sleep efficiency close to that of sea level values. These observations suggest that the prophylactic use of acetazolamide is likely to improve sleep in climbers and that a low dose of a benzodiazepine such as temazepam (10 mg) may be beneficial at high altitude. Studies are now needed to exclude any possibility of respiratory impairment at altitude before a firm recommendation can be made regarding the routine use of this hypnotic.

Efficacy of zopiclone in middle age

Effects of zopiclone (5.0, 7.5, and 10 mg) on sleep and on performance were studied in middle-aged subjects. Zopiclone (5.0-10.0 mg) reduced awake activity and the number of awakenings, and increased the duration of stage 2 sleep. The appearance of REM sleep was delayed, but this effect was without reduction over the whole night. There were no impairments in the digit symbol substitution test when zopiclone was compared with placebo, although there were less substitutions with 10.0 mg than with 5.0 mg. Symbol copying and choice reaction time were unaltered. Zopiclone would appear to be a useful hypnotic for those involved in skilled work. Based on the results obtained in healthy volunteers, the 5.0 mg dose would be appropriate for many; if in insomniac patients, 7.5 mg was needed, then it is likely to be free of undue impairment of performance the next day.

Irregularity of rest and activity: studies on circadian rhythmicity in man

1. Rectal temperature, electrolyte excretion and performance were studied in young adults who followed an irregular pattern of work and rest for 9 days in an isolation unit. 2. In the analysis, effects evoked by the pattern of work and rest were separated from the oscillatory component, and rhythms for individual days were examined by the cosinor method. 3. During the schedule, rhythms no longer showed a period of exactly 24 h, and this effect was confirmed by studies using a repeated cycle of irregular work and rest and by studies using constant routines. 4. Temperature and urinary constituents differed in the strength and phase of their rhythms when corrected for evoked effects, as well as in the strength of the evoked effects themselves. 5. There was evidence of deterioration in performance during work periods which exceeded 9 h, but there was no evidence of progressive deterioration in performance over the 9 day schedule.

Hypnotics and transient insomnia

An hypnotic should be used only when there is evidence of sleep disturbance. The wide range of sleep disorders (e.g. delayed sleep onset or problems of sleep maintenance) and the added complication that the patient may be involved subsequently in skilled work demand that the pharmacokinetics of various hypnotics must be understood before the correct hypnotic can be chosen. Impaired performance is more severe and persists far longer with compounds that are slowly eliminated and with the use of higher doses. The particular situations of aircrew and mountaineers have been studied in detail. Caution must be exercised in the management of aircrew coping with irregularity of rest and work. Temazepam has been used for aircrew for over 10 years and the absence of adverse effects ensures that it remains the recommended hypnotic in this area of medical practice. The relationship of insomnia with the hypoxic environment is undetermined. To investigate this, sleep was studied in six individuals during an expedition to the Himalayas. At altitude, temazepam led to less wakefulness and to drowsy sleep--there were no prolonged sleep latencies.

Nocturnal sleep and daytime alertness of aircrew after transmeridian flights

The nocturnal sleep and daytime alertness of aircrew were studied by electroencephalography and the multiple sleep latency test. After a transmeridian flight from London to San Francisco, sleep onset was faster and, although there was increased wakefulness during the second half of the night, sleep duration and efficiency over the whole night were not changed. The progressive decrease in sleep latencies observed normally in the multiple sleep latency test during the morning continued throughout the day after arrival. Of the 13 subjects, 12 took a nap of around 1-h duration in the afternoon preceding the return flight. These naps would have been encouraged by the drowsiness at this time and facilitated by the departure of the aircraft being scheduled during the early evening. An early evening departure had the further advantage that the circadian increase in vigilance expected during the early part of the day would occur during the latter part of the return flight.

Sleep after transmeridian flights

Nocturnal sleep and daytime sleep latencies, recorded electroencephalographically after westward and eastward flights across the North Atlantic involving time zone shifts of 5 h, were influenced by the time of the flight and by subsequent displacement of the rest period. After the westward flight there was sleep disturbance during the latter part of the first night. However, there was persistent disturbance of sleep after the eastward flight. A rapidly eliminated hypnotic may be useful for the first night or two after a westward flight and for a few nights after an overnight eastward flight.

Modulation of catecholamine transmission and sleep in man

The effect of modulation of catecholamine transmission on sleep in man was studied using mianserin (20 and 40 mg) and nomifensine (50 and 100 mg). It is suggested that reduced wakefulness induced by mianserin during sleep is primarily related to postsynaptic antagonism of alpha adrenoceptors, though a possible synergistic effect with antagonism of histamine H1 receptors cannot be excluded, while increased wakefulness with nomifensine is related to inhibition of the uptake of catecholamines and/or direct or indirect dopaminergic activity. The reduction in rapid eye movement (REM) sleep with both drugs is believed to be a non-specific effect which arises from a disturbance of the balance between monoaminergic and cholinergic influences.

Antihistamines: impaired performance and the tendency to sleep

The central effects of various antihistamines were studied using a variety of tests of performance, including visuo-motor co-ordination and dynamic visual acuity, as well as paper and pencil tests and critical flicker fusion. The possible relationship between performance and sedation was also studied using digit symbol substitution and latencies to drowsy sleep. There was high degree of correlation between drowsiness, as indicated by the relative ease with which individuals fell asleep over the day, and impaired performance, but it was not possible to establish the relationship for each time of the day. These findings lend some support to the suggestion that impaired performance with antihistamines may be a non-specific effect of sedation.

Central effects during the continuous osmotic infusion of a benzodiazepine (triazolam)

The effects of relatively constant plasma levels of a rapidly eliminated benzodiazepine (triazolam) were studied in young healthy males to determine whether tolerance to certain effects may develop over a relatively short period of time. The drug was given over a period of 30 h (2 days and 1 night) at zero-order rate using a rectal osmotic pump. Performance was measured at 2 hourly intervals during the day and was continuously impaired during the infusion, though there was a rapid recovery when the infusion ceased. All tasks were affected, in particular mental arithmetic and letter cancellation, but there was some improvement in performance during the second day. The normal circadian improvement in performance may have contributed to this effect, but some degree of tolerance to the effect of the drug cannot be excluded. Overnight there was a marked reduction in wakefulness, suppression of slow wave sleep, and delay to the onset and reduction in the duration of rapid eye movement sleep. During the night after infusion there was less slow wave sleep and increased wakefulness. The experimental design may prove useful in the study of tolerance to drugs.

Hypnotics and aircrew

The management of sleep difficulties which arise during air operations must be related, at least initially, to the cause, but the aeromedical specialist is frequently faced with the possible use of hypnotics. There are no simple guidelines, but an understanding of various issues will help toward the effective use of these drugs in those who have to cope with irregularity of rest and carry out skilled work. Some knowledge of the pharmacokinetics of the drugs concerned is useful as persistence of effect and the potential for accumulation with repeated ingestion are important factors, while efficacy in relation to sleep of different durations and at unusual times must also be considered.