Nightmare frequency is a risk factor for suicidal ideation during the COVID-19 pandemic

The association between nightmare frequency (NMF) and suicidal ideation (SI) is well known, yet the impact of the COVID-19 pandemic on this relation is inconsistent. This study aimed to investigate changes in NMF, SI, and their association during the COVID-19 pandemic. Data were collected in 16 countries using a harmonised questionnaire. The sample included 9328 individuals (4848 women; age M[SD] = 46.85 [17.75] years), and 17.60% reported previous COVID-19. Overall, SI was significantly 2% lower during the pandemic vs. before, and this was consistent across genders and ages. Most countries/regions demonstrated decreases in SI during this pandemic, with Austria (-9.57%), Sweden (-6.18%), and Bulgaria (-5.14%) exhibiting significant declines in SI, but Italy (1.45%) and Portugal (2.45%) demonstrated non-significant increases. Suicidal ideation was more common in participants with long-COVID (21.10%) vs. short-COVID (12.40%), though SI did not vary by COVID-19 history. Nightmare frequency increased by 4.50% during the pandemic and was significantly higher in those with previous COVID-19 (14.50% vs. 10.70%), during infection (23.00% vs. 8.10%), and in those with long-COVID (18.00% vs. 8.50%). The relation between NMF and SI was not significantly stronger during the pandemic than prior (rs = 0.18 vs. 0.14; z = 2.80). Frequent nightmares during the pandemic increased the likelihood of reporting SI (OR = 1.57, 95% CI 1.20-2.05), while frequent dream recall during the pandemic served a protective effect (OR = 0.74, 95% CI 0.59-0.94). These findings have important implications for identifying those at risk of suicide and may offer a potential pathway for suicide prevention.

Estimation bias and agreement limits between two common self-report methods of habitual sleep duration in epidemiological surveys

Accurate measurement of habitual sleep duration (HSD) is crucial for understanding the relationship between sleep and health. This study aimed to assess the bias and agreement limits between two commonly used short HSD self-report methods, considering sleep quality (SQ) and social jetlag (SJL) as potential predictors of bias. Data from 10,268 participants in the International COVID Sleep Study-II (ICOSS-II) were used. Method-Self and Method-MCTQ were compared. Method-Self involved a single question about average nightly sleep duration (HSDself), while Method-MCTQ estimated HSD from reported sleep times on workdays (HSDMCTQwork) and free days (HSDMCTQfree). Sleep quality was evaluated using a Likert scale and the Insomnia Severity Index (ISI) to explore its influence on estimation bias. HSDself was on average 42.41 ± 67.42 min lower than HSDMCTQweek, with an agreement range within ± 133 min. The bias and agreement range between methods increased with poorer SQ. HSDMCTQwork showed less bias and better agreement with HSDself compared to HSDMCTQfree. Sleep duration irregularity was - 43.35 ± 78.26 min on average. Subjective sleep quality predicted a significant proportion of variance in HSDself and estimation bias. The two methods showed very poor agreement and a significant systematic bias, both worsening with poorer SQ. Method-MCTQ considered sleep intervals without adjusting for SQ issues such as wakefulness after sleep onset but accounted for sleep irregularity and sleeping in on free days, while Method-Self reflected respondents' interpretation of their sleep, focusing on their sleep on workdays. Including an SQ-related question in surveys may help bidirectionally adjust the possible bias and enhance the accuracy of sleep-health studies.

Habitual short sleepers with pre-existing medical conditions are at higher risk of Long COVID

STUDY OBJECTIVES

Preliminary evidence suggests that the risk of Long COVID is higher among people with pre-existing medical conditions. Based on its proven adjuvant role in immunity, habitual sleep duration may alter the risk of developing Long COVID. The objective of this study was to determine whether the odds of Long COVID are higher among those with pre-existing medical conditions, and whether the strength of this association varies by habitual sleep duration.

METHODS

Using data from 13,461 respondents from 16 countries who participated in the 2021 survey-based International COVID Sleep Study II (ICOSS II), we studied the associations between habitual sleep duration, pre-existing medical conditions, and Long COVID.

RESULTS

Of 2,508 individuals who had COVID-19, 61% reported at least 1 Long COVID symptom. Multivariable logistic regression analysis showed that the risk of having Long COVID was 1.8-fold higher for average-length sleepers (6-9 h/night) with pre-existing medical conditions compared with those without pre-existing medical conditions (adjusted odds ratio [aOR] 1.84 [1.18-2.90]; P = .008). The risk of Long COVID was 3-fold higher for short sleepers with pre-existing medical conditions (aOR 2.95 [1.04-8.4]; P = .043) and not significantly higher for long sleepers with pre-existing conditions (aOR 2.11 [0.93-4.77]; P = .073) compared with average-length sleepers without pre-existing conditions.

CONCLUSIONS

Habitual short nighttime sleep duration exacerbated the risk of Long COVID in individuals with pre-existing conditions. Restoring nighttime sleep to average duration represents a potentially modifiable behavioral factor to lower the odds of Long COVID for at-risk patients.

CITATION

Berezin L, Waseem R, Merikanto I, et al. Habitual short sleepers with pre-existing medical conditions are at higher risk of long COVID. J Clin Sleep Med. 2024;20(1):111-119.

The association of insomnia with long COVID: An international collaborative study (ICOSS-II)

OBJECTIVE

There is evidence of a strong association between insomnia and COVID-19, yet few studies have examined the relationship between insomnia and long COVID. This study aimed to investigate whether COVID-19 patients with pre-pandemic insomnia have a greater risk of developing long COVID and whether long COVID is in turn associated with higher incident rates of insomnia symptoms after infection.

METHODS

Data were collected cross-sectionally (May-Dec 2021) as part of an international collaborative study involving participants from 16 countries. A total of 2311 participants (18-99 years old) with COVID-19 provided valid responses to a web-based survey about sleep, insomnia, and health-related variables. Log-binomial regression was used to assess bidirectional associations between insomnia and long COVID. Analyses were adjusted for age, sex, and health conditions, including sleep apnea, attention and memory problems, chronic fatigue, depression, and anxiety.

RESULTS

COVID-19 patients with pre-pandemic insomnia showed a higher risk of developing long COVID than those without pre-pandemic insomnia (70.8% vs 51.4%; adjusted relative risk [RR]: 1.33, 95% confidence interval [CI]: 1.07-1.65). Among COVID-19 cases without pre-pandemic insomnia, the rates of incident insomnia symptoms after infection were 24.1% for short COVID cases and 60.6% for long COVID cases (p < .001). Compared with short COVID cases, long COVID cases were associated with an increased risk of developing insomnia symptoms (adjusted RR: 2.00; 95% CI: 1.50-2.66).

CONCLUSIONS

The findings support a bidirectional relationship between insomnia and long COVID. These findings highlight the importance of addressing sleep and insomnia in the prevention and management of long COVID.

Associations between changes in habitual sleep duration and lower self-rated health among COVID-19 survivors: findings from a survey across 16 countries/regions

BACKGROUND

Self-rated health (SRH) is widely recognized as a clinically significant predictor of subsequent mortality risk. Although COVID-19 may impair SRH, this relationship has not been extensively examined. The present study aimed to examine the correlation between habitual sleep duration, changes in sleep duration after infection, and SRH in subjects who have experienced SARS-CoV-2 infection.

METHODS

Participants from 16 countries participated in the International COVID Sleep Study-II (ICOSS-II) online survey in 2021. A total of 10,794 of these participants were included in the analysis, including 1,509 COVID-19 individuals (who reported that they had tested positive for COVID-19). SRH was evaluated using a 0-100 linear visual analog scale. Habitual sleep durations of < 6 h and > 9 h were defined as short and long habitual sleep duration, respectively. Changes in habitual sleep duration after infection of ≤ -2 h and ≥ 1 h were defined as decreased or increased, respectively.

RESULTS

Participants with COVID-19 had lower SRH scores than non-infected participants, and those with more severe COVID-19 had a tendency towards even lower SRH scores. In a multivariate regression analysis of participants who had experienced COVID-19, both decreased and increased habitual sleep duration after infection were significantly associated with lower SRH after controlling for sleep quality (β = -0.056 and -0.058, respectively, both p < 0.05); however, associations between current short or long habitual sleep duration and SRH were negligible. Multinomial logistic regression analysis showed that decreased habitual sleep duration was significantly related to increased fatigue (odds ratio [OR] = 1.824, p < 0.01), shortness of breath (OR = 1.725, p < 0.05), diarrhea/nausea/vomiting (OR = 2.636, p < 0.01), and hallucinations (OR = 5.091, p < 0.05), while increased habitual sleep duration was significantly related to increased fatigue (OR = 1.900, p < 0.01).

CONCLUSIONS

Changes in habitual sleep duration following SARS-CoV-2 infection were associated with lower SRH. Decreased or increased habitual sleep duration might have a bidirectional relation with post-COVID-19 symptoms. Further research is needed to better understand the mechanisms underlying these relationships for in order to improve SRH in individuals with COVID-19.

Sleep symptoms are essential features of long-COVID - Comparing healthy controls with COVID-19 cases of different severity in the international COVID sleep study (ICOSS-II)

Many people report suffering from post-acute sequelae of COVID-19 or "long-COVID", but there are still open questions on what actually constitutes long-COVID and how prevalent it is. The current definition of post-acute sequelae of COVID-19 is based on voting using the Delphi-method by the WHO post-COVID-19 working group. It emphasizes long-lasting fatigue, shortness of breath and cognitive dysfunction as the core symptoms of post-acute sequelae of COVID-19. In this international survey study consisting of 13,628 subjects aged 18-99 years from 16 countries of Asia, Europe, North America and South America (May-Dec 2021), we show that post-acute sequelae of COVID-19 symptoms were more prevalent amongst the more severe COVID-19 cases, i.e. those requiring hospitalisation for COVID-19. We also found that long-lasting sleep symptoms are at the core of post-acute sequelae of COVID-19 and associate with the COVID-19 severity when COVID-19 cases are compared with COVID-negative cases. Specifically, fatigue (61.3%), insomnia symptoms (49.6%) and excessive daytime sleepiness (35.8%) were highly prevalent amongst respondents reporting long-lasting symptoms after hospitalisation for COVID-19. Understanding the importance of sleep-related symptoms in post-acute sequelae of COVID-19 has a clinical relevance when diagnosing and treating long-COVID.

Shift workers are at increased risk of severe COVID-19 compared with day workers: Results from the international COVID sleep study (ICOSS) of 7141 workers

The present study had two main aims. First, to investigate whether shift/night workers had a higher prevalence and severity of COVID-19 compared with day workers. Second, to investigate whether people regularly working in face-to-face settings during the pandemic exhibited a higher prevalence and severity of COVID-19 compared with those having no need to be in close contact with others at work. Data consisted of 7141 workers from 15 countries and four continents who participated in the International COVID Sleep Study-II (ICOSS-II) between May and December 2021. The associations between work status and a positive COVID-19 test and several indications of disease severity were tested with chi-square tests and logistic regressions adjusted for relevant confounders. In addition, statistical analyses were conducted for the associations between face-to-face work and COVID-19 status. Results showed that shift/night work was not associated with an increased risk of COVID-19 compared to day work. Still, shift/night workers reported higher odds for moderate to life-threatening COVID-19 (adjusted odds ratio (aOR) = 2.71, 95%-confidence interval = 1.23-5.95) and need for hospital care (aOR = 5.66, 1.89-16.95). Face-to-face work was associated with an increased risk of COVID-19 (aOR = 1.55, 1.12-2.14) but not with higher disease severity. In conclusion, shift/night work was not associated with an increased risk of COVID-19, but when infected, shift/night workers reported more severe disease. Impaired sleep and circadian disruption commonly seen among shift/night workers may be mediating factors. Working face-to-face increased the risk of COVID-19, likely due to increased exposure to the virus. However, face-to-face work was not associated with increased disease severity.

The online and offline effects of changing movement timing variability during training on a finger-opposition task

In motor learning tasks, there is mixed evidence for whether increased task-relevant variability in early learning stages leads to improved outcomes. One problem is that there may be a connection between skill level and motor variability, such that participants who initially have more variability may also perform worse on the task, so will have more room to improve. To avoid this confound, we experimentally manipulated the amount of movement timing variability (MTV) during training to test whether it improves performance. Based on previous studies showing that most of the improvement in finger-opposition tasks comes from optimizing the relative onset time of the finger movements, we used auditory cues (beeps) to guide the onset times of sequential movements during a training session, and then assessed motor performance after the intervention. Participants were assigned to three groups that either: (a) followed a prescribed random rhythm for their finger touches (Variable MTV), (b) followed a fixed rhythm (Fixed control MTV), or (c) produced the entire sequence following a single beep (Unsupervised control MTV). While the intervention was successful in increasing MTV during training for the Variable group, it did not lead to improved outcomes post-training compared to either control group, and the use of fixed timing led to significantly worse performance compared to the Unsupervised control group. These results suggest that manipulating MTV through auditory cues does not produce greater learning than unconstrained training in motor sequence tasks.

Disturbances in sleep, circadian rhythms and daytime functioning in relation to coronavirus infection and Long-COVID - A multinational ICOSS study

This protocol paper describes the second survey produced by the International Covid Sleep Study (ICOSS) group with the aim to examine the associations between SARS-CoV-2 infection and sleep, sleepiness, and circadian problems as potential predisposing factors for more severe COVID-19 disease profile and for development of Long-COVID in the general population. The survey consists of 47 questions on sleep, daytime sleepiness, circadian rhythm, health, mental wellbeing, life habits, and socioeconomic situation before and during the pandemic, and conditional questions to those reporting having had coronavirus infection, being vaccinated, or suffering from particular sleep symptoms or sleep disorders. Surveys will be administered online between May and November 2021 in Austria, Brazil, Bulgaria, Canada, China, Croatia, Finland, France, Germany, Israel, Italy, Japan, Norway, Portugal, Sweden and USA. Data collected by the survey will give valuable information on the open questions regarding COVID-19 disease risk factors, symptomatology and evolution of Long-COVID, and on other long-term consequences related to the pandemic.

Outdoor daylight exposure and longer sleep promote wellbeing under COVID-19 mandated restrictions

Light is an important regulator of daily human physiology in providing time‐of‐day information for the circadian clock to stay synchronised with the 24‐hr day. The coronavirus disease 2019 (COVID‐19) pandemic led to social restrictions in many countries to prevent virus spreading, restrictions that dramatically altered daily routines and limited outdoor daylight exposure. We previously reported that sleep duration increased, social jetlag decreased, and mid‐sleep times delayed during social restrictions (Global Chrono Corona Survey, N = 7,517). In the present study, we investigated in the same dataset changes in wellbeing and their link to outdoor daylight exposure, and sleep–wake behaviour. In social restrictions, median values of sleep quality, quality of life, physical activity and productivity deteriorated, while screen time increased, and outdoor daylight exposure was reduced by ~58%. Yet, many survey participants also reported no changes or even improvements. Larger reductions in outdoor daylight exposure were linked to deteriorations in wellbeing and delayed mid‐sleep times. Notably, sleep duration was not associated with outdoor daylight exposure loss. Longer sleep and decreased alarm‐clock use dose‐dependently correlated with changes in sleep quality and quality of life. Regression analysis for each wellbeing aspect showed that a model with six predictors including both levels and their deltas of outdoor daylight exposure, sleep duration and mid‐sleep timing explained 5%–10% of the variance in changes of wellbeing scores (except for productivity). As exposure to daylight may extenuate the negative effects of social restriction and prevent sleep disruption, public strategies during pandemics should actively foster spending more daytime outdoors.

The impact of the early phase of the COVID-19 pandemic on mental-health services in Europe

PURPOSE

The current COVID-19 pandemic confronts psychiatric patients and mental health services with unique and severe challenges.

METHODS

In order to identify these trans-national challenges across Europe, an ad-hoc survey was conducted among 23 experts, each answering for one European or aligned country.

RESULTS

A number of important themes and issues were raised for the impact of COVID-19 on mental health and mental health services, barriers to service provision and future consequences. A number of key issues were reported by colleagues across several jurisdictions, even though these were at different stages of their national epidemics.

CONCLUSIONS

Based on these findings, we articulate some important learnings from the early stages of the COVID-19 European pandemic, and highlight key considerations for all countries' mental health services as the current pandemic develops and for future pandemics.

Better later: evening practice is advantageous for motor skill consolidation in the elderly

How does the time of day of a practice session affect learning of a new motor sequence in the elderly? Participants practiced a given finger tapping sequence either during morning or evening hours. All participants robustly improved performance speed within the session concurrent with a reorganization of the tapping pattern of the sequence. However, evening-trained participants showed additional gains overnight and at 1 wk posttraining; moreover, evening training led to a further reorganization of the tapping pattern offline. A learning experience preceding nocturnal sleep can lead to a task-specific movement routine as an expression of novel “how to” knowledge in the elderly.

COVID-19-mandated social restrictions unveil the impact of social time pressure on sleep and body clock

In humans, sleep regulation is tightly linked to social times that assign local time to events, such as school, work, or meals. The impact of these social times, collectively—social time pressure, on sleep has been studied epidemiologically via quantification of the discrepancy between sleep times on workdays and those on work-free days. This discrepancy is known as the social jetlag (SJL). COVID-19-mandated social restrictions (SR) constituted a global intervention by affecting social times worldwide. We launched a Global Chrono Corona Survey (GCCS) that queried sleep–wake times before and during SR (preSR and inSR). 11,431 adults from 40 countries responded between April 4 and May 6, 2020. The final sample consisted of 7517 respondents (68.2% females), who had been 32.7 ± 9.1 (mean ± sd) days under SR. SR led to robust changes: mid-sleep time on workdays and free days was delayed by 50 and 22 min, respectively; sleep duration increased on workdays by 26 min but shortened by 9 min on free days; SJL decreased by ~ 30 min. On workdays inSR, sleep–wake times in most people approached those of their preSR free days. Changes in sleep duration and SJL correlated with inSR-use of alarm clocks and were larger in young adults. The data indicate a massive sleep deficit under pre-pandemic social time pressure, provide insights to the actual sleep need of different age-groups and suggest that tolerable SJL is about 20 min. Relaxed social time pressure promotes more sleep, smaller SJL and reduced use of alarm clocks.

Broadband, millimeter-wave antireflection coatings for large-format, cryogenic aluminum oxide optics

We present two prescriptions for broadband ($ {\sim} 77 - 252\;{\rm GHz} $), millimeter-wave antireflection coatings for cryogenic, sintered polycrystalline aluminum oxide optics: one for large-format (700 mm diameter) planar and plano-convex elements, the other for densely packed arrays of quasi-optical elements-in our case, 5 mm diameter half-spheres (called "lenslets"). The coatings comprise three layers of commercially available, polytetrafluoroethylene-based, dielectric sheet material. The lenslet coating is molded to fit the 150 mm diameter arrays directly, while the large-diameter lenses are coated using a tiled approach. We review the fabrication processes for both prescriptions, then discuss laboratory measurements of their transmittance and reflectance. In addition, we present the inferred refractive indices and loss tangents for the coating materials and the aluminum oxide substrate. We find that at 150 GHz and 300 K the large-format coating sample achieves $ (97 \pm 2)\% $ transmittance, and the lenslet coating sample achieves $ (94 \pm 3)\% $ transmittance.

ADHD 24/7: Circadian clock genes, chronotherapy and sleep/wake cycle insufficiencies in ADHD

Objectives: The current paper addresses the evidence for circadian clock characteristics associated with attention-deficit hyperactivity disorder (ADHD), and possible therapeutic approaches based on chronomodulation through bright light (BL) therapy.Methods: We review the data reported in ADHD on genetic risk factors for phase-delayed circadian rhythms and on the role of photic input in circadian re-alignment.Results: Single nucleotide polymorphisms in circadian genes were recently associated with core ADHD symptoms, increased evening-orientation and frequent sleep problems. Additionally, alterations in exposure and response to photic input may underlie circadian problems in ADHD. BL therapy was shown to be effective for re-alignment of circadian physiology toward morningness, reducing sleep disturbances and bringing overall improvement in ADHD symptoms. The susceptibility of the circadian system to phase shift by timed BL exposure may have broad cost-effective potential implications for the treatment of ADHD.Conclusions: We conclude that further research of circadian function in ADHD should focus on detection of genetic markers (e.g., using human skin fibroblasts) and development of BL-based therapeutic interventions.

A Delayed Advantage: Multi-Session Training at Evening Hours Leads to Better Long-Term Retention of Motor Skill in the Elderly

The acquisition and retention of motor skills is necessary for everyday functioning in the elderly and may be critical in the context of motor rehabilitation. Recent studies indicate that motor training closely followed by sleep may result in better engagement of procedural (“how to”) memory consolidation processes in the elderly. Nevertheless, elderly individuals are mostly morning oriented and a common practice is to time rehabilitation programs to morning hours. Here, we tested whether the time-of-day wherein training is afforded (morning, 8–10:30 a.m., or evening, 6–9 p.m.) affects the long-term outcome of a multi-session motor practice program (10 sessions across 3–4 weeks) in healthy elderly participants. Twenty-nine (15 women) older adults (60–75 years) practiced an explicitly instructed five-element key-press sequence by repeatedly generating the sequence “as fast and accurately as possible.” The groups did not differ in terms of sleep habits and quality (1-week long actigraphy); all were morning-oriented individuals. All participants gained robustly from the intervention, shortening sequence tapping duration and retaining the gains (> 90%) at 1-month post-intervention, irrespective of the time-of-day of training. However, retesting at 7-months post-intervention showed that the attrition of the training induced gains was more pronounced in the morning trained group compared to the evening group (76 and 56.5% loss in sequence tapping time; 7/14 and 3/14 participants showed a > 5% decline in accuracy relative to end of training, respectively). Altogether, the results show that morning-oriented older adults effectively acquired skill in the performance of a sequence of finger movements, in both morning and evening practice sessions. However, evening training leads to a significant advantage, over morning training, in the long-term retention of the skill. Evening training should be considered an appropriate time window for motor skill learning in older adults, even in individuals with morning chronotype. The results are in line with the notion that motor training preceding a sleep interval may be better consolidated into long-term memory in the elderly, and thus result in lower forgetting rates.

Subclinical Scores in Self-Report Based Screening Tools for Attention Deficits Correlate With Cognitive Traits in Typical Evening-Type Adults Tested in the Morning

Previous studies suggest that in adolescents and young adults, evening chronotype is a subclinical factor in physical, cognitive, and psychiatric fitness; poor sleep habits and larger misalignment with the social schedule constraints may exacerbate symptoms of inattention, impulsivity and the risks for detrimental behaviors. The influence of chronotype on neurocognitive performance during morning hours and scores in self-reports about attention deficit symptoms (ADS) and executive functioning, was explored in 42 healthy young university students (29 women), divided to evening type (ET) and combined morning/intermediate type (MT/IT) groups. Evening chronotypes scored significantly higher in the questionnaires of inattention Adult ADHD Self-Report Scale (ASRS-6) (MT/IT: 1.62 ± 1.59; ET: 2.71 ± 1.62, p < 0.05) and day-time sleepiness Epworth scale (MT/IT: 7.19 ± 5.17; ET: 11.48 ± 5.26, p < 0.01), reported lower subjective alertness (MT/IT: 63.02 ± 21.40; ET: 40.76 ± 17.43, p < 0.001), and had slower reaction times (MT/IT: 321.47 ± 76.81; ET: 358.94 ± 75.16, p < 0.05) during tests, compared to non-evening chronotypes. Nevertheless, ETs did not significantly differ in self-reports of executive functioning in the Behavioral Rating Inventory of Executive Functions-A (BRIEF-A) from non-ETs. The scores on standard self-report screening tools for ADS and executive functioning (ASRS-6, BRIEF-A-Metacognition) correlated with eveningness. We conclude that eveningness, subjective sleepiness and low arousal levels during morning can present as subclinical Attention Deficit and Hyperactivity Disorder (ADHD) symptoms in typical young adults with no evident sleep problems. Self-report based screening tools for ADS and executive functioning reflect chronotype-related traits in healthy young adults. Strong eveningness may bias the results of neurocognitive performance screening for ADHD when administered at morning hours.

Effect of age on spatial memory performance in real museum vs. computer simulation

BACKGROUND

Healthy older adults frequently complain on difficulty in recalling the locations of objects of everyday use. Cognitive abilities decline with normal aging; inefficiencies of information processing, as well as deterioration of neuronal structures, may impede the performance of complex cognitive skills such as spatial memory. Extraneous, task-irrelevant cognitive load in real environments is usually high and might interfere with spatial memory abilities of older adults. The purpose of this study was to determine (1) the extent to which older adults maintain their cognitive capacity during a spatial memory task as compared to young adults and (2) whether this capacity is affected by performance of the task in a real environment setting where the cognitive demands are similar to a simulation, but the physical demands (navigating via walking versus via a mouse) vary.

METHODS

In the museum, participants physically moved between display stations to locate hidden tokens performing a task in which an ongoing representation of previous searches had to be remembered. A comparable task was implemented via mouse actions on a computer simulation. Seventeen healthy older (60-80 years) and twenty younger (20-45 years) adults performed both tasks in a counterbalanced order.

RESULTS

The younger group was superior to the older group in terms of success rate and completion time for both conditions. All participants performed better during the simulated task. The delta between the total performance score in the two settings of the older group was significantly larger as compared to the younger group, suggesting a differential impact of setting on the groups.

CONCLUSIONS

Our results highlight the importance and feasibility of experimentation in ecologically relevant settings: differences were found in the way the cognitive performance of older and younger adults was affected by setting. Older adults appear to preserve basic cognitive abilities required for successful performance of object-location memory tasks. However, real museum setting appeared to impose higher demands on the older adults.

Observation of an expert model induces a skilled movement coordination pattern in a single session of intermittent practice

We tested how observation of a skilled pattern of planar movements can assist in the learning of a new motor skill, which otherwise requires rigorous long-term practice to achieve fast and smooth performance. Sixty participants performed a sequence of planar hand movements on pre-test, acquisition, post-test and 24 h post-training blocks, under 1 of 4 conditions: an observation group (OG), a slowed observation group (SOG), a random motion control group (RMCG) and a double physical training control group (DPTCG). The OG and SOG observed an expert model's right hand performing the study task intermittently throughout acquisition, RMCG observed random dots movement instead of a model. Participants in the DPTCG received extra physical practice trials instead of the visually observed trials. Kinematic analysis revealed that only in conditions with observation of an expert model there was an instant robust improvement in motor planning of the task. This step-wise improvement was not only persistent in post-training retests but was also apparently implicit and subject to further incremental improvements in movement strategy over the period of 24 hours. The rapid change in motor strategy was accompanied by a transient within-session increase in spatial error for the observation groups, but this went away by 24 h post-training. We suggest that observation of hand movements of an expert model coaligned with self-produced movements during training can significantly condense the time-course of ecologically relevant drawing/writing skill mastery.

Atypical Within-Session Motor Procedural Learning after Traumatic Brain Injury but Well-Preserved Between-Session Procedural Memory Consolidation

Using the finger-to-thumb opposition sequence (FOS) learning task, we characterized motor skill learning in sub-acute patients hospitalized for rehabilitation following traumatic brain injury (TBI). Ten patients (Trained TBI) and 11 healthy participants (Trained Healthy) were trained using a multi-session protocol: a single session was afforded in the first week of the study, and four daily sessions were afforded during the second week. Intensity of practice was adapted to patients. Performance speed and accuracy were tested before and after each session. Retention was tested 1 month later. Ten patients (Control TBI) had no FOS training and were tested only at the beginning and the end of the 6 week period. Although baseline performance on the FOS was very slow, all three phases of skill learning found in healthy adults (acquisition, between-session consolidation gains, and long-term retention) could be identified in patients with TBI. However, their time-course of learning was atypical. The Trained TBI group improved in speed about double the spontaneous improvements observed in the Control TBI group, with no speed-accuracy tradeoff. Normalized to their initial performance on the FOS, the gains accrued by the Trained TBI group after a first training were comparable to those accrued by healthy adults. Only during the second week with daily training, the rate of improvement of the Trained TBI group lagged behind that of the Trained Healthy group, due to increasing within-sessions losses in performance speed; no such losses were found in healthy participants. The Functional Independence Measure scores at the start of the study correlated with the total gains attained at the end of the study; no correlations were found with severity of injury or explicit memory impairments. Despite within-sessions losses in performance, which we propose reflect cognitive fatigue, training resulted in robust overall learning and long-term retention in patients with moderate-severe TBI. Given that the gains in performance evolved mainly between sessions, as delayed, offline, gains, our results suggest that memory consolidation processes can be effectively engaged in patients with TBI. However, practice protocols and schedules may need to be optimized to better engage the potential for long-term plasticity in these patients.

Background matters: Minor vibratory stimulation during motor skill acquisition selectively reduces off-line memory consolidation

Although a ubiquitous situation, it is not clear how effective is a learning experience when task-irrelevant, sensory noise occurs in the background. Here, young adults were trained on the finger opposition sequence task, in a well-established training and testing protocol affording measures for online as well as off-line learning. During the training session, one group experienced a minor background vibratory stimulation to the trunk by the means of vibrating cushion, while the second group experienced recorded sound vibrations. A control group was trained with no extra sensory stimulation. Sensory stimulation during training had no effect on the online within-session gains, but dampened the expression of the off-line, consolidation phase, gains in the two sensory stimulation groups. These results suggest that background sensory stimulation can selectively modify off-line, procedural memory consolidation processes, despite well-preserved on-line learning. Classical studies have shown that neural plasticity in sensory systems is modulated by motor input. The current results extend this notion and suggest that some types of task-irrelevant sensory stimulation, concurrent with motor training, may constitute a 'gating' factor - modulating the triggering of long-term procedural memory consolidation processes. Thus, vibratory stimulation may be considered as a behavioral counterpart of pharmacological interventions that do not interfere with short term neural plasticity but block long-term plasticity.

Procedural Memory Consolidation in Attention-Deficit/Hyperactivity Disorder Is Promoted by Scheduling of Practice to Evening Hours

In young adults without attention-deficit/hyperactivity disorder (ADHD) training on a novel movement sequence results not only in large within-session (online) gains in task performance but also in additional (delayed, off-line) gains in the performance, expressed after an interval of sleep. In contrast, young people with ADHD, given an identical practice, were shown to improve online but expressed much smaller delayed gains overnight. As delayed gains in performance are taken to reflect procedural ("how to") memory consolidation processes, this may explain skill learning deficits in persons with ADHD. However, motor training is usually provided in morning sessions, and, given that persons with ADHD are often evening types, chronobiological constraints may constitute a hidden factor. Here, we tested the hypothesis that evening training, compared to morning training, would result in larger overnight consolidation gains following practice on a novel motor task in young women with ADHD. Participants with (N = 25) and without (N = 24) ADHD were given training on a finger opposition sequence tapping task, either in the morning or at evening. Performance was assessed before and immediately after training, overnight, and at 2 weeks post-training. Individuals with ADHD reported a general preference for evening hours. Evening training was equally effective in participants with and without ADHD, both groups showing robust consolidation gains in task performance overnight. However, the ability to express delayed gains overnight was significantly reduced in participants with ADHD if trained in the morning. Typical peers were as effective in expressing overnight consolidation phase gains irrespective of the time-of-day wherein the training session was afforded. Nevertheless, even after morning training, participants with ADHD fully retained the gains acquired within the first 24 h over an interval of about 2 weeks. Our results suggest that procedural memory consolidation processes are extant and effective in ADHD, but require that specific biobehavioral conditions be met. The affordance of training in the evening hours can relax some of the constraints on these processes in ADHD. The current results are in line with the notion that the control of what is to be retained in procedural memory is atypical or more stringent in ADHD.

Offline Optimization of the Relative Timing of Movements in a Sequence Is Blocked by Retroactive Behavioral Interference

Acquisition of motor skills often involves the concatenation of single movements into sequences. Along the course of learning, sequential performance becomes progressively faster and smoother, presumably by optimization of both motor planning and motor execution. Following its encoding during training, "how-to" memory undergoes consolidation, reflecting transformations in performance and its neurobiological underpinnings over time. This offline post-training memory process is characterized by two phenomena: reduced sensitivity to interference and the emergence of delayed, typically overnight, gains in performance. Here, using a training protocol that effectively induces motor sequence memory consolidation, we tested temporal and kinematic parameters of performance within (online) and between (offline) sessions, and their sensitivity to retroactive interference. One group learned a given finger-to-thumb opposition sequence (FOS), and showed robust delayed (consolidation) gains in the number of correct sequences performed at 24 h. A second group learned an additional (interference) FOS shortly after the first and did not show delayed gains. Reduction of touch times and inter-movement intervals significantly contributed to the overall offline improvement of performance overnight. However, only the offline inter-movement interval shortening was selectively blocked by the interference experience. Velocity and amplitude, comprising movement time, also significantly changed across the consolidation period but were interference -insensitive. Moreover, they paradoxically canceled out each other. Current results suggest that shifts in the representation of the trained sequence are subserved by multiple processes: from distinct changes in kinematic characteristics of individual finger movements to high-level, temporal reorganization of the movements as a unit. Each of these processes has a distinct time course and a specific susceptibility to retroactive interference. This multiple-component view may bridge the gap in understanding the link between the behavioral changes, which define online and offline learning, and the biological mechanisms that support those changes.

Living Labs: overview of ecological approaches for health promotion and rehabilitation

PURPOSE

The term "Living Lab" was coined to reflect the use of sensors to monitor human behavior in real life environments. Until recently such measurements had been feasible only within experimental laboratory settings. The objective of this paper is to highlight research on health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning.

METHOD

Selected articles exemplifying the key technologies that allow monitoring of the motor-cognitive activity of persons with disabilities during naturally occurring daily experiences in real-life settings are discussed in terms of (1) the ways in which the Living Lab approach has been used to date, (2) limitations related to clinical assessment in rehabilitation settings and (3) three categories of the instruments most commonly used for this purpose: personal technologies, ambient technologies and external assistive systems.

RESULTS

Technology's most important influences on clinical practice and rehabilitation are in a shift from laboratory-based to field-centered research and a transition between in-clinic performance to daily life activities. Numerous applications show its potential for real-time clinical assessment.

CONCLUSIONS

Current technological solutions that may provide clinicians with objective, unobtrusive measurements of health and function, as well as tools that support rehabilitation on an individual basis in natural environments provide an important asset to standard clinical measures.

IMPLICATIONS FOR REHABILITATION

Until recently objective clinical assessment could not be readily performed in a client's daily functional environment. Novel technologies enable health care sensing and monitoring devices that enable direct, objective and accurate capture of real-world functioning. Such technologies are referred to as a "Living Lab" approach since they enable the capture of objective and non-obtrusive data that clinicians can use to assess performance. Research and development in this field help clinicians support maintain independence and quality of life for people who have disabilities or who are aging, and to promote more effective methods of long-term rehabilitation and maintenance of a healthy life style.

Training haptic stiffness discrimination: time course of learning with or without visual information and knowledge of results

OBJECTIVE

In this study, we explored the time course of haptic stiffness discrimination learning and how it was affected by two experimental factors, the addition of visual information and/or knowledge of results (KR) during training.

BACKGROUND

Stiffness perception may integrate both haptic and visual modalities. However, in many tasks, the visual field is typically occluded, forcing stiffness perception to be dependent exclusively on haptic information. No studies to date addressed the time course of haptic stiffness perceptual learning.

METHOD

Using a virtual environment (VE) haptic interface and a two-alternative forced-choice discrimination task, the haptic stiffness discrimination ability of 48 participants was tested across 2 days. Each day included two haptic test blocks separated by a training block Additional visual information and/or KR were manipulated between participants during training blocks.

RESULTS

Practice repetitions alone induced significant improvement in haptic stiffness discrimination. Between days, accuracy was slightly improved, but decision time performance was deteriorated. The addition of visual information and/or KR had only temporary effects on decision time, without affecting the time course of haptic discrimination learning.

CONCLUSION

Learning in haptic stiffness discrimination appears to evolve through at least two distinctive phases: A single training session resulted in both immediate and latent learning. This learning was not affected by the training manipulations inspected.

APPLICATION

Training skills in VE in spaced sessions can be beneficial for tasks in which haptic perception is critical, such as surgery procedures, when the visual field is occluded. However, training protocols for such tasks should account for low impact of multisensory information and KR.

Kinematic strategies underlying improvement in the acquisition of a sequential finger task with self-generated vs. Cued repetition training

Many motor skills, such as typing, consist of articulating simple movements into novel sequences that are executed faster and smoother with practice. Dynamics of re-organization of these movement sequences with multi-session training and its dependence on the amount of self-regulation of pace during training is not yet fully understood. In this study, participants practiced a sequence of key presses. Training sessions consisted of either externally (Cued) or self-initiated (Uncued) training. Long-term improvements in performance speed were mainly due to reducing gaps between finger movements in both groups, but Uncued training induced higher gains. The underlying kinematic strategies producing these changes and the representation of the trained sequence differed significantly across subjects, although net gains in speed were similar. The differences in long-term memory due to the type of training and the variation in strategies between subjects, suggest that the different neural mechanisms may subserve the improvements observed in overall performance.

Contribution of night and day sleep vs. simple passage of time to the consolidation of motor sequence and visuomotor adaptation learning

There is increasing evidence supporting the notion that the contribution of sleep to consolidation of motor skills depends on the nature of the task used in practice. We compared the role of three post-training conditions in the expression of delayed gains on two different motor skill learning tasks: finger tapping sequence learning (FTSL) and visuomotor adaptation (VMA). Subjects in the DaySleep and ImmDaySleep conditions were trained in the morning and at noon, respectively, afforded a 90-min nap early in the afternoon and were re-tested 12 h post-training. In the NightSleep condition, subjects were trained in the evening on either of the two learning paradigms and re-tested 12 h later following sleep, while subjects in the NoSleep condition underwent their training session in the morning and were re-tested 12 h later without any intervening sleep. The results of the FTSL task revealed that post-training sleep (day-time nap or night-time sleep) significantly promoted the expression of delayed gains at 12 h post-training, especially if sleep was afforded immediately after training. In the VMA task, however, there were no significant differences in the gains expressed at 12 h post-training in the three conditions. These findings suggest that "off-line" performance gains reflecting consolidation processes in the FTSL task benefit from sleep, even a short nap, while the simple passage of time is as effective as time in sleep for consolidation of VMA to occur. They also imply that procedural memory consolidation processes differ depending on the nature of task demands.

Motor sequence learning increases sleep spindles and fast frequencies in post-training sleep

STUDY OBJECTIVES

To investigate polysomnographic (PSG) sleep and NREM sleep characteristics, including sleep spindles and spectral activity involved in offline consolidation of a motor sequence learning task.

DESIGN

Counterbalanced within-subject design.

SETTING

Three weekly visits to the sleep laboratory.

PARTICIPANTS

Fourteen healthy participants aged between 20 and 30 years (8 women).

INTERVENTIONS

Motor sequence learning (MSL) task or motor control (CTRL) task before sleep.

MEASUREMENTS AND RESULTS

Subjects were trained on either the MSL or CTRL task in the evening and retested 12 hours later the following morning on the same task after a night of PSG sleep recording. Total number and duration of sleep spindles and spectral power between 0.5 and 24 Hz were quantified during NREM sleep. After performing the MSL task, subjects exhibited a large increase in number and duration of sleep spindles compared to after the CTRL task. Higher sigma (sigma; 13 Hz) and beta (beta; 18-20 Hz) spectral power during the post-training night's sleep were also observed after the MSL task.

CONCLUSIONS

These results provide evidence that sleep spindles are involved in the offline consolidation of a new sequence of finger movements known to be sleep dependent. Moreover, they expand on prior findings by showing that changes in NREM sleep following motor learning are specific to consolidation (and learning), and not to nonspecific motor activity. Finally, these data demonstrate, for the first time, higher fast rhythms (beta frequencies) during sleep after motor learning.

Daytime sleep condenses the time course of motor memory consolidation

Two behavioral phenomena characterize human motor memory consolidation: diminishing susceptibility to interference by a subsequent experience and the emergence of delayed, offline gains in performance. A recent model proposes that the sleep-independent reduction in interference is followed by the sleep-dependent expression of offline gains. Here, using the finger-opposition sequence-learning task, we show that an interference experienced at 2 h, but not 8 h, following the initial training prevented the expression of delayed gains at 24 h post-training. However, a 90-min nap, immediately post-training, markedly reduced the susceptibility to interference, with robust delayed gains expressed overnight, despite interference at 2 h post-training. With no interference, a nap resulted in much earlier expression of delayed gains, within 8 h post-training. These results suggest that the evolution of robustness to interference and the evolution of delayed gains can coincide immediately post-training and that both effects reflect sleep-sensitive processes.

Retinotopic axis specificity and selective clustering of feedback projections from V2 to V1 in the owl monkey

Cortical maps and feedback connections are ubiquitous features of the visual cerebral cortex. The role of the feedback connections, however, is unclear. This study was aimed at revealing possible organizational relationships between the feedback projections from area V2 and the functional maps of orientation and retinotopy in area V1. Optical imaging of intrinsic signals was combined with cytochrome oxidase histochemistry and connectional anatomy in owl monkeys. Tracer injections were administered at orientation-selective domains in regions of pale and thick cytochrome oxidase stripes adjacent to the border between these stripes. The feedback projections from V2 were found to be more diffuse than the intrinsic horizontal connections within V1, but they nevertheless demonstrated clustering. The clusters of feedback axons projected preferentially to interblob cytochrome oxidase regions. The distribution of preferred orientations of the recipient domains in V1 was broad but appeared biased toward values similar to the preferred orientation of the projecting cells in V2. The global spatial distribution of the feedback projections in V1 was anisotropic. The major axis of anisotropy was systematically parallel to a retinotopic axis in V1 corresponding to the preferred orientation of the cells of origin in V2. We conclude that the feedback connections from V2 to V1 might play a role in enhancing the response in V1 to collinear contour elements.

Multiple shifts in the representation of a motor sequence during the acquisition of skilled performance

When do learning-related changes in performance occur? Here we show that the knowledge of a sequence of movements evolves through several distinctive phases that depend on two critical factors: the amount of practice as well as the passage of time. Our results show the following. (i) Within a given session, large performance gains constituted a signature for motor novelty. Such gains occurred only for newly introduced conditions irrespective of the absolute level of performance. (ii) A single training session resulted in both immediate but also time-dependent, latent learning hours after the termination of practice. Time in sleep determined the time of expression of these delayed gains. Moreover, the delayed gains were sequence-specific, indicating a qualitative change in the representation of the task within 24 h posttraining. (iii) Prolonged training resulted in additional between-session gains that, unlike the effects of a single training session, were confined to the trained hand. Thus, the effects of multisession training were qualitatively different than the immediate and time-dependent effects of a single session. Altogether, our results indicate multiple time-dependent shifts in the representation of motor experience during the acquisition of skilled performance.

Relapsing cutaneous polyarteritis nodosa associated with streptococcal infections

BACKGROUND

Polyarteritis nodosa is an aggressive, often fatal form of vasculitis associated with multi-organ involvement. Cutaneous polyarteritis nodosa is purported to be a more benign form of this disorder with involvement limited to the skin.

METHODS

The identification of a female patient from childhood to adulthood documenting repeated episodes of cutaneous polyarteritis nodosa following bouts of recurrent streptococcal pharyngitis.

RESULTS

Repeated bouts of streptococcal pharyngitis at ages 11, 28, and 33 years were followed by episodes of cutaneous polyarteritis nodosa, documented by histopathologic skin changes and clinical presentation, and confirmed by therapeutic management.

CONCLUSIONS

Various infectious and non-infectious conditions have been linked both to the initiation and relapse of this disease. We describe a patient with recurrent episodes of cutaneous polyarteritis nodosa spanning a period of over 20 years with each episode appearing to be linked to a prior streptococcal infection.

Application of micellar electrokinetic chromatography to the quality control of pharmaceutical formulations: the analysis of xanthine derivatives

Micellar electrokinetic chromatography (MEKC) has been applied to the analysis of three different drugs. Although belonging to different therapeutic classes, all these drugs contain xanthine derivatives as active substances. Pentoxifylline was separated from eight related xanthines. Quantitative MEKC was applied to determine impurities (caffeine and xanthine) in the purified drug at the 0.05-0.1% level and also for the determination of the active substance in Agapurin tablets. Ethofylline and theophylline were separated from ephedrine and mebrophenhydramine and determined in Xantedrylettae tablets while caffeine was separated from mephenhydramine and determined in Kinedryl tablets. In all cases, simple borate buffers with sodium dodecyl sulfate as the surfactant were satisfactory and little separation optimization was required. The relative standard deviation (RSD) of the migration times was better than 1% while the RSD of the observed areas was better than 2%. This demonstrates that MEKC is a valuable alternative for the traditional high-performance liquid chromatography analysis of drugs and drug formulations.

The long-term management of duodenal ulceration using an H2-antagonist: symptomatic self-care compared with maintenance treatment

In a 48-week study of 319 duodenal ulcer patients, symptomatic self-care with an histamine H2-receptor antagonist (flexible self-chosen dosing with cimetidine 0, 400 or 800 mg/day) was compared with maintenance treatment (cimetidine 400 mg nocte). The rate of withdrawal from the study was similar in both groups. The mean consumption of cimetidine 400 mg tablets was significantly higher in the maintenance group (7.2 vs. 5.4 tablets/week; P less than 0.0001), but the mean cumulative number of days with ulcer symptoms was higher in the symptomatic self-care group (47.2 vs. 29.1 days in 48 weeks). The estimated number of days of work-loss due to ulcer symptoms was similar in both groups (approximately 4 days in the 48 weeks of observation). It is concluded that symptomatic self-care using an H2-antagonist can provide not only an economic but also an effective strategy for the long-term management of uncomplicated duodenal ulceration.

[The food behavior of schoolchildren in the GDR and the Lithuanian SSR]

Food behavior was studied in schoolchildren of the same age in the GDR (1602) and in the Lithuanian SSR (720 schoolchildren). The examinee represented schoolchildren from towns, regional centres and rural areas. Food behavior of schoolchildren, aged 11-13 years, in the GDR and the Lithuanian SSR is practically similar, but it has been noted that more children in the GDR receive a second breakfast, while in the Lithuanian SSR more children receive afternoon snacks. The schoolchildren should be taught the principles of the rational nutrition during their studies. Active sanitary propaganda is necessary for learning the principles of sound way of life including the principles of rational nutrition.

Psychophysiological and cognitive characteristics of ulcer and rheumatoid arthritis patients

This study examined differences in the physiological and cognitive response patterns among peptic ulcer, rheumatoid arthritis, and healthy group subjects to two types of stressors-slides of autopsies and imagined scenes involving conflicts and attitudes proposed to be associated with the two psychosomatic disorders. Ten subjects were assessed in each group. Results indicated that the ulcer patients demonstrated a heart rate accelerative trend, while arthritic and normal subjects showed significant deceleration, in response to the aversive slides of autopsies. Ulcer patients also reported paying less attention to the slides, and experiencing more anxiety when viewing them, relative to the other subjects. In response to the imagined scenes, the arthritic patients responded with more heart rate acceleration, apparently because of the greater emotional imagery produced by the scenes in these subjects. Finally, self-report and interview data did not lend support to a derivative of the specificity-of-attitude model of psychosomatic disorders.