Explore the vast range of titles available.

Drowsiness while driving negatively impacts road safety, especially in truck drivers. The present study investigated the feasibility and alerting effects of a daylight-supplementing in-truck lighting system (DS) providing short-wavelength enriched light before, during, and after driving. In a within-participants design, eight truck drivers drove a fully-loaded truck under wintry Scandinavian conditions (low daylight levels) with a DS or placebo system for five days. Subjective and objective measures of alertness were recorded several times daily, and evening melatonin levels were recorded three times per study condition. DS significantly increased daytime light exposure without causing negative side effects while driving. In addition, no negative carry-over effects were observed on evening melatonin and sleepiness levels or on nighttime sleep quality. Moreover, objective alertness (i.e., psychomotor vigilance) before and after driving was significantly improved by bright light exposure. This effect was accompanied by improved subjective alertness in the morning. This field study demonstrated that DS was able to increase daytime light exposure in low-daylight conditions and to improve alertness in truck drivers before and after driving (e.g., during driving rest periods). Further studies are warranted to investigate the effects of daylight-supplementing in-cabin lighting on driving performance and road safety measures.

Background Restless legs syndrome (RLS), a disorder characterized by an urge to move one’s legs during sleep or rest, leads to impaired sleep quality. Many patients with RLS report increased daytime sleepiness, but this has seldom been the focus of clinical research. The current study empirically investigated the prevalence and severity of daytime sleepiness in RLS. Methods This prospective study included 29 newly diagnosed treatment-naïve patients with RLS and 31 healthy controls and assessed standardized subjective (tiredness symptom scale [TSS], Stanford Sleepiness Scale [SSS], Epworth Sleepiness Scale [ESS]), cognitive (psychomotor vigilance task [PVT], Mackworth Clock Test [MCT]), and physiological measures (pupillary unrest index [PUI]). RLS symptom severity was assessed, and the effects of RLS on general health aspects and subjective sleep quality (Pittsburgh Sleep Quality Index) were compared to control data. Results Patients had moderate to severe RLS with significant negative effects on general health, quality of life, and sleep quality. Patients with RLS showed more subjective daytime sleepiness (ESS) and current sleepiness (TSS, SSS) than controls. The objective performance of patients in sustained attention tasks (P VT, MCT) was significantly worse than that of controls. Additionally, patients showed higher PUI scores. Conclusion In the present study, RLS was associated with markedly impaired subjective sleep quality and with subjectively and objectively increased daytime sleepiness. Since daytime sleepiness can be a major factor leading to compromised quality of life, assessing and treating sleepiness should be incorporated into standard diagnostics and treatment.

Background Sleep disorders are among the most common symptoms of depression. Both the ICD-10/11 and DSM‑5 list sleep disorders of all types as diagnostic criteria for depression, but these are not defined in detail. Objective This study focused on the prevalence of daytime sleepiness and associated sleep disorders in patients diagnosed with a severe depressive episode. Materials and methods In total, 192 inpatients with a moderate/severe depressive episode from an open acute psychiatric ward were included. Sleep history immediately after admission and sleep-related questionnaires, such as the Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Regensburg Insomnia Scale (RIS), were collected. Polysomnographic assessment was performed in 82 patients with suspected sleep disorders. Patient groups (e.g., with and without sleepiness or apnea) were compared. Results The prevalence of daytime sleepiness (ESS > 10) was 25.3%. Fatigue and insomnia were reported in 66.7 and 75.7% of patients, respectively. Polysomnography revealed a prevalence of sleep apnea of 18.2%, and sleep apnea was newly diagnosed in 80% of these patients. Daytime sleepiness was more common in patients with undiagnosed sleep apnea. Patients with daytime sleepiness had more fatigue but did not have more severe depression. Conclusion The present results highlight the importance of assessing sleep history in psychiatric patients, especially those with depression. The ESS may be a useful tool to specifically assess daytime sleepiness as opposed to depression-related fatigue. A systematic assessment of sleepiness and specific sleep disorders, in particular sleep apnea, might contribute to improved treatment of inpatients with depression.

Background Night shift work leads to severe short- and long-term side effects, posing a risk to personal and occupational safety. Objective This study aimed to test the effects of blue-enriched light-emitting glasses on sleepiness, alertness, and sustained attention during the early morning hours of night shift work. Methods To remedy the risks of reduced alertness, sustained attention, and increased sleepiness in a single-blind study design, Luminette® 3 (Lucimed SA, Wavre, Belgium) glasses emitting blue-enriched light (BL) were tested from 05:00 to 05:30 during night shift work in 21 participants at a sleep laboratory, and the effects were compared with those of glasses emitting sham dim red light (DRL). Sleepiness was rated hourly from 21:00 to 07:30 using the Karolinska Sleepiness Scale, while alertness was assessed using the PC Psychomotor Vigilance Task before and after the intervention. At the end of the night shift, sustained attention (using the computerized Mackworth Clock Test), comfort ratings, and fatigue were measured. Statistical analyses were conducted using the Friedman and Wilcoxon signed-rank tests. Results Sleepiness increased significantly throughout the night and was not significantly reduced after the intervention, with a more prolonged reduction using BL. Compared with using DRL, using BL revealed no clear benefit in terms of alertness or sustained attention, yet comfort ratings were slightly better, without any negative side effects. Conclusion In the current study, BL glasses were not clearly superior to DRL glasses in ameliorating the negative side effects of night shift work. Despite some limitations, however, this field study showed high ecological validity and demonstrated the convenient use of an intervention that is easy to implement in a realistic workplace setting.

This volume offers a critical historical assessment of the negotiation of the Treaty on the Non-Proliferation of Nuclear Weapons (NPT) and of the origins of the nonproliferation regime. The NPT has been signed by 190 states and was indefinitely extended in 1995, rendering it the most successful arms control treaty in history. Nevertheless, little is known about the motivations and strategic calculi of the various middle and small powers in regard to their ultimate decision to join the treaty despite its discriminatory nature. While the NPT continues to be central to current nonproliferation efforts, its underlying mechanisms remain under-researched. Based on newly declassified archival sources and using previously inaccessible evidence, the contributions in this volume examine the underlying rationales of the specific positions taken by various states during the NPT negotiations. Starting from a critical appraisal of our current knowledge of the genesis of the nonproliferation regime, contributors from diverse national and disciplinary backgrounds focus on both European and non-European states in order to enrich our understanding of how the global nuclear order came into being. This book will be of much interest to students of nuclear proliferation, Cold War history, security studies and IR.

This study aimed to evaluate the impact of traffic noise along the motorway on sleep quality, sleepiness, and vigilant attention in long-haul truck drivers. This was a randomized, crossover, within-subject controlled study. Healthy long-haul truck drivers spent 6 consecutive nights in a real truck berth with full sleep laboratory equipment. During 3 nights, subjects were exposed to replayed traffic noise alongside motorways, whereas the other 3 nights were without traffic noise. Polysomnography was recorded during the nights and numerous sleepiness tests and vigilance examinations were performed during the following standardized working day. Outcome measures were compared between noisy and silent nights using the paired Wilcoxon test. Ten healthy long-haul truck drivers with a mean age of 36.3 ± 7.3 years completed the study as planned. On noisy nights, subjects had greater latencies to the rapid eye movement (REM) phase (90 ± 32 min vs 69 ± 16 min, P = 0.074) and higher percentages of sleep stage 1 (13.7 ± 5.5% vs 11.2 ± 4.4%; P = 0.059). Subjects also rated their sleep quality as having been better during nights without noise (28.1 ± 3.7 vs 30.3 ± 6.2, P = 0.092). The impact of these differences on daytime sleepiness and vigilance was rather low; however, mean Karolinska Sleepiness Scale (KSS) scores measured during the course of the following day were higher on six out of eight occasions after noisy nights. The effects of overnight traffic noise on sleep quality are detectable but unlikely to have any major impact on the vigilant attention and driving performance of long haul-truck drivers with low nocturnal noise sensitivity. This might not be true for subgroups prone to sleeping disorders.

Purpose Using a partial sleep deprivation paradigm, the aim of the study was to investigate the sensitivity of a computer-based test battery of fitness to drive to detect impairments related to sleepiness. Methods Forty-seven healthy subjects (34 females, mean age 26.0 ± 6.8 years) participated in a counterbalanced within-subject design of two conditions: (i) normal night sleep and (ii) partial sleep deprivation (PSD) with 4 h time in bed. For the assessment of fitness to drive, we used a validated traffic psychological test battery. Moreover, well-established measures of sleepiness highly responsive to sleep deprivation were applied: the Karolinska Sleepiness Scale (KSS), pupillography (Pupil Unrest Index (PUI) as physiological sleepiness indicator) and two sustained attention tasks (psychomotor Vigilance Task and Mackworth Clock Test). Results Subjective and physiological sleepiness were significantly increased after PSD, accompanied by large ( d  > 1.50 for KSS) and medium ( d  = 0.55 for PUI) effect sizes. Sleepiness-related performance decrements were found in both sustained attention tasks ( d  = 0.59–0.77). Assessing driving-related ability, PSD induced decrements only in the test domain Reaction Test (reaction time d  = 0.54 and motor time d  = 0.45). All other subtests—as well as the overall judgement of fitness to drive—were not significantly affected by PSD. Conclusion In contrast to established tests of sustained attention and subjective sleepiness, computer-based test batteries of fitness to drive might lack sensitivity to core aspects of sleepiness as they mainly consist of short and stimulating subtests. Therefore, tasks that require sustained attention should be an essential part of traffic psychological test batteries when sleepiness is a potential issue.

Background: In military flight operations, during flights, fighter pilots constantly work under hyperoxic breathing conditions with supplemental oxygen in varying hypobaric environments. These conditions are suspected to cause oxidative stress to neuronal organ tissues. For civilian flight operations, the Federal Aviation Administration (FAA) also recommends supplemental oxygen for flying under hypobaric conditions equivalent to higher than 3048 m altitude, and has made it mandatory for conditions equivalent to more than 3657 m altitude. Aim: We hypothesized that hypobaric–hyperoxic civilian commercial and private flight conditions with supplemental oxygen in a flight simulation in a hypobaric chamber at 2500 m and 4500 m equivalent altitude would cause significant oxidative stress in healthy individuals. Methods: Twelve healthy, COVID-19-vaccinated (third portion of vaccination 15 months before study onset) subjects (six male, six female, mean age 35.7 years) from a larger cohort were selected to perform a 3 h flight simulation in a hypobaric chamber with increasing supplemental oxygen levels (35%, 50%, 60%, and 100% fraction of inspired oxygen, FiO2, via venturi valve-equipped face mask), switching back and forth between simulated altitudes of 2500 m and 4500 m. Arterial blood pressure and oxygen saturation were constantly measured via radial catheter and blood samples for blood gases taken from the catheter at each altitude and oxygen level. Additional blood samples from the arterial catheter at baseline and 60% oxygen at both altitudes were centrifuged inside the chamber and the serum was frozen instantly at −21 °C for later analysis of the oxidative stress markers malondialdehyde low-density lipoprotein (M-LDL) and glutathione-peroxidase 1 (GPX1) via the ELISA test. Results: Eleven subjects finished the study without adverse events. Whereas the partial pressure of oxygen (PO2) levels increased in the mean with increasing oxygen levels from baseline 96.2 mm mercury (mmHg) to 160.9 mmHg at 2500 m altitude and 60% FiO2 and 113.2 mmHg at 4500 m altitude and 60% FiO2, there was no significant increase in both oxidative markers from baseline to 60% FiO2 at these simulated altitudes. Some individuals had a slight increase, whereas some showed no increase at all or even a slight decrease. A moderate correlation (Pearson correlation coefficient 0.55) existed between subject age and glutathione peroxidase levels at 60% FiO2 at 4500 m altitude. Conclusion: Supplemental oxygen of 60% FiO2 in a flight simulation, compared to flying in cabin pressure levels equivalent to 2500 m–4500 m altitude, does not lead to a significant increase or decrease in the oxidative stress markers M-LDL and GPX1 in the serum of arterial blood.

In the historiography of the 1967 War, the common reading is to portray it as an \"inadvertent war.\" Using recently declassified documents, this article offers an alternative interpretation. In critically examining existing master plan theories, it is shown that the United Arab Republic's (UAR) military actions were limited in size and were without aggressive intentions. The Israeli decision to strike was taken not for military reasons but rather to prevent a diplomatic solution which might have entailed disadvantages for the Israeli side.