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A custom radiation monitoring system was developed by Oregon State University at the request of the Woods Hole Oceanographic Institute to measure radioactive cesium contaminants in the ocean waters near Fukushima Dai-ichi Nuclear Power Plant. The system was to be used on board the R/V Ka'imikai-O-Kanaloa during a 15 d research cruise to provide real-time approximations of radionuclide concentration and alert researchers to the possible occurrence of highly elevated radionuclide concentrations. A NaI(Tl) scintillation detector was coupled to a custom-built compact digital spectroscopy system and suspended within a sealed tank of continuously flowing seawater. A series of counts were acquired within an energy region corresponding to the main photopeak of (137)Cs. The system was calibrated using known quantities of radioactive (134)Cs and (137)Cs in a ratio equating to that present at the reactors' ocean outlet. The response between net count rate and concentration of (137)Cs was then used to generate temporal and geographic plots of (137)Cs concentration throughout the research cruise in Japanese coastal waters. The concentration of (137)Cs was low but detectable, reaching a peak of 3.8 ± 0.2 Bq/L.

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OBJECTIVES: Rickets can still be observed among children and adolescents living in Europe, and a significant proportion of healthy children and adolescents presents serum 25-hydroxyvitamin D (25-(OH)D) values below the threshold indicating an insufficient vitamin D status. We have previously proposed detecting at risk individuals with a decision-making abacus based on questionnaires assessing calcium and vitamin D intakes and vitamin D production via sun exposure. METHODS: We tested the validity of this detection by receiver operating characteristic (ROC) analysis, using, as the main outcome measure, the serum 25-(OH)D values measured at the time of questionnaires presentation. In addition, the original questionnaires have been simplified by limiting the items to those significantly associated with 25-(OH)D values. The study group included 116 children and adolescents aged 6 to 17 years, seen at the end of the winter, and randomized in 2 groups: "test", for the development of the tool (n =75), and "validation" (n =41). RESULTS: The present analysis shows that the proposed decision-making abacus has a sufficient ability to detect children at risk of vitamin D deficiency (with 25-(OH)D values below 10 ng/ml): area under the curve 0.748/0.895, sensibility 0.71/0.83, and specificity 0.62/0.80, in the test and validation groups, respectively. CONCLUSION: These questionnaire and abacus may offer a substantial help to detect children and adolescents at risk of vitamin D deficiency in both a private office or hospital environment.

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A non-comparative study was conducted to examine the effects of 80,000 IU vitamin D given in a single dose to 59 pregnant women from northern or southern France between their 27th and 32nd week of gestation during the winter season. Serum levels of 25 hydroxy-vitamin D (25 OH D), intact Parathyroid Hormone (iPTH), calcium, phosphates, proteins were measured at the inclusion, at delivery (mother and arterial cord) and in the newborn between the 3rd and the 5th day of life. The mothers' sun exposure and their vitamin D dietary intakes were evaluated with scores at the inclusion and at delivery. Before vitamin D supplementation, 34% of the women had a 25 OH D concentration below 10 ng/ml and 32% had hypocalcemia. At delivery, only one woman had a low 25 OH D concentration, whereas 15% of the women showed hypocalcemia. No neonatal hypocalcemia was observed and no vitamin D overdose was recorded in this study. The mothers' vitamin D dietary intakes were quite high; the lack of sun exposure during last summer appeared as a major vitamin D deficiency risk. A single dose of 80,000 IU vitamin D, taken between the 27th and the 32nd amenorrhoea weeks in winter, seems to be a good compromise between efficacy and tolerance.

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A decision-making table, using three questionnaires, is proposed to determine the vitamin D status in children and adolescents. The first questionnaire assesses the vitamin D endogenous synthesis, taking into account the sunlight exposure and the time interval out of the sun. The second questionnaire quantifies the vitamin D dietary intake within three levels: optimal, medium or low. In case of a medium dietary score, a third questionnaire evaluates the daily calcium intake, taking into account the fact that vitamin D metabolism is increased by a low calcium intake (under 400 mg/day). This decision-making table should enable the detection of children and adolescents at risk of vitamin D deficiency and requiring an adapted prophylaxis. Its accuracy will be assessed in prospective surveys.

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The role of oral appliances in the routine treatment of obstructive sleep apnea (OSA) is not well defined. This prospective study attempts to clarify the clinical role of a specific oral appliance, the mandibular repositioning device (MRD). This study evaluated the demographic, polysomnographic, and cephalometric radiographic findings predictive of treatment success or failure with the MRD. Twenty-nine patients were diagnosed with mild to severe OSA by nocturnal polysomnography. The majority of these patients were intolerant to nasal continuous positive airway pressure (CPAP) and all were fitted with a MRD. Twenty-three of these patients were compliant initially with MRD use and received post-treatment nocturnal polysomnogrpahy at a mean of 104 days after receiving the device. The respiratory disturbance index (RDI) decreased with MRD use (37 +/- 23 versus 18 +/- 20 events/hour, p < 0.001), and 16 of the 23 patients (69%) were considered responders (decrease in RDI > or = 50% and posttreatment RDI < or = 20). Measurements of subjective and objective daytime sleepiness, nocturnal oxygen desaturation, and snoring were all improved with MRD use. A pre-treatment RDI > 40 was present in four of the seven (67%) non-responders. Age, body mass index, and cephalometric radiographic measurements were not predictive of treatment outcome. Sixteen of 23 patients (70%) continue to use the MRD after 3.4 +/- 0.7 years. This study suggests that the MRD is useful in the long-term treatment of patients with OSA of mild to moderate severity.

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This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.

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Clonazepam (1 mg h.s.) and temazepam (30 mg h.s.) were studied in 10 patients diagnosed as having insomnia with nocturnal myoclonus. Each subject underwent two nocturnal polysomnographic recordings while drug-free, two during treatment with clonazepam, and two during treatment with temazepam. Treatment sessions were 7 days long, and recordings were done on nights 6 and 7 of the treatment sessions. A 14-day washout period separated the treatment sessions. The order of drugs used in the first and second treatment sessions was randomized. Objective and subjective sleep laboratory data showed that both drugs improved the sleep of patients with insomnia in association with nocturnal myoclonus. Neither drug significantly reduced the number of nocturnal myoclonic events. Sleep changes were consistent with those produced by sedative benzodiazepines in general. Thus, the data support clinical reports that clonazepam, a benzodiazepine marketed for the indication of seizure, is useful in improving sleep disturbances associated with nocturnal myoclonus. Temazepam, a benzodiazepine marketed for the indication of insomnia, was found to be a suitable alternative to clonazepam in the treatment of insomnia associated with nocturnal myoclonus. The present data and other studies suggest the need for a model that explains why leg movements and sleep disturbances may wax and wane independently.

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The Sleep Disorders Clinic at the San Diego Veterans Administration Medical Center provides a diagnostic service within a public hospital. Case records of the first 117 patients receiving polysomnograms in our clinic were reviewed. Of these patients, 44 percent were found to have sleep apnea, 24 percent nocturnal myoclonus and 8 percent narcolepsy. Our experience shows that in a health maintenance organization, a sleep disorders clinic provides diagnostic information (based on a polysomnogram and a sleep history) which is very helpful in the final diagnosis of medical disorders. Very few recordings were noncontributory. In this setting, a sleep disorders clinic is justified by its rich diagnostic yield.

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