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By: John Walter Krakauer, M.A., M.D.

  • Director, the Center for the Study of Motor Learning and Brain Repair
  • Professor of Neurology

https://www.hopkinsmedicine.org/profiles/results/directory/profile/9121870/john-krakauer

In the 2-year carcinogenicity study in rats symptoms 7 days after conception cheap oxcarbazepine 300 mg on-line, an increased incidence of retinal atrophy was observed at all doses treatment gonorrhea discount 600 mg oxcarbazepine with amex. In subsequent studies of suvorexant in albino and pigmented rats medicine clip art order oxcarbazepine american express, retinal atrophy was delayed in onset and symptoms stomach ulcer discount 300mg oxcarbazepine, after approximately one year of dosing, was of lower incidence and severity in pigmented rats. Two similarly designed, 3-month, randomized, double-blind, placebo-controlled, parallel-group studies were conducted (Study 1 and Study 2). The higher doses were found to have similar efficacy to lower doses, but significantly more adverse reactions were reported at the higher doses. The analysis showed clinically meaningful impaired driving performance in some subjects. Three trials showed no significant effects on memory or balance compared to placebo. Memory was not impaired, as assessed by an immediate and delayed word recall test at 4 hours post-dose. Patients using the 20 mg dose should be cautioned against next-day driving and other activities requiring full mental alertness as this dose is associated with a higher risk of impaired driving. Advise patients that increased drowsiness may increase the risk of falls in some patients [see Warnings and Precautions (5. Tell patients and their families to call their healthcare providers if they develop any of these symptoms. Suicide Tell patients to report any worsening of depression or suicidal thoughts immediately. Alcohol and Other Drugs Ask patients about alcohol consumption, prescription medicines they are taking, and drugs they may be taking without a prescription. Advise patients to report all of their prescription and nonprescription medicines, vitamins and herbal supplements to the prescriber. Note that market specific restrictions or transition-of-care benefit limitations may apply. Note that market specific restrictions or transition-of-care benefit limitations may apply. The preferred agent is not acceptable due to concomitant clinical conditions, such as but not limited to the following: A. Other known disease state or medication contraindication which is not also associated with the requested non-preferred agent. Note that market specific restrictions or transition-of-care benefit limitations may apply. Individual has experienced one of the following adverse effects on previous therapy: 1. Behavior or mood changes interfering with daily activities, including complaints of abdominal distress, sleep problems, or oppositional/rebellious/aggressive behavior. Dextroamphetamine (Dexedrine, Dexedrine Spansules, ProCentra solution (and generic), Zenzedi and generic products): A. Note that market specific restrictions or transition-of-care benefit limitations may apply. Note that market specific restrictions or transition-of-care benefit limitations may apply. Assess the risk of abuse prior to prescribing and monitor for signs of abuse and dependence while on therapy. Strattera (atomoxetine) has a black box warning for suicidal ideation in children and adolescents. Individuals who are started on therapy should be monitored closely for suicidality (suicidal thinking and behavior), clinical worsening, or unusual changes in behavior. Note that market specific restrictions or transition-of-care benefit limitations may apply. Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment. Diagnosis and Management of Attention Deficit Hyperactivity Disorder in Primary Care for School-Age Children and Adolescents. Note that market specific restrictions or transition-of-care benefit limitations may apply. Sleep should be proactively evaluated, and sleep disturbances should be treated as part of the total care of patients with epilepsy. Introduction hygiene, coexisting sleep disorders, and circadian rhythm disturbances. Although our society tends to accept poor disrupt sleep, and even more evidence shows that sei- sleep as the norm, it can result in considerable impair- zures themselves can disrupt sleep, even when they occur ment of daytime functioning and quality of life even in during wakefulness. In patients with epi- management of sleep disruption in epilepsy is that an- lepsy, the consequences are potentially more severe than ticonvulsant drugs can alter sleep, both bene? Of even more concern is bance are reviewed with an emphasis on those that are the potential for a continual cycle of sleep disruption, most common in patients with epilepsy. The impact of worsening seizures, and further impairment of sleep that these disorders is discussed, followed by a review of the can be responsible for intractability of epilepsy in some potential impact of anticonvulsant drugs. Despite this, many treating physicians over- sleep should be an essential part of the total care of look the potential for treatable causes of sleep disrup- patients with epilepsy. Potential causes of sleep disruption in epilepsy and include factors that are also relevant to the general population, such as insu? Bazil / Epilepsy & Behavior 4 (2003) S39?S45 months as controls (39% vs 18%) and that the presence familiar and which a large number of physicians have of sleep disturbance is associated with further signi? Review of sleep hygiene can also be time worsening of quality of life beyond that attributable to consuming, and in a busy o? In addition, this large the basic principle of sleep hygiene is optimization of study showed that the presence of sleep disturbance in the conditions for sleep. Many would like to believe that sleeping and may be inherent to the disorder itself. Although sleep cannot be fully controlled, it that patients with epilepsy had increased daytime can be encouraged and optimized, and this is the prin- drowsiness compared with controls (neurology patients ciple of sleep hygiene. Humans have score (more daytime sleepiness) when a sleep apnea scale many processes that are based on circadian rhythms, was included, suggesting that this treatable condition and sleep is among them. Core body temperature and may be responsible for much of the problem in patients release of hormones, including melatonin, cortisol, and with epilepsy. Children with epilepsy ually, and rapid alterations in daily schedules are not showed higher scores for poor-quality sleep, anxiety well tolerated. Psychologi- One of the more common reasons for inadequate cally, the bedroom, and particularly the bed, should be sleep is perhaps the most obvious: failing to spend en- associated with sleep and not with other (particularly ough time in bed. People should refrain from activities ulation, and it is largely a cultural phenomenon. The other than sleep and sex in the bed, particularly stressful demands of modern society, including work, family, and activities. It is also sometimes necessary for some Although most believe this to be benign, chronic sleep persons to avoid reading or watching television in bed. This is corroborated by the ?Sleep in America? poll and staring at the clock; this tends to again associate the of more than 1000 adults conducted by the National bed with anxiety. Epilepsy patients are from bed and do quiet activities, returning to bed only certainly not immune from this, although the magnitude when sleepy. Activities that tend to stimulate? particularly exercise?should be avoided late in the day 2. Al- Sleep hygiene is a fairly straightforward concept, but though it can help induce drowsiness, it can result in it is one with which a large number of patients are un- early-morning awakening. Bazil / Epilepsy & Behavior 4 (2003) S39?S45 S41 and other stimulants should be avoided late in the day. It may seem that such In addition, it is important that persons do not spend disruption could be relatively minor, but even brief sei- too long in bed and oversleep for prolonged periods zures can result in prolonged alterations in sleep struc- after the normal sleep cycle has completed. Many studies have shown improvement in sleep While these principles are relatively simple, it is with treatment of nocturnal seizures [9?11]. In particu- amazing how many patients and physicians do not think lar, most have shown improvement in sleep e? Sleep disorders have relatively normal sleep on seizure-free nights except for slightly decreased sleep e?

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Additional changes of genetic material establish non-reversible malignant phenotype which is capable of progression 714x treatment discount oxcarbazepine line. For survival of tumor tissue an adequate supply of oxygen and nutritive substances is essential so angiogenesis is crucial for progression stage treatment quadratus lumborum buy oxcarbazepine once a day. There is substantial evidence that multimodal therapy might be the most useful one medications 4 less buy discount oxcarbazepine 300mg. Combination of chemotherapeutic drugs medicine 003 order discount oxcarbazepine online, irradiation, inhibitors of signal transduction and antibodies against various cell surface antigens may be beneficial. Inhibition of node molecule action in oncogenic signaling networks is goal of targeted cancer therapy. Multi-target drugs are substances that are capable of acting through more than one mechanism. For inhibition of node molecules upstream molecules that are responsible for activation of node molecule may be potential efficient target for drug therapy. Therefore chemopreventive agents are designed to block anti-apoptotic pathways and potentiate the effect of chemotherapeutic agents. Investigation is aiming towards determination of difference between physiological and pathological phenotype. This technique documents expression of thousands of genes on single microscope glass. There is extensive work in bioinformatics field to analyze micro-array data so that information acquired is reliable for biomedical purposes. Cell signaling in carcinoma cells - differences between healthy cells and transformed cells 6. It is well known that distinct phenotypes can be accomplished by the same set of proteins. For this phenomenon cells use different signal transduction modules within the same multiprotein complexes. A large scale of different methodologies is applied in functional proteomics to analyze protein complexes. Functional proteomics offers strategies to employ all of these methodologies in order to elucidate signal transduction module responsible for specific phenotype. Advancement in cloning techniques contributed to more effective transfection assay. Variations of this assay are extensively used in screening for potential tumorigenesis initiators. These decisions can be made through various cell signaling pathways of which some are more or less ubiquitous while others are regarded as more specific for tumor type. Cell signaling in carcinoma cells - differences between healthy cells and transformed cells 6. It is governing transcription for genes implicated in some physiological events such as cell survival, cell adhesion, differentiation and cell growth. Also, it is also implicated in pathophysiological events like inflammation, autoimmune diseases and carcinogenesis (cancer promotion, progression and angiogenesis). Instead of undergoing cell death program, cancer cell is enabled to survive and establish a clone of neoplastic cells. Immunohistochemical staining using anti-p65 antibody was positive in papillary, follicular and anaplastic cancer tissue specimens. It shows rapid invasive growth and has a strong metastatic potential to distant organs. Chemotherapy and radiation in combination are standard therapy for anaplastic carcinoma. Outcome of this malignancy in spite of multimodal therapy is still unsatisfactory. Overactivation of this pathway is known mechanism of resistance to those therapies. Cell signaling in carcinoma cells - differences between healthy cells and transformed cells inhibitors allows reducing the dosage and alleviates side-effects. Therefore management of thyroid carcinoma is becoming more important public health problem. Eighty percent of all thyroid carcinomas are papillary carcinomas, 15% follicular, 4% medullary and 1% anaplastic. Cancers that are of follicular cell origin are: papillary, follicular, Hurthle cell cancer and anaplastic. Cell signaling in carcinoma cells - differences between healthy cells and transformed cells Figure 6. Receptor tyrosine kinases are cell-surface molecules that transduce signals for cell growth and differentiation. In an adult, it is expressed in several cell lines: spleen, thymus, lymph nodes, salivary glands, spermatogonia and thyroid tissue. Somatic mutations generated due to radiation, can cause papillary thyroid carcinomas. Cell signaling in carcinoma cells - differences between healthy cells and transformed cells 6. It was trialed in 30 patients with locally advanced or metastatic hereditary medullary thyroid cancer with germline mutation. Partial response was seen in 20 percent of patients and another 30 percent of patients maintained stable disease during treatment (172 days). Early results suggest that motesanib has some 131 effect in patients with advanced I-resistant differentiated thyroid cancer. Almost all of them (95%) involve T-to A transversion in nucleotide 1799 and result in a valine-to-glutamate substitution at residue 600 (V600E). It is not common in thyroid carcinoma in children, nor in carcinomas caused by exposure to radiation. In progressive papillary carcinoma minimal or partial response was shown in some patients but complete results are yet to be released. Cell signaling in carcinoma cells - differences between healthy cells and transformed cells 6. Functionally, these proteins are involved in cell growth and malignant transformation. These mutations are found in 10-15 % of papillary thyroid cancers and in 40-50 % follicular thyroid carcinomas. This mutation is present in 35% of follicular thyroid carcinoma and in a lesser extent in Hurthle-cell carcinoma and follicular adenoma. Molecular mechanisms involved in differentiated thyroid cancer invasion and metastasis. Cell signaling in carcinoma cells - differences between healthy cells and transformed cells 4. Novel chemotherapy options for advanced thyroid tumors: small molecules offer great hope. Institute of Laboratory Medicine, University of Pecs, Hungary Many of the major principles governing clinical endocrinology taken for granted today were established during the last 50 years. In fact, during this period, twelve individuals received or shared Nobel Prizes for discoveries directly related to endocrinology and hormone assays. This group can be expanded to 20 if we include Nobel Prizes given for discoveries of prostaglandins, growth factors and neurotransmitters. From the tremendous amount of information gathered during half a century, we have selected six topics that had a particular impact on the practice of endocrinology and therefore on hormone measurements. Laboratory evaluation of thyroid status centers on chemical measurements of thyroid gland secretory products present in the circulation, assessment of the hypothalamic-pituitary-thyroid axis, and measurement of related molecules that affect thyroid gland function, such as thyroid binding proteins and autoantibodies. The hinge region between these two domains contains a nuclear localization sequence. The carboxy-terminal region also contains multiple contact surfaces that are important for heterodimerization with its partner, retinoid X receptor as well as protein? protein interactions with co-repressors and co-activators. Due to the high technique requirements and cost of physical separations, most clinical laboratories routinely use direct analogue immunoassays for fT3 and fT4 measurements, which are typically performed on immunoassay platforms. Basic concepts and misconcepts in clinical and diagnostic endocrinology Nevertheless, these immunoassays are all binding protein dependent to some extent and thereby susceptible to various interferences and uncertainties. Accordingly, many researchers have questioned the accuracy, validity, and reliability of direct analogue immunoassays (2).

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However treatment goals 600 mg oxcarbazepine overnight delivery, with the demonstration of inhibition of haemagglutination by a serum from pregnant women symptoms 5 days past ovulation buy generic oxcarbazepine 600mg on-line, Tg was established to be a normal component of serum medicine 93 5298 discount oxcarbazepine. Later electrophoresis confirmed the presence of Tg like material in the sera of normal subjects administering medications 8th edition quality oxcarbazepine 300mg. Assays using non-isotopic labels with high sensitivity and precision have also been developed. A wide variation has been observed in the assay characteristics reported by several laboratories. The technical details of the methodology used for serum Tg determination along with the clinical status of the patient is extremely important for a meaningful interpretation of serum Tg results. Variability of reagents Since there is a lack of availability of an international standard Tg preparation the source of the antigen used may differ amongst laboratories. Thyroglobulin is a very large molecule and has several antigenic determinants and many isoforms. Biochemical variations in the Tg molecule in terms of amino acid composition, carbohydrate content and iodide content have been demonstrated [4. Although this has improved intermethod variation, differences between methods still exist [4. Another source of variation amongst Tg preparations is the inherent instability of the Tg molecule due to its high susceptibility to proteolysis. Even under ideal conditions of storage 0 (using protease inhibitors, storing at -40 C, making several aliquots for preventing frequent freezing and thawing, preparing stocks in carrier protein, etc. The altered antigenic properties of degraded Tg may result in under or, over estimation of serum Tg. Even amongst the commercial kits available, there are variations due to differences in reagents. The antibodies used in the immunoassay are directed towards epitope located in the discontinuous region and therefore recognize conformational isoforms of Tg [4. The use of highly specific monoclonal antibodies for measurement of serum Tg by several investigators have shown that abnormal isoforms of Tg secreted by tumour may remain undetected in such systems [4. Therefore the antisera used by different laboratories may also explain variable inter-laboratory results. Hook effect the Hook effect results from a large amount of the antigen, which saturates the binding and gives a falsely negative value and is applicable to one step solid phase sandwich assays. Though such sera are relatively few, it is important to identify them so that the assay can be performed at various dilutions of sera. Interference from thyroglobulin autoantibodies TgAb interference affects all Tg methods to some degree by causing over or underestimation of serum Tg concentrations [4. Underestimation is the characteristic pattern of interference in immunometric assays because Tg complexed with TgAb appears to be blocked from participating in the two-site reaction. It is unclear whether very low concentrations of naturally occurring TgAb are the cause of the interference found with some seemingly TgAb-negative serum samples [4. Most laboratories still use insensitive hemagglutination techniques to detect TgAb in serum despite reports that TgAb concentrations too low to be detected by hemagglutination can interfere with serum Tg measurements [4. Sensitive TgAb immunoassay methods are recommended for screening serum for interfering TgAb before Tg measurement is undertaken. Using immunoassays, TgAb can be detected in 4% to 27% of normal subjects, 20% to 45% of patients with thyroid carcinoma [4. It is difficult to predict which serum samples with TgAb will interfere with serum Tg measurements because the TgAb concentration does not correlate with the degree of interference assessed by recovery or dilution studies [4. Attempts to overcome TgAb interference in immunometric assay by using monoclonal antibodies restricted to epitopes not involved in autoantibody formation has not overcome the interference problem [4. Thus, any serum Tg value reported in patients with TgAb must be interpreted cautiously. In fact, it is probably better not to report serum Tg values at all in patients with TgAb in their serum, unless the Tg assay method can be shown to give serum Tg values concordant with clinical status. Critical level for discerning the disease the range or the cut-off value used in different clinical conditions to ascertain the recurrence, presence or absence of disease is most important. Theoretically, it should be derived from non-cancerous athyrotic individuals (patients or controls). At least a minimum disease free period of 5 year after adequate treatment is required for establishing the cut-off value. Although the fetal and maternal thyroid axis are controlled independently, maternal iodine intake influences fetal thyroid function such that cord serum Tg concentrations are correlated negatively with maternal urinary iodine excretion at the time of delivery [4. Thyroid size and cord serum Tg concentrations are increased in infants born to smoking mothers [4. This is thought to be secondary to a goiterogenic effect of thyocyanite, the concentrations of which are correlated positively in cord and maternal serum [4. Although, infants with congenital hypothyroidism usually have abnormally low or high serum Tg concentration depending on the underlying pathology, the serum Tg concentration is not diagnostic [4. The Tg value together with the results of ultrasonography and radionuclide imaging of the thyroid can be used to determine the aetiology of congenital hypothyroidism [4. Low but detectable serum Tg concentrations are characteristic of both thyroid agenesis and thyroid ectopy [4. Serum Tg concentrations are high, sometimes very high (1000 ng/ml), in infants with thyroid hormone resistance, iodide transport or deiodinase defects and other inborn errors of T4 biosynthesis [4. Serum Tg concentrations fall approximately 50% during the first few months of life, after which they decline very gradually to reach adult level after puberty. Thyroglobulin can be detected in the serum of all normal subjects when sensitive methods are used [4. There is no diurnal or seasonal variability in serum Tg concentrations, but the concentration does appear to be under the control of a dominant gene [4. The long term intraperson biologic variation is relatively small, whereas interperson variability is high. Three factors determine serum Tg concentrations in most clinical situations: thyroid cell mass [4. At steady state, thyroid size is the dominant factor, modulating serum Tg concentrations [4. Serum Tg levels are significantly higher in women on oestrogen therapy as compared to those in the control group which explains the raised Tg level in women. However, increase in serum Tg in advanced age where the oestrogen levels would be low argues against the role of oestrogen alone as the factor responsible for raised Tg level in women. Serum Tg concentrations change in parallel with the small changes in thyroid size that occur during the menstrual cycle and are higher in pregnant women than in non- pregnant women; specially during the third trimester [4. In primary diagnosis Although Tg is present in most differentiated thyroid carcinomas and some anaplastic thyroid carcinomas [4. Furthermore, a normal serum Tg value does not exclude carcinoma in any patient with thyroid nodular disease. However, immunostaining of tissue for Tg is a useful histological probe for identifying metastases of thyroid carcinoma and for identifying neck masses being of thyroid origin [4. Among patients with thyroid carcinoma, serum Tg concentrations are usually higher in those with follicular carcinoma than in those with papillary carcinoma probably because follicular carcinomas are more advanced at the time of diagnosis rather than because of any intrinsic differences between the two tumour types. Among patients with proven differentiated thyroid carcinoma, preoperative serum Tg concentrations are possibly correlated with tumour mass [4. In post-surgical management the difference between pre and postoperative serum Tg values is an indicator of the completeness of the surgery. A rise in the level of Tg is indicative of a recurrence or presence of metastases while a fall indicates regression of the tumour [4. The reported sensitivity for detection of metastatic disease varies between 52-100% while the specificity ranges between 5. Occasionally, serum Tg levels are low in spite of the presence of proven metastases [4. In such cases the tumour is either poorly differentiated or the Tg produced by the tumour is structurally altered and not detected in the immunoassay. It is also related to the location of the metastatic site, with higher values in distal metastases [4. The sensitivity for detection of osseous metastatic disease (high serum Tg level) has been 100% [4. A low serum Tg value does not always rule out the involvement of the thyroid as a primary site of malignancy as some undifferentiated or poorly differentiated tumours and at times nodal diseases fail to show elevated serum Tg in appreciable amounts [4.

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However treatment lichen sclerosis cheap oxcarbazepine 150 mg visa, these scores may To provide feedback to users about their sleep medicine in the 1800s purchase 300mg oxcarbazepine mastercard, commercial not necessarily provide users an accurate picture of their sleep sensors often focus on determining objective measures sleep quality because sleep efficiency scores vary on such as sleep efficiency symptoms esophageal cancer order 300mg oxcarbazepine visa, sleep latency 3 medications that cannot be crushed order oxcarbazepine with visa, and the different hardware specification and sensing sensitivities. Commercial sensors tend to focus less on problem is that it is nowhere near sensitive enough on subjective measures. However, the focus on objective normal and way too sensitive on sensitive setting. I had a measures led many users to have a broken mental model of restless night the night I had it on normal, waking multiple what sensors can infer and what information is useful to times, and it recorded 15 minutes of restless sleep and no address sleep concerns. The next night, on sensitive, I had much better of explanation as to the formula/algorithm that lead to the sleep, and it recorded only 3 1/4 hrs. E1 suggested, ?I would focus more on the trends than difference between what the clinicians reported and what I would on just the night to night scores. I8 said: ?The band gave me too need to approach it with a dose of skepticism and then follow much deep sleep when compared with the actual exam P8. What the effect that a medication would the right kind of feedback to lead to changes. The feedback on sleep stages Reviewers of sensing devices place high value in sleep provided by commercial sensors promotes incorrect mental sensing devices that can infer sleep quality based on sleep models on what these sensors can infer and how these stages stages. Survey respondents reflected the same perspective, on issues people actually have control over, such as sleep considering sleep stages to be representative of sleep quality hygiene and modifiable behaviors. Experts expressed a desire to help users understand night, which was good, I only pretty much had the amount of what these sensors can actually infer about sleep: ?I think it hours that I was having light sleep and deep sleep What I [feedback from the device] needs to be scaled back into what eventually understood was that I was having not enough we can expect them [users] to realistically understand and deep sleep?. The sleep experts we interviewed believe people generally Making unscientific correlations based on sleep stages misunderstand the relationship between sleep quality and In line with previous work [34], some users conducted a self- sleep stages. However, the focus on sleep stages led users to only word that they would think about? (E5). Although make unscientific correlations between daily behaviors and there has been evidence that time spent in specific sleep specific sleep stages. Like sleep scores, every sleep sensing device has its own proprietary algorithm to determining sleep stages. Figure 2 shows R195?s comparison of the sleep stage inference provided by two different sensors on Figure 2. I always knew it was bad to have a big meal before bed, recommendations aim to mitigate the tension between user- but now I actually have the data to back it up? (R8, Jawbone driven goals, expert recommendations, and the sensing Up3). For good sleep hygiene, avoiding large late night meals limitations of current commercial sleep sensing technologies. A poor night?s sleep that a big meal might cause restless sleep, and therefore for one person can be satisfactory and rested sleep for cutting down on large meals might have allowed them to another person. Furthermore, the effects of a poor night?s have less restlessness, leading to better sleep quality overall. Sleep quality self- In some cases, such inferences can sometimes lead to actions assessments is often used by clinicians to assess the severity that can be potentially detrimental to health. Users assessments should be used to learn and assess which types want the means to self-experiment: ?I basically want a sleep of modifiable behaviors worked best in helping a user tracker that has three or four variable knobs ?You had improve their sleep over time. Many people who track sleep Contextualize Sleep Quality with Journaling additionally wanted to add notes to add context to their sleep the current state of feedback does not support long-term to help assess what is affecting their sleep. We recommend sleep technologies theories about what was causing me to sleep well or not and support long-term visualizations of bed time, wake time, and I had to track those in a different app. Long-term visualizations can provide a richer to track them in the same [sleep app] to help me see trends? and more holistic view on variability compared to daily (S86). These types of information not only provide context feedback focused on sleep stage. Viewing long-term trends to people?s sleep quality, but can also help address the will help users address aspects of sleep hygiene related to subjective aspect of sleep quality: ?[I would like to track] maintaining a consistent bedtime and wake time. Number of sleep hours and quality [to] cross-check against We also recommend allowing users to log major life events what I feel during the day? (S177). These logs will help users identify help users better identify personal triggers affecting their events in their daily life that might be impacting their sleep. Our data reflects that many people who track Integrating long-term trends and life logs will contextualize sleep want to test a hypothesis they have about their sleep lifestyle changes and help users to assess and focus on quality. Users want to test a variety of factors that could be aspects that positively or negatively affect their sleep. These Contextualizing sleep data and supporting sleep self- include medication, stress, diet, aspects of their assessments will also help physicians diagnose what is environments, and other aspects of their health including affecting a patient?s sleep. Our findings show that sleep sensors increase awareness in prioritizing sleep and help users address modifiable Focus on Actionable Feedback behaviors and their sleep hygiene. On the other hand, current We find that feedback helps users connect their daytime feedback focuses on sleep metrics people do not have control behaviors, pre-bedtime behaviors, and environmental to directly change (e. To help people draw meaningful recommendations for on the feedback sleep sensing conclusions from sleep data, designs need to develop ways technology can provide to users. Our guidelines draw from of presenting feedback to users beyond correlational graphs. Systems can allow people to test behaviors such as the timing of caffeine accidentally promoting false precision and to avoid non- consumption or installing noise and light blocking curtains. Users should to be able to act on impact of that change on their sleep duration, timing, or their own health and use sleep sensing technologies to satisfaction. We hope tool makers will continue to innovate on new metrics Finally, technologies can promote good sleep health by for sleep health beyond what is currently possible in the delivering timely behavior change suggestions or actions, clinic. We also want to emphasize that new, experimental such as turning off electronic devices close to bedtime or features, such as new sleep measurements, should be clearly automatically dimming lights at night. Tool makers should ensure tools are suggestions, experts recommended a two-week period of designed primarily with the shared goal of improved sleep data collection before offering personalized suggestions. Clinically, these people learn about their sleep habits and how to improve metrics are calculated using brain waves to identify the onset sleep health by providing feedback on their sleep. However, current sleep sensing certain types of feedback lead users to develop broken technologies infer these same metrics based on physiological mental models about what sleep sensors have the ability to signals such as body movement, breathing, and heart rate. This substitution in sensors, the metrics used to give sleep quality feedback vary sensing modality introduces a certain level of inaccuracy. We suggest future tools display data in ranges rather a single-point value, based on sleep sensing data and self- than single point values. These ranges will focus on overall sleep feedback that integrates modifiable behaviors. Sleep self-assessments can help personalize and without compromising on the metrics. We hope this work Increase Transparency in Formulae and Algorithms leads to new designs which better align sleep sensing Our results indicate that users have broken mental models technologies with user?s needs and integrate evidence-based about how sleep sensing technologies work. Publicly frameworks and strategies created by the sleep research documenting the algorithms and formulae used to calculate community. This can reviewed and granted exemption by the University of be applied to sleep sensing technologies to equip users to Washington?s Institutional Review Board. Sleep as a Restorative Process unscientific correlations could lead to practices which are and a Theory to Explain Why. Nediyana Daskalova, Danae Metaxa-Kakavouli, design: defining customer-centered systems. Retrieved September 21, 2016 from Proceedings of the 29th Annual Symposium on User books. Kroes, Martin Dresler, conference on Human factors in computing systems and Francesco P. Eun Kyoung Choe, Bongshin Lee, Matthew Kay, of sleep hygiene in promoting public health: A Wanda Pratt, and Julie A. User- Shahriyar Amini, John Zimmerman, and Jason I centered Visualizations of Uncertainty in Everyday, Hong. Movement a Pound: Reconsidering the Bathroom Scale User toward a novel activity monitoring device. Market Study on Sleep Aids: Sleep Apnea to Witness Learning from a learning thermostat. When fitness trackers Proceedings of the 27th international conference on don?t ?fit. The chair called for the submission of Declaration of Interest forms to the Secretariat in respect of the agenda items.

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