Validity,potential clinical utility and comparison of a consumer activity tracker and a research‐grade activity tracker in insomnia disorder II: Outside the laboratory

Accurate assessment of sleep can be fundamental for monitoring, managing and evaluating treatment outcomes within diseases. A proliferation of consumer activity trackers gives easy access to objective sleep. We evaluated the performance of a commercial device (Fitbit Alta HR) relative to a research‐grade actigraph (Actiwatch Spectrum Pro) in measuring sleep before and after a cognitive behavioural intervention in insomnia disorder. Twenty‐five individuals with DSM‐5 insomnia disorder (M = 50.6 ± 15.9 years) wore Fitbit and Actiwatch and completed a sleep diary during an in‐laboratory polysomnogram, and for 1 week preceding and following seven weekly sessions of cognitive‐behavioural intervention for insomnia. Device performance was compared for sleep outcomes (total sleep time, sleep latency, sleep efficiency and wake after sleep onset). The analyses assessed (a) agreement between devices across days and pre‐ to post‐treatment, and (b) whether pre‐ to post‐treatment changes in sleep assessed by devices correlated with clinical measures of change. Devices generally did not significantly differ from each other on sleep variable estimates, either night to night, in response to sleep manipulation (pre‐ to post‐treatment) or in response to changes in environment (in the laboratory versus at home). Change in sleep measures across time from each device showed some correlation with common clinical measures of change in insomnia, but not insomnia diagnosis as a categorical variable. Overall, the Fitbit provides similar estimates of sleep outside the laboratory to a research grade actigraph. Despite the similarity between Fitbit and Actiwatch performance, the use of consumer technology is still in its infancy and caution should be taken in its interpretation.     

Construction and characterization of bivalent Shigella flexneri 2a vaccine strains SC608(pCFAI) and SC608(pCFAI/LTB) that express antigens from enterotoxigenic Escherichia coli

An invasive strain of Shigella flexneri 2a (SC608) has been developed as a vector for the expression and delivery of heterologous antigens. SC608 is an aspartate semialdehyde dehydrogenase (asd) derivative of SC602 (icsA iuc), a well-characterized live attenuated vaccine strain which has undergone several clinical trials in human volunteers. When administered orally at a single 10(4) (CFU) dose, SC602 is both immunogenic and efficacious against shigellosis. Using asd-based plasmid vectors, we designed SC608 to express the enterotoxigenic Escherichia coli (ETEC) fimbrial subunit CfaB (CFA/I structural subunit) alone or in combination with the E. coli B subunit of heat-labile enterotoxin (LTB). The expression of each heterologous protein in SC608 was verified by immunoblot analysis. Each strain was comparable to the parent strain, SC602, in a HeLa cell invasion assay. After intranasal immunizations of guinea pigs, serum and mucosal immune responses were detected against both Shigella lipopolysaccharide and heterologous ETEC antigens by enzyme-linked immunosorbent assay and ELISPOT analysis. All immunized animals were subsequently protected against a challenge with wild-type S. flexneri 2a in a keratoconjunctivitis Sereny test. Serum antibodies generated against LTB and CfaB demonstrated antitoxin and agglutination activities, respectively. These results suggest that CfaB and LTB expressed in SC608 retain important conformational epitopes that are required for the generation of antibodies that have functional activities. These initial experiments demonstrate that a fully invasive Shigella vaccine strain can be engineered to deliver antigens from other diarrheal pathogens.     

Prevalence of dysglycemia and its associations with age and body mass index among community dwelling adults in a developing country

International Journal of Diabetes in Developing Countries - Dysglycemia includes prediabetes and diabetes. We aimed to study the prevalence of dysglycemia, and its associations with age and body...     

Validity,potential clinical utility,and comparison of consumer and research‐grade activity trackers in Insomnia Disorder I: In‐lab validation against polysomnography

Consumer activity trackers claiming to measure sleep/wake patterns are ubiquitous within clinical and consumer settings. However, validation of these devices in sleep disorder populations are lacking. We examined 1 night of sleep in 42 individuals with insomnia (mean = 49.14 ± 17.54 years) using polysomnography, a wrist actigraph (Actiwatch Spectrum Pro: AWS) and a consumer activity tracker (Fitbit Alta HR: FBA). Epoch‐by‐epoch analysis and Bland?Altman methods evaluated each device against polysomnography for sleep/wake detection, total sleep time, sleep efficiency, wake after sleep onset and sleep latency. FBA sleep stage classification of light sleep (N1 + N2), deep sleep (N3) and rapid eye movement was also compared with polysomnography. Compared with polysomnography, both activity trackers displayed high accuracy (81.12% versus 82.80%, AWS and FBA respectively; ns) and sensitivity (sleep detection; 96.66% versus 96.04%, respectively; ns) but low specificity (wake detection; 39.09% versus 44.76%, respectively; p = .037). Both trackers overestimated total sleep time and sleep efficiency, and underestimated sleep latency and wake after sleep onset. FBA demonstrated sleep stage sensitivity and specificity, respectively, of 79.39% and 58.77% (light), 49.04% and 95.54% (deep), 65.97% and 91.53% (rapid eye movement). Both devices were more accurate in detecting sleep than wake, with equivalent sensitivity, but statistically different specificity. FBA provided equivalent estimates as AWS for all traditional actigraphy sleep parameters. FBA also showed high specificity when identifying N3, and rapid eye movement, though sensitivity was modest. Thus, it underestimates these sleep stages and overestimates light sleep, demonstrating more shallow sleep than actually obtained. Whether FBA could serve as a low‐cost substitute for actigraphy in insomnia requires further investigation.