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Long-term evolution of daytime somnolence in patients with sleep apnea/hypopnea syndrome treated by continuous positive airway pressure.

We demonstrated in a previous study that excessive daytime sleepiness (EDS) in patients who have sleep apnea/hypopnea syndrome (SAHS) and are undergoing continuous positive airway pressure (CPAP) treatment improved differently in two groups of patients: in group I, multiple sleep latency tests (MSLT) were normalized after 50 days of treatment (individual value > 10 minutes), whereas they remained low (individual value < 10 minutes) in group II, with a significant difference between groups. To evaluate the long-term evolution of daytime somnolence under nasal CPAP treatment, five patients from group I and seven patients from group II underwent a new polysomnography and MSLT 4 years after the previous study. Clinical, polysomnographic and MSLT results obtained at baseline before treatment (T1), after the initial 50-day period of CPAP treatment (T2), and after 4 years (T3) were compared. The significant difference in mean MSLT value between the two groups previously observed at T1 and T2 disappeared at T3 (group I: 12.4+/-5.9 minutes; group II: 9.7+/-5.9 minutes). We found that this long-term improvement in excessive daytime somnolence was independent of the initial MSLT value, the severity of SAHS, and the initial MSLT changes under nasal CPAP. Long-term MSLT evolution was significantly correlated to CPAP compliance. These results demonstrate that even in the absence of a significant increase in MSLT at the beginning of CPAP treatment, further improvement is still possible several years later, which may encourage the regular, long-term use of nasal CPAP by patients.

Aged↗

[Bronchial reactivity during continuous and interrupted exposure to respiratory irritants].

Evolution of bronchial reactivity was examined in a sample of aluminium potroom workers exposed to a variety of respiratory irritants in concentrations below the MAC values for Yugoslavia (hydrogen fluoride, particulate fluorides, sulphur dioxide). Lung function indices and bronchial reactivity were measured in 24 workers continuously employed in an aluminium plant and in nine workers who had ceased to work in the plant. Measurements took place over a two-year interval. A sustained level of bronchial reactivity was recorded in both examined groups regardless of occupational practice. Even in workers with dyspnoea and airway obstruction bronchial reactivity did not worsen in spite of continuous exposure. Avoidance of exposure to potroom fumes did not bring about any significant improvement of reactivity, moreover, bronchial reactivity deteriorated in one worker. Owing to discordance between spirometric values and bronchial reactivity, a follow-up of workers removed from harmful occupational exposure is suggested.

Adult↗

Warning signals and predator-prey coevolution.

Theories of the evolution of warning signals are typically expressed using analytic and computational models, most of which attribute aspects of predator psychology as the key factors facilitating the evolution of warning signals. Sherratt provides a novel and promising perspective with a model that considers the coevolution of predator and prey populations, showing how predators may develop a bias towards attacking cryptic prey in preference to conspicuous prey. Here, we replicate the model as an individual-based simulation and find, in accordance with Sherratt, that predators evolve a bias towards attacking cryptic prey. We then use a Monte Carlo simulation to calculate the relative survivorships of cryptic and conspicuous prey and stress that, as it stands, the model does not predict the evolution or stability of warning signals. We extend the model by giving predators continuous attack strategies and by allowing the evolution of prey conspicuousness: results are robust to the first modification but, in all cases, cryptic prey always enjoy a higher survivorship than conspicuous prey. When conspicuousness is allowed to evolve, prey quickly evolve towards crypsis, even when runaway coevolution is enabled. Sherratt's approach is promising, but other aspects of predator psychology, besides their innate response, remain vital to our understanding of warning signals.

Animals↗

A comparison study of self-adaptation in evolution strategies and real-coded genetic algorithms.

This paper discusses the self-adaptive mechanisms of evolution strategies (ES) and real-coded genetic algorithms (RCGA) for optimization in continuous search spaces. For multi-membered evolution strategies, a self-adaptive mechanism of mutation parameters has been proposed by Schwefel. It introduces parameters such as standard deviations of the normal distribution for mutation into the genetic code and lets them evolve by selection as well as the decision variables. In the RCGA, crossover or recombination is used mainly for search. It utilizes information on several individuals to generate novel search points, and therefore, it can generate offspring adaptively according to the distribution of parents without any adaptive parameters. The present paper discusses characteristics of these two self-adaptive mechanisms through numerical experiments. The self-adaptive characteristics such as translation, enlargement, focusing, and directing of the distribution of children generated by the ES and the RCGA are examined through experiments.

Algorithms↗

Evolution of schistosomiasis-induced pathology after therapy and interruption of exposure to schistosomes: a review of ultrasonographic studies.

Ultrasonography (US) is suitable for diagnosing schistosomiasis-related organic pathology and is particularly useful to assess its evolution after therapy and/or interruption of exposure to the Schistosoma parasites. Evolution of pathology after treatment: Regression of hepatic abnormalities in Schistosma mansoni-infected children and adolescents has been observed already from 7 months post-therapy on. This does, however, not occur in all cases: individual differences are great ranging from spontaneous regression of pathology without treatment to persistence of pathology lasting for years after therapy even without re-infection. Intensity and duration of exposure, different parasite strains, patients' age and genetic background all influence the evolution of pathology. In communities at continuous exposure to S. mansoni infection, repeated re-treatment is required to control hepatosplenic morbidity. In Schistosoma japonicum infection, changes around the portal tree may regress, but characteristic diffuse abnormalities described as 'network pattern' abnormalities do not resolve. In Schistosoma haematobium infection bladder abnormalities and urinary tract obstruction frequently resolve after treatment. Clinically relevant pathology may resurge from 1 year after therapy on if exposure continues. Subjects with more advanced pathology before therapy, appear to be at higher risk of pathology re-appearance. Evolution of pathology after interruption of exposure to schistosomiasis: Knowledge on the evolution of pathology induced by S. mansoni is limited to some reports in emigrants and to the experience of ultrasonographists working in areas, where transmission has been partially interrupted. Due to the longevity of the parasite, infection may last for many years. Even after elimination of the parasites severe pathology may persist for long. In S. haematobium infection spontaneous healing after interruption of re-exposure may occur, but cases have been reported where urogenital lesions led to complications many years after exposure. Contrary to hepatosplenic and urinary pathology, knowlegde on the evolution of other organic abnormalities is very limited: studies on the evolution of biliary abnormalities or intestinal pathology have not been published. Genital pathology may be induced by all Schistosoma spp. Post-therapy evolution of genital schistosomiasis is largely ignored. In some European travellers partial regression of prostatic fibrosis has been described. Schistosomal adnexitis leading to infertility and/or ectopic pregnancy has been reported occurring many years after interruption of exposure. Ultrasonography (US) has never been used to study the influence of schistosomiasis on pregnancy. Concluding, current knowlegde on the evolution of pathology after treatment and/or interruption of exposure is still fragmentary. Frequently, fibrosis reverses after therapy, but advanced pathology may persist for long. Therefore, the possibility of severe clinical complications has to be taken into account, even if the infection is inactive since many years. In interventions aimed at controlling schistosomiasis-related morbidity, evolution of pathology must be monitored by US in representative patient cohorts. Further systematic US-studies are needed not only on the evolution of hepatosplenic and urinary pathology but also on that of intestinal, biliary and genital pathology induced by schistosomiasis, as well as on the influence of schistosomiasis on the outcome of pregnancy.

Adolescent↗

Midsagittal cranial shape variation in the genus Homo by geometric morphometrics.

Midsagittal profiles of crania referred to different taxa of the genus Homo have been analyzed by geometric morphometric techniques. Comparisons between single specimens using the thin-plate-spline function suggest a generalized reduction of the lower face, associated with antero-posterior development of the braincase occurring (possibly in parallel evolution) along distinct human lineages. Furthermore, Neandertals display a projection of the midface, and modern humans show a derived globularity of the vault associated with midsagittal parietal bulging. Principal Component Analysis demonstrates a bimodal pattern of variation, which describes an "archaic" pole (rather heterogeneous in terms of taxonomy) clearly distinguishable from the modern one. The first two principal components - that explain together 80% of the total variance in shape - involve respectively fronto-parietal expansion and midfacial prognathism. These results contribute to identify different structural patterns in human evolution, supporting discontinuity rather than continuity of cranial shape among different taxa of the genus Homo, especially when considering the differences between Neandertals and early modern humans.

Animals↗

Monitoring respiratory function by computer in ICU. Preliminary work.

The structure of the respiratory monitoring system under construction in Brussels University Hospitals is described. It is modular and hierarchized. It is based on the observation of the lung mechanics, of the flows of inspired and expired gases and of continuous blood measurements in patients artificially ventilated. Respiratory monitoring may be confined to the continuous observation of the natural evolution of a large number of parameters and the extraction of the most possible information with the aid of automatic calculations effected in real time. The authors propose to add deliberate and controlled aggressions of the pulmonary system in order to observe its dynamic behavior. Practical function tests are described. They lead to the calculation of functional residual capacity, continuous distribution of tidal volume, and pulmonary capillary blood flow. These tests can be performed automatically by using a new electronic unit built in our laboratory. It enables a digital computer to control the functioning of a commercially available ventilator.

Belgium↗

Is your organization ready for total quality management?

The evolution to a Total Quality Management (TQM) or Continuous Quality Improvement (CQI) philosophy is particularly attractive in the health care industry in its search for better ways of doing business to ensure financial survival in the current competitive environment. This article, however, suggests that some organizations may not benefit from attempting to implement methodology to achieve the widely accepted financial and operational benefits, not because of any weakness in the conceptual framework, but because of the culture and/or lack of dedicated resources required to ensure the acceptance and success of the approach. As a result, many providers are discovering that after a few years of implementation, benefits to the organization are not being recognized to the extent possible. Specific issues that have been identified as essential requirements to a successful implementation process or evolution to a continuous improvement culture are described in this article.

Health Personnel↗

Phylogeny and evo-devo: characters, homology, and the historical analysis of the evolution of development.

The concept of homology continues to attract more and more commentary. In systematic and evolutionary biology the meaning of homology as synapomorphic similarity inherited from a common ancestor has gained wide acceptance over the last three or four decades. In recent years, however, developmental biologists, in particular, have argued for a new approach to, and new definition for, homology that revolves around the desire to make it more process-oriented and more mechanistic. These efforts raise questions about the relationship between developmental and evolutionary biology as well as how the evolution of development is to be studied. It is argued in this paper that this new approach to homology seemingly decouples developmental biology from the study of the evolution of development rather than to facilitate that study. In contrast, applying the notion of historical, phylogenetic homology to developmental data is inherently comparative and therefore evolutionary.

Anatomy, Comparative↗

Specialization of the DNA-cleaving activity of a group I ribozyme through in vitro evolution.

In an earlier study, an in vitro evolution procedure was applied to a large population of variants of the Tetrahymena group I ribozyme to obtain individuals with a 10(5)-fold improved ability to cleave a target single-stranded DNA substrate under simulated physiological conditions. The evolved ribozymes also showed a twofold improvement, compared to the wild-type, in their ability to cleave a single-stranded RNA substrate. Here, we report continuation of the in vitro evolution process using a new selection strategy to achieve both enhanced DNA and diminished RNA-cleavage activity. Our strategy combines a positive selection for DNA cleavage with a negative selection against RNA binding. After 36 "generations" of in vitro evolution, the evolved population showed an approximately 100-fold increase in the ratio of DNA to RNA-cleavage activity. Site-directed mutagenesis experiments confirmed the selective advantage of two covarying mutations within the catalytic core of the ribozyme that are largely responsible for this modified behavior. The population of ribozymes has now undergone a total of 63 successive generations of evolution, resulting in an average of 28 mutations relative to the wild-type that are responsible for the altered phenotype.

Animals↗

Agoraphobia, panic disorder and generalized anxiety disorder: some implications of recent advances.

The nature of the relationship between 'panic disorder', agoraphobia and general anxiety disorder remains open. The aetiological theories which have tried to link them with the aid of biological and psychological concepts fail to take account of conflicting observations. 'Panic' attacks are not confined to agoraphobic and related disorders, being indistinguishable from the attacks of acute anxiety and phobic aversion manifest in a wide range of anxiety and affective disorders. There is continuity and discontinuity in the evolution of agoraphobia; those affected differ in respect of a range of premorbid features from patients with other disorders and control subjects. These variables include family history, life development, trait anxiety and other personality characteristics including introversion, neuroticism and probably emotional dependence on others. Not all the claims made on behalf of the efficacy of pharmacological treatment on the one hand and behavioural therapies on the other are substantiated. The success achieved by behavioural treatment appear to endure over some years. But the residual disabilities and defects that follow all forms of treatment and the problems posed by patient selection and high drop-out rates have received insufficient attention. Aetiological theories of agoraphobia and related conditions have been advanced along biomedical, psychological and psychodynamic lines. Some evidence supports each kind of theory. But none is wholly consistent with the findings regarding its phenomenology and evolution. Recent biological investigations have led to the formulation of hypotheses in relation to anticipatory and chronic anxiety in terms of changes in synaptic connections, enhancement of transmitter release as well as alterations in molecular configuration and regulation of gene expression. It would be premature to conclude that these findings can provide a unitary conceptual framework for the explanation of human anxiety disorders. The psychological, behavioural and psychodynamic aspects of this group of disorders should all continue to receive due attention both in clinical management and scientific investigation.

Adolescent↗

A strain of Bacillus sphaericus causes slower development of resistance in Culex quinquefasciatus.

Two field-collected Culex quinquefasciatus colonies were subjected to selection pressure by three strains of Bacillus sphaericus, C3-41, 2362, and IAB59, under laboratory conditions. After 13 and 18 generations of exposure to high concentrations of C3-41 and IAB59, a field-collected low-level-resistant colony developed >144,000- and 46.3-fold resistance to strains C3-41 and IAB59, respectively. A field-collected susceptible colony was selected with 2362 and IAB59 for 46 and 12 generations and attained >162,000- and 5.7-fold resistance to the two agents, respectively. The pattern of resistance evolution in mosquitoes depended on continuous selection pressure, and the stronger the selection pressure, the more quickly resistance developed. The resistant colonies obtained after selection with B. sphaericus C3-41 and 2362 showed very high levels of cross-resistance to B. sphaericus 2362 and C3-41, respectively, but they displayed only low-level cross-resistance to IAB59. On the other hand, the IAB59-selected colonies had high cross-resistance to both strains C3-41 and 2362. Additionally, the slower evolution of resistance against strain IAB59 may be explained by the presence of another larvicidal factor. This is in agreement with the nontoxicity of the cloned and purified binary toxin (Bin1) of IAB59 for 2362-resistant larvae. We also verified that all the B. sphaericus-selected colonies showed no cross-resistance to Bacillus thuringiensis subsp. israelensis, suggesting that it would be a promising alternative in managing resistance to B. sphaericus in C. quinquefasciatus larvae.

Animals↗

Microbial adaptation and change: avian influenza.

The evolution of influenza is a continuing process involving viral and host factors. The increasing frequency of emergence of the highly pathogenic H5N1, H7N3 and H7N7 influenza viruses and the panzootic spread of H9N2 influenza virus, all of which can be potentially transmitted to humans, are of great concern to both veterinary and human public health officials. The question is how soon the next pandemic will emerge. A convergence of factors, including the population densities of poultry, pigs and humans, are likely factors affecting the evolution of the virus. Highly concentrated poultry and pig farming, in conjunction with traditional live animal or 'wet' markets, provide optimal conditions for increased mutation, reassortment and recombination of influenza viruses. Strategies to reduce the evolution of influenza and the emergence of pandemics include the separation of species, increased biosecurity, the development of new vaccine strategies and better basic knowledge of the virus. More effective co-operation between scientists and veterinary and public health officials is required to achieve these goals.

Animals↗

The spatial struggle of tit-for-tat and defect.

The pioneering work by Trivers (1971), Axelrod (1984) and Axelrod & Hamilton (1981) has stimulated continuing interest in explaining the evolution of cooperation by game theory, in particular, the iterated prisoner's dilemma and the strategy of tit-for-tat. However these models suffer from a lack of biological reality, most seriously because it is assumed that players meet opponents at random from the population and, unless the population is very small, this excludes the repeated encounters necessary for tit-for-tat to prosper. To meet some of the objections, we consider a model with two types of players, defectors (D) and tit-for-tat players (T), in a spatially homogeneous environment with player densities varying continuously in space and time. Players only encounter neighbours but move at random in space. The analysis demonstrates major new conclusions, the three most important being as follows. First, stable coexistence with constant densities of both players is possible. Second, stable coexistence in a pattern (a spatially inhomogeneous stationary state) may be possible when it is impossible for constant distributions (even unstable ones) to exist. Third, invasion by a very small number of T-players is sometimes possible (in contrast with the usual predictions) and so a mutation to tit-for-tat may lead to a population of defectors being displaced by the T-players.

Animals↗

Evolving structures in surgical oncology and the role of the Federation of European Cancer Societies in continuing medical education.

This article describes the evolution of a European system of accreditation of educational events in oncology and the establishment by the Federation of European Cancer Societies of the Accreditation Council of Oncology in Europe. It draws attention to the need for a coordinated system which is acceptable in the different European countries so that an international system of "Eurocredits" can be devised. Through the official Union Europeénne des Médecins Specialistes (UEMS), reciprocity with the accrediting bodies in the United States and other countries is planned.

Accreditation↗

Continuity versus split and reconstitution: exploring the molecular developmental corollaries of insect eye primordium evolution.

Holometabolous insects like Drosophila proceed through two phases of visual system development. The embryonic phase generates simple eyes of the larva. The postembryonic phase produces the adult specific compound eyes during late larval development and pupation. In primitive insects, by contrast, eye development persists seemingly continuously from embryogenesis through the end of postembryogenesis. Comparative literature suggests that the evolutionary transition from continuous to biphasic eye development occurred via transient developmental arrest. This review investigates how the developmental arrest model relates to the gene networks regulating larval and adult eye development in Drosophila, and embryonic compound eye development in primitive insects. Consistent with the developmental arrest model, the available data suggest that the determination of the anlage of the rudimentary Drosophila larval eye is homologous to the embryonic specification of the juvenile compound eye in directly developing insects while the Drosophila compound eye primordium is evolutionarily related to the yet little studied stem cell based postembryonic eye primordium of primitive insects.

Animals↗

Retroviruses, ascorbate, and mutations, in the evolution of Homo sapiens.

Mutations, induced by free radicals, provide a rich molecular palette that other evolutionary forces can select for or against. A recent hypothesis proposed that large numbers of free radicals were produced when, millions of years ago, Anthropoidea lost the ability to produce endogenous ascorbate, increasing the frequency of mutations and accelerating the evolution of higher primates. Recognizing that retroviruses have been active throughout the period of primate evolution, we suggest that an endogenous retrovirus or other retroviral-like element may have been involved in mutating the gene coding for gulonolactone oxidase (GLO), the terminal step in ascorbate synthesis, approximately 45 million years ago. This possibility is supported by the presence of Alu elements (a common primate retroelement) adjacent to the site of a missing segment of the nonfunctional GLO gene. Although Homo sapiens and other higher primates produce other endogenous antioxidants, including superoxide dismutase and uric acid, they do not quench the same radicals as ascorbate and cannot fully compensate for a lack of endogenous ascorbate. As a consequence, a retrovirus may have played a pivotal role in primate and H. sapiens evolution, and the absence of endogenous ascorbate may be continuing to accelerate the rate of H. sapiens and primate evolution.

Animals↗

Evolution of avalanche conducting states in electrorheological liquids.

Charge transport in electrorheological fluids is studied experimentally under strongly nonequilibrium conditions. By injecting an electrical current into a suspension of conducting nanoparticles we are able to initiate a process of self-organization which leads, in certain cases, to formation of a stable pattern which consists of continuous conducting chains of particles. The evolution of the dissipative state in such a system is a complex process. It starts as an avalanche process characterized by nucleation, growth, and thermal destruction of such dissipative elements as continuous conducting chains of particles as well as electroconvective vortices. A power-law distribution of avalanche sizes and durations, observed at this stage of the evolution, indicates that the system is in a self-organized critical state. A sharp transition into an avalanche-free state with a stable pattern of conducting chains is observed when the power dissipated in the fluid reaches its maximum. We propose a simple evolution model which obeys the maximum power condition and also shows a power-law distribution of the avalanche sizes.

Journal Article↗