Accused robber to undergo evaluation
Accused robber to undergo evaluation
The man accused of robbing the Dairy Mart will undergo a psychological evaluation. James Hawkins Jr.
Read more on The Inter-Mountain
Tags: accused, Evaluation, robber, undergo
June 16th, 2010 at 10:34 pm
San Bernardino County prosecutors have declined to file charges in the fatal officer-involved shooting of a 23-year-old man last year. Prosecutors said Tuesday that Officer Joseph Aguilar’s use of deadly force against Cedric May was justifiable because a suspected robber was pointing a stun gun at the officer’s partner.
June 17th, 2010 at 12:50 pm
Derby news: Staff threatened by armed robber: Staff at a Derbyshire Co-Op store are threatened by a man during an …
June 19th, 2010 at 11:04 am
I don't think that 911, works in the UK
I'd act very frightened; that shouldn't be too difficult, under the circumstances.
June 20th, 2010 at 9:53 am
A 50-year-old man working at a store on the Southwest Side was shot and critically wounded during a robbery Friday night.
The man was working in the store on the 8500 block of South Cicero Avenue about 8:45 p.m. when a robber walked in, displayed a handgun and demanded money, according to preliminary information from Police News Affairs.
The robber shot the man in the face and arm before fleeing with the cash drawer from the store, police said.
The victim was taken to Advocate Christ Medical Center in critical condition. No one was in custody, and no suspect description was immediately available. Wentworth Area detectives were investigating.
–Staff report
June 23rd, 2010 at 7:06 am
Tell her that Lindsay Lohan will be there too.
June 30th, 2010 at 6:41 pm
they don't as they do not have elemental iron on their skins.
they have some iron ions in their blood and tissues, that's all.
animals don't rust….
July 10th, 2010 at 1:34 am
“It’s too facile to blame Ronald Reagan and his Republican ilk. Democrats have been almost as reluctant to attack inequality or even to recognize it as the central economic and social problem of our age. (As Bill Clinton’s labor secretary, I should know.) The reason is simple. As money has risen to the top, so has political power. Politicians are more dependent than ever on big money for their campaigns. Modern Washington is far removed from the Gilded Age, when, it’s been said, the lackeys of robber barons literally deposited sacks of cash on the desks of friendly legislators. Today’s cash comes in the form of ever increasing campaign donations from corporate executives and Wall Street, their ever bigger platoons of lobbyists and their hordes of PR flacks.”
July 11th, 2010 at 4:03 pm
lol 0:38
August 3rd, 2010 at 10:50 am
Would it make you happier if she was? <—- That is an unnecessary attack and insult and an assumption that makes absolutely no sense.
August 5th, 2010 at 1:52 pm
La Liga Real Madrid's Kaka set for surgery – Kaka has left the Real Madrid's training camp and will undergo arthros…
August 18th, 2010 at 1:34 pm
(Props: YouTube.com/PrivateMichael104) The story of Tito Ortiz getting punched out by convicted bank robber Lee Murray during an alleyway altercation after UFC 38 has grown into one of MMA’s most beloved bits of folklore. The most famous version — relayed second-hand from a drunken Pat Miletich and published in Matt Hughes’s autobiography Made in America — ends with Tito Ortiz getting starched by “like, a five-punch combo,” then boot-stomped. On this Friday’s installment of Michael Schiavello’s HDNet interview series The Voice Vs…, Ortiz gets to tell his side of the tale. Basically, it was Ortiz’s friend that was getting stomped, and when Murray dropped Ortiz with a punch it was more of slip then anything else, and that only happened after Murray was running away like a little bitch, and Tito was able to pop back up anyway. As Tito explains, “I was never unconscious at the time, in my whole career I’ve never been unconscious, and I never will go unconscious.” Also, Lee Murray’s…
August 27th, 2010 at 3:00 am
My doctor just put me on Clonazepam Friday and all I did was mention to her that I was having trouble with my heart racing,fluttering feelings in my chest and it was hard to breath. She said it sounded like anxiety.
She then asked if anything at home had "changed"–no, she then asked if something tramatic had happened–no, she asked if I felt depressed–no.
That is all she asked.
I wasn;t so sure if it was anxiety but now I believe it is, my symptoms have got a lot worse since Friday night–something is very wrong with my step-dad. Since he went intp the hospital that nigth, the symptoms have hit harder and more often.
August 31st, 2010 at 8:24 am
oh many did ya boi do likez hardz words and shiznit ya my son you know how we do upz in thiz hizzzayyyyyyyy, like straight upp my ninja like stashed the hizzay of pillz up in his left pocketzzzz and den like got arresteddz and was like yo mang how do i like workz diz outz u nah meannnnnnnnnn pimp pimp hooooraayyyy.
September 2nd, 2010 at 7:28 pm
I am 34, and the answer is NO…
September 9th, 2010 at 4:39 am
Green Care Management – Doncaster, South Yorkshire – My client, a large mental health care provider, is currently recruiting for a Senior Staff Nurse for their secure hospital based in Doncaster, South Yorkshire. As Senior Staff Nurse, you will take responsibility for assessing the care needs of patients and the planning development, implementation and evaluation of individual care plans. You will be responsible for supervising and mentoring newly qualified nurses and be a role model for the staff team. You will assist in providing a safe and therapeutic environment for all who use and work in the hospital. You will have a number of clinical duties, and work closely with colleagues that are both junior and senior to you. You will be RMN/RNLD qualified ideally with 2 years experience of working within a mental health/ Learning Disabilties set
September 13th, 2010 at 3:42 am
Chicago Breaking News – Tribune Chicago man charged with ‘apologetic’ home invasion Chicago Sun-Times A Chicago man who police say repeatedly apologized to his victim as he took jewelry and money from her north suburban home last month has been charged with … Thank You! Police Nab Polite Burglary Suspect NBC Chicago Police show no sympathy for ‘polite bandit’ Chicago Tribune Police Arrest Apologetic Robber, aka ‘Polite Bandit’ MyFox Chicago all 11 news articles Related posts:Apologetic burglar takes $485, jewelry in Skokie – Chicago Sun-Times ‘Pink Panther’ theft suspect charged – Chicago Sun-Times Burglar Steals Jewelry, Apologizes – MyFox Chicago
September 13th, 2010 at 8:42 am
Very tough to say if theres an optimum. A lot of big construction companies will throw all their money in the pot and not know whether or not they'll have some left over at the end till the job is done. The company I work for is just the opposite, perhaps to a fault. They monitor EVERYTHING. The categories you listed kind of overlap in my mind. I'd say the big three things to divy time up to are quality control (building the work right), safety/environmental (making sure you don't get sued), and work efficiency/productivity (building it cheap). Don't know what to tell you for a good ratio, but you can expect to have about 75 people working overhead on, say, a 500 million dollar job.
September 21st, 2010 at 9:14 pm
Miranda Rights.*
October 1st, 2010 at 1:00 pm
The reason it’s the other robbers fault, is because he went in breaking the law. HIS actions lead to the death of his “friend”. Don’t give me the desperate plea. Many people have nothing and find ways to survive and even prosper without sticking a gun in someones face. Calling someone garbage that is callus enough to point a gun at someone and demand money they didn’t work for, earn or even deserve, does not make BillyJoe88 a racist. Self defense is not murder.
October 9th, 2010 at 1:11 pm
You aren't too specific about if your daughter is seeing a psychiatrist or a psychologist. During a psychiatric evaluation the evaluator will asses- suicidial-homocidal ideation, alcohol or other drug use, level of depression, level of funtioning (this is also reffered to as a GAF score on the DSM-IV), and screen for possible symptoms of depression, anxiety or any other mental illnesses listed in the DSM-IV. In addition they will look at certain things such as Appearance, Flow of Speech,Content of Speech, Affect/Mood. Social Behavior.
Depending if you are going to a psychologist they may do a genogram to analysize the family history of the problem (not sure what symptoms she has or what she is suffering from but somethings run strong in families). If a psychologist believe that there is a specific disorder (again I dont know her symptoms) than they may choose to administer an assessment to determine if she is suffering from a particular disorder.
Depending on the doctor or psychologist you choose in some cases psychiatrists and psychologists work hand in hand. This is often the case in in-patient settings as well as some offices.
Good luck with your daughter
October 24th, 2010 at 11:00 am
Love this video. Really creative way to educate students how to evaluate websites for research. I certainly found it useful. TQ!
November 13th, 2010 at 7:33 pm
Evaluation of Acute Hepatitis C Infection Surveillance — United …
December 3rd, 2010 at 8:54 am
Does this have any implications in online communitys like world of warcraft or is this 20 years in the future and then its obsolete
December 5th, 2010 at 3:57 am
no on the first part but the second one is tougher….
if you have a ticket and refuse to allow a strip search, you can be arrested, taken to jail, and forced to have a strip search to includ body cavities
February 11th, 2011 at 2:46 pm
it depends on what the robber is doing and if the owner reasonably fears for his life. The robber doesn't need to be carrying a weapon in order to inflict great bodily harm or death, so the owner may defend his life by killing the robber if he is attacked or reasonably anticipates an attack. However, the owner may not shoot the robber to only protect the goods in the store. Other circumstances could come into play as well, for instince if the owner's competition across the street was murdered a week prior, a court may consider the owners actions less punishable, much as a court may be tougher on the owner is the guy was carrying a toy gun and the owner admits that he was pretty sure the gun was fake.
February 25th, 2011 at 7:43 am
Honeywell – Guildford, Surrey – Will perform and/ or coordinate all aspects of basic design packages and process studies for UOP Processes. This will entail the use of process simulation packages to generate heat and material balances, utility balances, evaluation and specification of process equipment, preparation of Process Flow Diagrams and development of Piping & Instrumentation Diagrams. .Will function as the technical lia
March 4th, 2011 at 5:41 am
makes me glad i dont live in America. any of those places are better than the US
March 5th, 2011 at 6:11 am
I cant remember, they just gave me some horrible relaxing stuff to take.
March 16th, 2011 at 11:30 am
yes !!!!!SHREDDERS!!!!! great band.
March 19th, 2011 at 2:37 am
To be without electronics is like a brain flush.
April 11th, 2011 at 3:43 am
Colwyn Bay, Conwy – New Directions Education require Learning Support Assistants in temporary positions in a Primary School In Colwyn Bay. Applicants will need to have experience of working within a classroom environment. All candidates will be required to undergo a New Directions CRB Disclosure and will be subject to references.
April 18th, 2011 at 3:12 pm
LATEST INFOTAINMENT 4 U :”During the examination of Sonu, who was admitted yesterday, it was detected that her amputated left leg has swelling and infection which may require further surgery for treatment,” said the sources at Chattrapati Shahuji Maharaj Medical University, where Arunima was shifted yesterday.As of now the dead tissues were removed, wound cleaned and fresh dressing was done, they said.”Though her condition is stable, but due to excessive bleeding Sonu’s haemoglobin level has gone down fairly due to which transfusion was done last night,” the sources said.Sonu’s case is that of amputation below the knee and she has been kept in high-dependency ward, they added.The 23-year-old player was earlier undergoing treatment at Bareilly district hospital where she was admitted on April 12, a day after being thrown out of the Padmavat Express by three men trying to rob her when she was travelling to Delhi to appear for an examination.The police had lodged an FIR under section 307…
May 7th, 2011 at 3:30 pm
NOT A GAMEBOY THO!! HAHAHAHAHAHAHAHAHA!!!
May 10th, 2011 at 4:24 am
Flagstaff police searching for suspected bank robber – AZFamily
May 11th, 2011 at 1:36 pm
Monopolies of industries and resources (John D. Rockfeller – oil, J.P. Morgan – shipping and banking)
Preventing competitors from reaching the marketplace by limiting their ability to move their goods.
May 12th, 2011 at 5:26 am
An Elk Grove man has been arrested on suspicion of collecting illegal upfront fees in connection with loan modification services.
May 18th, 2011 at 8:31 am
i’m doing a speech that has the same title.. very VERY dramatic
June 26th, 2011 at 8:43 am
Noooooo. Please keep firing ppl Nate.. It’s what you do best.
June 26th, 2011 at 7:47 pm
RT Project Evaluation Consultant, International Consul, Chisinau, MOLDOVA
July 3rd, 2011 at 8:59 pm
TOKYO (AP) — Boeing Co.’s long-delayed 787 completed its maiden trans-Pacific journey and landed in Japan, where the more fuel-efficient jet will undergo testing this week with All Nippon Airways in preparation for its first commercial launch….
July 13th, 2011 at 8:32 am
They actually don't
In the bone marrow that's where red blood cells are made (among other things)
As a red blood cell matures, it simply gets older and dies. So your bone marrow will continuously make new cells so make up for the loss.
September 3rd, 2011 at 7:29 pm
“The Vatican has rejected claims by Irish PM Enda Kenny that it sabotaged efforts by Irish bishops to report child-molesting priests to police. It follows the damning Cloyne Report that showed how allegations of clerical sex-abuse in Cork had been covered up. In a speech to parliament in July, Mr Kenny accused the Church of putting its reputation ahead of abuse victims. The Vatican said it was “sorry and ashamed” over the scandal but said his claims were “unfounded”. “The Holy See is deeply concerned at the findings of the commission of inquiry concerning grave failures in the ecclesiastical governance of the diocese of Cloyne,” said the Vatican, in a detailed response to the allegations. “The Holy See… in no way hampered or sought to interfere in any inquiry into cases of child sex abuse in the Diocese of Cloyne.” “Furthermore, at no stage did the Holy See seek to interfere with Irish civil law or impede the civil authority in the exercise of its duties.” ‘Misinterpretation’ Mr Kenny had told the Irish parliament that the report into how allegations of sex abuse by priests in Cork had been covered up showed change was urgently needed. Enda Kenny accused the Catholic Church of putting its reputation ahead of child rape victims “The rape and torture of children were downplayed or ‘managed’ to uphold instead the primacy of the institution, its power, standing and ‘reputation’,” he said. Parliament then passed a motion deploring the Holy See for “undermining child protection frameworks” after a letter to Irish bishops appeared to diminish Irish guidelines on reporting sex abuse by referring to them as “study guidelines”. The Vatican then recalled its special envoy in Dublin, Papal Nuncio Giuseppe Leanza, to discuss the impact of the report. But the Holy See’s response, published on Saturday, said Mr Kenny’s blistering accusations were based on a misinterpretation of a 1997 Vatican letter expressing “serious reservations” about the Irish bishops’ 1996 policy requiring bishops to report abusers to police. “In a spirit of humility, the Holy See, while rejecting unfounded accusations, welcomes all objective and helpful observations and suggestions to combat with determination the appalling crime of sexual abuse of minors,” said the statement. Released in July, the 400-page Cloyne Report found that Bishop John Magee – who stood down in March 2009 after serving as bishop of Cloyne since 1987 – had falsely told the government and the health service that his diocese was reporting all abuse allegations to authorities. It also found that the bishop deliberately misled another inquiry and his own advisors by creating two different accounts of a meeting with a priest suspected of abusing a child – one for the Vatican and the other for diocesan files. It discovered that, contrary to repeated assertions on its part, the Diocese of Cloyne did not implement the procedures set out in the Church protocols for dealing with allegations of child sex-abuse. It said the greatest failure was that no complaints, except one in 1996, were reported to the health authorities until 2008. It said the disturbing findings were compounded by the fact that the commission found that the Vatican’s response to the Church guidelines was entirely unhelpful and gave comfort and support to those who dissented from the guidelines. It said this was “wholly unacceptable”.”
October 21st, 2011 at 2:05 pm
If someone comes into a hospital and demands that their arm be removed for no adequately explained reason, no one will do it. Yet mutilating a girl based on religious dumbassery is perfectly okay.
October 24th, 2011 at 8:38 am
I know this recut is years old and it is probably too late to be commenting on it, but that was bloody hilariouse
November 10th, 2011 at 9:42 am
Adwaa Rabia Trading-Adwaa Rabia group – United Arab Emirates – Riyadh, Ar Riyad – Urgently Needed Native Female ESL Instructors Princess Nora UniversityPosition Available: 633 ESL Instructors Job Location: Princess Norah University, Riyadh Saudi Arabia Contract Type / Duration: Direct / 2 Years Renewable Gender: Female(s) Only Job Description • Curriculum Development• 20 Hours Classroom Teaching• Evaluation Of Student Work• Mentoring And Advising Students• Undertaking
November 11th, 2011 at 7:47 am
UKStaffsearch – Aldershot, Hampshire – Our reputable client based in Hampshire are seeking a Software Applications Engineer to join the team in Basingstoke. You’ll be developing software components for Digital TV products such as drivers, firmware, and evaluation GUI’s and supporting customers with such software components. To be considered for this role, you’ll need solid experience in C++ and C# programming on a variety of operating
November 14th, 2011 at 5:28 pm
St. John Medical Center – Tulsa, OK – Company: St. John Medical Center Facility: St. John Medical Center, Inc. (201) at Tulsa Department: 10 East A clinically competent Registered Nurse who uses the nursing process of assessment, nursing diagnosis, outcomes identification, planning, implementation, and evaluation to provide care to assigned patients. Responsible and accountable for identifying and prioritizing needs, formulating the p
November 19th, 2011 at 8:06 am
dog sia i do practise keep fail LOL. evaluation easier ah?
November 19th, 2011 at 5:16 pm
HCA North Texas – Arlington, TX – RN CDU (Days)-00015-43723 Primary Location: United States-Texas-Arlington Job: Nursing – Professional Schedule: Full-time JOB RESPONSIBILITIES: * Performs initial triage evaluation and assigns acuity level to patients. * Follows standard of care utilizing Nursing Process in delivery of care. * Maintains accountability for professional decisions and actions. * Performs nursing assessmentdiagnosisca
January 5th, 2012 at 3:28 am
JAKARTA, Jan. 4 (UPI) — The wife of a man accused of carrying out bombings on Christian churches in Bali was sent to prison for two years Wednesday for lying on a passport application.
January 11th, 2012 at 10:50 pm
ROI Academy offers practical approaches to measuring training effectiveness and also offers evaluating training training impact employee performance training ROI and training needs analysis
January 16th, 2012 at 11:01 am
Murdoch remark is like pot calling the kettle black. Robber Baron can’t accept the Google success story
January 17th, 2012 at 12:41 pm
Accent MRI pacemaker launched in India: The new pacemaker and lead allow patients to undergo full-body, high-res…
February 8th, 2012 at 5:36 am
“I know you’ll still kiss the guy’s nuts because he agrees with your view point on one issue, but he is a pretty shitty individual. He’s a 9/11 truther. He has attacked the Orang Asli (the aboriginals of Malaysia). He also has an extremely long history of rabid anti-semitism that dates back to the 1970′s when he wrote in his book that “The Jews for example are not merely hook-nosed, but understand money instinctively.” In more recent times he has accused the Jews of conspiring to destroy the Malay state.”
April 18th, 2012 at 9:36 pm
INTRODUCTION — Thousands of articles about sleep and sleep disorders appear each year in medical and psychological journals, and to date, more than 80 different sleep disorders have been described. However, despite the intensive efforts that these publications reflect, there is still no definitive explanation for why we sleep. Sleep is not a passive process, but rather an active state that is as complex as wakefulness. The brain is not “at rest” during sleep; it is involved in a wide variety of activities.
The normal physiology of sleep, including sleep stages and architecture, will be presented here. The effect of sleep deprivation is discussed elsewhere. (See “Definition and consequences of sleep deprivation”).
OVERVIEW OF SLEEP STAGES — From 1968 until 2007, sleep researchers and clinicians analyzed sleep using a standardized manual (published in 1968), which described both recording methods and techniques for describing sleep [1] . In 2007, the American Academy of Sleep Medicine (AASM) published a revision of this manual [2] . Starting in July of 2008, all sleep disorders centers accredited by the AASM will be required to use the modified scoring rules included in the new manual. In contrast, sleep researchers and clinicians not subject to the rules of the AASM may continue to use the older scoring rules. Sleep researchers and clinicians should state clearly which standards they are using. In the discussion that follows, the scoring rules are described according to the previous manual. Changes that exist in the new AASM manual are highlighted.
Because of the large volume of data produced in a typical 8 hour sleep study, all sleep is analyzed in 20 or 30 second epochs, with each epoch being assigned a single sleep stage. Sleep is subdivided into two general states: rapid eye movement sleep (REM) and non-rapid eye movement sleep (NREM). NREM sleep is further subdivided into four NREM stages.
REM SLEEP — Rapid eye movement sleep was first described in 1953 when researchers observed periods of relatively fast electroencephalogram (EEG) activity recurring every 90 to 120 minutes [3] . It is now generally accepted that REM sleep is characterized by three main features: A low voltage, fast frequency EEG pattern, which in many ways resembles an active, awake EEG pattern. For this reason, REM sleep is sometime called paradoxical sleep. An atonic electromyogram (EMG), consistent with inactivity of all voluntary muscles except the extraocular muscles. For all intents and purposes, the individual is paralyzed during REM sleep. The atonia of REM sleep is known to result from direct inhibition of alpha motor neurons. Atonia during REM sleep is incomplete or absent in some humans; when absent, both humans and other animals appear to act out their dreams [4] . In humans, the lack of appropriate muscle atonia during REM sleep is considered to be abnormal, causing a potentially dangerous sleep disorder called REM Behavior Disorder (RBD) [5] . The presence of rapid eye movements. The chances are high that the patient will report dreaming if awakened during this period.
Phasic and tonic REM sleep — All three primary characteristics of REM sleep are not always present simultaneously. REM sleep can be thought of as consisting of two somewhat different states, based on the occurrence of rapid eye movements in phasic bursts (phasic REM sleep) interspersed between periods of tonic REM sleep.
REM sleep is a predominantly parasympathetic (vagal) state, but during phasic REM sleep, there are sudden bursts of sympathetic nervous system (SNS) activity associated with rapid eye movements. These bursts of SNS activity have been reported to be associated with sudden increases in arterial blood pressure, cardiac or cerebral ischemia, cardiac arrhythmias, and sudden changes in heart and respiratory rates [6,7] . Short central apneas and hypopneas are also common during phasic bursts of rapid eye movements.
Long cardiac asystoles have been noted to occur in otherwise healthy young individuals during phasic bursts of REMs [8] . It has been suggested that REM sleep, and phasic REM sleep in particular, may be a trigger for cardiovascular and cerebrovascular ischemic events that are reported to occur more frequently in the early morning hours [6] .
Function of REM sleep — The function of REM sleep is uncertain, although some data suggest an important role for REM sleep in memory consolidation (see “Functions of sleep” below). Following REM sleep deprivation by medication or frequent awakenings, REM sleep rebounds to quantities higher than normal. In addition, rats die after several weeks of total deprivation of REM sleep [9] . This suggests that REM sleep plays some essential, but not yet fully understood function.
Clinical issues related to REM sleep — Several aspects of REM sleep have relevance to clinical sleep disorders: Abnormalities in REM sleep are thought to be the cause of narcolepsy. (See “Diagnosis and neurobiology of narcolepsy”). The voluntary muscle atonia of REM sleep, as well as associated autonomic and metabolic changes, may exacerbate sleep apnea. The absence of muscle atonia may result in the “acting out” of dreams in rare disorders such as REM sleep behavior disorder. This can result in injury to the patient. REM sleep may be suppressed by alcohol, monoamine oxidase inhibitors, tricyclic antidepressants, stimulants, and some hypnotic/sedative drugs. Medications with prominent anti-cholinergic effects may also delay or suppress REM sleep.
NREM SLEEP — According to the prior scoring rules, NREM sleep consists of four sleep stages, which are defined primarily by the frequency and amplitude of the EEG [1] . In contrast, the new AASM scoring rules define three NREM stages [2] .
Stage 1 sleep — Stage 1 sleep is the transition from wakefulness to deeper sleep, and is characterized by relatively fast EEG frequencies in the theta range (4 to 7 Hz). It is the lightest stage of sleep, and some sleep researchers do not consider it to be a true physiologic sleep stage. Additionally, patients awakened from stage 1 sleep typically do not perceive that they were actually asleep.
Stage 1 sleep typically accounts for 2 to 5 percent of total sleep time in young adults. An increased amount or percentage of stage 1 sleep typically suggests sleep fragmentation due to a sleep disorder.
Stage 2 sleep — Stage 2 sleep, sometimes called intermediate sleep, is a true physiologic stage of sleep. It typically accounts for 40 to 50 percent of total sleep time.
Stage 2 sleep is characterized by a slowing of EEG frequency and an increase in EEG amplitude. Two distinct features of NREM sleep appear on the EEG for the first time in this sleep stage: Sleep spindles. These are transient “spindle” shaped features of the EEG with a frequency of 12-14 Hz lasting at least 0.5 seconds. They are most prominent at the vertex of the scalp. k-complexes. These consist of a high amplitude negative wave followed by a negative wave. They are usually thought to be associated with arousal.
Benzodiazepines typically increase stage 2 sleep at the expense of stages 3 and 4 sleep.
Stages 3 and 4 sleep — Stages 3 and 4 sleep, frequently referred to as deep sleep or slow wave sleep, typically account for 20 percent of total sleep time in young adults. They are characterized by a transition to an EEG with high amplitude delta EEG waves (1.5 to 3 Hz). The new AASM scoring rules combine stages 3 and 4 as stage N3 [2] .
Function of NREM sleep — The function of NREM sleep is also uncertain, although stages 3 and 4 sleep have been reported to be associated with restorative functions of sleep, ie, restoration of alertness and energy. The arousal threshold is highest during these stages. Some data indicate that deep sleep is increased in athletes after significant physical effort.
SLEEP ARCHITECTURE — Sleep stages occur in cycles lasting 90 to 120 minutes each. Four to five such cycles occur during a typical night of sleep. During the first half of the night, the individual typically passes from wakefulness briefly into stage 1 sleep and then to stages 2, 3, and 4. Stages 3 and 2 reappear, after which REM sleep is observed for the first time. During the second half of the night, stage 2 and REM sleep alternate.
Abnormalities of sleep architecture, such as REM sleep occurring earlier than 90 to 120 minutes, may be suggestive of sleep disorders such as narcolepsy, or may result from irregular sleep/wake organization, withdrawal from certain medications (eg, tricyclic antidepressants, MAO inhibitors), or depression. Sleep disorders will increase the number of sleep stage changes and may completely disrupt the normal cycling of sleep. (See “Diagnosis and neurobiology of narcolepsy” and see “The effect of drugs on sleep quality and architecture”).
Changes with age — Both the quantity and quality of sleep change significantly with aging [10] . In general, deep or slow wave sleep (stages 3 and 4) declines with age, while light sleep (stage 1) increases. The number of arousals and the amount of wakefulness also increase in later years.
Physiologic functions— Physiologic functions, such as reflexes, physiologic feedback, and control systems, may vary with the state of consciousness. Differences occur during sleep compared to wakefulness, as well as during different stages of sleep, such as NREM, tonic REM, and phasic REM sleep (show figure 1) [11] .
MEASUREMENT OF SLEEP AND SLEEPINESS — Modern sleep medicine has a variety of objective tools for the measurement of sleep and sleepiness. Performing sleep studies as part of a diagnostic evaluation is common and is accepted by almost all insurance carriers.
Polysomnography — Sleep is generally measured during an all night sleep study or polysomnogram (PSG), which involves simultaneous recording of several physiologic variables. Sleep studies require attachment of electrodes to the scalp for recording the EEG, to the face near the right and left eyes for measurement of rapid eye movements, and to the chin for measurement of muscle tone [12] . (See “Polysomnography in obstructive sleep apnea in adults”).
Other physiologic parameters, such as airflow and breathing effort, oxyhemoglobin saturation, leg movements, electrocardiogram, and body position may also be measured depending on the purposes of the sleep study. All measurements are performed continuously throughout the patient’s usual sleep period. All physiologic tracings are then analyzed, and a final report of sleep quantity and quality is prepared and interpreted.
Sleep studies are most often performed in specially designed and equipped laboratories, which are staffed by trained polysomnographic technologists. Sleep studies may also be performed in the home using ambulatory equipment. Ambulatory studies are not as comprehensive as studies in the sleep laboratory, but may be sufficient for more limited purposes. Significant controversy remains about the validity and reliability of ambulatory sleep studies in the patient’s home, especially if a technician is not present. (See “Portable monitoring in obstructive sleep apnea in adults”).
Multiple sleep latency test — The multiple sleep latency test (MSLT) is an objective measure of daytime sleepiness that has been in common use for more than 15 years [13] . It was developed because patients frequently appear to be unaware of just how sleepy they are. The test is based upon an operational definition of sleepiness: the sleepier an individual is, the faster (s)he will fall asleep. The following protocol is typically used: The patient is given four to five opportunities to nap, usually at two hour intervals during the day. On each occasion, the individual is asked to lie down on a bed in a quiet, darkened sleep room and fall asleep as quickly as possible. The EEG, eye movements, and muscle tone are measured during the test. The latency from wakefulness to sleep onset is measured to determine the “sleep latency.” Each session is terminated after 15 minutes of sleep.
The process is repeated during each of the four to five naps, and a mean sleep latency across all the naps is computed. Generally, a mean sleep latency of 5 minutes or less is considered indicative of severe daytime sleepiness, while a mean sleep latency of 15 minutes or longer is consistent with normal alertness. The abnormal appearance of REM sleep during two or more of the four to five naps is also thought to be consistent with a diagnosis of narcolepsy.
Maintenance of wakefulness test — The maintenance of wakefulness test (MWT) is a variant of the MSLT [14] . However, it differs in its goals as well as in the nature of the instructions given to the patient. Patients are typically tested while reclining in a quiet, darkened room. Instead of being asked to fall asleep as quickly as possible, they are requested to stay awake for as long as possible.
Conceptually, the MWT is a test of the individual’s ability to stay awake, and it is therefore believed to be a more practical test of whether a person’s sleepiness is likely to impair the ability to drive or work. The MWT also allows the element of motivation to enter into the equation, as is likely to be the case in real life situations.
Epworth sleepiness scale — The Epworth sleepiness scale is a paper and pencil scale that has come into widespread use, typically as part of an office evaluation [15] . It describes a number of situations (eg, as a passenger in a car, sitting quietly after lunch, etc) and asks the patient to rate how likely it would be for him or her to become drowsy or fall asleep in those situations (show figure 2). Although there are no well established norms, a score >12 is usually thought to be abnormal.
FUNCTIONS OF SLEEP — There is no general agreement about the possible function(s) of sleep, or even about whether there is one or more than one function of sleep. Numerous theories have been raised over the years [16,17] . One, some, all, or none of these theories may be true. The most prominent theory is the Restorative Theory of Sleep, which, in its simplest for
May 5th, 2012 at 6:54 pm
Only the main shrine of the 89-year-old Wat Ananda Metyarama temple will be preserved in the renovation; everything else will be built anew. Temple officials, timing this announcement for Vesak Day …
May 16th, 2012 at 5:26 pm
RT WHAT? NO!! RT Official: Dani Alves has broken his collarbone on training today and will undergo surgery this afternoon #fcblive
May 20th, 2012 at 4:47 pm
Daisy, a 3-year-old red river hog, lay on the exam table at the Sacramento Zoo’s veterinary hospital surrounded by a crowd of student vets.
Emily Harryman watches Daisy, a 3-year-old red river hog, undergo an imaging scan at the Sacramento Zoo’s veterinary hospital. The ultrasound revealed that Daisy was pregnant with three piglets.
Cal Foster, center, and his brother Jordy, left, watch Daisy the hog’s ultrasound through a window in the wall of the operating room. Visitors can also watch through a newly installed audiovisual system.