Sleep architecture of elite soccer players surrounding match days as measured by WHOOP straps

This study aimed to quantify and compare sleep architecture before and after home and away matches in elite soccer players from the English Premier League. Across two seasons, 6 male players (age 28 ± 5 y; body mass 85.1 ± 9.5 kg; height 1.86 ± 0.09 m) wore WHOOP straps to monitor sleep across 13 matches that kicked off before 17:00 h. For each, sleep was recorded the night before (MD-1), after (MD) and following the match (MD +1). Across these 3 days total sleep time (TST), sleep efficiency (SE), sleep disturbances, wake time, light sleep, deep sleep, REM sleep, sleep and wake onsets, alongside external load, were compared. TST was reduced after MD versus MD +1 (392.9 ± 76.4 vs 459.1 ± 66.7 min, p = 0.003) but no differences existed in any other sleep variables between days (p > 0.05). TST did not differ after home (386.9 ± 75.7 min) vs. away matches (401.0 ± 78.3 min) (p = 0.475), nor did other sleep variables (p > 0.05). GPS-derived external load peaked on MD (p < 0.05). In conclusion, despite reduced TST on MD, sleep architecture was unaffected after matches played before 17:00 h, suggesting sleep quality was not significantly compromised.

Evaluation of a Sepsis Alert in the Pediatric Acute Care Setting

BACKGROUND

Severe sepsis can cause significant morbidity and mortality in pediatric patients. Early recognition and treatment are vital to improving patient outcomes.

OBJECTIVE

The study aimed to evaluate the impact of a best practice alert in improving recognition of sepsis and timely treatment to improve mortality in the pediatric acute care setting.

METHODS

A multidisciplinary team adapted a sepsis alert from the emergency room setting to facilitate identification of sepsis in acute care pediatric inpatient areas. The sepsis alert included clinical decision support to aid in timely treatment, prompting the use of intravenous fluid boluses, and antibiotic administration. We compared sepsis-attributable mortality, time to fluid and antibiotic administration, proportion of patients who required transfer to a higher level of care, and antibiotic days for the year prior to the sepsis alert (2017) to the postimplementation phase (2019).

RESULTS

We had 79 cases of severe sepsis in 2017 and 154 cases in 2019. Of these, we found an absolute reduction in both 3-day sepsis-attributable mortality (2.53 vs. 0%) and 30-day mortality (3.8 vs. 1.3%) when comparing the pre- and postintervention groups. Though our analysis was underpowered due to small sample size, we also identified reductions in median time to fluid and antibiotic administration, proportion of patients who were transferred to the intensive care unit, and no observable increase in antibiotic days.

CONCLUSION

Electronic sepsis alerts may assist in improving recognition of sepsis and support timely antibiotic and fluid administration in pediatric acute care settings.

6th vital sign app: Testing validity and reliability for measuring gait speed

BACKGROUND

Gait speed tests are useful predictors of different health outcomes in people. These tests can be administered by the convenience of one's smartphone.

RESEARCH QUESTION

Is the 6th Vital Sign app valid and reliable for measuring gait speed?

METHODS

The study used a prospective test-retest design. Fifteen college subjects were asked to walk at their normal pace for 2 min. Each subject performed two trials. Speed was recorded by the 6th Vital Sign app, Brower timing gates, and by hand-measurement of distance walked divided by the 2 min. Criterion validity was assessed by paired t-tests, Cohen's D effect sizes, and Pearson correlation tests. Inter-trial reliability within each device was assessed with Pearson correlation tests.

RESULTS

Speed measured by the app was significantly lower than speed measured by gates (p = 0.004) and by hand-measurement (p = 0.009). The difference between gates and hand-measurement was not significant (p = 0.684). The speed measured by gates and hand-measurement were very highly correlated (r = 0.974), but speed measured by app was only moderately correlated with gates (r = 0.370) and hand-measurement (r = 0.365). The inter-trial reliability was fairly high with correlations r = 0.916, 0.944, and 0.941 when speed was measured by the app, gates, and hand-measurement, respectively.

SIGNIFICANCE

The app tended to underestimate speed when compared to gate and hand-measurements. Therefore, we conclude that the 6^th Vital Sign app is not valid for use for clinical diagnosis or prognosis.

Associations between neural correlates of visual stimulus processing and set-shifting in ill and recovered women with anorexia nervosa

Women ill with anorexia nervosa (AN) have been shown to exhibit altered cognitive functioning, particularly poor set-shifting (SS). In this study, we investigated whether brain activation in frontal and parietal regions during visual stimulus processing correlates with SS ability. Women currently ill with AN (AN; N=14), recovered women (REC; N=14) and healthy controls (HC; N=15), viewed alternating blocks of food and non-food pictures during functional magnetic resonance imaging (fMRI). The Berg's Card Sorting Task was completed outside the scanner to measure SS. A priori regions of interest (ROIs) were defined in frontal and parietal regions. The activation during visual stimulus processing in several ROIs correlated positively with poor SS ability in REC, particularly in the left dorsal anterior cingulate cortex (dACC). The correlations with poor SS ability were opposite in AN patients, particularly in the right dACC. These findings underscore that addressing heightened levels of cognitive control associated with higher frontal activation could reduce cognitive inflexibility in recovered women. In AN, greater activation in frontal and parietal regions might be necessary to perform at normal levels during various tasks. Thus, weight restoration could be necessary for AN patients prior to addressing cognitive inflexibility.

The challenge of West Nile virus in Europe: knowledge gaps and research priorities

West Nile virus (WNV) is continuously spreading across Europe, and other continents, i.e. North and South America and many other regions of the world. Despite the overall sporadic nature of outbreaks with cases of West Nile neuroinvasive disease (WNND) in Europe, the spillover events have increased and the virus has been introduced into new areas. The high genetic diversity of the virus, with remarkable phenotypic variation, and its endemic circulation in several countries, require an intensification of the integrated and multidisciplinary research efforts built under the 7th Framework Programme of the European Union (FP7). It is important to better clarify several aspects of WNV circulation in Europe, including its ecology, genomic diversity, pathogenicity, transmissibility, diagnosis and control options, under different environmental and socio-economic scenarios. Identifying WNV endemic as well as infection-free areas is becoming a need for the development of human vaccines and therapeutics and the application of blood and organs safety regulations. This review, produced as a joint initiative among European experts and based on analysis of 118 scientific papers published between 2004 and 2014, provides the state of knowledge on WNV and highlights the existing knowledge and research gaps that need to be addressed with high priority in Europe and neighbouring countries.

Altered food-cue processing in chronically ill and recovered women with anorexia nervosa

Anorexia nervosa (AN) is a severe mental disorder characterized by food restriction and weight loss. This study aimed to test the model posed by Brooks et al. (2012a,b) that women suffering from chronic AN show decreased food-cue processing activity in brain regions associated with energy balance and food reward (bottom-up; BU) and increased activity in brain regions associated with cognitive control (top-down; TD) when compared with long-term recovered AN (REC) and healthy controls (HC). Three groups of women, 15 AN (mean illness duration 7.8 ± 4.1 years), 14 REC (mean duration of recovery 4.7 ± 2.7 years) and 15 HC viewed alternating blocks of food and non-food images preceded by a short instruction during functional magnetic resonance imaging (fMRI), after fasting overnight. Functional region of interests (fROIs) were defined in BU (e.g., striatum, hippocampus, amygdala, hypothalamus, and cerebellum), TD (e.g., medial and lateral prefrontal cortex, and anterior cingulate), the insula, and visual processing areas (VPA). Food-cue processing activation was extracted from all fROIs and compared between the groups. In addition, functional connectivity between the fROIs was examined by modular partitioning of the correlation matrix of all fROIs. We could not confirm the hypothesis that BU areas are activated to a lesser extent in AN upon visual processing of food images. Among the BU areas the caudate showed higher activation in both patient groups compared to HC. In accordance with Brooks et al.'s model, we did find evidence for increased TD control in AN and REC. The functional connectivity analysis yielded two clusters in HC and REC, but three clusters in AN. In HC, fROIs across BU, TD, and VPA areas clustered; in AN, one cluster span across BU, TD, and insula; one across BU, TD, and VPA areas; and one was confined to the VPA network. In REC, BU, TD, and VPA or VPA and insula clustered. In conclusion, despite weight recovery, neural processing of food cues is also altered in recovered AN patients.

Longitudinal changes in the physical activity of adolescents with anorexia nervosa and their influence on body composition and leptin serum levels after recovery

Objective

Patients with anorexia nervosa (AN) are often observed to have high levels of physical activity, which do not necessarily diminish after a successful therapy. Previous studies have shown that body fat tissue recovery in these patients is associated with a disproportional restoration of the adipocyte hormone, leptin. Therefore, we wondered whether the individual variation in physical activity in AN patients prior to treatment may be related to body fat percentage and plasma leptin level outcome.

Method

Body fat percentage, leptin serum, and physical activity levels (accelerometer) were measured in adolescents with an (n=37, age 13 to 17.5 years) at initial assessment, at the end of study participation (median 12 months), and at one-year follow-up.

Results

Accelerometer data were used to split the patients in two groups: those with low (n=26) and those with high levels of physical activity (HLPA, n=11). These groups did not differ in terms of age, IQ, presence of menses, BMI and season of admission. The HLPA group was characterized by a longer total duration of illness. Physical activity levels during therapy decreased for the group with initially HLPA and increased for the group with low levels of physical activity (to comparable levels). Physical activity remained stable after one year. The increase in body fat percentage and leptin levels were dependent on the recovery status; however, recovered patients with initially HLPA had significantly higher fat mass during the follow-up.

Discussion

HLPA, an important modulator of AN progression in adolescents, can be successfully diminished by therapeutic intervention. Among recovered patients, those with initially HLPA had higher fat mass levels than those with low levels of physical activity. This finding suggests that HLPA are an important modulator of the body composition recovery mechanism.

Neuropsychological weaknesses in anorexia nervosa: set-shifting, central coherence, and decision making in currently ill and recovered women

OBJECTIVE

The purpose of this study is to examine set-shifting, central coherence, and decision making in women currently ill with anorexia nervosa (AN), women recovered from AN, and healthy control women. We aim to test whether these neuropsychological weaknesses persist after recovery, and explore relations between the impairments

RESULTS

Compared to control women, ill and recovered women showed poor set-shifting and decision making. There were strong correlations between set-shifting and central coherence in the ill and recovered women. Decision making did not correlate with the other measures.

DISCUSSION

The present findings suggest that impaired set-shifting and decision making are stable traits in women with AN. Because individual differences within these groups were large, a rigid thinking style is only present in a (sub)population of ill and recovered women. Decision-making performance is not related to a rigid thinking style, but further research in this area is warranted.

Cutaneous short-interfering RNA therapy

Since the 1990s, RNA interference (RNAi) has become a major subject of interest, not only as a tool for biological research, but also, more importantly, as a therapeutic approach for gene-related diseases. The use of short-interfering RNAs (siRNAs) for the sequence-specific knockdown of disease-causing genes has led to numerous preclinical and even a few clinical studies. Applications for cutaneous delivery of therapeutic siRNA are now emerging owing to a strong demand for effective treatments of various cutaneous disorders. Although successful studies have been performed using several different delivery techniques, most of these techniques encounter limitations for translation to the clinic with regards to patient compliance. This review describes the principal findings and applications in cutaneous RNAi therapy and focuses on the promises and pitfalls of the delivery systems.

Medication safety program reduces adverse drug events in a community hospital

BACKGROUND

There is widespread interest in improving medication safety, particularly in the hospital setting. Numerous suggestions have been made as to how this should be done, but there is a paucity of data demonstrating the effectiveness of any of the interventions that have been proposed.

OBJECTIVES

To assess the impact of a wide ranging, community hospital based patient safety program on patient harm as measured by the rate of adverse drug events.

DESIGN

An audit of discharged hospital patients was conducted from January 2001 to December 2003. Baseline data were collected for the first 6 months and multiple drug protocols and other interventions were instituted on the nursing units and in the pharmacy department over the subsequent 9 months (transition period). These interventions were largely based on information about medication risks acquired from internal medication event reporting. Each month of the study adverse drug events (ADE) were sought from a random sample of inpatient charts. A trigger tool was used to detect clues to ADEs, the presence of which was confirmed or excluded by detailed manual chart review. The severity of these events was categorized using the classification system of the National Coordinating Council for Medication Error and Reporting and Prevention.

MAIN OUTCOME MEASURES AND RESULTS

Median ADEs per 1000 doses of medication dispensed declined significantly from 2.04 to 0.65 (p<0.001). Median ADEs per 100 patient days declined significantly from 5.07 to 1.30 (p<0.001). The proportion of inpatients with one or more ADE in the baseline period was 31% and declined threefold (p<0.001). The severity of reported medication events also declined. The number of ADEs associated conclusively with patient harm was 1.67 per total doses delivered in the baseline period and declined eightfold (p<0.001).

CONCLUSION

The implementation of a carefully planned series of low cost interventions focused on high risk medications, driven by information largely from internal event reporting, and designed to improve a hospital's medication safety leads to a significant decrease in patient harm.

The role of the novel D2/beta2-agonist, Viozan (sibenadet HCl), in the treatment of symptoms of chronic obstructive pulmonary disease: results of a large-scale clinical investigation

Viozan (sibenadet HCl, AR-C68397AA) is a novel dual D2 dopamine receptor, beta2-adrenoceptor agonist, developed specifically to treat the key symptoms of chronic obstructive pulmonary disease (COPD), breathlessness, cough and sputum. The dual sensory nerve modulation and bronchodilator effects of sibenadet have been demonstrated in initial dose-ranging studies of patients with COPD and large-scale clinical evaluation has now been completed. Sibenadet efficacy was determined by assessing symptomatic changes, as defined by the novel assessment tool, the Breathlessness, Cough and Sputum Scale (BCSS). The findings of two placebo-controlled studies are reported. These multicentre, double-blind, placebo-controlled studies recruited over 2000 patients with stable COPD, randomized to receive sibenadet (500 microg) or placebo, pressurized metered-dose inhaler (pMDI) (three times daily) for a period of 12 or 26 weeks. Diary cards were completed daily by patients throughout the study to record BCSS scores, peak expiratory flow (PEF), study drug and rescue bronchodilator usage, changes in concomitant medication and adverse events. The primary endpoints were defined as change from baseline to the final 4 weeks of the treatment period in mean BCSS total score, and forced expiratory volume in one second (FEV1) measured 1 hour after administration of the final dose of study drug and expressed as a percentage of the predicted FEV1. In addition, clinic assessments were made to determine changes in pulmonary function, health-related quality of life, perception of treatment efficacy and adverse events. Despite initial improvements in mean daily BCSS total scores in patients receiving sibenadet, the difference in the change from baseline to the final 4 weeks of the treatment period between the two treatment groups was neither statistically significant, nor considered to be of clinical importance. Although marked bronchodilator activity was seen early on with sibenadet treatment, the duration of effect diminished as the studies progressed. Sibenadet use was not associated with any safety concerns. These studies, utilizing the novel BCSS, have clearly illustrated that, despite initial symptomatic improvement with sibenadet therapy, this clinical benefit was not sustained over the course of the study.

A comparative study of the effects of carbamazepine and the NMDA receptor antagonist remacemide on road tracking and car-following performance in actual traffic

RATIONALE

Antiepileptic drugs are known to produce side effects which may impair driving performance. Performance effects, however, may differ substantially between individual antiepileptic drugs.

OBJECTIVE

To compare the effects of carbamazepine, remacemide, and placebo on actual driving performance during a 12-day incremental dosing regimen.

METHODS

Twenty-two healthy volunteers participated in a three-way, double-blind, cross-over driving study. Treatment effects were assessed in two actual driving tests carried out on days 8, 10, and 12 of each treatment period. The Road Tracking Test involved driving an instrumented vehicle at a constant speed and steady lateral position between the delineated lane boundaries. Standard deviation of lateral position (SDLP) was measured to indicate precision of road tracking control. The Car-Following Test involved driving the same vehicle behind a leading car and maintaining that distance while the latter executed a series of deceleration/acceleration maneuvers. Time to speed adaptation (TSA) and brake reaction time were the primary measures.

RESULTS

Remacemide did not affect the subjects' driving performance. Carbamazepine increased SDLP throughout treatment and lengthened TSA on day 8. Changes in SDLP relative to placebo were comparable to those previously seen in drivers conducting the same test with blood alcohol concentrations of 0.05 g/dl.

CONCLUSION

Remacemide, at the given dose regimen, does not affect driving performance. Carbamazepine, at the given dose regimen, can produce mild but sufficient impairment to put epileptic patients at risk when driving, at least during initiation therapy.

Interactions between oligonucleotides and cationic polymers investigated by fluorescence correlation spectroscopy

PURPOSE

To evaluate whether fluorescence correlation spectroscopy (FCS) can be used to characterize the complexation between oligonucleotides and cationic polymers.

METHODS

The features of the complexes between rhodamine labeled oligonucleotides (Rh-ONs) and poly(2-dimethylamino)ethyl methacrylate (pDMAEMA), poly(ethylene glycol)-poly(ethyleneimine) (pEG-pEI), and diaminobutane-dendrimer-(NH2)64 (DAB64) were characterized by light scattering, electrophoretic mobility, electrophoresis, and FCS.

RESULTS

At low polymer/Rh-ON ratios, a decrease of the fluorescence of the Rh-ONs was observed on binding of the Rh-ONs to all cationic polymers. This was explained by the creation of "multimolecular complexes" in which the Rh-labels quench each other. The multimolecular complexes, which are highly fluorescent as they carry a number of Rh-ONs, resulted in high fluorescence peaks in the fluorescence fluctuation profile as measured by FCS. For pDMAEMA and DAB64, at higher polymer/Rh-ON ratios the fluorescence of the polyplexes increased, caused by the formation of "monomolecular complexes," which consist of only one Rh-ON per polymer. In the case of pEG-pEI, the fluorescence stayed constant when the polymer/Rh-ON ratio increased, so multimolecular polyplexes remained. FCS confirmed these results as the high fluorescence peaks disappeared in case of pDMAEMA/Rh-ON and DAB64/Rh-ON dispersions, but remained present for pEG-pEI/Rh-ON dispersions.

CONCLUSIONS

FCS seems applicable for study of the interactions between ONs and different types of cationic polymers.

Health promotion partnerships: service and education addressing the health needs of vulnerable groups

This paper describes partnerships between service and education that can assist in meeting the health care needs of vulnerable population groups. Baccalaureate nursing students learn about population-based nursing practice as a means of addressing health needs. Each semester, groups of 8-10 senior students work with a community agency serving a population at risk. Students assess health needs and plan, implement, and evaluate a health promotion intervention with the population and the agency. Emphasis is placed on designing culturally appropriate interventions that are accomplished in partnership with the agency and population. Projects which illustrate the generalizability of this approach will be discussed. Such experiences reduce barriers that separate education from practice. Community agencies benefit as health needs that might not otherwise be met are addressed.

Resolution of erectile dysfunction and inhibited male orgasm in a single homosexual male and transfer of inhibited male orgasm cure to his partner: a case report

The following case study illustrates the treatment of a single male with an erectile dysfunction as well as an inability to achieve orgasm by partner stimulation. His partner also suffered from the latter dysfunction. Although we never saw his partner, we were able to cure both dysfunctions in the patient and reportedly his partner's difficulty as well.

Competency-based orientation for clinical nurse educators

The orientation process highlights entry into new roles and responsibilities. The attainment of competence in this process can be enhanced through the appropriate identification of requisite knowledge and skills and the use of creative tools to establish an organized process and documentation of progress. Clinical educators in acute care settings require an orientation program that incorporates both clinical and educational components. Formal communication between a new hire and preceptor and subsequent documentation for both administrative and peer review provide increased accountability. Therefore, a variety of strategies, often melding the clinical and teaching roles, becomes crucial to a successful orientation program.

Safety of lumbar puncture in patients with hemophilia

STUDY OBJECTIVE

To determine the safety of lumbar puncture in patients with hemophilia who are pretreated with clotting factor.

DESIGN

Retrospective analysis of medical records between 1980 and 1990.

SETTING

Three hospitals, each serving as a regional hemophilia center.

PARTICIPANTS

Thirty-three patients with hemophilia A or B who received one or more lumbar puncture.

INTERVENTION

All patients received replacement of deficient factor before the lumbar puncture. Serious post-lumbar puncture complications were defined as motor or sensory deficits, incontinence, or documented intraspinal hemorrhage.

RESULTS

Thirty-three patients with hemophilia A or B received a total of 52 lumbar punctures during the study period. Thirty of 33 patients (91%) had severe baseline factor deficiency, two (6%) had moderate deficiency, and one (3%) had mild deficiency. There were no serious complications reported as a result of the lumbar puncture. The 95% confidence interval for the risk of a serious complication was 0% to 5.8%.

CONCLUSION

With adequate factor replacement, a lumbar puncture can be done safely in patients with hemophilia.

Universal precautions: how effective are they against methicillin-resistant Staphylococcus aureus?

1. Because MRSA is commonly carried asymptomatically, colonized patients and caregivers are usually not recognized. During outbreaks, colonized and infected patients act as reservoirs and caregivers become transient carriers. 2. Because universal precautions and body substance isolation were originally developed in response to the AIDS epidemic to meet the safety needs of hospital caregivers, the use of universal precautions in extended care facilities should be further studied and refined. 3. In planning for effective training, enforcement, and compliance with universal precautions, it is essential that employees understand not only the importance of protecting themselves, but also the need to prevent cross-infection. 4. If a patient has an MRSA respiratory tract infection, the environment, including the air, may become heavily contaminated. Caregivers should wear masks to prevent nasal colonization.

Wedge resection in host cornea to correct post-keratoplasty astigmatism

The obvious problem with surgery of this nature is that the amount of wedge to be removed is partially guess work. Doctor Troutman's keratoscope attachment to his microscope is very helpful. I have tried thermokeratoplasty in a very similar case, but the disadvantages of pain, ulceration, vascularization, and considerable return to pre-burn K readings have made me abandon this technique. If there is an obvious override, then the keratoplasty wound itself must be revised in the usual manner. However, for the present, when a graft looks perfect but the K readings reveal otherwise, a judicious wedge resection between graft and limbus (location being in the flattest meridian) would appear to be a most reasonable operation.

Anaesthesia for autokeratoplasty. Some important considerations illustrated by a case report

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