Sleep pattern gender differences and fragmentation in postpartum parents of twins.

OBJECTIVE: Parents of newborn twins are at risk for both shortened sleep duration and sleep discontinuity. The purpose of this study was to characterize weekday and weekend sleep duration, sleep continuity, and awakenings in both mothers and fathers of newborn twins during the first 3 months at home. MATERIAL AND METHODS: Sleep-wake parameters were assessed at two time points using self-report diaries and actigraphy in 75 families with newborn twins. To assess sleep on weekdays and weekends with minimal subject burden, actigraphy recordings of both parents commenced at 9:00 p.m. Saturday and terminated at 9:00 p.m. Tuesday. RESULTS: Mean sleep duration over 24 hours for parents of twins ranged between 6.7 and 7.5 hours during the first 3 months postpartum and did not significantly differ on weekdays or weekends for mothers. Weekend sleep was more fragmented for fathers at both one month and three months with more awakenings, compared to weekday sleep. Mothers had more fragmented night sleep compared to fathers at one month. In contrast, at three months postpartum fathers had shorter total sleep time and night sleep time, but fewer night awakenings on weekdays than mothers. No differences were observed in weekend sleep duration or sleep patterns between mothers and fathers at three months. DISCUSSION: Consolidated sleep periods for both parents averages three hours or less during the first three months postpartum and sleep for both parents is fragmented. In families with newborn twins, the extent of sleep disruption for mothers and fathers is similar.

A brief intervention to reduce burnout and improve sleep quality in medical students.

BACKGROUND: Perceived stress, burnout, and poor sleep quality are high among medical students. Interventions designed to target these issues are necessary to promote the health and well-being of medical students. The purpose of this study was twofold: 1) to assess the feasibility of implementing a sunrise alarm clock intervention with medical students and 2) to evaluate the impact of the intervention on perceived stress, burnout scores, and sleep quality. METHODS: We conducted a feasibility study to evaluate the efficacy of a two-week, sunrise alarm clock intervention in combination with electronic device removal at bedtime. We assessed first- and second-year medical students' perceived stress, burnout scores, including Emotional Exhaustion, Depersonalization, and Low Sense of Personal Achievement, and sleep quality before and after the intervention. In addition, we measured smartphone addiction prior to the intervention. RESULTS: A total of 57 students consented to participate, of which 55 completed both the pre- and post-assessments (3.5% attrition). The mean age of the participants was 24.8 ± 1.9 years, 50.9% (n = 29) identified as women, and 68.4% (n = 39) identified as white. Pre-intervention, 42.1% (n = 24) of students met criteria for smartphone addiction and 77.2% (n = 44) met criteria for poor sleep quality. In addition, 22.8% (n = 13) of participants had high emotional exhaustion, 64.9% (n = 31) high depersonalization, and 42.1% (n = 24) low sense of personal accomplishment prior to the intervention. Following the two-week intervention, participants showed improvements in emotional exhaustion (p = 0.001, Cohen's d = 0.353), depersonalization (p = 0.001, Cohen's d = 0.411) low sense of personal accomplishment (p = 0.023, Cohen's d = 0.275), perceived stress (p < .001, Cohen's d = .334), and sleep quality (p < 0.001, Cohen's d = 0.925). The number of participants who reported poor sleep quality decreased to 41.8% (n = 23), demonstrating a significant decline (p = 0.026). Participants also improved subjective sleep quality (p < 0.001, Cohen's d = 1.033), sleep duration (p = 0.001, Cohen's d = 0.431), sleep latency (p < 0.001, Cohen's d = 0.433), and sleep efficiency (p = 0.021, Cohen's d = 0.673). CONCLUSIONS: These findings suggest that the two-week sunrise alarm clock protocol with electronic device removal was effective in improving sleep quality and reducing burnout scores, and perceived stress. However, additional research comparing this intervention to a proper control group is needed to draw meaningful conclusions about the effectiveness of this intervention.

Burnout, Perceived Stress, Sleep Quality, and Smartphone Use: A Survey of Osteopathic Medical Students.

CONTEXT: Burnout is a psychological syndrome that results from prolonged exposure to stressful work activities and includes 3 dimensions: emotional exhaustion (EE), depersonalization (DP), and low sense of personal accomplishment (PA). Burnout is a widespread problem in numerous professions but is particularly high among medical students, residents, and early-career physicians compared with college graduates of similar age. However, minimal research has addressed burnout in osteopathic medical students. OBJECTIVE: To assess levels of burnout in osteopathic medical students and to examine the relationship among burnout, perceived stress, sleep quality, and smartphone use. METHODS: This study used a cross-sectional study design and an anonymous, electronic questionnaire service to administer the Maslach Burnout Inventory, the Perceived Stress Scale-4, the Pittsburgh Sleep Quality index, and the Smartphone Addiction Scale Short Version. RESULTS: A total of 385 participants (mean [SD] age, 25 [2.4] years; 208 [54.0%] women; 286 [74.3%] white; 138 [35.8%] second-year osteopathic medical students [OMSs]) completed the survey. Of the 385 participants, 9 (2.3%) reported high EE, 67 (17.4) reported high DP, and 310 (80.5) reported a high level of low PA. When comparing dimensions of burnout by gender, only levels of PA differed by gender, with men reporting higher levels of burnout compared with women (χ12=5.2, P=.022). Further, levels of DP differed by year in medical school (χ 2=17.3, P=.008), with post-hoc comparisons showing differences between OMS I and OMS III (F=4.530, df=3, P=.004). Linear regression models showed that higher perceived stress (standardized ß=0.5, P<.001), poorer sleep quality (standardized ß=0.2, P=.001), and higher smartphone addiction scores (standardized ß=0.1, P<.001) were associated with higher EE. Similarly, higher perceived stress (standardized ß=0.2, P<.001), poorer sleep quality (standardized ß=0.2, P=.001), and higher smartphone addiction scores (standardized ß=0.2, P=.001) were associated with higher DP. Only higher perceived stress was associated with higher levels of low PA (standardized ß=-0.4, P<.001). CONCLUSIONS: These findings suggest independent associations with EE, DP, perceived stress, sleep quality, and smartphone use. Additional research with a larger, more diverse sample is needed to confirm these findings. If confirmed, wellness interventions can be designed to target 2 modifiable factors: sleep quality and smartphone use.

Sleeping Arrangements in Families with Twins.

This paper describes home sleeping arrangements used by parents of twins and investigates whether room sharing (twins in the same room as parents) or cobedding (crib-sharing between twins) influences parental night time sleep duration or sleep quality. A secondary analysis of data obtained from a longitudinal study of sleep in 104 families with twins was undertaken. Over 65% of twins were cobedded at 4 weeks; this decreased to approximately 42% by 13 weeks of age. Approximately 64% of families practiced room sharing at 4 weeks, this decreased to approximately 40% by 13 weeks of age. Mothers and fathers who both room shared and cobedded their twins at 9 weeks of age were most likely to experience restricted sleep duration when compared to other sleeping arrangements. Results suggest that parents of twins may not be following the most recent AAP recommendations regarding safe infant sleep for multiple birth infants.

Assessment of Cytomegalovirus Hybrid Preventative Strategy in Pediatric Heart Transplant Patients.

BACKGROUND: Prevention strategies for cytomegalovirus (CMV) in pediatric transplant recipients are sparsely reported. A hybrid strategy that combines prophylaxis with preemptive therapy using serial CMV viral load monitoring is an emerging option. We report our clinical outcomes with a hybrid strategy in pediatric heart transplant recipients. METHODS: A retrospective chart review was performed for pediatric heart transplant recipients who received a hybrid strategy of 2-4 weeks intravenous ganciclovir followed by serial whole blood CMV monitoring from 2002 to 2010. Subject demographics, medications, drug levels, serial CMV viral loads, intravascular ultrasound and angiography reports, and histopathology were collected. Descriptive statistics and patient groups were compared using χ(2), Fisher's exact, and Wilcoxon rank-sum tests. RESULTS: Twelve females and 13 males, ranging from 4 months to 19 years of age, underwent 26 heart transplants. Mean follow-up was 39 months (range, 5-94 months). Fourteen (54%) subjects were CMV donor (D) + /recipient (R) - , 8 (31%) were D + /R + , and 4 (15%) were D - /R + . Six subjects (23%) died of complications unrelated to CMV. Median prophylaxis duration was 25 days (range, 7-70 days). Ten (38%) subjects developed CMV infection: 1 subject had 2 episodes of CMV syndrome, and 1 subject had 2 episodes CMV. Although 6 of 14 patients with coronary artery vasculopathy had prior CMV, no association was found (P = .81). Median time to first CMV DNAemia was 2.3 months (range, 9 days to 24.8 months). Median time to viral load clearance was 29 days (range, 4-233 days). In addition, 25 D - /R- patients were transplanted and received no prophylaxis; 2 (8%) patients developed CMV infection. CONCLUSIONS: Pediatric heart transplant recipients who were at risk for CMV and treated with a novel preventative hybrid strategy developed CMV infection, syndrome, and disease at rates similar to those reported in literature for prophylactic strategies.

Nanoparticle-wetted surfaces for relays and energy transmission contacts.

Submonolayer coatings of noble-metal nanoparticle liquids (NPLs) are shown to provide replenishable surfaces with robust asperities and metallic conductivity that extends the durability of electrical relays by 10 to 100 times (depending on the current driven through the contact) as compared to alternative approaches. NPLs are single-component materials consisting of a metal nanoparticle core (5-20 nm Au or Pt nanoparticles) surrounded by a covalently tethered ionic-liquid corona of 1.5 to 2 nm. Common relay failure modes, such as stiction, surface distortion, and contact shorting, are suppressed with the addition of a submonolayer of NPLs to the contact surfaces. This distribution of NPLs results in a force profile for a contact-retraction cycle that is distinct from bare Au contacts and thicker, multilayer coatings of NPLs. Postmortem examination reveals a substantial decrease in topological change of the electrode surface relative to bare contacts, as well as an indication of lateral migration of the nanoparticles from the periphery towards the contact. A general extension of this concept to dynamic physical interfaces experiencing impact, sliding, or rolling affords alternatives to increase reliability and reduced losses for transmittance of electrical and mechanical energy.