Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents.

Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.

Evaluation of 1,4-dioxane attenuation processes at the Gelman Site, Michigan, USA.

1,4-Dioxane released at the Gelman Site in Washtenaw County, Michigan, produced a series of contaminant plumes migrating up to 3 km through a heterogenous glacial aquifer system. An analysis of 1,4-dioxane concentrations in the Eastern Area of the Gelman Site between 2011 and 2017 documented a mass balance deficit of 2200 kg in excess of 2100 kg of 1,4-dioxane removed via remediation. Five mechanisms were evaluated to account for the mass deficiency: sorption, matrix diffusion, biodegradation, surface discharge, and bypass of the existing monitoring well network. The mass of 1,4-dioxane sorbed to aquifer and aquitard materials and the mass of 1,4-dioxane diffused into low permeability zones were estimated. However, decreasing aqueous concentrations across most of the contaminated area between 2011 and 2017 are expected to induce desorption and back diffusion during this period. Surface water discharge to a storm drain in the downgradient portion of the site was analyzed using concentration measurements and stream gage data. Results suggest that 1,4-dioxane mass entering the drain during the period between 2011 and 2017 was insufficient to account for the mass deficiency. Although available geochemical measurements indicate predominantly anaerobic aquifer conditions at the Gelman Site, biodegradation of 1,4-dioxane was estimated using first order decay rate constants from other sites where conditions may be more favorable. Results suggest that biodegradation could explain some but not all of the missing mass. Bypass of the downgradient monitoring well network is the most parsimonious explanation for the 1,4-dioxane mass deficit. This conclusion is supported by documented flow path complexity through the aquifer system and the sparse density of monitoring wells in the downgradient Eastern Area. These findings underscore the importance of characterizing aquifer heterogeneity when modeling and remediating persistent groundwater contaminants such as 1,4-dioxane.

Eveningness chronotype preference among individuals at clinical high risk for psychosis.

BACKGROUND: Circadian rhythm disturbances are frequently implicated in psychosis. Indeed, research has suggested several avenues by which circadian rhythms may play a mechanistic role as well as contribute to clinical outcomes. Despite its potential role as a risk factor, little is known about circadian rhythm disruption among individuals at clinical high risk (CHR) for psychosis, clinical correlates, or specificity to the psychosis risk syndrome. METHODS: Eighty-four CHR, 74 individuals with depressive disorders (DD), and 101 non-psychiatric controls (NPC) participated in structured clinical interviews and provided self-reports of chronotype preference. Clinical (positive, negative, anxious, and depressive symptoms) and social functioning outcomes were self-reported and/or clinician-rated. Analyses of covariance controlling for demographics examined group differences in chronotype preference, and partial Pearson correlations evaluated associations with clinical/functional outcomes. RESULTS: Group differences were observed (F(11, 246) = 8.05, p < .001) with CHR and DD individuals indicating greater eveningness preference compared to NPC. A follow-up sensitivity analysis examining CHR participants with (n = 25) and without (n = 59) depressive disorders indicated no difference in chronotype preference (F(10,72) = 0.00, p = .99). Greater eveningness preference was related to greater negative symptoms (i.e., avolition; r = -0.25) and anxiety (r = -0.34) among CHR individuals. CONCLUSIONS: CHR and DD display greater preference for eveningness chronotype compared to NPC indicating the disruption is associated with a range of mental health concerns, and not specific to the psychosis-risk syndrome. However, comorbidity with DD did not appear to be driving the finding in the CHR group. Further research may examine shared versus non-shared underlying mechanisms contributing to chronotype preference across psychiatric presentations.

Determination of 1,4-dioxane in water samples using freeze-assisted liquid-liquid extraction and gas chromatography-mass spectrometry with select reaction monitoring.

In this study, we developed an analytical method for the determination of 1,4-dioxane in aqueous solutions using freeze-assisted liquid-liquid extraction, also known as frozen microextraction, and gas chromatography with triple quadrupole mass spectrometry with select reaction monitoring. The method is capable of quantifying 1,4-dioxane across a broad range of concentrations (1-10 000 µg/L) relevant to contaminated sites, with an instrument detection limit and method detection limit experimentally verified as 2.1 and 2.2 µg/L, respectively. In contrast to methods with similar detection limits that require 50 to 500 mL volume of sample, our method uses only 200 µL of sample. The method presented here facilitates field and laboratory applications where small sample volumes and high precision are required and could be extended to other strongly water-soluble GC-amenable analytes.

Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents.

Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.

Feasibility and Acceptability of Wearable Sleep Electroencephalogram Device Use in Adolescents: Observational Study.

BACKGROUND: Adolescence is an important life stage for the development of healthy behaviors, which have a long-lasting impact on health across the lifespan. Sleep undergoes significant changes during adolescence and is linked to physical and psychiatric health; however, sleep is rarely assessed in routine health care settings. Wearable sleep electroencephalogram (EEG) devices may represent user-friendly methods for assessing sleep among adolescents, but no studies to date have examined the feasibility and acceptability of sleep EEG wearables in this age group. OBJECTIVE: The goal of the research was to investigate the feasibility and acceptability of sleep EEG wearable devices among adolescents aged 11 to 17 years. METHODS: A total of 104 adolescents aged 11 to 17 years participated in 7 days of at-home sleep recording using a self-administered wearable sleep EEG device (Zmachine Insight+, General Sleep Corporation) as well as a wristworn actigraph. Feasibility was assessed as the number of full nights of successful recording completed by adolescents, and acceptability was measured by the wearable acceptability survey for sleep. Feasibility and acceptability were assessed separately for the sleep EEG device and wristworn actigraph. RESULTS: A total of 94.2% (98/104) of adolescents successfully recorded at least 1 night of data using the sleep EEG device (mean number of nights 5.42; SD 1.71; median 6, mode 7). A total of 81.6% (84/103) rated the comfort of the device as falling in the comfortable to mildly uncomfortable range while awake. A total of 40.8% (42/103) reported typical sleep while using the device, while 39.8% (41/103) indicated minimal to mild device-related sleep disturbances. A minority (32/104, 30.8%) indicated changes in their sleep position due to device use, and very few (11/103, 10.7%) expressed dissatisfaction with their experience with the device. A similar pattern was observed for the wristworn actigraph device. CONCLUSIONS: Wearable sleep EEG appears to represent a feasible, acceptable method for sleep assessment among adolescents and may have utility for assessing and treating sleep disturbances at a population level. Future studies with adolescents should evaluate strategies for further improving usability of such devices, assess relationships between sleep EEG-derived metrics and health outcomes, and investigate methods for incorporating data from these devices into emerging digital interventions and applications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03843762; https://clinicaltrials.gov/ct2/show/NCT03843762.

THE EFFECTS OF POSTURAL AND ANATOMICAL ALIGNMENT ON SPEED, POWER, AND ATHLETIC PERFORMANCE IN MALE COLLEGIATE ATHLETES: A RANDOMIZED CONTROLLED TRIAL.

BACKGROUND: Many human beings are strongly influenced by right-sided dominance. This may cause potentially pathologic or dysfunctional asymmetries within the innominates of the pelvis, which in turn influences movement throughout the body including the glenohumeral (GH), vertebral, femoral acetabular (FA), sacroiliac, and costovertebral joints. Techniques based upon the science of Postural Restoration® may help correct these asymmetries and improve multiple physiological and mechanical aspects of sports performance. PURPOSE: To examine difference between non-manual, Postural Restoration® exercises and traditional postural interventions on anatomical alignment, available range of motion and symmetry, and speed and power in active college-aged males. STUDY DESIGN: Randomized control trial, pretest-posttest control group design. METHODS: 25 male collegiate students (age = 21 ± 3 years) who met the ACSM guidelines to be considered physically active were chosen to participate. Participants completed a vertical jump test using a power analyzer (Tendo Sport, Lexington, SC, USA) and the pro agility test. Anatomical alignment was assessed through an adduction drop test, extension drop test, and standard goniometric measurements including femoral acetabular external rotation (ER), internal rotation (IR), flexion, and abduction, and glenohumeral internal rotation. Participants were randomly assigned to either non-manual, Postural Restoration® techniques or traditional posture improvement exercises. Following a four-week intervention period, participants were reassessed using the same aforementioned outcomes completed pre-intervention. RESULTS: Participants who completed the non-manual, Postural Restoration® techniques demonstrated significant improvements in pro-agility scores (-0.03 ± 0.10 seconds; p=0.0005). Neither set of interventions improved vertical jump scores (Treatment: + 35.7 ± 288.02 W, p=0.1000; Control: -10.08 ± 301.04 W, p=0.381). Areas of anatomical alignment that demonstrated significant change included the treatment group for FA IR (p=0.010) and FA abduction (p=0.035) symmetry and the left adduction drop test (p=0.039). CONCLUSION: Non-manual exercise techniques based upon the science of Postural Restoration® may equalize asymmetries present in FA internal rotation and hip abduction. Improvements in symmetry of joint motion may indicate a restoration of neutrality of the pelvis and femoroacetabular joints. By improving anatomical alignment, through establishing a neutral pelvis, athletes may demonstrate improved neuromechanical efficiency, and kinesthetic control of multi-directional motions required for enhanced sports performance markers. LEVEL OF EVIDENCE: 1b.

Borrelidin Induces the Unfolded Protein Response in Oral Cancer Cells and Chop-Dependent Apoptosis.

Oral squamous cell carcinoma (OSCC) is the most common cancer affecting the oral cavity, and US clinics will register about 30,000 new patients in 2015. Current treatment modalities include chemotherapy, surgery, and radiotherapy, which often result in astonishing disfigurement. Cancers of the head and neck display enhanced levels of glucose-regulated proteins and translation initiation factors associated with endoplasmic reticulum (ER) stress and the unfolded protein response (UPR). Previous work demonstrated that chemically enforced UPR could overwhelm these adaptive features and selectively kill malignant cells. The threonyl-tRNA synthetase (ThRS) inhibitor borrelidin and two congeners were discovered in a cell-based chemical genomic screen. Borrelidin increased XBP1 splicing and led to accumulation of phosphorylated eIF2α and UPR-associated genes, prior to death in panel of OSCC cells. Murine embryonic fibroblasts (MEFs) null for GCN2 and PERK were less able to accumulate UPR markers and were resistant to borrelidin. This study demonstrates that UPR induction is a feature of ThRS inhibition and adds to a growing body of literature suggesting ThRS inhibitors might selectively target cancer cells.

Pilot study of a pharmaceutical care intervention in an outpatient lung transplant clinic.

BACKGROUND: Lung transplant recipients have complex drug regimens. Study objectives were to assess drug therapy problems (DTPs), pharmacist recommendations, and patient satisfaction with pharmacist services. METHODS: Using a pharmaceutical care assessment process, pharmacists identified DTPs and made therapeutic recommendations. Number of DTPs identified per pharmacist visit was calculated and compared to standard care visits through retrospective chart review. Potential clinical impact of recommendations was evaluated by blinded clinicians. Patient satisfaction was assessed via survey. RESULTS: Fifty-five DTPs were identified in 43 patients over 50 pharmacist visits (1.05 ± 1.34 DTPs per visit). In these same patients, rate of DTP identification was 0.51 ± 0.64 DTPs per standard visit in the preceding two-wk period (p = 0.018 vs. pharmacist visit). The most common DTPs identified by the pharmacist were adverse drug effect (27%) and untreated indication (25%). Overall, 62% of pharmacist recommendations were rated very significant or significant. Survey return rate was 58% and satisfaction scores ranged from 3 to 5 out of 5. Review of medications and teaching regarding the use of medications received the most "very satisfied" and "highly important" scores. CONCLUSIONS: Pharmacists can make valuable contributions in a lung transplant clinic setting by identifying DTPs and making recommendations with a positive impact on patient outcomes and satisfaction.

Common complications of fracture repair.

Complications are a reality of fracture repair. Many can be avoided or minimized by being aware of their pathophysiology and predisposing factors. Others are unavoidable but their resolution may be aided by early diagnosis and appropriate treatment. Major complications of fracture repair include osteomyelitis, delayed union, nonunion, malunion, premature physeal closure, and fracture associated sarcoma. Consideration of these complications should factor into presurgical patient evaluation as well as postoperative management. This discussion focuses on how to avoid, recognize, and treat these complications.