bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health behaviors of American pregnant women: a cross-sectional analysis of NHANES 2007–2014
Authors: Francis Ellen C , Zhang Lu , Witrick Brian , Chen Liwei 
Published: September 2019

AbstractBackgroundThis study examined engagement in five health behaviors among pregnant women in the USA.MethodsPregnant women who participated in the National Health and Nutrition Examination Survey 2007–2014 were included in this study. Five health behaviors were examined: adequate fruit and vegetable consumption, prenatal multivitamin use, physical activity, sleep and smoking. Multivariable regressions were used to estimate the odds ratio and 95% confidence interval of characteristics associated with health behaviors.ResultsAmong 248 pregnant women, only 10.2% engaged in all five health behaviors and 35.4% consumed adequate fruits and vegetables. For adequate fruit and vegetable consumption, Hispanic and women of ‘other’ race were more likely to meet the recommendation compared to non-Hispanic white (P = 0.01 and P = 0.03, respectively); high school graduates were less likely to meet the recommendation compared to those with at least some college education or more (P = 0.04).ConclusionsAdequate fruit and vegetable consumption among pregnant women was poor and differed by race/ethnicity and education status. Because of the cross-sectional design, we cannot examine engagement in health behaviors continuously throughout pregnancy. Future research with longitudinal data over the course of pregnancy is needed to confirm these results.
Quantitative associations between objective sleep measures and early-morning mobility in Parkinson’s disease: cross-sectional analysis of the PHASE study
Authors: Kataoka Hiroshi , Saeki Keigo , Yamagami Yuki , Sugie Kazuma , Obayashi Kenji 
Published: September 2019

Abstract

Study Objectives
Previous studies have suggested associations between sleep measures and early-morning akinesia; however, objective evidence is limited. The purpose of this study was to evaluate the associations between objective sleep measures and morning mobility among patients with Parkinson’s disease (PD).

Methods
In this cross-sectional study, we measured objective sleep parameters and morning mobility in 157 patients with PD (mean age, 71.4 years) for six consecutive days using an actigraph placed on the nondominant wrist. Low morning mobility was defined as less than 100 counts/min within the first 2 hours after rising.

Results
The mean duration of low morning mobility was 55.7 minutes (SD, 23.8), and the mean sleep parameters were as follows: sleep efficiency (SE), 72.1% (13.6); wake after sleep onset (WASO), 104.7 minutes (57.9); total sleep time (TST), 343.6 minutes (104.0); and fragmentation index (FI), 3.5 (3.4). Multivariable linear regression analysis adjusted for potential confounders demonstrated significant associations between better objective sleep measures and shorter low morning mobility (SE per %: β, −0.419; 95% CI = −0.635 to −0.204; p &lt; 0.001; WASO per min: β, 0.056; 95% CI = 0.003 to 0.109; p = 0.039; and FI per unit; β, 1.161; 95% CI = 0.300 to 2.023; p = 0.009) but not TST (p = 0.78). These findings were not altered by different cutoff values of mobility (50 counts/min) or duration (1 h after rising).

Conclusions
In patients with PD, better objective sleep measures are significantly associated with shorter low morning mobility. Future studies investigating whether improved sleep reduces symptoms of low morning mobility are required.
Sleep and wake are shared and transmitted between individuals with insomnia and their bed-sharing partners
Authors: Walters Elizabeth M , Phillips Andrew J K , Mellor Alix , Hamill Kellie , Jenkins Melissa M , Norton Peter J , Baucom Donald H , Drummond Sean P A 
Published: September 2019

AbstractPatients with insomnia frequently report disturbing, or being disturbed by, their bedpartner. We aimed to (1) characterize how individuals with insomnia and their bedpartners influence each other’s sleep and (2) identify characteristics predicting vulnerability to wake transmission. Fifty-two couples (aged 19–82 years), where one individual was diagnosed with insomnia, participated. Sleep/wake patterns were monitored via actigraphy and sleep diaries for seven nights. Minute-by-minute sleep and wake concordance (simultaneous sleep/wake epochs), number of wake transmissions received (awakenings immediately preceded by wakefulness in the bedpartner), percent wake transmissions received (percentage of total awakenings that were transmitted), and percent of bedpartner’s wake minutes resistant to transmission (ability to sleep through bedpartner wakefulness) were calculated. Mixed-effects modeling assessed within-couple bedtime and chronotype differences as predictors of dyadic sleep. We described rates of sleep concordance (MPatient = 63.8%, MPartner = 65.6%), wake concordance (MPatient = 6.6%, MPartner = 6.6%), total transmissions received (MPatient = 5.5, MPartner = 6.9 per night), percent transmissions received (MPatient = 18.5%, MPartner = 23.4% of total awakenings), and percent minutes resistant (MPatient = 56.4%, MPartner = 58.6% of bedpartner’s wake time). Partners received wake transmissions at 1.25 times the rate of patients. Percent transmissions received was increased in couples with concordant bedtimes and individuals with later chronotype than their bedpartner. Patterns of chronotype and bedtime order predicting percent minutes resistant to transmission differed across the length of the rest interval. Transmission provides a novel characterization of how bedpartners influence sleep and provide insight into mechanisms of insomnia generation and maintenance. Understanding modifiable risk factors may provide ways to personalize insomnia treatments.Clinical Trial Researching Effective Sleep Treatments (Project REST), ANZCTR Registration: ACTRN12616000586415
Wakefulness/sleep architecture and electroencephalographic activity in mice lacking the translational repressor 4E-BP1 or 4E-BP2
Authors: Areal Cassandra C , Cao Ruifeng , Sonenberg Nahum , Mongrain Valérie 
Published: September 2019

Abstract
Sleep and sleep loss are affecting protein synthesis in the brain, but the contribution of translational control to wakefulness and sleep regulation remains poorly understood. Here, we studied the role of two suppressors of protein synthesis, the eukaryotic translation initiation factor 4E-binding proteins 1 and 2 (4E-BP1 and 4E-BP2), in sleep architecture and electroencephalographic (EEG) activity as well as in the EEG and molecular responses to acute sleep loss. The EEG of mice mutant for the genes encoding 4E-BP1 or 4E-BP2 (Eif4ebp1 and Eif4ebp2 knockout [KO] mice) was recorded under undisturbed conditions and following a 6-hour sleep deprivation (SD). The effect of SD on the expression of genes known to respond to SD was also measured in the prefrontal cortex of Eif4ebp1 and Eif4ebp2 KO mice. Eif4ebp1 KO mice differed from wild-type mice in parameters of wakefulness and sleep quantity and quality, and more subtly in the gene expression response to SD. For instance, Eif4ebp1 KO mice spent more time in slow-wave sleep (SWS) and showed altered baseline 24-h time courses of SWS delta (1–4 Hz) activity and sigma (10–13 Hz) activity. Eif4ebp2 KO mice differed from wild-type mice only for wakefulness and sleep quality, expressing changes in EEG spectral activity generally revealed during and after SD. These findings suggest different roles of effectors of translational control in the regulation of wakefulness and sleep and of synchronized cortical activity.
Sleep deprivation undermines the link between identity and intergroup bias
Authors: Zhang Jinxiao , Yang Yang , Hong Ying-Yi 
Published: September 2019

Abstract
This research seeks to bridge two findings—on the one hand, top-down controlled processes inhibit display of intergroup bias; on the other one hand, sleep deprivation impairs cognitive control processes. Connecting these two proven statements, begs the question: would sleep deprivation also influence intergroup bias? This intriguing link has hardly been explored in extant literature. To fill this gap, we theorize through the lens of social identity. Previous research has shown that individuals who share a common identity with an outgroup are more motivated to inhibit biases toward the outgroup than do their counterparts who do not endorse such common identity. We predicted that this motivated inhibition would be compromised by sleep deprivation. Across two studies, as predicted, we found that only when an individual has adequate sleep did common ingroup identity attenuate the display of intergroup bias, whereas individuals with short habitual sleep (study 1) or after one-night sleep deprivation (study 2) displayed equally high levels of intergroup bias regardless of their high or low levels of common ingroup identity. In the global context of incessant intergroup bias and diminishing sleep time, our findings offer new insights for understanding and handling intergroup bias.
Plasma exosomes in OSA patients promote endothelial senescence: effect of long-term adherent continuous positive airway pressure
Authors: Khalyfa Abdelnaby , Marin Jose M , Qiao Zhuanhong , Rubio David Sanz , Kheirandish-Gozal Leila , Gozal David 
Published: September 2019

Abstract
Obstructive sleep apnea (OSA) is associated with increased risk for end-organ morbidities, which can collectively be viewed as accelerated aging. Vascular senescence is an important contributor to end-organ dysfunction. Exosomes are released ubiquitously into the circulation, and transfer their cargo to target cells facilitating physiological and pathological processes. Plasma exosomes from 15 patients with polysomnographically diagnosed OSA at baseline (OSA-T1) after 12 months of adherent continuous positive airway pressure (CPAP) treatment (OSA-T2), 13 untreated OSA patients at 12-month intervals (OSA-NT1, OSA-NT2), and 12 controls (CO1 and CO2) were applied on naïve human microvascular endothelialcells-dermal (HMVEC-d). Expression of several senescence gene markers including p16 (CDKN2A), SIRT1, and SIRT6 and immunostaining for β-galactosidase activity (x-gal) were performed. Endothelial cells were also exposed to intermittent hypoxia (IH) or normoxia (RA) or treated with hydrogen peroxide (H2O2), stained with x-gal and subjected to qRT-PCR. Exosomes from OSA-T1, OSA-NT1, and OSA-NT2 induced significant increases in x-gal staining compared to OSA-T2, CO1, and CO2 (p-value &lt; 0.01). p16 expression was significantly increased (p &lt; 0.01), while SIRT1 and SIRT6 expression levels were decreased (p &lt; 0.02 and p &lt; 0.009). Endothelial cells exposed to IH or to H2O2 showed significant increases in x-gal staining (p &lt; 0.001) and in senescence gene expression. Circulating exosomes in untreated OSA induce marked and significant increases in senescence of naïve endothelial cells, which are only partially reversible upon long-term adherent CPAP treatment. Furthermore, endothelial cells exposed to IH or H2O2 also elicit similar responses. Thus, OSA either directly or indirectly via exosomes may initiate and exacerbate cellular aging, possibly via oxidative stress-related pathways.
Clozapine-associated secondary antibody deficiency
Authors: Ponsford Mark J. , Pecoraro Antonio , Jolles Stephen 
Published: September 2019

Purpose of review
Clozapine has recently been described as a novel cause of secondary antibody deficiency (SAD), associated with long-term therapy. Here we critically review the evidence linking clozapine use to an increased infection risk, describe immunological alterations, and discuss potential mechanisms.

Recent findings
Individuals with schizophrenia are at two to five times more likely to develop pneumonia than the general population, in particular, when receiving clozapine. Delayed-onset distinguishes clozapine-associated hypogammaglobulinaemia from agranulocytosis or neutropenia that occur at lesser frequency. Biomarker searches in treatment-resistant schizophrenia highlight an immune signature associated with long-term clozapine use. This includes reduction in class-switched memory B cells, echoing common variable immunodeficiency. Recent identification of a role for dopamine in T follicular helper–B cell interactions may inform future clinical studies.

Summary
The detrimental impact of the increased infection risk associated with clozapine necessitates a re-evaluation of the current monitoring strategies as well as further studies to better understand the underlying mechanisms of SAD in this setting. On the basis of available evidence, we suggest simple modifications to clozapine monitoring including integration of routine vaccination, smoking cessation, and assessment of humoral immunity. Further studies are required to understand the role of clozapine in neuroinflammation as well as other potentially autoantibody-mediated diseases.
Mission Drift: Are Medical School Admissions Committees Missing the Mark on Diversity?
Authors: Poole Kenneth G. , Jordan Barbara L. , Bostwick J. Michael 
Published: September 2019

Diversity initiatives in U.S. medical education, following the passage of the Civil Rights Act of 1964, were geared toward increasing the representation of African Americans—blacks born in the United States whose ancestors suffered under slavery and Jim Crow laws. Over time, blacks and, subsequently, underrepresented minorities in medicine (URMs), became a proxy for African Americans, Puerto Ricans, Mexican Americans, and Native Americans, thus obscuring efforts to identify and recruit specifically African Americans. Moreover, demographic shifts resulting from the recent immigration of black people from Africa and the Caribbean have both expanded the definition of “African American medical students” and shifted the emphasis from those with a history of suffering under U.S. oppression and poverty to anyone who meets a black phenotype.
Increasingly, research indicates that African American patients fare better when their physicians share similar historical and social experiences. While all people of color risk discrimination based on their skin color, not all have the lived experience of U.S.-based, systematic, multigenerational discrimination shared by African Americans. In the high-stakes effort to increase URM representation in medical school classes, admissions committees may fail to look beyond the surface of phenotype, thus missing the original intent of diversity initiatives while simultaneously conflating all people of color, disregarding their divergent historical and social experiences. In this Perspective, the authors contend that medical school admissions committees must show greater discernment in their holistic reviews of black applicants if historical wrongs and continued underrepresentation of African Americans in medicine are to be redressed.
Racial and Ethnic Disparities in Postcardiac Arrest Targeted Temperature Management Outcomes*
Authors: Jacobs Claire S. , Beers Louis , Park Suna , Scirica Benjamin , Henderson Galen V. , Hsu Liangge , Bevers Matthew , Dworetzky Barbara A. , Lee Jong Woo 
Published: September 2019

Objectives:
To evaluate racial and ethnic disparities in postcardiac arrest outcomes in patients undergoing targeted temperature management.

Design:
Retrospective study.

Setting:
ICUs in a single tertiary care hospital.

Patients:
Three-hundred sixty-seven patients undergoing postcardiac arrest targeted temperature management, including continuous electroencephalogram monitoring.

Interventions:
None.

Measurements and Main Results:
Clinical variables examined in our clinical cohort included race/ethnicity, age, time to return of spontaneous circulation, cardiac rhythm at time of arrest, insurance status, Charlson Comorbidity Index, and time to withdrawal of life-sustaining therapy. CT at admission and continuous electroencephalogram monitoring during the first 24 hours were used as markers of early injury. Outcome was assessed as good (Cerebral Performance Category 1–2) versus poor (Cerebral Performance Category 3–5) at hospital discharge. White non-Hispanic (“White”) patients were more likely to have good outcomes than white Hispanic/nonwhite (“Non-white”) patients (34.4 vs 21.7%; p = 0.015). In a multivariate model that included age, time to return of spontaneous circulation, initial rhythm, combined electroencephalogram/CT findings, Charlson Comorbidity Index, and insurance status, race/ethnicity was still independently associated with poor outcome (odds ratio, 3.32; p = 0.003). Comorbidities were lower in white patients but did not fully explain outcomes differences. Nonwhite patients were more likely to exhibit signs of early severe anoxic changes on CT or electroencephalogram, higher creatinine levels and receive dialysis, but had longer duration to withdrawal of lifesustaining therapy. There was no significant difference in catheterizations or MRI scans. Subgroup analysis performed with patients without early electroencephalogram or CT changes still revealed better outcome in white patients.

Conclusions:
Racial/ethnic disparity in outcome persists despite a strictly protocoled targeted temperature management. Nonwhite patients are more likely to arrive with more severe anoxic brain injury, but this does not account for all the disparity.
Hyperosmolar Therapy in Pediatric Severe Traumatic Brain Injury—A Systematic Review
Authors: Stopa Brittany M. , Dolmans Rianne G. F. , Broekman Marike L. D. , Gormley William B. , Mannix Rebekah , Izzy Saef 
Published: September 2019

Objectives:
Traumatic brain injury is a leading cause of hospital visits for children. Hyperosmolar therapy is often used to treat severe traumatic brain injury. Hypertonic saline is used predominantly, yet there remains disagreement about whether hypertonic saline or mannitol is more effective.

Data Sources:
Literature search was conducted using Pubmed, Cochrane, and Embase. Systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Study Selection:
Retrospective and prospective studies assessing use of hyperosmolar therapy in pediatric patients with severe traumatic brain injury were included.

Data Extraction:
Two independent authors performed article review. Two-thousand two-hundred thirty unique articles were initially evaluated, 11 were included in the final analysis, with a total of 358 patients. Study quality was assessed using Modified Newcastle-Ottawa Scale and Jadad score.

Data Synthesis:
Of the 11 studies, all evaluated hypertonic saline and four evaluated both hypertonic saline and mannitol. Nine reported that hypertonic saline lowered intracranial pressure and two reported that mannitol lowered intracranial pressure. The studies varied significantly in dose, concentration, and administrations schedule for both hypertonic saline and mannitol. Five studies were prospective, but only one directly compared mannitol to hypertonic saline. The prospective comparison study found no difference in physiologic outcomes. Clinical outcomes were reported using different measures across studies. For hypertonic saline-treated patients, mechanical ventilation was required for 6.9–9 days, decompressive craniectomy was required for 6.25–29.3% of patients, ICU length of stay was 8.0–10.6 days, in-hospital mortality was 10–48%, and 6-month mortality was 7–17%. In mannitol-treated patients, ICU length of stay was 9.5 days, in-hospital mortality was 56%, and 6-month mortality was 19%.

Conclusions:
Both hypertonic saline and mannitol appear to lower intracranial pressure and improve clinical outcomes in pediatric severe traumatic brain injury, but the evidence is extremely fractured both in the method of treatment and in the evaluation of outcomes. Given the paucity of high-quality data, it is difficult to definitively conclude which agent is better or what treatment protocol to follow.
Development and Validity of a Workplace Health Promotion Best Practices Assessment
Authors: Imboden Mary T. , Castle Patricia H. , Johnson Sara S. , Jenkins Kristi Rahrig , Pitts Jennifer S. , Grossmeier Jessica , Mangen David J. , Mason Shawn , Noeldner Steven P. 
Published: September 2019

Objective:
To explore the factor structure of the HERO Health and Well-being Best Practices Scorecard in Collaboration with Mercer (HERO Scorecard) to develop a reduced version and examine the reliability and validity of that version.

Methods:
A reduced version of the HERO Scorecard was developed through formal statistical analyses on data collected from 845 organizations that completed the original HERO Scorecard.

Results:
The final factors in the reduced Scorecard represented content pertaining to organizational and leadership support, program comprehensiveness, program integration, and incentives. All four implemented practices were found to have a strong, statistically significant effect on perceived effectiveness. Organizational and leadership support had the strongest effect (β = 0.56), followed by incentives (β = 0.23).

Conclusion:
The condensed version of the HERO Scorecard has the potential to be a promising tool for future research on the extent to which employers are adopting best practices in their health and well-being (HWB) initiatives.
Impact of nurse practitioner navigation on access to care for patients with refractory gastroesophageal reflux disease
Authors: Nandwani Monica , Clarke John O. , Kuriakose Clair , Stevenson Eleanor 
Published: September 2019

ABSTRACT

Background:
Gastroesophageal reflux disease (GERD) is a common digestive complaint that can negatively affect patients' quality of life and have serious complications if inadequately treated.

Local problem:
Facilitating prompt and efficient access to digestive care is imperative especially given the current burden of gastrointestinal diseases such as GERD.

Methods:
A clinical team conducted a quality improvement study in which a nurse practitioner (NP) navigator performed a preconsultation chart review for patients with refractory GERD referred to an Esophagus Center between August and December 2018.

Interventions:
Based on preconsultation chart review, the NP navigator arranged for diagnostic testing and follow-up. Days from consultation to testing completion and establishment of plan were tracked and compared with historic controls. The NP navigator documented time spent for chart review and care coordination.

Results:
The median number of days from consultation to testing completion for patients who underwent NP navigation and required diagnostic testing (n = 26) was 33.5 as compared with 64.5 for historic controls who required testing but received usual care (n = 28) (p = .005). The median number of days from consultation to establishment of a management plan was 52 for patients who underwent NP navigation as compared with 97 for historic controls who did not (p = .005). The mean amount of time spent by the NP navigator for chart review and care coordination was 17.5 min (n = 30).

Conclusions:
Incorporation of NP navigators into gastroenterology practices offers a potential solution for timelier patient care delivery.
A checklist for faculty and preceptor to enhance the nurse practitioner student clinical experience
Authors: Pitts Courtney , Padden Diane , Knestrick Joyce , Bigley Mary B. 
Published: September 2019

ABSTRACT
The National Organization of Nurse Practitioner Faculties and the American Association of Nurse Practitioners collaborated to develop a document outlining expectations when establishing clinical experiences for nurse practitioner (NP) students. A literature review explored the beliefs of clinical preceptors and NP faculty in relation to the process of the establishment and completion of successful clinical experiences. From the literature, the development of two guidance checklists addressed the expectations and responsibilities of the NP faculty and clinical preceptor during the clinical placement process. In light of challenges to secure clinical sites for NP students, it is imperative that the clinical placement process is standardized and the communicative pathway between the NP faculty and clinical preceptor improved.