Maturational trend of daytime sleep propensity in adolescents.

STUDY OBJECTIVES: The teenage increase in sleepiness is not simply a response to decreasing nighttime sleep duration. Daytime sleepiness increases across adolescence even when prior sleep duration is held constant. Here we determine the maturational trend in daytime sleep propensity assessed with the multiple sleep latency test (MSLT) and assess the trend's relation to pubertal maturation and changes in the sleep electroencephalogram. We also evaluate whether the relation of daytime sleep propensity to prior sleep duration changes between ages 10 and 23 years. METHODS: Participants (n = 159) entered the study between ages 9.8 and 22.8 years and were studied annually for up to 3 years. Annually, participants kept each of three sleep schedules in their homes: 7, 8.5, and 10 hours in bed for 4 consecutive nights with polysomnography on nights 2 and 4. MSLT-measured daytime sleep propensity was assessed in the laboratory on the day following the fourth night. RESULTS: A two-part linear spline model described the maturation of daytime sleep propensity. MSLT sleep likelihood increased steeply until age 14.3 years, after which it did not change significantly. The maturational trend was strongly associated with the adolescent decline in slow-wave (delta, 1-4 Hz) EEG power during NREM sleep and with pubertal maturation assessed with Tanner stage measurement of breast/genital development. The effect of prior sleep duration on sleep likelihood decreased with age. CONCLUSIONS: Adolescent brain changes related to pubertal maturation and those reflected in the delta decline contribute to the adolescent increase in daytime sleep propensity.

Earlier Bedtime and Its Effect on Adolescent Sleep Duration.

BACKGROUND AND OBJECTIVES: Sleep duration decreases by ∼10 minutes per year throughout adolescence. A circadian phase delay and changes in homeostatic sleep regulation enable adolescents to stay up later. We determine if teens are able to increase sleep duration by advancing bedtime and whether this ability changes with age. METHODS: A younger cohort of 77 participants ranging in age from 9.9 to 16.2 years were studied annually for 3 years. An older cohort of 67 participants ranging in age from 15.0 to 20.6 years was studied only once. Annually, participants kept each of 3 different time in bed (TIB) schedules (7, 8.5, and 10 hours) for 4 consecutive nights. Participants kept their habitual weekday rise times; TIB was altered by advancing bedtimes. We report polysomnography-measured sleep durations from the fourth night of the TIB schedule. RESULTS: Despite increases in sleep onset latency and wake after sleep onset, sleep duration increased with TIB as bedtime was advanced. Average (SE) sleep duration increased from 402.8 (1.6) minutes with 7 hours to 470.6 (2.1) minutes with 8.5 hours to 527.5 (3.0) minutes with 10 hours TIB. Sleep duration decreased with age (1.55 [0.48] minutes/year), but the TIB effect on sleep duration did not (TIB by age interaction, P = .42). CONCLUSIONS: Adolescents can substantially increase sleep duration by advancing bedtime, and this ability does not change between ages 10 and 21 years. Additional research is needed to determine how to translate these findings from experiment-controlled sleep schedules to real-world sleep duration increases.

Complications, Adverse Drug Events, High Costs, and Disparities in Multisystem Inflammatory Syndrome in Children vs COVID-19.

Importance: Multisystem inflammatory syndrome in children (MIS-C) causes severe inflammation of multiple organ systems after SARS-CoV-2 infection. During the pandemic, surveillance reporting of MIS-C was voluntary, with likely underreporting. For a rare syndrome like MIS-C, numerous data are needed to explore the disease in greater detail. Objective: To use large all-payer billing data and the new International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) code for MIS-C to compare outcomes across MIS-C and COVID-19 over all 4057 hospitals in 31 states. Design, Setting, and Participants: A retrospective cross-sectional study of all COVID-19 and MIS-C hospitalizations in individuals younger than 21 years from 31 states was conducted, using Agency for Healthcare Research and Quality 2021 Healthcare Cost and Utilization Project data. Analyses were conducted from February 1 to October 20, 2022. Main Outcomes and Measures: Fifty complications, adverse medication events, costs, and the Social Vulnerability Index. Results: There were 4107 individuals with MIS-C (median age, 9 [IQR, 5-13] years; 2443 [59.5%] male; 1384 [38.1%] White) and 23 686 individuals with COVID-19 without MIS-C (median age, 15 [IQR, 5-18] years; 12 878 [54.4%] female; 4605 [44.1%] White), with 1.48 (95% CI, 1.35-1.62) MIS-C hospitalizations per 100 000 children per month, ranging from 0.97 hospitalizations per 100 children for White and 1.99 hospitalizations per 100 children for Black children. Outcomes worsened as the number of organ system dysfunctions increased from 2 to 8 organs. Deaths associated with MIS-C increased from less than 1% to 5.8% (95% CI, 3.3%-8.4%) and from less than 1% to 17.2% (95% CI, 11.7%-22.7%) for COVID-19 (P = .001). Adverse medication events associated with MIS-C increased from 4.9% (95% CI, 3.8%-6.0%) to 17.8% (95% CI, 13.7%-22.0%) and from 1.2% (95% CI, 1.0%-1.3%) to 13.4% (95% CI, 8.4%-18.3%) for COVID-19. The median length of stay for MIS-C increased from 4 (IQR, 2-5) to 8 (IQR, 5-12) days and from 3 (IQR, 2-5) to 16 (IQR, 7-23) days for COVID-19. Median costs for MIS-C increased from $16 225 (IQR, $9244-$26 822) to $53 359 (IQR, $35 920-$86 882) and from $6474 (IQR, $3741-$12 103) to $98 643 (IQR, $30 675-$204 956) for COVID-19. The percentage of MIS-C cases that were in Black children doubled from 16.2% to 31.7% (P = .001) as organ dysfunction increased, remaining unchanged with COVID-19. Hospital stays for MIS-C increased by 1 day (P = .01) for Black patients compared with White patients, with Black patients moving from the bottom to top quartile of socioeconomic vulnerability, with no disparity with COVID-19. Conclusions and Relevance: In this cross-sectional study, MIS-C was more common and severe than previously reported, with more racial disparities in outcomes than were seen in patients with COVID-19. The findings of this study suggest that relying on mean outcomes for MIS-C from past studies can be misleading, since outcomes and disparities varied widely with the number of multiorgan dysfunctions.

Carpal Motion in Chronic Geissler IV Scapholunate Interosseous Ligament Wrists.

PURPOSE: This study evaluated the biomechanics of Geissler IV (G4) wrists in cadavers and compared them with intact specimens after multiple ligament sectioning to create scapholunate instability. It also evaluated carpal motion changes after sectioning of the lunotriquetral interosseous ligament (LTIL). METHODS: Eight cadaver wrists determined to be G4 arthroscopically were tested using a wrist joint motion simulator. The LTIL was then sectioned, and carpal motion was recorded again. Carpal motions were compared with 37 normal wrists after sectioning of the scapholunate interosseous ligament and other ligaments to create a G4 wrist. RESULTS: Carpal motion of the 37 normal wrists after ligamentous sectioning was similar to motion of the 8 specimens noted to be G4. These wrists did not demonstrate subluxation of the scaphoid that may occur after ligament sectioning. After sectioning of the LTIL, there were significant changes in lunate and triquetral motion. CONCLUSIONS: These findings support the hypothesis that sectioning multiple ligaments in normal wrists to create scapholunate instability causes average motion comparable to that seen in G4 wrists. Ligamentous sectioning can cause a range of scaphoid instability. Lunotriquetral interosseous ligament sectioning in native G4 wrists caused greater changes in triquetral than scaphoid range of motion. CLINICAL RELEVANCE: Patients with arthroscopically determined G4 lesions have an incompetent SLIL and scapholunate instability but do not necessarily have scapholunate dissociation and subluxation. Cadaver studies that evaluate instability by sectioning specific intact wrist ligaments are similar to the G4 specimens and thus are a good approximation of naturally occurring wrist instability. The functionality of secondary stabilizers not seen arthroscopically may explain the differences in motion. Geissler IV wrists and ligament-sectioned wrists are points on the spectrum of carpal instability, which is determined by the extent of damage to multiple ligamentous structures.

Spontaneous spinal epidural hematoma: literature review.

Review the current literature regarding spontaneous spinal epidural hematomas (SSEHs) and report on the known risk factors, evaluation, and treatment of this rare entity. A literature search was performed using PubMed and Ovid to identify articles pertaining to SSEHs. Due to the rarity of the pathologic entity, only scattered case reports and associated reviews are available. SSEHs are a rare yet potentially life-altering event. The underlying risk factors are poorly understood, and SSEHs present with minimal or no antecedent trauma. SSEHs warrant urgent surgical intervention given the associated risk of permanent neurologic sequelae. Given the potential for persistent neurologic deficits, physicians must entertain a clinical suspicion of SSEH when a patient presents with a history of back pain followed by neurologic deficits. Even without clear risk factors for hemorrhage, the appropriate evaluation to include advanced imaging studies should be obtained to allow for identification of this entity and urgent surgical management.

Conocimiento sobre la administración de medicamentos en el paciente crítico del egresado de la Especialidad de Enfermería Intensiva Lima 2015 / Knowledge about the administration of medication in the critical patient of the graduated from the specialty of intensive nursing Lima 2015

Determinar el Conocimiento sobre la administración de medicamentos en el paciente crítico del egresado de la especialidad de enfermería intensiva. Metodología: El estudio es cuantitativo, de nivel aplicativo, descriptivo y corte transversal. La población estuvo conformada por 45 estudiantes egresados de la especialidad de enfermería intensiva. La técnica que se utilizó fue la encuesta y como instrumento el cuestionario, validado por 8 expertos y prueba piloto. Resultados: El 48,9 por ciento de la población estudiada fluctúa entre 26-30 años seguido de las egresadas de 31-35 años en un 28,9 por ciento y 44,4 por ciento solteras. Según el área laboral el 33,3 por ciento laboran en hospitalización, el 31 por ciento en Emergencia y el 24,4 por ciento en UCI. Según los años de experiencia en el área el 66,7 por ciento nunca laboraron en UCI, el 17,8 por ciento tienen menos de un año de experiencia y solo el 4,4 por ciento tienen >5 años de experiencia. En cuanto al Conocimiento en administración de medicamentos el 46,6 por ciento tienen Conocimiento Medio y el 13,3 por ciento alto, lo que llama la atención por la mínima diferencia con el conocimiento bajo, considerando que el 24,4 por ciento de las encuestadas labora en UCI, además que el conocimiento en fármacos cardiológicos y neurológicos son bajos en 51.1 por ciento y 46.7 por ciento respectivamente. Conclusión: El Conocimiento de las egresadas de Enfermería Intensiva es bajo a medio, con mínimo intervalo de diferencia, siendo el conocimiento cardiovascular y neurológico el que menos aciertos tuvo, reflejando que el contenido teórico de Farmacología recibida en las instituciones educativas de especialidad en Enfermería Intensiva es insuficiente, el cual deja vacíos, crea ansiedad, aumenta el riesgo de mala praxis frente al usuario crítico, lo que no contribuye ostensiblemente en el fortalecimiento de su desarrollo profesional...

To determine the knowledge on medication administration in critically ill patients the graduate specialty of intensive nursing. Methodology: The study is quantitative, applicative, descriptive and cross-sectional level. The population consisted of 45 students graduated from the specialty of intensive nursing. The technique used was the survey questionnaire and an instrument validated by eight experts and pilot. Results: 48.9 per cent of the study population ranges from 26 to 30 years followed by graduates of 31-35 years by 28.9 per cent and 44.4 per cent single. According to the workplace 33.3 per cent work in hospitalization, 31 per cent and 24.4 per cent Emergency ICU. According to years of experience in 66.7 per cent never worked in ICU, 17.8 per cent had less than a year of experience and only 4.4 per cent had >5 years of experience. Knowledge regarding the administration of medications 46.6 per cent had average knowledge and 13.3 per cent high, which is notable for the minimal difference with low knowledge, considering that 24.4 per cent of respondents working in UCI also knowledge in cardiological and neurological drugs are low in 51.1 per cent and 46.7 per cent respectively. Conclusion: Knowledge of Intensive Nursing graduates is low to medium, with a minimum interval of difference, being the cardiovascular and neurological knowledge that had fewer hits, reflecting the theoretical content of Pharmacology received in educational institutions specializing in Intensive Nursing It is insufficient, which leaves gaps, creates anxiety, increases the risk of malpractice against critical user, which does not contribute significantly in strengthening their professional development...

Rejection-(dis)identification and ethnic political engagement among first-generation Latino immigrants to the United States.

Immigrants to the United States face rejection from other Americans on the basis of their ethnic group membership. Among members of ethnic minority groups who were born in the United States, rejection is tied to higher ethnic identification and less positive attitudes toward the national majority. Relatively little research has examined this relationship among first-generation immigrants (i.e., people who were born in another country but who migrated to the United States) or has considered political engagement on behalf of one's ethnic group as an outcome. In this study we examined the relationship among ethnic-based rejection, ethnic and national identification, and ethnic political engagement among first-generation Latino immigrants in the northeastern United States. We found that first-generation Latino immigrants who perceived ethnic-based rejection were less likely to identify with Americans and less likely to report willingness to engage politically on behalf of their ethnic group in the United States. Perceived rejection was not significantly associated with ethnic identification, which was not related to ethnic political engagement. The study demonstrates that ethnic-based rejection has unique implications for identification and ethnic political engagement among first-generation Latino immigrants.

Endothelin 3 induces skin pigmentation in a keratin-driven inducible mouse model.

Endothelin 3 (Edn3) encodes a ligand important to developing neural crest cells and is allelic to the spontaneous mouse mutation occurring at the lethal spotting (ls) locus. Edn3(ls/ls) mutants exhibit a spotted phenotype due to reduced numbers of neural crest-derived melanocyte precursors in the skin. In this study, we show that when Edn3 is driven by the keratin 5 promoter and thereby placed proximal to melanocyte lineage cells, adult mice manifest pigmented skin harboring dermal melanocytes. Using a tetracycline inducible system, we show that the postnatal expression of Edn3 is required to maintain these dermal melanocytes, and that early expression of the Edn3 transgene is important to the onset of the hyperpigmentation phenotype. Crosses into Edn3(ls/ls) mutants demonstrate that the Edn3 transgene expression does not fully compensate for the endogenous expression pattern. Crosses into tyrosine kinase receptor Kit(Wv) mutants indicate that Edn3 can partially compensate for Kit's role in early development. Crosses into A(y) mutant mice considerably darkened their yellow coat color suggesting a previously unreported role for endothelin signaling in pigment switching. These results demonstrate that exogenous Edn3 affects both precursors and differentiated melanocytes, leading to a phenotype with characteristics similar to the human skin condition dermal melanocytosis.