A randomised controlled trial of prehabilitation in patients undergoing elective cardiac surgery.

The feasibility, safety and efficacy of prehabilitation in adult patients awaiting elective cardiac surgery are unknown. A total of 180 participants undergoing elective cardiac surgery were allocated randomly to receive either standard pre-operative care or prehabilitation, consisting of pre-operative exercise and inspiratory muscle training. The primary outcome was change in six-minute walk test distance from baseline to pre-operative assessment. Secondary outcomes included change in inspiratory muscle strength (maximal inspiratory pressure); sarcopenia (handgrip strength); quality of life and compliance. Safety outcomes were pre-specified surgical and pulmonary complications and adverse events. All outcomes were assessed at baseline; at pre-operative assessment; and 6 and 12 weeks following surgery. Mean (SD) age was 64.7 (10.2) years; 33/180 (18%) were women. In total, 65/91 (71.4%) participants who were allocated to prehabilitation attended at least four of eight supervised in-hospital exercise classes; participants aged > 50 years were more likely than younger participants to attend (odds ratio (95%CI) of 4.6 (1.0-25.1)). Six-minute walk test was not significantly different between groups (mean difference (95%CI) -7.8 m (-30.6-15.0), p = 0.503) in the intention-to-treat analysis. Subgroup analyses based on tests for interaction indicated improvements in six-minute walk test distance were larger amongst sarcopenic patients in the prehabilitation group (p = 0.004). Change in maximal inspiratory pressure from baseline to all time-points was significantly greater in the prehabilitation group, with the greatest mean difference (95%CI) observed 12 weeks after surgery (10.6 cmH2 O (4.6-16.6) cmH2 O, p < 0.001). There were no differences in handgrip strength or quality of life up to 12 weeks after surgery. There was no significant difference in postoperative mortality (one death in each group), surgical or pulmonary complications. Of 71 pre-operative adverse events, six (8.5%) were related to prehabilitation. The combination of exercise and inspiratory muscle training in a prehabilitation intervention before cardiac surgery was not superior to standard care in improving functional exercise capacity measured by six-minute walk test distance pre-operatively. Future trials should target patients living with sarcopenia and include inspiratory muscle strength training.

The association between nationality and nurse job satisfaction in Saudi Arabian hospitals.

BACKGROUND: Job satisfaction is important for increasing nurse retention rates. However, there is little research examining whether there is an association between nationality and job satisfaction among nurses. AIM: To examine whether there is an association between nationality and nurse job satisfaction. METHODS/DESIGN: A cross-sectional survey design was utilized, and 743 nurses from three major government hospitals in Saudi Arabia participated in the survey. Job satisfaction was measured using McCloskey/Mueller Satisfaction Scale. Data were collected between May 2014 and February 2015. RESULTS: Compared with Saudi nurses, expatriate nurses had overall lower job satisfaction after controlling for other predictors. While expatriates were less satisfied than Saudi nurses about extrinsic rewards and family-work balance, however, Saudi nurses were less satisfied than expatriate nurses about their professional opportunities, praise and recognition, and co-worker relationships. CONCLUSION: For some subscales, Saudi nurses were more satisfied than expatriate nurses, while for other subscales, the opposite was true. Nationality should be included in job satisfaction studies in countries with migrant workforces, as nationality-based differences may have been present but masked in earlier international studies by aggregating satisfaction across national groups. IMPLICATIONS FOR NURSING & HEALTH POLICY: Policy makers in Saudi Arabia and other countries with migrant nursing workforces should have effective induction programmes that help newly employed nurses - migrant and local - clearly understand their jobs, roles and responsibilities. Policy makers must have sufficient evidence to modify the reward system to ensure fairness and equality for all.

Wake up call for collegiate athlete sleep: narrative review and consensus recommendations from the NCAA Interassociation Task Force on Sleep and Wellness.

Sleep is an important determinant of collegiate athlete health, well-being and performance. However, collegiate athlete social and physical environments are often not conducive to obtaining restorative sleep. Traditionally, sleep has not been a primary focus of collegiate athletic training and is neglected due to competing academic, athletic and social demands. Collegiate athletics departments are well positioned to facilitate better sleep culture for their athletes. Recognising the lack of evidence-based or consensus-based guidelines for sleep management and restorative sleep for collegiate athletes, the National Collegiate Athletic Association hosted a sleep summit in 2017. Members of the Interassociation Task Force on Sleep and Wellness reviewed current data related to collegiate athlete sleep and aimed to develop consensus recommendations on sleep management and restorative sleep using the Delphi method. In this paper, we provide a narrative review of four topics central to collegiate athlete sleep: (1) sleep patterns and disorders among collegiate athletes; (2) sleep and optimal functioning among athletes; (3) screening, tracking and assessment of athlete sleep; and (4) interventions to improve sleep. We also present five consensus recommendations for colleges to improve their athletes' sleep.

Augmented supraspinal fatigue following constant-load cycling in the heat.

The development of central fatigue is prominent following exercise-induced hyperthermia, but the contribution of supraspinal fatigue is not well understood. Seven endurance-trained cyclists (mean ± SD peak O2 uptake, 62.0 ± 5.6 mL/kg/min) completed two high-intensity constant-load cycling trials (296 ± 34 W) to the limit of tolerance in a hot (34 °C, 20% relative humidity) and, on a separate occasion, for the same duration, a control condition (18 °C, 20% relative humidity). Core body temperature (Tc ) was measured throughout. Before and immediately after each trial, twitch responses to supramaximal femoral nerve and transcranial magnetic stimulation were obtained from the knee extensors to assess neuromuscular and corticospinal function, respectively. Exercise time was 11.4 ± 2.6 min. Peak Tc was higher in the hot compared with control (38.36 ± 0.43 °C vs 37.86 ± 0.36 °C; P = 0.035). Post-exercise reductions in maximal voluntary contraction force (13 ± 9% vs 9 ± 5%), potentiated twitch force (16 ± 12% vs 21 ± 13%) and voluntary activation (9 ± 7% vs 7 ± 7%) were similar in hot and control trials, respectively. However, cortical voluntary activation declined more in the hot compared with the control (8 ± 3% vs 3 ± 2%; P = 0.001). Exercise-induced hyperthermia elicits significant central fatigue of which a large portion can be attributed to supraspinal fatigue. These data indicate that performance decrements in the heat might initially originate in the brain.

A changing tide: what the new 'foundations of behavior' section of the 2015 medical college admissions test® might mean for undergraduate neuroscience programs.

Each year over 50,000 college students and alumni take the Medical College Admissions Test® (MCAT) and apply for admissions to medical school. After an extensive review process, the MCAT has undergone a major revision in form and content in order to better reflect the competencies medical students will need to be successful in their training and practice. Starting in April 2015, for the first time since the test's inception, the MCAT will include social and behavioral sciences content. The new section of the MCAT exam titled "The Psychological, Social and Biological Foundations of Behavior" will test pre-health competencies that combine content knowledge with scientific inquiry and reasoning skills. Anticipating growing interest in curriculum related to the new competency based content on the exam, the AAMC (Association of American Medical Colleges) established the Pre-health Collection within MedEdPORTAL's iCollaborative, a free repository of teaching resources. This online space gives faculty members the opportunity to share access to instructional resources in order to prepare or revise courses to include pre-health competencies. As a result of the increased content related to mind-body connections, undergraduate pre-medical students will be more likely to enroll in neuroscience courses to learn these competencies, or declare neuroscience majors, as the typical neuroscience major course requirements now meet most of the suggested pre-requisite competencies for medical school.

The Negative Effects of Travel on Student Athletes Through Sleep and Circadian Disruption.

Collegiate athletes must satisfy the academic obligations common to all undergraduates, but they have the additional structural and social stressors of extensive practice time, competition schedules, and frequent travel away from their home campus. Clearly such stressors can have negative impacts on both their academic and athletic performances as well as on their health. These concerns are made more acute by recent proposals and decisions to reorganize major collegiate athletic conferences. These rearrangements will require more multi-day travel that interferes with the academic work and personal schedules of athletes. Of particular concern is additional east-west travel that results in circadian rhythm disruptions commonly called jet lag that contribute to the loss of amount as well as quality of sleep. Circadian misalignment and sleep deprivation and/or sleep disturbances have profound effects on physical and mental health and performance. We, as concerned scientists and physicians with relevant expertise, developed this white paper to raise awareness of these challenges to the wellbeing of our student-athletes and their co-travelers. We also offer practical steps to mitigate the negative consequences of collegiate travel schedules. We discuss the importance of bedtime protocols, the availability of early afternoon naps, and adherence to scheduled lighting exposure protocols before, during, and after travel, with support from wearables and apps. We call upon departments of athletics to engage with sleep and circadian experts to advise and help design tailored implementation of these mitigating practices that could contribute to the current and long-term health and wellbeing of their students and their staff members.

The effect of surface tension reduction on the clinical performance of sodium hypochlorite in endodontics.

Sodium hypochlorite (NaOCl) is recommended as an endodontic irrigant in view of its broad antimicrobial and tissue dissolution capacities. To enhance its penetration into inaccessible areas of root canals and to improve its overall effect, the addition of surface-active agents has been suggested. The aim of this investigation was to review the effect of the reduction of the surface tension on the performance of NaOCl in endodontics. A search was performed in the Medline electronic database (articles published up to 28 July 2012, in English) with the search terms and combinations as follows: 'sodium hypochlorite AND surface tension or interfacial force or interfacial tension or surface-active agent or amphiphilic agent or surface active agent or surfactant or tenside or detergent'. The purpose of this search was to identify publications that compared NaOCl alone and NaOCl modified with the addition of a surface-active agent in endodontics. A hand search of articles published online ('in-press' and 'early view'), and appearing in the reference list of the articles included, was further performed, using the same search criteria as the electronic search. The search identified 302 publications, of which 11 fulfilled the inclusion/exclusion criteria of the review. The evidence available suggests that surface-active agents improve the penetration of NaOCl in the main canal and have no effect on its pulp tissue dissolution ability. There are, however, insufficient data to enable a sound conclusion to be drawn regarding the effect of modifying NaOCl's surface tension on lubrication, antimicrobial and smear layer or debris removal abilities.

University housing reinforces the negative relationship between interpersonal violence, psychological distress, and suicidality in undergraduates, particularly among gender diverse students.

OBJECTIVE: To compare academic and mental health outcomes across diverse gender identities in the context of interpersonal violence and campus housing. PARTICIPANTS: 45,549 students from 124 self-selected post-secondary institutions. METHODS: Various academic and health measures from the National College Health Assessment Spring 2017 dataset were analyzed for differences across five gender identities (cis women, cis men, transwomen, transmen, and genderqueer students), and two housing categories (university housing and non-university housing). RESULTS: When compared to cisgender peers, gender diverse students reported greater experiences of interpersonal violence and higher levels of negative academic and mental health outcomes. Living in university housing was associated with an increase in these disparities. CONCLUSIONS: University housing, which usually reinforces fixed gender binaries, is associated with worse outcomes for gender diverse students. These data can help higher education institutions better understand and address problems that disproportionately impact transgender and gender diverse students, who represent a growing demographic.

Psychological Well-Being in Asian and Asian American University Students: Impacts of Discrimination During the COVID-19 Pandemic.

PURPOSE: The aim of this study is to determine what modifiable behavioral and sociological factors were predictive of psychological distress and suicide risk in Asian and Asian American students, the ethnic group with the highest unmet mental health need in collegiate populations. We also compared these relationships in Fall 2019 to Fall 2020 to better understand how the impact of these factors changed during the COVID-19 pandemic and concurrent increase in Anti-Asian discrimination. METHODS: We used factor analysis to extract a wide range of predictor variables from the Fall 2019 and Fall 2020 American College Health Association's National College Health Assessment III. Next, we used structural equation modeling to identify significant drivers of psychological distress (Kessler-6 scale) and suicidality (Suicide Behavior Questionnaire-Revised scale) in Asian and Asian American students (n = 4,681 in 2019 and 1,672 in 2020). RESULTS: When compared to 2019, experiencing discrimination in 2020 had a substantially larger effect on both psychological distress and suicidality among Asian and Asian American university students. Loneliness and depression were also significant drivers of negative mental health outcomes both years, and their effect magnitudes remained largely unchanged. Being well rested had a protective effect against psychological distress both years. DISCUSSION: During the COVID-19 pandemic, discrimination was an important driver of psychological distress and suicidality in Asian and Asian American students. These findings suggest that organizations should enhance culturally competent mental healthcare services, while also working at the systems level to reduce bias and discrimination.

Sleep quality mediates the relationship between traumatic events, psychological distress, and suicidality in college undergraduates.

Objectives: To determine whether sleep quality mediates the relationship between traumatic life events and psychological wellbeing in college students. Methods: 40,646 undergraduate responses from the Spring 2017 National College Health Assessment II were evaluated for relationships between two predictor variables: satisfactory sleep and traumatic life events, and two outcome variables: psychological distress (a composite of anxiety, exhaustion, feeling overwhelmed, depression, sadness, loneliness, hopelessness, and anger) and suicidality (composite of self-harm behaviors, suicidal ideation, suicide attempts). Linear mediation regression analysis via structural equation modeling was used to test these relationships. Results: Each additional traumatic life event students reported experiencing was associated with a 27.6% - 58.9% increase in the odds of reporting indicators of psychological distress or suicidality. Satisfactory sleep significantly mediated this negative relationship (proportional effects between 10.6 and 12.5%). Conclusions: Healthy sleep mediates the impact of traumatic life events on psychological distress and suicidality.

Music and the mind: a new interdisciplinary course on the science of musical experience.

In this paper the instructors describe a new team-taught transdisciplinary seminar, "Music and Mind: The Science of Musical Experience." The instructors, with backgrounds in music and neuroscience, valued the interdisciplinary approach as a way to capture student interest and to reflect the inherent interconnectivity of neuroscience. The course covered foundational background information about the science of hearing and musical perception and about the phenomenology of musical creation and experience. This two-credit honors course, which attracted students from eleven majors, integrated experiential learning (active listening, journaling, conducting mini-experiments) with rigorous reflection and discussion of academic research. The course culminated in student-led discussions and presentations of final projects around hot topics in the science of music, such as the 'Mozart Effect,' music and religious experience, etc. Although this course was a two-credit seminar, it could easily be expanded to a four-credit lecture or laboratory course. Student evaluations reveal that the course was successful in meeting the learning objectives, that students were intrinsically motivated to learn more about the discipline, and that the team-taught, experiential learning approach was a success.

Daytime sleepiness among Midwestern firefighters.

Excessive daytime sleepiness (EDS) is the most common symptom of sleep-disorders. Although high levels of EDS have been reported among firefighters, there is a limited understanding on EDS in firefighters. A cross-sectional survey was conducted in full-time firefighters (n = 275). The survey included the Epworth Sleepiness Scale to assess EDS, as well as other questions related to job characteristics, health history, and demographics. Firefighters reported inadequate sleep hours, extremely short sleep latencies, and high EDS higher than the general population. A majority of firefighters indicated a willingness to consult with a sleep professional. Risk factors associated with EDS included at least five years of professional experiences and depression diagnosis. Our findings suggest that EDS is widespread among firefighters. With increasing time on the job, frequencies of both obesity and EDS increase, which can have severe and compounding effects on health and safety.

Body mass index at the time of diagnosis and the risk of advanced stages and poorly differentiated cancers of the breast: findings from a case-series study.

INTRODUCTION: Obesity is a risk factor for postmenopausal breast cancer and is independently associated with shorter disease-free and overall survival. Currently, in clinical settings, the combination of stage and grade of cancer at the initial presentation of the disease is the best prognostic indicator. OBJECTIVE: To evaluate the association between body mass index (BMI) and risk of advanced stages and poorly differentiated grade of breast cancer. DESIGN: A case-series study of women diagnosed with their first primary invasive breast cancer. Patients include a total of 831 women aged >or=40 years with a mean BMI of 29.6(± 6.6) kg m(-2). Pathological, clinical and demographic data were retrieved from electronic medical records. Multinomial logistic regression analysis was preformed to estimate the risk of more advanced stages and poorly differentiated grade of cancer, adjusting for covariates. RESULTS: Obese compared with normal weight women had an 80% increased risk of cancer with more advanced stages (III/IV) and poorly differentiated grade (odds ratio = 1.80, 95% confidence interval 1.13-2.86, P = 0.014). No significant increase in risk was observed for overweight women. CONCLUSION: Obesity at the time of diagnosis of breast cancer is associated with more advanced stages and poorly differentiated grade of cancers.

Sleep Predicts Collegiate Academic Performance: Implications for Equity in Student Retention and Success.

College students show high levels of insufficient sleep, excessive daytime sleepiness, sleep schedule irregularity, poor sleep quality, and inadequate sleep hygiene. This article describes the evidence linking poor sleep with impaired academic performance; discusses mediating environmental, behavioral, and demographic factors that correlate with sleep; and highlights examples of successful health promotion initiatives on college campuses. Given that students who are traditionally minoritized on college campuses tend to have worse sleep, improving sleep health emerges as an important issue for retention, equity, and inclusion.

Follow-up to Hartmann & Prichard: Should universities invest in promoting healthy sleep? A question of academic and economic significance.

OBJECTIVE: We use regression results from Hartmann & Prichard (2018) in conjunction with other publicly available data to estimate the economic benefits from early identification and treatment of sleep problems on raising the likelihood of students' college graduation and future earnings. RESULTS: The benefits of improved graduation rates and future earnings exceed the cost of being screened, educated, and treated for sleep problems. CONCLUSIONS: Based on the demand for information about healthy sleep by students and the established link between sleep problems and academic success, universities should consider instituting sleep health programs to identify and support students with sleep disturbances early in their academic careers.

An Update on Dual Orexin Receptor Antagonists and Their Potential Role in Insomnia Therapeutics.

STUDY OBJECTIVES: Current pharmacological options for the treatment of insomnia insufficiently meet the needs of all insomnia patients. Approved treatments are not consistently effective in improving sleep onset and sleep maintenance, while also having complicated safety profiles. These limitations highlight the unmet need for additional medications and treatment strategies. Initial research suggests that the dual orexin receptor antagonists (DORAs) may offer an additional pharmaceutical option to treat insomnia in some patients. METHODS: We reviewed the existing literature on dual orexin receptor antagonists in PubMed databases using the search terms "orexin receptor antagonist," "almorexant" "filorexant," "lembroexant" and "suvorexant"; searches were limited to English language primary research articles, clinical trials, and reviews. RESULTS: Targeting the orexin receptor system for treatment of insomnia offers an additional and alternative pharmacological approach to more common gamma aminobutyric acid agonist sedative hypnotic treatment. Effectiveness is not well established in the current literature; however, the literature does suggest efficacy. Preclinical reports also suggest the potential for treatment in individuals with comorbid Alzheimer disease and insomnia. CONCLUSIONS: DORAs offer an additional treatment option for insomnia. More clinical trials are needed to robustly evaluate their safety and effectiveness in several subclasses of individuals with insomnia. Given the published literature, head-to-head comparisons to existing treatment for insomnia are warranted.

Calculating the contribution of sleep problems to undergraduates' academic success.

OBJECTIVES: The objective of this study is to determine to what degree sleep disturbances predict academic success, relative to other known risk factors for decreased academic performance. METHODS: We performed regression analyses on data from the Spring 2009 American College Health Association National College Health Assessment II dataset (n=55,322 students) to isolate the relative contribution of the frequency of sleep problems in the previous week to GPA and the likelihood of withdrawing from a course. In our estimations, we also controlled for other factors that influence academic success such as demographic and academic variables, drug and alcohol use, perceived stress, and employment hours. RESULTS: Sleep disturbances were found to be a significant independent predictor of academic problems; on average, each additional day per week that a student experienced sleep problems raised the probability of dropping a course by 10% and lowered the cumulative GPA by 0.02. Factors such as stress, binge drinking, marijuana and other illicit drug use, which typically receive more attention by university administrators, had similar or relatively smaller negative associations with academic success as compared to disturbed sleep. Approximately three quarters of students surveyed reported never receiving information about sleep from their university. CONCLUSIONS: Sleep education represents an underutilized opportunity for universities to maximize retention rates and academic success.

Demographics, Health, and Risk Behaviors of Young Adults Who Drink Energy Drinks and Coffee Beverages.

Objective: The present study investigates risk behaviors, sleep habits, and mental health factors associated with caffeinated beverage use in young adults. Materials and Methods: Students from a midsize private university (n = 159) completed a 15-minute anonymous questionnaire, including questions on risk behaviors, sleep habits, alcohol, and caffeine consumption. We compared behaviors between the top ∼15% ("high end") of energy drink users (≥3/month) and coffee users (≥16/month) to those with less frequent or no caffeine consumption. Results: Caffeine consumption was frequent among young adults. In the last month, 36% of students had an energy drink, 69% had coffee or espresso, and 86% reported having any caffeine; however, the majority of students were unaware of the caffeine content in these beverages. High-end energy drink consumers reported more risk-taking behaviors (increased drug and alcohol use and less frequent seat belt use), sleep disturbances (later bedtimes, harder time falling asleep, and more all-nighters), and higher frequency of mental illness diagnoses than those who consumed fewer energy drinks. In contrast, the frequency of most risk behaviors, sleep disturbances, and mental illness diagnoses was not significantly different between the high-end and general population of coffee drinkers. Conclusion: Students with delayed sleep patterns, mental illness, and higher frequency of substance use and risk behaviors were more likely to be regular energy drink users but not regular coffee drinkers. It is unclear whether the psychoactive content in energy drinks results in different behavioral effects than just caffeine in coffee, and/or different personality/health populations are drawn to the two types of beverages.

Depression, anxiety, and tobacco use: Overlapping impediments to sleep in a national sample of college students.

OBJECTIVES: To examine how tobacco use and depression/anxiety disorders are related to disturbed sleep in college students. PARTICIPANTS: 85,138 undergraduate respondents (66.3% female, 74.5% white, non-Hispanic, ages 18-25) from the Spring 2011 American College Health Association-National College Health Assessment II database. METHODS: Multivariate analyses of tobacco use (none, intermediate, daily) and mental health (diagnosed and/or symptomatic depression or anxiety) were used to predict sleep disturbance. RESULTS: Daily tobacco use was associated with more sleep problems than binge drinking, illegal drug use, obesity, gender, and working >20 hours/week. Students with depression or anxiety reported more sleep disturbances than individuals without either disorder, and tobacco use in this population was associated with the most sleep problems. CONCLUSIONS: Tobacco use and depression/anxiety disorders are both independently associated with more sleep problems in college students. Students with depression and/or anxiety are more likely to be daily tobacco users, which likely exacerbates their sleep problems.