Radiation Reveal: Moving from research engagement to involvement.

Here, we report on the process of a highly impactful and successful creative, collaborative, and multi-partner public engagement project, Radiation Reveal. It brought together ten young adults aged 17-25-year-olds with experience of radiotherapy with researchers at Cancer Research UK RadNet City of London across three 2-hour online workshops. Our aims were to 1) initiate discussions between young adults and radiation researchers, and 2) identify what people wish they had known about radiotherapy before or during treatment. These aims were surpassed; other benefits included peer support, participants' continued involvement in subsequent engagement projects, lasting friendships, creation of support groups for others, and creation and national dissemination of top ten tips for medical professionals and social media resources. A key learning was that this project required a dedicated and (com)passionate person with connections to national cancer charities. When designing the project, constant feedback is also needed from charities and young adults with and without radiotherapy experience. Finally, visually capturing discussions and keeping the door open beyond workshops further enhanced impact. Here, we hope to inform and inspire people to help project the patient voice in all we do.

Systematic review and meta-analysis of Murray's law in the coronary arterial circulation.

Murray's law has been viewed as a fundamental law of physiology. Relating blood flow ([Formula: see text]) to vessel diameter (D) ([Formula: see text]·âˆ·D3), it dictates minimum lumen area (MLA) targets for coronary bifurcation percutaneous coronary intervention (PCI). The cubic exponent (3.0), however, has long been disputed, with alternative theoretical derivations, arguing this should be closer to 2.33 (7/3). The aim of this meta-analysis was to quantify the optimum flow-diameter exponent in human and mammalian coronary arteries. We conducted a systematic review and meta-analysis of all articles quantifying an optimum flow-diameter exponent for mammalian coronary arteries within the Cochrane library, PubMed Medline, Scopus, and Embase databases on 20 March 2023. A random-effects meta-analysis was used to determine a pooled flow-diameter exponent. Risk of bias was assessed with the National Institutes of Health (NIH) quality assessment tool, funnel plots, and Egger regression. From a total of 4,772 articles, 18 were suitable for meta-analysis. Studies included data from 1,070 unique coronary trees, taken from 372 humans and 112 animals. The pooled flow diameter exponent across both epicardial and transmural arteries was 2.39 (95% confidence interval: 2.24-2.54; I2 = 99%). The pooled exponent of 2.39 showed very close agreement with the theoretical exponent of 2.33 (7/3) reported by Kassab and colleagues. This exponent may provide a more accurate description of coronary morphometric scaling in human and mammalian coronary arteries, as compared with Murray's original law. This has important implications for the assessment, diagnosis, and interventional treatment of coronary artery disease.

Psychometric Evaluation of the Insomnia Severity Index in Nurses.

OBJECTIVES: Examine psychometric properties of the Insomnia Severity Index (ISI) in a sample of nurses. METHOD: In a sample of day shift nurses (N = 289), a confirmatory factor analysis (CFA), convergent and discriminant validity analyses, and a test-retest reliability analysis were performed. RESULTS: CFA showed that a two-factor model provided the best fit. The ISI had moderate to poor convergent validity with sleep diary parameters, and moderate convergent validity with the Sleep Condition Indicator (r = -.66), Pittsburgh Sleep Quality Index (r = .66), and PROMIS Sleep-Related Impairment measure (r = .67). The ISI demonstrated good discriminant validity with the measures Composite Scale of Morningness (r = -.27), Nightmares Disorder Index (r = .25), PTSD Checklist for DSM-5 (sleep items removed; r = .32), and Perceived Stress Scale (r = .43). The ISI had weaker discriminant validity with the PHQ-9 (r = .69) and Generalized Anxiety Disorder Screener (r = .51). The ISI demonstrated a good test-retest reliability (ICCs = .74-.88). CONCLUSIONS: The ISI is a psychometrically strong measure for the assessment of insomnia severity in day shift nurses. Overlap with psychological symptoms, primarily anxiety and depression, suggests caution while interpreting these constructs.

Mean affect and affect variability may interact to predict inflammation.

INTRODUCTION: Individuals with greater affect variability (i.e., moment-to-moment fluctuations possibly reflecting emotional dysregulation) are at risk for greater systemic inflammation, which is associated with cardiovascular disease. Some evidence suggests that affect variability is linked with poorer health indicators only among those with higher average levels of affect, particularly for positive affect (PA), and that associations may be non-linear. The present study sought to examine whether links between both PA and negative affect (NA) variability and inflammation are moderated by average level of affect. METHODS: Participants (N = 300, 50 % female, ages 21-70, 60 % non-Hispanic White, 19 % Hispanic, 15 % non-Hispanic Black) completed a lab assessment and provided a blood sample to measure systemic inflammation (i.e., TNF-α, IL-6, CRP). Affect was collected via a two-day ecological momentary assessment protocol where reports were collected about every 45-min during waking hours. Momentary affect ratings were averaged across both days (i.e., iM), separately for PA and NA, for each participant. Affect variability was calculated as the person-specific SD (i.e., iSD) of affect reports, separately for PA and NA. Linear and quadratic interactions were tested. Models included covariates for sex, race, and body mass index. RESULTS: There were significant interactions between NA iM and NA iSD predicting TNF-α (b = 6.54; p < 0.05) and between PA iM and PA iSD predicting IL-6 (b = 0.45; p < 0.05). Specifically, the association between these affect variability indicators and inflammatory markers were suggestive of a positive association among those with higher average affect but a negative association among those with lower average affect. There was no evidence of non-linear associations between affect and inflammation. DISCUSSION: Incorporating interactive effects between affect variability and average affect may be an important consideration in understanding affective-inflammatory associations.

Using a frequentist and Bayesian approach to examine video game usage, substance use, and sleep among college students.

Video games are a popular form of entertainment. However, there is mixed evidence for the association between video game usage and poor sleep quality, short sleep duration, or delayed sleep timing. The current study examined associations between daily sleep behaviours and video game usage via a Bayesian and frequentist statistical approach. Caffeine and alcohol consumption were also assessed as moderators, as these behaviours may co-occur with video game usage and poor sleep. 1032 (72% female) undergraduate students were recruited between 2006-2007. Participants completed questionnaires examining video game and substance use, as well as sleep diaries for 1 week. Frequentist analyses revealed that video game usage was related to increased variability in the total sleep time, and a later average sleep midpoint, but not sleep efficiency. Alcohol use moderated the relationships between video game usage and both average and variability in total sleep time. Caffeine use was related to shorter average total sleep time and more variability in sleep efficiency. Alcohol consumption was related to more variability in the total sleep time and sleep midpoint, and a later average sleep midpoint. Bayesian models suggested strong evidence that video game playing was associated with later average sleep midpoint. Like the frequentist approach, alcohol consumption moderated the relationship between video game usage and both average and variability in total sleep time, but the evidence was weak. The effect sizes for both approaches tended to be small. Using a rigorous statistical approach and a large sample, this study provides robust evidence that video game usage may not be strongly associated with poor sleep among undergraduate students.

Treatment of comorbid sleep disorders and posttraumatic stress disorder in U.S. active duty military personnel: A pilot randomized clinical trial.

Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT-I&N) and cognitive processing therapy (CPT) for PTSD are first-line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N = 93) to one of three conditions: CBT-I&N delivered before CPT, CBT-I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT-I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms, d = -0.36; insomnia, d = -0.77; sleep efficiency, d = 0.62; and nightmares, d = -.53. Compared to participants who received CBT-I&N delivered before CPT, those who received CBT-I&N delivered after CPT demonstrated larger improvements in PTSD symptoms, d = 0.48, and sleep efficiency, d = -0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone.

Internal consistency reliability of mental health questionnaires in college student athletes.

OBJECTIVES: To examine the internal consistency reliability and measurement invariance of a questionnaire battery designed to identify college student athletes at risk for mental health symptoms and disorders. METHODS: College student athletes (N=993) completed questionnaires assessing 13 mental health domains: strain, anxiety, depression, suicide and self-harm ideation, sleep, alcohol use, drug use, eating disorders, attention deficit hyperactivity disorder (ADHD), bipolar disorder, post-traumatic stress disorder (PTSD), gambling and psychosis. Internal consistency reliability of each measure was assessed and compared between sexes as well as to previous results in elite athletes. Discriminative ability analyses were used to examine how well the cut-off score on the strain measure (Athlete Psychological Strain Questionnaire) predicted cut-offs on other screening questionnaires. RESULTS: Strain, anxiety, depression, suicide and self-harm ideation, ADHD, PTSD and bipolar questionnaires all had acceptable or better internal consistency reliability. Sleep, gambling and psychosis questionnaires had questionable internal consistency reliability, although approaching acceptable for certain sex by measure values. The athlete disordered eating measure (Brief Eating Disorder in Athletes Questionnaire) had poor internal consistency reliability in males and questionable internal consistency reliability in females. CONCLUSIONS: The recommended mental health questionnaires were generally reliable for use with college student athletes. To truly determine the validity of the cut-off scores on these self-report questionnaires, future studies need to compare the questionnaires to a structured clinical interview to determine the discriminative abilities.

Tracking the stochastic growth of bacterial populations in microfluidic droplets.

Bacterial growth in microfluidic droplets is relevant in biotechnology, in microbial ecology, and in understanding stochastic population dynamics in small populations. However, it has proved challenging to automate measurement of absolute bacterial numbers within droplets, forcing the use of proxy measures for population size. Here we present a microfluidic device and imaging protocol that allows high-resolution imaging of thousands of droplets, such that individual bacteria stay in the focal plane and can be counted automatically. Using this approach, we track the stochastic growth of hundreds of replicateEscherichia colipopulations within droplets. We find that, for early times, the statistics of the growth trajectories obey the predictions of the Bellman-Harris model, in which there is no inheritance of division time. Our approach should allow further testing of models for stochastic growth dynamics, as well as contributing to broader applications of droplet-based bacterial culture.

How much does sleep vary from night-to-night? A quantitative summary of intraindividual variability in sleep by age, gender, and racial/ethnic identity across eight-pooled datasets.

Habitual sleep duration and efficiency vary widely by age, gender, and racial/ethnic identity. Despite growing research on the importance of night-to-night, intraindividual variability (IIV) in sleep, few studies have examined demographic differences in sleep IIV. The present study describes typical sleep IIV overall and by demographics among healthy sleepers. Eight datasets of healthy sleepers (N = 2,404; 26,121 total days of sleep data) were synthesised to examine age, gender, and racial/ethnic identity differences in sleep IIV measured via diaries, actigraphy, and electroencephalography (EEG). Sleep IIV estimates included the intraindividual standard deviation (iSD), root mean square of successive differences (RMSSD), coefficient of variation (CV), and a validated Bayesian Variability Model (BVM). There was substantial IIV in sleep across measurement types (diary, actigraphy, EEG) for both sleep duration (iSD: 85.80 [diary], 77.41 [actigraphy], 67.04 [EEG] minutes; RMSSD: 118.91, 108.89, 91.93 minutes; CV: 19.19%, 19.11%, 18.57%; BVM: 60.60, 58.20, 48.60 minutes) and sleep efficiency (iSD: 5.18% [diary], 5.22% [actigraphy], 6.46% [EEG]; RMSSD: 7.01%, 7.08%, 8.44%; CV: 5.80%, 6.27%, 8.14%; BVM: 3.40%, 3.58%, 4.16%). Younger adults had more diary and actigraphy sleep duration IIV. Gender differences were inconsistent. White and non-Hispanic/Latinx adults had less IIV in sleep duration and efficiency compared to racial/ethnic minority groups. Even among healthy sleepers, sleep varies widely from night-to-night. Like mean sleep, there also may be disparities in IIV in sleep by demographic characteristics. Study results help characterise normative values of sleep IIV in healthy sleepers.

Daily stress and sleep associations vary by work schedule: A between- and within-person analysis in nurses.

Nurses experience poor sleep and high stress due to demanding work environments. Night shift work is common among nurses and may exacerbate stress-sleep associations. We examined bidirectional associations between daily stress and sleep, and moderation by recent shift worker status and daily work schedule among nurses. Participants were 392 nurses (92% female; 78% White, mean age = 39.54, SD = 11.15) who completed 14 days of electronic sleep diaries and actigraphy. They simultaneously completed assessments of daily stress and work schedule upon awakening (day shift vs. night shift [work between 9 p.m.-6 a.m.] vs. off work). Participants were classified as recent night shift workers if they worked at least one night shift during the past 14 days (n = 101; 26%). In the entire sample, greater daily stress predicted shorter self-reported total sleep time and lower self-reported sleep efficiency that night. Shorter self-reported and actigraphy total sleep time and lower self-reported sleep efficiency predicted higher next-day stress. Compared with recent night shift workers, day workers reported higher stress after nights with shorter total sleep time. Stress-sleep associations mostly did not vary by nurses' daily work schedule. Sleep disturbances and stress may unfold in a toxic cycle and are prime targets for tailored interventions among nurses. Night shift workers may be less susceptible to the effects of short sleep on next-day stress. Research is needed to understand the short- and long-term effects of shift work and address the unique sleep challenges nurses face.

Organisational failure: rethinking whistleblowing for tomorrow's doctors.

The duty to protect patient welfare underpins undergraduate medical ethics and patient safety teaching. The current syllabus for patient safety emphasises the significance of organisational contribution to healthcare failures. However, the ongoing over-reliance on whistleblowing disproportionately emphasises individual contributions, alongside promoting a culture of blame and defensiveness among practitioners. Diane Vaughan's 'Normalisation of Deviance' (NoD) provides a counterpoise to such individualism, describing how signals of potential danger are collectively misinterpreted and incorporated into the accepted margins of safe operation. NoD is an insidious process that often goes unnoticed, thus minimising the efficacy of whistleblowing as a defence against inevitable disaster. In this paper, we illustrate what can be learnt by greater attention to the collective, organisational contributions to healthcare failings by applying NoD to The Morecambe Bay Investigation. By focusing on a cluster of five 'serious untoward incidents' occurring in 2008, we describe a cycle of NoD affecting trust handling of events that allowed poor standards of care to persist for several years, before concluding with a poignant example of the limitations of whistleblowing, whereby the raising of concerns by a senior consultant failed to generate a response at trust board level. We suggest that greater space in medical education is needed to develop a thorough understanding of the cultural and organisational processes that underpin healthcare failures, and that medical education would benefit from integrating the teaching of medical ethics and patient safety to resolve the tension between systems approaches to safety and the individualism of whistleblowing.

Secondary individual outcomes following multicouple group therapy for posttraumatic stress disorder: An uncontrolled pilot study with military dyads.

Cognitive-behavioral conjoint therapy (CBCT) for posttraumatic stress disorder (PTSD) has demonstrated efficacy for improving PTSD and comorbid symptoms and relationship adjustment. To enhance treatment efficiency and scalability, we developed a 2-day, abbreviated, intensive, multicouple group version of CBCT for PTSD (AIM-CBCT for PTSD). Prior work demonstrated that AIM-CBCT for PTSD wasassociated with reductions in PTSD and comorbid symptoms in a sample of 24 post-9/11 active duty military or veteran couples who received the treatment in a retreat format over a single weekend. The current study investigated secondary outcomes regarding trauma-related cognitions, psychosocial impairment, and insomnia. For trauma-related cognitions, reductions were nonsignificant and small at 1-month follow-up, ds = -0.14 to -0.32. However, by 3-month follow-up, there were significant, medium effect size reductions in total trauma-related cognitions, d = -0.68, and negative views of self and others, ds = -0.64 and -0.57, respectively, relative to baseline. There was also a nonsignificant, small-to-medium effect-size reduction in self-blame, d = -0.43, p = .053, by 3-month follow-up. For psychosocial impairment, there were significant and medium-to-large and large effect size reductions by 1- and 3-month follow-ups, ds = -0.73 and -0.81, respectively. There were nonsignificant, small effect size reductions in insomnia at both 1- and 3-month follow-ups relative to baseline, ds = -0.30 and -0.34, respectively. These findings suggest that AIM-CBCT for PTSD is associated with reductions in maladaptive posttraumatic cognitions and psychosocial impairment but that adjunctive interventions may be needed to address insomnia.

Racial/ethnic variations in inflammatory markers: exploring the role of sleep duration and sleep efficiency.

Individuals from minoritized racial/ethnic groups have higher levels of circulating inflammatory markers. However, the mechanisms underlying these differences remain understudied. The objective of this study was to examine racial/ethnic variations in multiple markers of inflammation and whether impaired sleep contributes to these racial/ethnic differences. Nurses from two regional hospitals in Texas (n = 377; 71.62% White; 6.90% Black; 11.14% Hispanic, 10.34% Asian; mean age = 39.46; 91.78% female) completed seven days of sleep diaries and actigraphy to assess mean and variability in total sleep time (TST) and sleep efficiency (SE). On day 7, blood was drawn to assess 4 inflammatory markers: C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-1 beta (IL-1ß), and tumor necrosis factor-alpha (TNF-α). Results from regression models showed differences in inflammatory markers by race/ethnicity, adjusting for age and gender. The associations between sleep parameters and inflammatory markers also varied by race/ethnicity. Among White nurses, lower mean and greater variability in actigraphy-determined TST and greater variability in diary-determined TST were associated with higher levels of IL-6. Among Black nurses, lower mean diary-determined SE was associated with higher levels of IL-6 and IL-1ß. Among Hispanic nurses, greater diary-determined mean TST was associated with higher CRP. Among Asian nurses, greater intraindividual variability in actigraphy-determined SE was associated with lower CRP. Among nurses, we did not find racial/ethnic disparities in levels of inflammation. However, analyses revealed differential relationships between sleep and inflammatory markers by race/ethnicity. Results highlight the importance of using a within-group approach to understand predictors of inflammatory markers.

Characterizing Patterns of Nurses' Daily Sleep Health: a Latent Profile Analysis.

BACKGROUND: Nursing is a demanding occupation characterized by dramatic sleep disruptions. Yet most studies on nurses' sleep treat sleep disturbances as a homogenous construct and do not use daily measures to address recall biases. Using person-centered analyses, we examined heterogeneity in nurses' daily sleep patterns in relation to psychological and physical health. METHODS: Nurses (N = 392; 92% female, mean age = 39.54 years) completed 14 daily sleep diaries to assess sleep duration, efficiency, quality, and nightmare severity, as well as measures of psychological functioning and a blood draw to assess inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP). Using recommended fit indices and a 3-step approach, latent profile analysis was used to identify the best-fitting class solution. RESULTS: The best-fitting solution suggested three classes: (1) "Poor Overall Sleep" (11.2%), (2) "Nightmares Only" (8.4%), (3) "Good Overall Sleep" (80.4%). Compared to nurses in the Good Overall Sleep class, nurses in the Poor Overall Sleep or Nightmares Only classes were more likely to be shift workers and had greater stress, PTSD symptoms, depression, anxiety, and insomnia severity. In multivariate models, every one-unit increase in insomnia severity and IL-6 was associated with a 33% and a 21% increase in the odds of being in the Poor Overall Sleep compared to the Good Overall Sleep class, respectively. CONCLUSION: Nurses with more severe and diverse sleep disturbances experience worse health and may be in greatest need of sleep-related and other clinical interventions.

"Generalized unsafety" as fear inhibition to safety signals in adults with and without childhood trauma.

The Generalized Unsafety Theory of Stress posits that low heart rate variability contributes to a perception of "generalized unsafety" (i.e., constantly perceiving oneself to be unsafe), independent of stressful events or stress-related symptomatology. We tested this claim by examining if resting heart rate variability, trait worry, posttraumatic stress symptoms, trauma history, and age of onset predicted fear inhibition, a measure of generalized unsafety. A Pavlovian discriminant conditioning paradigm was used to assess fear inhibition level by comparing eyeblink startle potentiation to a threat cue (presented with air blast) with startle potentiation to a safety signal (never presented with air blast). Survey and laboratory responses were collected from 42 adults who were 20 years old on average, 86% Women, and 76% White. Heart rate variability did not independently predict variation in fear inhibition, as hypothesized. Rather, higher levels of posttraumatic stress symptoms and greater cumulative interpersonal trauma predicted lower fear inhibition. Individuals reporting childhood trauma had higher trait worry, which predicted more severe posttraumatic stress symptoms. These findings highlight the role of attenuated inhibitory learning in stress-related symptomatology and developmentally disruptive trauma. Ability to distinguish threat from safety is a plausible biobehavioral mechanism by which adversity impacts development.

Web-based provider training of cognitive behavioral therapy of insomnia: engagement rates, knowledge acquisition, and provider acceptability.

Insomnia is common but severely underreported and undertreated. One possible reason for this problem is the lack of providers in cognitive behavioral therapy for insomnia (CBT-I). To address this we created CBTIweb.org, an online training platform for providers to learn the basics of sleep, assessing insomnia, and CBT-I. The present study assessed the reach of CBTIweb by examining engagement, knowledge acquisition, and perceived acceptability. Participants who registered for CBTIweb self-reported their practice setting and personal characteristics (i.e. degree, profession, licensure status). Knowledge acquisition was assessed with pre- and post-tests, and provider acceptability was assessed via a survey. In the first three months after launching CBTIweb, 2586 providers registered and 624 of these completed the training within three months of registering. Chi-square tests of independence revealed no differences in completion rates by education or profession, though trainees were more likely to initiate and complete treatment than licensed providers. Paired t tests revealed significant knowledge acquisition, and most providers positively rated the website navigation, content, aesthetics, and understanding of core CBT-I skills. This study demonstrated CBTIweb is an effective platform for training health professionals to be minimally proficient in the gold standard treatment for insomnia disorder.

Testing the role of aerobic exercise in the treatment of posttraumatic stress disorder (PTSD) symptoms in U.S. active duty military personnel: a pilot study.

The purpose of this pilot study was to determine if the efficacy of imaginal exposure for symptoms of posttraumatic stress disorder (PTSD) could be improved by adding aerobic exercise. We hypothesized that aerobic exercise would enhance the efficacy of exposure therapy. Active duty service members with clinically significant symptoms of posttraumatic stress (PTSD Checklist-Stressor-Specific Version, [PCL-S], ≥25) were randomized into one of four conditions: exercise only; imaginal exposure only; imaginal exposure plus exercise; no exercise/no exposure therapy (control). Participants (N = 72) were primarily male, Army, noncommissioned officers ranging in age from 22 to 52. PTSD symptom severity decreased over time (p < .0001); however, there were no significant differences between the experimental conditions. The prediction that imaginal exposure augmented with aerobic exercise would be superior to either imaginal exposure alone or aerobic exercise alone was not supported, suggesting that engaging in exercise and imaginal exposure simultaneously may not be any better than engaging in either activity alone. A better understanding of individually administered and combined exercise and exposure therapy interventions for PTSD is warranted.

Efficacy of unsupervised exercise in adults with obstructive lung disease: a systematic review and meta-analysis.

INTRODUCTION: The benefits of unsupervised exercise programmes in obstructive lung disease are unclear. The aim of this systematic review was to synthesise evidence regarding the efficacy of unsupervised exercise versus non-exercise-based usual care in patients with obstructive lung disease. METHODS: Electronic databases (MEDLINE, CINAHL, Embase, Allied and Complementary Medicine Database, Web of Science, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database) and trial registers (ClinicalTrials.gov, Current Controlled Trials, UK Clinical Trials Gateway and WHO International Clinical Trials Registry Platform) were searched from inception to April 2020 for randomised trials comparing unsupervised exercise programmes with non-exercise-based usual care in adults with chronic obstructive pulmonary disease (COPD), non-cystic fibrosis bronchiectasis or asthma. Primary outcomes were exercise capacity, quality of life, mortality, exacerbations and respiratory cause hospitalisations. RESULTS: Sixteen trials (13 COPD, 2 asthma, 1 chronic bronchitis: 1184 patients) met the inclusion criteria. Only data on COPD populations were available for meta-analysis. Unsupervised exercise resulted in a statistically but not clinically significant improvement in the 6-Minute Walk Test (n=5, MD=22.0 m, 95% CI 4.4 to 39.6 m, p=0.01). However, unsupervised exercise did lead to statistically significant and clinically meaningful improvements in St. George's Respiratory Questionnaire (n=4, MD=-11.8 points, 95% CI -21.2 to -2.3 points, p=0.01) and Chronic Respiratory Disease Questionnaire domains (dyspnoea: n=4, MD=0.5 points, 95% CI 0.1 to 0.8 points, p<0.01; fatigue: n=4, MD=0.7 points, 95% CI 0.4 to 1.0 points, p<0.01; emotion: n=4, MD=0.5 points, 95% CI 0.2 to 0.7 points, p<0.01; mastery: unable to perform meta-analysis) compared with non-exercise-based usual care. DISCUSSION: This review demonstrates clinical benefits of unsupervised exercise interventions on health-related quality of life in patients with COPD. High-quality randomised trials are needed to examine the effectiveness of prescription methods.

The Cycle of Daily Stress and Sleep: Sleep Measurement Matters.

BACKGROUND: Disturbed sleep can be a cause and a consequence of elevated stress. Yet intensive longitudinal studies have revealed that sleep assessed via diaries and actigraphy is inconsistently associated with daily stress. PURPOSE: We expanded this research by examining daily associations between sleep and stress using a threefold approach to assess sleep: sleep diaries, actigraphy, and ambulatory single-channel electroencephalography (EEG). METHODS: Participants were 80 adults (mean age = 32.65 years, 63% female) who completed 7 days of stressor and sleep assessments. Multilevel models were used to examine bidirectional associations between occurrence and severity of daily stress with diary-, actigraphy-, and EEG-determined sleep parameters (e.g., total sleep time [TST], sleep efficiency, and sleep onset latency, and wake after sleep onset [WASO]). RESULTS: Participants reported at least one stressor 37% of days. Days with a stressor were associated with a 14.4-min reduction in actigraphy-determined TST (ß = -0.24, p = 0.030), but not with other actigraphy, diary, or EEG sleep measures. Nights with greater sleep diary-determined WASO were associated with greater next-day stressor severity (ß = 0.01, p = 0.026); no other diary, actigraphy, or EEG sleep measures were associated with next-day stressor occurrence or severity. CONCLUSIONS: Daily stress and sleep disturbances occurred in a bidirectional fashion, though specific results varied by sleep measurement technique and sleep parameter. Together, our results highlight that the type of sleep measurement matters for examining associations with daily stress. We urge future researchers to treat sleep diaries, actigraphy, and EEG as complementary-not redundant-sleep measurement approaches.

Sleep quality and outcome of exposure therapy in adults with social anxiety disorder.

INTRODUCTION: Poor sleep is prevalent among individuals with social anxiety disorder (SAD) and may negatively affect exposure therapy outcomes. Poor sleep may impair memory and learning, and thus compromise fear extinction learning thought to take place in exposure therapy. We examined poor sleep as a predictor of exposure therapy outcomes for SAD and the moderating role of d-cycloserine (DCS) on this relationship. METHODS: Participants were 152 individuals with a primary diagnosis of SAD. As part of a randomized clinical trial evaluating the efficacy of DCS for enhancing the effects of exposure therapy, they completed self-report baseline measure of sleep quality, and self-report sleep diaries assessing sleep duration (total sleep time [TST]) and sleep quality the nights before and after treatment sessions. RESULTS: Poorer baseline sleep quality was significantly associated with slower improvement over time and worse symptom outcomes at the end of treatment and follow-up after controlling for baseline symptoms of depression and social anxiety. Greater TST the night before treatment predicted lower SAD symptoms at the next session, after controlling for symptoms at the previous session. There was no relation between prior or subsequent night sleep quality on symptoms at the next session. No associations were moderated by DCS. CONCLUSIONS: We replicated and extended findings indicating that poor sleep quality is associated with poorer exposure therapy outcomes for SAD. Assessing for sleep difficulties before treatment initiation and incorporating sleep interventions into treatment may enhance exposure therapy outcomes for SAD.