Sink or Swim? Sleep Patterns in Highly Trained Adolescent Swimmers during the In-Season Phase of Training.

Objectives The aim of this study was to investigate the sleeping patterns of highly-trained adolescent swimmers. Further objectives were to compare subjective and objective measures of sleep and to evaluate the relationship between electronic device use and sleep in this cohort. Methods Fifteen national-level swimmers (age: 16.4 ± 1.0 years) wore wrist actigraphs while completing sleep diaries over a two-week training period. Types of nights were classified as early morning training (≤7am - EARLY), day training (>7am - DAY), and no training (REST). Information on electronic device use before bed and other sleep behaviors was collected via questionnaires. Results Total sleep time (TST) was significantly ( p < 0.05) shorter on nights preceding EARLY (5:53 ± 1:06 hour:min) compared with nights preceding DAY (7:40 ± 1:12 hour:min) and REST (7:59 ± 1:19 hour:min). Participants overestimated subjective TST by ∼54 minutes when compared with objectively measured TST ( p < 0.05). Discussion Adolescent athletes obtained a greater amount of sleep prior to later training the next day or before rest days, when compared with early morning swim training the next day. Adolescents also overestimated their sleep duration by ∼1 hour per night. There were no significant relationships between electronic device use at night and measured sleep indices.

The Effectiveness of a Pediatric Emergency Medicine Block Education Session for Pediatric Residents.

BACKGROUND AND OBJECTIVE: There exists no standardized curriculum for pediatric residents to develop procedural skills during residency training. Many pediatric residency programs are transitioning to block education sessions; the effectiveness of this format for delivering pediatric emergency medicine (PEM) procedural curriculum has not been evaluated. The objective is to determine if a PEM block education session improved pediatric residents' knowledge and confidence in 4 domains: laceration repair, splinting of extremities, resuscitation/airway management, and point-of-care ultrasound. METHODS: Pediatric residents at the University of California at San Diego participated in a 4-hour PEM block education session during which they rotated through 4 interactive stations: laceration repair, splinting of extremities, resuscitation/airway management, and point-of-care ultrasound. Residents' knowledge was assessed using 2 distinct multiple-choice tests, each consisting of 20 questions (5 questions per domain). Residents were block randomized to take one version of the test as the pretest and the other version as the posttest. Residents' confidence was assessed for each domain using a standardized 5-point confidence tool before and after the block education session. RESULTS: Forty-five residents attended the PEM block education session. Forty-three residents completed both the preknowledge and postknowledge tests. The PEM block education session resulted in an almost 14% increase in knowledge test when comparing preknowledge and postknowledge scores (P < 0.0001). Significant improvement in resident confidence was seen in all 4 domains (P < 0.0001). CONCLUSIONS: The PEM block educational session improved both pediatric residents' knowledge and confidence in domains frequently encountered in the pediatric emergency department.

"Choose Physical Therapy" for Neonatal Abstinence Syndrome: Clinical Management for Infants Affected by the Opioid Crisis.

In response to the opioid crisis, the American Physical Therapy Association has strongly advocated for physical therapy as a safe alternative to pharmacological pain management through the "#ChoosePT" campaign and the dedication of a PTJ special issue to the nonpharmacological management of pain. Physical therapists not only play an important role in the rehabilitation of the nearly 2 million adolescents and adults addicted to prescription opioids but also provide care to infants born to mothers with various drug addictions. This Perspective article explores the incidence, pathophysiology, and risk factors for neonatal abstinence syndrome and describes the clinical presentations of withdrawal and neurotoxicity in infants. Discipline-specific recommendations for the physical therapist examination and plan of care, including pharmacological management considerations, are outlined. Nonpharmacological management, including supportive care, feeding, parent education, social aspects of care, and follow-up services, are discussed from a physical therapy perspective. Finally, this article reviews developmental outcomes in infants with neonatal abstinence syndrome and reflects on challenges and future directions of research in this area.

New Canadian guideline provides evidence-based approach to non-occupational HIV prophylaxis.

The incidence of HIV infections in Canada has increased yearly since 2014. New cases of HIV have resulted almost exclusively from non-occupational exposures, including sexual contact and needle sharing. Appropriate HIV post-exposure prophylaxis is under-prescribed to patients who present to the emergency department after a high-risk exposure. In November of 2017, a Canadian guideline on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) was published. The guideline presents a standardized, evidence-based approach to assessing risk for HIV transmission and prescribing HIV prophylaxis. This summary highlights the key points from the guideline that are relevant to the practice of emergency medicine in Canada.

From pillow to podium: a review on understanding sleep for elite athletes.

Sleep is considered vital to human health and well-being, and is critical to physiological and cognitive functioning. Elite athletes experience high training and competition demands, and are often exposed to various factors, situations, and environments that can cause sleep impairments. Previous research has shown that athletes commonly experience sleep loss in the lead up to and following competition, which could have significant impacts on their preparation, performance, and recovery. In particular, the results from previous research show significant reductions in total sleep time (~1:40 h:min) and significant increases in sleep latency (~45 minutes) following evening competition. Napping is common in both the training and competition setting in athletes; however, research on the effect of napping on physiology and performance is limited. In contrast, research on strategies and interventions to improve sleep are increasing in the athletic population, with sleep hygiene research resulting in significant improvements in key sleep indices. This review investigates the physiological importance of sleep in athletes, current tools to monitor athletes' sleep, the role of sleep for cognitive functioning and athletic performance, the prevalence of sleep disturbances and the potential mechanisms causing sleep disturbances, the role of napping, and different intervention strategies to improve sleep.

The Influence of Match-Day Napping in Elite Female Netball Athletes.

PURPOSE: To assess the effect of match-day napping and duration of naps on perceptual and performance indices in elite female netball players over 2 consecutive netball seasons. METHODS: A total of 14 elite female netball athletes (mean [SD]; age = 23 [6] y) participated in an observational study over 26 competition matches. On each match day, athletes provided information on their napping habits and perceived energy levels, then performed 3 countermovement jumps 3 h:30 min prior to the start of the match. One hour after the match, subjective player performance ratings from the players and 2 members of the coaching staff were obtained. Naps were characterized into 3 conditions for analysis: no nap (NN), <20-min nap (SHORT), and ≥20-min nap (LONG). RESULTS: A significant difference in peak jump velocity was observed between the SHORT and the NN condition in favor of the shorter nap (3.23 [0.26] and 3.07 [0.36] m·s-1, respectively, d = 0.34, P < .05). A moderate, significant difference (d = 0.85; P < .05) was observed for the coach rating of performance (out of 10) between the SHORT and the NN condition (7.2 [0.8] and 6.4 [0.9], respectively) in favor of SHORT. CONCLUSIONS: The findings from the study would suggest that a short nap (<20 min) on the day of competition can enhance jump velocity and improve subjective performance in elite netball players, as assessed by coaching staff.

Sleep and stress hormone responses to training and competition in elite female athletes.

Stress hormone and sleep differences in a competition versus training setting are yet to be evaluated in elite female team-sport athletes. The aim of the current study was to evaluate salivary cortisol and perceptual stress markers during competition and training and to determine the subsequent effects on sleep indices in elite female athletes. Ten elite female netball athletes (mean ± SD; age: 23 ± 6 years) had their sleep monitored on three occasions; following one netball competition match (MATCH), one netball match simulation session (TRAIN), and one rest day (CONTROL). Perceived stress values and salivary cortisol were collected immediately pre- (17:15 pm) and post-session (19:30 pm), and at 22:00 pm. Sleep monitoring was performed using wrist actigraphy assessing total time in bed, total sleep time (TST), efficiency (SE%), latency, sleep onset time and wake time. Cortisol levels were significantly higher (p < .01) immediately post MATCH compared with TRAIN and CONTROL (mean ± SD; 0.700 ± 0.165, 0.178 ± 0.127 and 0.157 ± 0.178 µg/dL, respectively) and at 22:00 pm (0.155 ± 0.062, 0.077 ± 0.063, and 0.089 ± 0.083 µg/dL, respectively). There was a significant reduction in TST (-118 ± 112 min, p < .01) and SE (-7.7 ± 8.5%, p < .05) following MATCH vs. TRAIN. Salivary cortisol levels were significantly higher, and sleep quantity and quality were significantly reduced, following competition when compared to training and rest days.

Sleep-hygiene Education improves Sleep Indices in Elite Female Athletes.

The importance of sleep in providing psychophysiological recovery in elite athletes is often overlooked. In other populations (eg shift workers and adolescent students), sleep hygiene education may serve to acutely improve sleep indices. However, this is yet to be examined in an elite athlete setting. Therefore, the aim of the current study was to evaluate the effect of a sleep hygiene education session on sleep indices in elite athletes. The study involved 26 elite female netball athletes performing one week of baseline sleep monitoring (PRE), followed by a sleep hygiene education session and a further week of sleep monitoring (POST) in a single group, pre- post design. The sleep hygiene education session focused on providing information on the importance of sleep for athletes and practical tips to improve sleep quality and quantity. Sleep monitoring was performed using wrist actigraphy to assess total sleep time (TST), sleep efficiency (SE%), total time in bed (TTB), sleep latency (SL), wake episodes per night (WE), sleep onset variance (SOV), wake variance (WV) wake episode duration (WED), sleep onset time (SOT), and wake time (WT). There was a significant improvement in TST (mean ± SD; 22.3 ± 39.9 minutes, p=0.01) PRE to POST sleep hygiene education session, the difference associated with a small effect (ES: 0.39). A significant improvement PRE to POST was found for WV (p=0.03), and for WED (p=0.03). There were no significant differences for SE%, SL, TTB, WE, SOV, SOT, WT. The current study reports that a sleep hygiene education session is effective in improving sleep quantity in elite female athletes in an acute setting.

What wrist should you wear your actigraphy device on? Analysis of dominant vs. non-dominant wrist actigraphy for measuring sleep in healthy adults.

OBJECTIVE: Differences in sleep results due to the placement of actigraphy devices (non-dominant vs. dominant wrist) are yet to be determined. METHODS: 65 nights of data from 13 adult participants was collected while participants wore two actigraphy devices, one on each wrist. Sleep indices including total sleep time (TST), total time in bed (TTB), sleep efficiency (SE%), sleep latency (SL), wake after sleep onset (WASO), sleep onset time (SOT) and wake time (WT) were assessed between the two devices. RESULTS: There were no significant differences between devices for any of the measured sleep variables (p>0.05). SE%, SL and WASO resulted in high correlations between devices (0.89, 0.89 and 0.76, respectively), with all other sleep variables resulting in very high correlations (>0.90) between devices. CONCLUSIONS: Based on our results, it does not seem critical which wrist the actigraphy device is worn on for measuring key sleep variables.

Missed Opportunities for HIV Prophylaxis Among Emergency Department Patients With Occupational and Nonoccupational Body Fluid Exposures.

STUDY OBJECTIVE: Exposures to HIV are frequently managed in the emergency department (ED) for assessment and potential initiation of HIV postexposure prophylaxis. Despite established guidelines, it is unclear whether patients with a nonoccupational exposure are managed similarly to patients with an occupational exposure. METHODS: This retrospective study used an administrative database to identify consecutive patients at a single ED with a discharge diagnosis of "blood or body fluid exposure" without sexual assault from April 1, 2007 to June 30, 2013. Patient exposure details and physician management were ascertained according to predefined guidelines. The primary outcome was the proportion of patients with high-risk exposures who were correctly given HIV prophylaxis; the secondary outcome was the proportion of patients with low-risk exposures who were correctly not given HIV prophylaxis. Other outcomes included the proportion of patients who had a baseline HIV test in the ED, the proportion who followed up with an HIV test within 6 months, and the number of seroconversions in this group. All outcomes were compared between nonoccupational and occupational exposure. RESULTS: Of 1,972 encounters, 1,358 patients (68.9%) had an occupational exposure and 614 (31.1%) had a nonoccupational exposure. In the occupational exposure group, 190 patients (14.0%) were deemed high risk, with 160 (84.2%; 95% confidence interval [CI] 78.1% to 88.9%) appropriately given prophylaxis. In the nonoccupational exposure group, 287 patients (46.7%) had a high-risk exposure, with 208 (72.5%; 95% CI 66.8% to 77.5%) given prophylaxis, for a difference of 11.7% (95% CI 3.8% to 19.1%). For low-risk exposures, appropriate management of both occupational and nonoccupational exposure was similar (92.4% versus 93.0%). At the index ED visit, 90.5% of occupational exposure patients and 76.7% of nonoccupational exposure patients received HIV testing, for a difference of 13.8% (95% CI 10.1% to 17.7%). At 6 months, 25.4% of patients with an occupational exposure and 35.0% of patients with a nonoccupational exposure had a follow-up test, for a difference of -9.6% (95% CI -14.2% to -5.1%). Of patients who had follow-up testing within 6 months, 4 of 215 (1.9%) in the nonoccupational exposure group tested newly positive for HIV, whereas 0 of 345 (0%) in the occupational exposure group tested positive. CONCLUSION: For ED patients with blood or body fluid exposures, those with high-risk nonoccupational exposures were not given HIV prophylaxis nearly twice as often as those with high-risk occupational exposure. Although 6-month follow-up testing rates were low, 1.9% of high-risk nonoccupational exposure patients seroconverted.

Inter-device reliability of an automatic-scoring actigraph for measuring sleep in healthy adults.

Actigraphy has become a common method of measuring sleep due to its non-invasive, cost-effective nature. An actigraph (Readiband™) that utilizes automatic scoring algorithms has been used in the research, but is yet to be evaluated for its inter-device reliability. A total of 77 nights of sleep data from 11 healthy adult participants was collected while participants were concomitantly wearing two Readiband™ actigraphs attached together (ACT1 and ACT2). Sleep indices including total sleep time (TST), sleep latency (SL), sleep efficiency (SE%), wake after sleep onset (WASO), total time in bed (TTB), wake episodes per night (WE), sleep onset variance (SOV) and wake variance (WV) were assessed between the two devices using mean differences, 95% levels of agreement, intraclass correlation coefficients (ICC), typical error of measurement (TEM) and coefficient of variation (CV%) analysis. There were no significant differences between devices for any of the measured sleep variables (p>0.05). TST, SE, SL, TTB, SOV and WV all resulted in very high ICC's (>0.90), with WASO and WE resulting in high ICC's between devices (0.85 and 0.80, respectively). Mean differences of -2.1 and 0.2 min for TST and SL were associated with a low TEM between devices (9.5 and 3.8 min, respectively). SE resulted in a 0.3% mean difference between devices. The Readiband™ is a reliable tool for researchers using multiple devices of this brand in sleep studies to assess basic measures of sleep quality and quantity in healthy adult populations.

Increased risk of suicide attempts among Black and Latino lesbians, gay men, and bisexuals.

Members of racial/ethnic minority groups have a lower lifetime prevalence than have Whites of mental disorders, a risk factor for suicide attempts; paradoxically, however, lesbian, gay, and bisexual (LGB) ethnic minority youths may be at increased risk for suicide attempts relative to White LGB youths. We found that the increased risk of suicide attempts among racial/ethnic minority LGB respondents in our sample relative to White respondents was not explained by excess youth onset of depression and substance abuse or by a higher susceptibility to suicide in the racial/ethnic minority LGB group.

Cortical thickness of the frontopolar area in typically developing children and adolescents.

The development of the frontopolar cortex (FPC) through late childhood and adolescence was investigated using measures of cortical thickness. T(1)-weighted structural MRIs from 35 typically developing participants aged 8-20 years were used to construct 3D models of the brain, from which cortical thickness was measured. There was a significant inverse association between age and cortical thickness, such that cortical thickness decreased as age increased between 8 and 20 years. There was no effect of laterality or gender on cortical thickness.