Sleep disturbance and cognitive functioning among firefighters.

Firefighters are at risk for chronic sleep disruption due to their rotating 24-hour on and 48-hour off work schedule and hazardous work conditions. Forty-five firefighters were assessed to determine the impact of their shift schedule on sleep duration, sleep quality, processing speed, sustained attention, vigilance, and mental health. Assessments were conducted at the start and end of shift.

Potential uses of naltrexone in emergency department patients with opioid use disorder.

Despite widespread recognition of the opioid crisis, opioid overdose remains a common reason for Emergency Department (ED) utilization. Treatment for these patients after stabilization often involves the provision of information for outpatient treatment options. Ideally, an ED visit for overdose would present an opportunity to start treatment for opioid use disorder (OUD) immediately.

Quality of Life Enhancement Research Program: Lessons Learned.

The attempted Quality of Life Enhancement program appeared to be a novel method for creating a symbiotic and sustainable relationship between a large Southeastern university and local nursing home and assisted living facilities (ALF), through which ALF residents would attend university arts and sporting events. During implementation, it was discovered that this project was unsustainable, undesired, unneeded by many care centers, difficult to implement, and required a dedicated and specialized staff. After attempting to enroll 14 local care facilities, only 2 were interested in becoming involved and produced 5 eligible participants.

Code Help: Can This Unique State Regulatory Intervention Improve Emergency Department Crowding?

Introduction: Emergency department (ED) crowding adversely affects multiple facets of high-quality care. The Commonwealth of Massachusetts mandates specific, hospital action plans to reduce ED boarding via a mechanism termed "Code Help." Because implementation appears inconsistent even when hospital conditions should have triggered its activation, we hypothesized that compliance with the Code Help policy would be associated with reduction in ED boarding time and total ED length of stay (LOS) for admitted patients, compared to patients seen when the Code Help policy was not followed.

System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings.

The appropriate communication and management of incidental findings on emergency department (ED) radiology studies is an important component of patient safety. Guidelines have been issued by the ACR and other medical associations that best define incidental findings across various modalities and imaging studies. However, there are few examples of health care facilities designing ways to manage incidental findings.

The relationship between moderate alcohol consumption, depressive symptomatology, and C-reactive protein: the Health and Retirement Study.

Objective: Moderate alcohol use has been broadly associated with health benefits among older adults, including improved mood. Aims of this study were to evaluate the relationship of moderate alcohol use and depressive symptomatology over a period of eight years, and to examine inflammation, indicated by C-reactive protein (CRP), as one mechanism by which this relationship functions.

Methods: The study included 3177 community-dwelling participants over the age of 65 in 2008 drawn from the Health and Retirement Study.

Socioeconomic status and hippocampal volume in children and young adults.

An individual's socioeconomic status (SES) is often viewed as a proxy for a host of environmental influences. SES disparities have been linked to variance in brain structures particularly the hippocampus, a neural substrate of learning and memory. However, it is unclear whether the association between SES and hippocampal volume is similar in children and adults.

Code-based Diagnostic Algorithms for Idiopathic Pulmonary Fibrosis. Case Validation and Improvement.

Rationale: Population-based studies of idiopathic pulmonary fibrosis (IPF) in the United States have been limited by reliance on diagnostic code-based algorithms that lack clinical validation.

Objectives: To validate a well-accepted International Classification of Diseases, Ninth Revision, code-based algorithm for IPF using patient-level information and to develop a modified algorithm for IPF with enhanced predictive value.

Methods: The traditional IPF algorithm was used to identify potential cases of IPF in the Kaiser Permanente Northern California adult population from 2000 to 2014.

Development of Database Assisted Structure Identification (DASI) Methods for Nontargeted Metabolomics.

Metabolite structure identification remains a significant challenge in nontargeted metabolomics research. One commonly used strategy relies on searching biochemical databases using exact mass. However, this approach fails when the database does not contain the unknown metabolite (i.

Complications of long-term opioid therapy for management of chronic pain: the paradox of opioid-induced hyperalgesia.

While opioids remain a valid and effective analgesic strategy for patients suffering from a wide variety of painful conditions, they are not a panacea. Increasingly, physicians must balance patient expectations of adequate pain control with known limitations of opioid pharmaceuticals including adverse effects, tolerance, addiction, withdrawal, and drug diversion. Further complicating the issue over the last decade is a growing body of evidence suggesting chronic opioid use may unexpectedly worsen the perception of pain in some individuals.

Recommendations to limit life support: a national survey of critical care physicians.

Rationale: There is debate about whether physicians should routinely provide patient surrogates with recommendations about limiting life support.

Objectives: To explore physicians' self-reported practices and attitudes.

Methods: A cross-sectional, stratified survey of 1,000 randomly selected US critical care physicians was mailed.

Critical care physicians' approaches to negotiating with surrogate decision makers: a qualitative study.

Objective: To describe how critical care physicians manage conflicts with surrogates about withdrawing or withholding patients' life support.

Design: Qualitative analysis of key informant interviews with critical care physicians during 2010. We transcribed interviews verbatim and used grounded theory to code and revise a taxonomy of themes and to identify illustrative quotes.

Sedation and analgesia for the mechanically ventilated patient.

Mechanically ventilated patients in the intensive care unit routinely require sedative and analgesic medications to manage pain and anxiety. These medications may have unpredictable effects with long-term use. Strategies that may help to improve patient outcomes include thoughtful selection of medications, use of objective sedation and pain scales, and implementation of protocolized sedation.

Altered mental status from olanzapine overdose treated with physostigmine.

Background: Olanzapine is commonly prescribed to patients with schizophrenia. One retrospective study demonstrates the efficacy of physostigmine in reversing mental status changes induced by olanzapine. We report two patients with delirium due to confirmed olanzapine overdose treated with physostigmine.

The relationship between service learning and medical student academic and professional outcomes.

Background: Little is known about the relationship between medical student participation in service and performance outcomes.

Purpose: To examine relationships between involvement in required service learning and measures of academic and professional achievement and specialty choice.

Methods: Using preexisting, self-reported data for Tulane University School of Medicine's class of 2004, we categorized students as low, moderate, or high on commitment and involvement in service learning (CISL) and compared to multiple outcomes: class rank; election to the Alpha Omega Alpha (AOA) Honor Society; election to the Gold Humanism in Medicine Honor Society; total percent scores on 2 multistation, structured, clinical examinations; and specialty choice per 2004 residency match results.

Monoamine oxidase inhibitor poisoning resulting from Internet misinformation on illicit substances.

The Internet may represent a new mechanism by which adolescents initiate the use of illicit substances. The existence of multiple partisan websites providing misinformation regarding the safety of these substances may lead to an increase in unsafe behavior among this age group. Adverse outcomes related to Internet-based drug information are rarely identified.

Development of form similarity as a Gestalt grouping principle in infancy.

Given evidence demonstrating that infants 3 months of age and younger can utilize the Gestalt principle of lightness similarity to group visually presented elements into organized percepts, four experiments using the familiarization/novelty-preference procedure were conducted to determine whether infants can also organize visual pattern information in accord with the Gestalt principle of form similarity. In Experiments 1 and 2, 6- to 7-month-olds, but not 3- to 4-month-olds, presented with generalization and discrimination tasks involving arrays of X and O elements responded as if they organized the elements into columns or rows based on form similarity. Experiments 3 and 4 demonstrated that the failure of the young infants to use form similarity was not due to insufficient processing time or the inability to discriminate between the individual X and O elements.

Lesions in the dentate hilum and CA2/CA3 regions of the rat hippocampus produce cognitive deficits that correlate with site-specific glial activation.

Thirty male rats pressed a lever three times (FR3) when a stimulus light (sD) was off to obtain sucrose pellets. They were then evenly divided into sham Controls versus groups lesioned bilaterally in the hippocampus by stercotaxic injection of ibotenic acid into the dentate hilum (HIL) or the CA2/CA3 region (CA2/3). On measures of recall of the FR3-sD task taken during the initial 30 min of a postlesion test session, the CA2/3 and especially the HIL groups showed significant (p < .

Thiamine and Alzheimer's disease. A pilot study.

As a test of the significance of previously described biochemical abnormalities in thiamine-dependent enzymes in brains and other tissues in patients with Alzheimer's disease, a double-blind, placebo-controlled, crossover, outpatient pilot study compared the effects of 3 g/d of oral thiamine hydrochloride for three months with those of a niacinamide placebo. Eleven moderately impaired patients with "probable Alzheimer's disease" by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria completed the study. All patients were well nourished and had no stigmata of dietary thiamine deficiency.

Replacement variant histone genes contain intervening sequences.

The nucleotide sequences of two chicken histone genes encoding replacement variant H3.3 polypeptides are described. Unlike the replication variant genes of chickens (and almost all other organisms), these genes contain intervening sequences; introns are present in both genes in the 5' noncoding and coding sequences.