Humans typically sleep in highly built settings that isolate them from environmental regulators of sleep. In postindustrial, highly urbanized environments, these conditions are combined with social ...schedules that include long commuting times to meet strict school and work times. Together, these conditions have created a “social time” that represents a major determinant of sleep timing and quality.My studies consist of sleep data from two human study populations living in the highly urbanized city of Seattle (Washington, USA) that represent unique contexts in which social time and the built environment have distinct effects on sleep.University students have a late chronotype, or natural inclination to sleep and wake at later times of the day. Students are severely affected by their social obligations because their early school and work times conflict with their late chronotypes. The misalignment between their circadian and social times is described as social jetlag and leads to inadequate sleep duration and quality. Social jetlag and insufficient sleep duration are linked to many health conditions, such as obesity and heart disease.The Covid-19 pandemic shutdown caused workplaces and universities to become remote, which led to little to no commute and more flexibility to choose betimes. We recorded actimetry and light data in students before-Covid (2019), during-Covid (2020), and after-Covid (2021). Compared to before- and after-Covid, during-Covid there was a decrease in the discrepancy between school day and weekend sleep timing, and a longer sleep duration during school days. Light exposure timing also showed higher coherence between school days and weekends during-Covid. Importantly, while interindividual variance in sleep parameters increased during-Covid intraindividual variation did not change, suggesting that increased freedom to choose bedtimes allowed university students to default to their own circadian time and align it better with their social time.People experiencing homelessness are typically not attending school or are unemployed, and unlike students their circadian and social times are more aligned. In contrast, the main challenge they face is the lack of an appropriate environment for optimal sleep. The homeless population in Seattle also has a variety of sleeping environments. We recorded actimetry and light exposure in homeless adults living in tents, tiny houses, permanent or overnight indoor shelters during the winter and summer. We also recorded this data in adults living in stable housing conditions to compare to the unhoused communities. Our results show that both the timing of sleep and its quality is affected by the homelessness conditions and seasons. We also see a drastic difference in light exposure timing and duration due to the differences in Seattle photoperiod in summer versus winter.Both of these studies show the impact of the social environment on a persons’ sleep timing and quality.
There is growing interest in developing artificial lighting that stimulates intrinsically photosensitive retinal ganglion cells (ipRGCs) to entrain circadian rhythms to improve mood, sleep, and ...health. Efforts have focused on stimulating the intrinsic photopigment, melanopsin; however, specialized color vision circuits have been elucidated in the primate retina that transmit blue-yellow cone-opponent signals to ipRGCs. We designed a light that stimulates color-opponent inputs to ipRGCs by temporally alternating short- and long-wavelength components that strongly modulate short-wavelength sensitive (S) cones. Two-hour exposure to this S-cone modulating light produced an average circadian phase advance of 1 h and 20 min in 6 subjects (mean age = 30 years) compared to no phase advance for the subjects after exposure to a 500 lux white light equated for melanopsin effectiveness. These results are promising for developing artificial lighting that is highly effective in controlling circadian rhythms by invisibly modulating cone-opponent circuits.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
OBJECTIVES:With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are ...safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitation for critically ill children and associated barriers.
DESIGN:National 2-day point prevalence study.
SETTING:Eighty-two PICUs in 65 hospitals across the United States.
PATIENTS:All patients admitted to a participating PICU for greater than or equal to 72 hours on each point prevalence day.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:The primary outcome was prevalence of physical therapy– or occupational therapy–provided mobility on the study days. PICUs also prospectively collected timing of initial rehabilitation team consultation, clinical and patient mobility data, potential mobility–associated safety events, and barriers to mobility. The point prevalence of physical therapy– or occupational therapy–provided mobility during 1,769 patient-days was 35% and associated with older age (adjusted odds ratio for 13–17 vs < 3 yr, 2.1; 95% CI, 1.5–3.1) and male gender (adjusted odds ratio for females, 0.76; 95% CI, 0.61–0.95). Patients with higher baseline function (Pediatric Cerebral Performance Category, ≤ 2 vs > 2) less often had rehabilitation consultation within the first 72 hours (27% vs 38%; p < 0.001). Patients were completely immobile on 19% of patient-days. A potential safety event occurred in only 4% of 4,700 mobility sessions, most commonly a transient change in vital signs. Out-of-bed mobility was negatively associated with the presence of an endotracheal tube (adjusted odds ratio, 0.13; 95% CI, 0.1–0.2) and urinary catheter (adjusted odds ratio, 0.28; 95% CI, 0.1–0.6). Positive associations included family presence in children less than 3 years old (adjusted odds ratio, 4.55; 95% CI, 3.1–6.6).
CONCLUSIONS:Younger children, females, and patients with higher baseline function less commonly receive rehabilitation in U.S. PICUs, and early rehabilitation consultation is infrequent. These findings highlight the need for systematic design of rehabilitation interventions for all critically ill children at risk of functional impairments.
Abstract
Younger adults have a biological disposition to sleep and wake at later times that conflict with early morning obligations like work and school; this conflict leads to inadequate sleep ...duration and a difference in sleep timing between school days and weekends. The COVID-19 pandemic forced universities and workplaces to shut down in person attendance and implement remote learning and meetings that decreased/removed commute times and gave students more flexibility with their sleep timing. To determine the impact of remote learning on the daily sleep–wake cycle we conducted a natural experiment using wrist actimetry monitors to compare activity patterns and light exposure in three cohorts of students: pre-shutdown in-person learning (2019), during-shutdown remote learning (2020), and post-shutdown in-person learning (2021). Our results show that during-shutdown the difference between school day and weekend sleep onset, duration, and midsleep timing was diminished. For instance, midsleep during school days pre-shutdown occurred 50 min later on weekends (5:14 ± 12 min) than school days (4:24 ± 14 min) but it did not differ under COVID restrictions. Additionally, we found that while the interindividual variance in sleep parameters increased under COVID restrictions the intraindividual variance did not change, indicating that the schedule flexibility did not cause more irregular sleep patterns. In line with our sleep timing results, school day vs. weekend differences in the timing of light exposure present pre- and post-shutdown were absent under COVID restrictions. Our results provide further evidence that increased freedom in class scheduling allows university students to better and consistently align sleep behavior between school days and weekends.
Graphical abstract
Graphical Abstract
Rapid Response Teams (RRT) are new emergency teams introduced to support the deteriorating patient. The purpose of this study was to determine if a particular educational intervention would prompt ...earlier initiation of RRTs. This quantitative, quasi-experimental study was conducted at a community hospital in the Midwest. Data were collected on the RRT calls prior to the intervention using a retrospective chart review. A self-study educational module and visual reminders were then introduced to all nurses on the study units. Data on RRT calls were then collected post-intervention. Patient and nurse demographics were also analyzed. The study did show that the intervention increased the percentage of earlier RRT calls after the educational intervention. However the results were not statistically significant most likely due to the small number of charts reviewed and the researcher's time restraint. However these findings suggest the need for a larger study.
HOLLYWOOD SHUFFLE Rice, Alicia
Vibe (New York, N.Y.),
04/2002, Volume:
4, Issue:
10
Magazine Article
It seems like just yesterday that coonery, discrimination, unemployment, and demeaning roles were big issues for black actors in H-town. wonders where we're at now.
Abstract Objectives To refine the Transfer Assessment Instrument (TAI 2.0), develop a training program for the TAI, and analyze the basic psychometric properties of the TAI 3.0, including ...reliability, standard error of measurement (SEM), minimal detectable change (MDC), and construct validity. Design Repeated measures. Setting A winter sports clinic for disabled veterans. Participants Wheelchair users (N=41) who perform sitting-pivot or standing-pivot transfers. Intervention Not applicable. Main Outcome Measures TAI version 3.0, intraclass correlation coefficients, SEMs, and MDCs for reliable measurement of raters' responses. Spearman correlation coefficient, 1-way analysis of variance, and independent t tests to evaluate construct validity. Results TAI 3.0 had acceptable to high levels of reliability (range, .74–.88). The SEMs for part 1, part 2, and final scores ranged from .45 to .75. The MDC was 1.5 points on the 10-point scale for the final score. There were weak correlations (ρ range, −.13 to .25; P >.11) between TAI final scores and subjects' characteristics (eg, sex, body mass index, age, type of disability, length of wheelchair use, grip and elbow strength, sitting balance). Conclusions With comprehensive training, the refined TAI 3.0 yields high reliability among raters of different clinical backgrounds and experience. TAI 3.0 was unbiased toward certain physical characteristics that may influence transfer. TAI fills a void in the field by providing a quantitative measurement of transfers and a tool that can be used to detect problems and guide transfer training.
Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work ...organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing.
Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame).
This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed.
ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.
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