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Jet lag can impair a variety of physical and mental functions. The impact of jet lag on athletic performance has been assumed but difficult to prove methodologically. The challenges have involved eliminating the impact of the quality of the opponent and the difficulties determining when an athlete actually traveled across time zones. Analyzing free throw (FT) shooting in the National Basketball Association allowed these challenges to be overcome. 48,309 games across 19 consecutive seasons were examined of which 675 games involved a team that met our definition of jet lag. In these games, players on the jet lagged teams made 12,154 of 16,286 (74.6%) FTs that were attempted while in the remaining games of that season, the same players on these teams made 993,962 of 1,318,188 (75.4%) FTs attempted, X2 (1, N = 1,334,474) = 5.21, p =.02. There was no significant impact of jet lag on the players who took the most number of FTs in these jet lagged games. However, the remaining players on the team made 7,394 of 10,016 (73.8%) FTs attempted in jet lagged games while the same players made 794,009 of 1,056,587 (75.1%) FTs in other games that season, X2 (1, N = 1,066,603) = 9.35, p =.002. When subcategorized further, the impact on the players on jet lagged teams was only seen when they traveled from east to west but not when travel was from west to east. Our analysis reveals that jet lag does negatively influence athletic performance, primarily through circadian rhythm disruption. However, elite athletes appear to be able to overcome this impact if they are given enough opportunities to do so. [ABSTRACT FROM AUTHOR]

For visitor games, visitor scores increased from 95.18 (1 day rest) to 97.11 at five days rest (p<0.0001) and home team win margin decreased from 4.3 (1 day rest) to 0.471 at five days rest (p<0.0001). In multivariate regression, with visitor team westward jet-lagged & home team non-jetlagged, home wins (60% to 68%, p=0.092) & scoring (99.07 to 99.31, p<=0.0001) increased, score margin decreased (3.24 to 2.83, p=0.031), and visitor points increased (95.84 to 96.49, p=0.083). B CONCLUSIONS: b When non-jet lagged home teams played jet-lagged visitors, scoring of both teams was higher. [Extracted from the article]

As obesity becomes more common worldwide, the prevalence of obstructive sleep apnoea (OSA) continues to rise. Obstructive sleep apnoea is a well-known disorder that causes chronic intermittent hypoxia (CIH), which is considered a risk factor for atherosclerosis directly and indirectly. Ischaemic heart disease remains the leading cause of death. Most risk factors for atherosclerosis are well understood. However, other factors such as CIH are less well understood. Several studies have investigated the pathophysiology of CIH, attempting to uncover its link to atherosclerosis and to determine whether OSA treatment can be a therapeutic modality to modify the risk for atherosclerosis. In this article, we will review the pathophysiology of OSA as an independent risk factor for cardiovascular disease and discuss the most common markers that have been studied. We will also examine the potential impact of OSA management as a risk factor modifier on the reversibility of atherosclerosis. [ABSTRACT FROM AUTHOR]

An abstract of the article "Thrombocytosis: A Delayed Marker of Stress" by Deepthi Gandhiraj, Firas Jafri, and Dipak Chandy is presented.

Introduction: Educational milestones are now used to assess the developmental progress of all U.S. graduate medical residents during training. Twice annually, each program's Clinical Competency Committee (CCC) makes these determinations and reports its findings to the Accreditation Council for Graduate Medical Education (ACGME). The ideal way to conduct the CCC is not known. After finding that deliberations reliant upon the new milestones were time intensive, our internal medicine residency program tested an approach designed to produce rapid but accurate assessments.Material and Methods: For this study, we modified our usual CCC process to include pre-meeting faculty ratings of resident milestones progress with in-meeting reconciliation of their ratings. Data were considered largely via standard report and presented in a pre-arranged pattern. Participants were surveyed regarding their perceptions of data management strategies and use of milestones. Reliability of competence assessments was estimated by comparing pre-/post-intervention class rank lists produced by individual committee members with a master class rank list produced by the collective CCC after full deliberation.Results: Use of the study CCC approach reduced committee deliberation time from 25 min to 9 min per resident (p < 0.001). Committee members believed milestones improved their ability to identify and assess expected elements of competency development (p = 0.026). Individual committee member assessments of trainee progress agreed well with collective CCC assessments.Conclusions: Modification of the clinical competency process to include pre-meeting competence ratings with in-meeting reconciliation of these ratings led to shorter deliberation times, improved evaluator satisfaction and resulted in reliable milestone assessments. [ABSTRACT FROM AUTHOR]

Intrathecal (IT), intraventricular (IVt), and intracisternal administration of nicardipine deliver treatment directly into the central nervous system. This route of drug delivery is being investigated as a potential treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). The authors reviewed the existing literature regarding the direct administration of nicardipine into the intracranial space for the treatment of vasospasm following aSAH. An electronic search of literature published between 1994 and 2018 was performed using PubMed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A variety of combinations of the search terms "intrathecal nicardipine," "intraventricular nicardipine," and "nicardipine prolonged-release" were used. A total of 17 studies were included in this systematic review, 3 of which were studies in animals. The studies consistently demonstrated that IT nicardipine successfully reverses vasospasm, but the effect, as shown in some studies, was limited to the immediate vicinity of drug release. The data regarding long-term clinical outcomes are variable, with some studies demonstrating marked improvement whereas others fail to demonstrate improved outcomes when compared with patients who receive standard of care. Although adverse sequalae were uncommon, IT and IVt administration and therapy were associated with adverse effects including headache, meningitis, and hydrocephalus. Given the findings presented in these studies, IT, IVt, and intracisternal (pellet) nicardipine administration can be useful treatment adjuncts for vasospasm following aSAH, especially in cases refractory to conventional forms of treatment. However, larger, controlled clinical trials are warranted. [ABSTRACT FROM AUTHOR]