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The American Thoracic Society Sleep Core Curriculum updates clinicians on important sleep topics, presented during the annual meeting, and appearing in summary here. This year's sleep core theme is sleep-disordered breathing and its management. Topics range from pathophysiological mechanisms for the association of obstructive sleep apnea (OSA) and metabolic syndrome, surgical modalities of OSA treatment, comorbid insomnia and OSA, central sleep apnea, and sleep practices during a pandemic. OSA has been associated with metabolic syndrome, independent of the role of obesity, and the pathophysiology suggests a role for sleep fragmentation and intermittent hypoxia in observed metabolic outcomes. In specific patient populations, surgical treatment modalities for OSA have demonstrated large reductions in objective disease severity compared with no treatment and may facilitate adherence to positive airway pressure treatment. Patient-centered approaches to comorbid insomnia and sleep apnea include evaluating for both OSA and insomnia simultaneously and using shared-decision making to determine the order and timing of positive airway pressure therapy and cognitive behavioral therapy for insomnia. The pathophysiology of central sleep apnea is complex and may be due to the loss of drive to breathe or instability in the regulatory pathways that control ventilation. Pandemic-era sleep practices have evolved rapidly to balance safety and sustainability of care for patients with sleep-disordered breathing.

The last several years have seen intense debate about the issue of transitioning between standard and daylight saving time. In the United States, the annual advance to daylight saving time in spring, and fall back to standard time in autumn, is required by law (although some exceptions are allowed under the statute). An abundance of accumulated evidence indicates that the acute transition from standard time to daylight saving time incurs significant public health and safety risks, including increased risk of adverse cardiovascular events, mood disorders, and motor vehicle crashes. Although chronic effects of remaining in daylight saving time year-round have not been well studied, daylight saving time is less aligned with human circadian biology-which, due to the impacts of the delayed natural light/dark cycle on human activity, could result in circadian misalignment, which has been associated in some studies with increased cardiovascular disease risk, metabolic syndrome and other health risks. It is, therefore, the position of the American Academy of Sleep Medicine that these seasonal time changes should be abolished in favor of a fixed, national, year-round standard time.

Physician burnout is a serious and growing threat to the medical profession and may undermine efforts to maintain a sufficient physician workforce to care for the growing and aging patient population in the United States. Burnout involves a host of complex underlying associations and potential for risk. While prevalence is unknown, recent estimates of physician burnout are quite high, approaching 50% or more, with midcareer physicians at highest risk. Sleep deprivation due to shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been implicated in the genesis and perpetuation of burnout. Maladaptive attitudes regarding sleep and endurance also may increase the risk for sleep deprivation among attending physicians. While duty-hour restrictions have been instituted to protect sleep opportunity among trainees, virtually no such effort has been made for attending physicians who have completed their training or practicing physicians in nonacademic settings. It is the position of the American Academy of Sleep Medicine that a critical need exists to evaluate the roles of sleep disruption, sleep deprivation, and circadian misalignment in physician well-being and burnout. Such evaluation may pave the way for the development of effective countermeasures that promote healthy sleep, with the goal of reducing burnout and its negative impacts such as a shrinking physician workforce, poor physician health and functional outcomes, lower quality of care, and compromised patient safety.

Background: After accounting for smoking history, lung cancer incidence is greater in African Americans than Whites. In the multiethnic cohort, total nicotine equivalents (TNE) are higher in African Americans than Whites at similar reported cigarettes per day. Greater toxicant uptake per cigarette may contribute to the greater lung cancer risk of African Americans. Methods: In a nested case-control lung cancer study within the Southern Community Cohort, smoking-related biomarkers were measured in 259 cases and 503 controls (40% White; 56% African American). TNE, the trans-3-hydroxycotinine/cotinine ratio, 4-(methylnitrosamino)-1-3-(pyridyl)-1-butanol (NNAL), mercapturic acid metabolites of volatile organic compounds, phenanthrene metabolites, cadmium (Cd), and (Z)-7-(1R,2R,3R,5S)-3,5-dihydroxy-2-[(E,3S)-3-hydroxyoct-1-enyl]cyclopenyl]hept-5-enoic acid were quantified in urine. Unconditional logistic regression was used to estimate the ORs and 95% confidence intervals (CI) for each biomarker and lung cancer risk. Results: TNE, NNAL, and Cd were higher in cases than controls (adjusted for age, race, sex, body mass index, and cigarettes per day). Among cases, these levels were higher in African Americans compared with Whites. After accounting for age, sex, body mass index, and pack-years, a one-SD increase in log-TNE (OR = 1.30; 95% CI, 1.10-1.54) and log-NNAL (OR = 1.27; 95% CI, 1.03-1.58 with TNE adjustment) was associated with lung cancer risk. In this study, in which NNAL concentration is relatively high, the association for log-TNE was attenuated after adjustment for log-NNAL. Conclusions: Smoking-related biomarkers provide additional information for lung cancer risk in smokers beyond smoking pack-years. [ABSTRACT FROM AUTHOR]

In 2005, a group of faculty who work in the field of teacher education and are invested in social justice formed a group to examine how teacher preparation programs address (or often do not address) LGBTQ lives and issues. Concern about the invisibility of LGBTQ people, movements in education, and a commitment to changing the current state of affairs propelled their gathering. Their conceptual framework for this project emerged from a desire to transform the oppressive systems of normativity, particularly heteronormativity, that constrain human flourishing and self-determination. Heteronormativity, the structures "that legitimize and privilege heterosexuality and heterosexual relationships as fundamental and "natural" within society," is pervasive in most institutions, including K-12 schools and universities. To challenge this invisibility in teacher education, the group consisting of between four and 12 members who represent 10 Illinois colleges and universities, became affiliated with the Illinois Safe Schools Alliance (the Alliance) and established the Pre-Professional Preparation Project, or P Project. They conducted an investigation from the position of a prospective student with access to the Internet, as looking at college and university websites is one of the fastest, easiest, and most increasingly popular ways to access information about these institutions and their teacher education programs. In other words, they conducted an electronic assessment (e-assessment) of all 57 Illinois teacher education programs. They then organized these data to create a snapshot of the state context for LGBTQ university students, generally, and prospective teachers, specifically. They chose to convey their findings via report cards. They called this project and their eventual report, released in 2009, "Visibility Matters." Because their purpose is, at least in part, to advocate for greater LGBTQ presence and visibility, they returned to the college and university websites one year later. "Visibility Matters 2010," released on May 4, 2010, recognizes those institutions that have shown improvement as well as includes their first look at social worker preparation programs in the state. This article examines the P Project which was intended to catalyze social change by highlighting institutionalized oppression associated with sexual- and gender-based differences. (Contains 5 notes.)

PurposeHigher physical activity (PA) has been associated with greater attenuation of body fat gain and preservation of lean mass across the lifespan. These analyses aimed to determine relationships of change in PA to changes in fat and lean body mass in a longitudinal prospective study of postmenopausal women.MethodsAmong 11,491 women enrolled at three Women's Health Initiative clinical centers who were selected to undergo dual-energy x-ray absorptiometry, 8352 had baseline body composition measurements, with at least one repeated measure at years 1, 3, and 6. PA data were obtained by self-report at baseline and 3 and 6 yr of follow-up. Time-varying PA effect on change in lean and fat mass during the 6-yr study period for age groups (50-59 yr, 60-69 yr, and 70-79 yr) was estimated using mixed effects linear regression.ResultsBaseline PA and body composition differed significantly among the three age groups. The association of change in fat mass from baseline and time-varying PA differed across the three age groups (P = 0.0006). In women age 50-59 yr, gain in fat mass from baseline was attenuated with higher levels of PA. Women age 70-79 yr lost fat mass at all PA levels. In contrast, change in lean mass from baseline and time-varying PA did not differ by age group (P = 0.1935).ConclusionsThe association between PA and change in fat mass varies by age group, with younger, but not older, women benefiting from higher levels of aerobic PA. Higher levels of aerobic activity are not associated with changes in lean mass, which tends to decrease in older women regardless of activity level. Greater attention to resistance training exercises may be needed to prevent lean mass loss as women age.

Using a theory of affordances, this study examines the introduction of e-books into the early literacy environment as resources that can increase children's opportunity for learning vocabulary. Added value was observed under conditions of (1) book browsing, (2) instruction, and (3) a print-only condition. A total of 33 4-year-olds (18 boys, 15 girls) from nine Head Start classrooms assigned to one of the three conditions participated over an 8-week period. Mean differences in target words learned in total and by mode in each condition were statistically significant in favor of the e-book-enriched environments. Differences in word learning between e-book environment conditions were clinically significant. Mean differences in words learned by total and by mode for children with varying levels of vocabulary knowledge (low, average, high) showed that those in e-book-enriched classrooms learned about 25% of the target words with children with low vocabulary showing comparable gains. Results suggest added value of e-books in the early literacy environment: (1) affording children more exposure to target words to their advantage, (2) creating a choice of reading material in the early literacy environment, and (3) providing built-in scaffolds (e.g., hotspots) that may carry some of the teaching load of vocabulary instruction.