Science Says

Background: Previous studies have reported impaired performance, sleepiness and sleep deprivation among night workers. The purpose of this study was to investigate the effect of color screen Light Filtering software on cognitive performance, alertness and sleep quality among night shift operators of a medical emergency operations center.

Methods: This field trial interventional study was carried out among 30 nightshift operators of shiraz emergency control center. The baseline assessments were carried out under the existing computer screen light conditions in the week preceding the installation of f.lux software. The same measurements were repeated again 4 weeks after installing the software. The cognitive performance of the participants was measured using continuous performance test (CPT) and n-back, while their sleep quality was assessed through Pietersburg Sleep Quality Index (PSQI). Further, to assess their subjective and objective alertness, Stanford sleepiness index and go/nogo test were used, respectively.

Results: The results of this study showed that Screen Light Filtering software significantly increased subjective (P<0.001) and objective alertness (P<0.05). Additionally, the performance of the working memory (P=0.008) and sleep quality (P=0.008) improved significantly after the intervention.

Conclusion: The results revealed that using Screen Light Filtering software is an effective and low-cost method to improve sleep quality and cognitive performance since it filters the short wavelength part of the spectrum and helps body adaptation.

Kazemi R, Alighanbari N, Zamanian Z. The effects of screen light filtering software on cognitive performance and sleep among night workers. Health Promot Perspect. 2019;9(3):233–240. Published 2019 Aug 6. doi:10.15171/hpp.2019.32.

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sections of the Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717920

In recent years, digital communication and social media have taken an indispensable role in human society. Social interactions are no longer bound to real-life encounters, but more often happen from behind a screen. Mimicking an online communication platform, we developed a new, fMRI compatible, social threat paradigm to investigate sex differences in reactions to social rejection. During the Verbal Interaction Social Threat Task (VISTTA), participants initiate 30 short conversations by selecting one of four predefined opening sentences. Two computerized interlocutors respond to the opening sentence mostly with negative comments and rejections toward the participant, which should induce social-evaluative threat. Physiological and subjective responses were measured, before, during, and after the VISTTA in 61 (29 male and 32 female) first year students who received either mostly negative (n = 31; threat group) or neutral comments (n = 30; control group). Two-level behavioral validation included social threatinduced mood changes in participants, and interlocutor evaluation. The latter consisted of multiple variables such as “willingness to cooperate” after every conversation, an overall fairness evaluation of interlocutors, and evaluations per reaction indicating how positive or negative it was received. We acquired additional physiological measures including cortisol assays via saliva samples, heart rate, and blood pressure. Confirming our hypotheses, peer rejection and exclusion during the VISTTA led to less willingness to cooperate and lower fairness evaluation of interlocutors. It also induced feelings of anger and surprise and lower happiness in the social-threat group. Women showed overall higher emotion ratings compared to men. Contrary to our a priori hypothesis, the VISTTA did not induce cortisol and heart rate increases. However, the stable cortisol response in women in the threat group does not follow the circadian decline and might reflect an endocrinological response. The decline in cortisol response in men in both the threat and control group could indicate faster habituation to the VISTTA. Taken together, these findings indicate effects of social-evaluative threat on a behavioral level, and more moderate effects on the emotional and physiological level. Sex differences in affective and cortisol responses may indicate that women are more susceptible for the social-evaluative threat than men. With a realistic implementation of verbal, interactive, and social components, the VISTTA is designed as an fMRI paradigm that can be applied to elucidate the neural representation of social-evaluative threat.

Tops S, Habel U, Abel T, Derntl B, Radke S. The Verbal Interaction Social Threat Task: A New Paradigm Investigating the Effects of Social Rejection in Men and Women. Front Neurosci. 2019;13:830. Published 2019 Aug 7. doi:10.3389/fnins.2019.00830.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Associated Data.

Sections of Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6692967/

Raising public awareness of sepsis, a potentially life-threatening dysregulated host response to infection, to hasten its recognition has become a major focus of physicians, investigators, and both non-governmental and governmental agencies. While the internet is a common means by which to seek out healthcare information, little is understood about patterns and drivers of these behaviors. We sought to examine traffic to Wikipedia, a popular and publicly available online encyclopedia, to better understand how, when, and why users access information about sepsis. Utilizing pageview traffic data for all available language localizations of the sepsis and septic shock pages between July 1, 2015 and June 30, 2018, significantly outlying daily pageview totals were identified using a seasonal hybrid extreme studentized deviate approach. Consecutive outlying days were aggregated, and a qualitative analysis was undertaken of print and online news media coverage to identify potential correlates. Traffic patterns were further characterized using paired referrer to resource (i.e. clickstream) data, which were available for a temporal subset of the pageviews. Of the 20,557,055 pageviews across 65 linguistic localizations, 47 of the 1,096 total daily pageview counts were identified as upward outliers. After aggregating sequential outlying days, 25 epochs were examined. Qualitative analysis identified at least one major news media correlate for each, which were typically related to high-profile deaths from sepsis and, less commonly, awareness promotion efforts. Clickstream analysis suggests that most sepsis and septic shock Wikipedia pageviews originate from external referrals, namely search engines. Owing to its granular and publicly available traffic data, Wikipedia holds promise as a means by which to better understand global drivers of online sepsis information seeking. Further characterization of user engagement with this information may help to elucidate means by which to optimize the visibility, content, and delivery of awareness promotion efforts.

Jabaley CS, Groff RF, Barnes TJ, Caridi-Scheible ME, Blum JM, O'Reilly-Shah VN. Sepsis information-seeking behaviors via Wikipedia between 2015 and 2018: A mixed methods retrospective observational study. PLoS One. 2019;14(8):e0221596. Published 2019 Aug 22. doi:10.1371/journal.pone.0221596.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of Abstract, Introduction, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6705833

Registered Dietitian Nutritionists (RDNs) are clinicians trained in the application of food, nutrition, and dietetics. Vegetarians and vegans have a lower risk of many nutrition-related chronic diseases that are epidemic while vegetarian and vegan diets are associated with reduced environmental impact. Despite this strong diet-disease and diet-environment connection, it is not known if dietetics students are taught the principles of vegetarian and vegan nutrition. The overarching goal of our study was to investigate curricular practices in accredited dietetics training programs in the United States (U.S.) including (1) the prevalence and perceived importance of vegetarian and vegan nutrition instruction and (2) if program directors connect vegetarian and vegan diets to climate change mitigation and resource conservation. Primary data were collected by way of a cross-sectional, Internet-based survey. All Accreditation Council for Education in Nutrition and Dietetics (ACEND) program directors in the U.S. (N = 574) were sent a 37-question survey and invited to participate in the study. Outcome measures included the prevalence of vegetarian and vegan nutrition instruction, quantifying if relationships exist among variables, and the frequency of connecting vegetarian and vegan diets to environmental impact. Descriptive and inferential statistics were utilized. Respondents (n = 205) indicated that over 51% of programs teach vegetarian nutrition while 49% teach vegan nutrition. There were significant differences between program type and the prevalence of vegetarian (p = 0.00005) and vegan (p = 0.00005) nutrition instruction. Over 90% of program directors believe that vegetarian and vegan nutrition should be taught. Over 50% of programs identify the connection between vegetarian and vegan diets in climate change mitigation and resource conservation. Most ACEND program directors believe vegetarian and vegan nutrition should be taught and half connect diet to environmental concern. Nevertheless, there is a discrepancy between beliefs and practice behaviors. These results suggest the need for increased collaboration and the use of novel techniques that better incorporate vegan and vegetarian nutrition throughout dietetics education.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Hawkins IW, Mangels AR, Goldman R and Wood RJ (2019) Dietetics Program Directors in the United States Support Teaching Vegetarian and Vegan Nutrition and Half Connect Vegetarian and Vegan Diets to Environmental Impact. Front. Nutr. 6:123. doi: 10.3389/fnut.2019.00123.

Sections of Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.frontiersin.org/articles/10.3389/fnut.2019.00123/full

Stress and anxiety have intertwined behavioral and neural underpinnings. These commonalities are critical for understanding each state, as well as their mutual interactions. Grasping the mechanisms underlying this bidirectional relationship will have major clinical implications for managing a wide range of psychopathologies. After briefly defining key concepts for the study of stress and anxiety in pre-clinical models, we present circuit, as well as cellular and molecular mechanisms involved in either or both stress and anxiety. First, we review studies on divergent circuits of the basolateral amygdala (BLA) underlying emotional valence processing and anxiety-like behaviors, and how norepinephrine inputs from the locus coeruleus (LC) to the BLA are responsible for acute-stress induced anxiety. We then describe recent studies revealing a new role for mitochondrial function within the nucleus accumbens (NAc), defining individual trait anxiety in rodents, and participating in the link between stress and anxiety. Next, we report findings on the impact of anxiety on reward encoding through alteration of circuit dynamic synchronicity. Finally, we present work unravelling a new role for hypothalamic corticotropin-releasing hormone (CRH) neurons in controlling anxiety-like and stress-induce behaviors. Altogether, the research reviewed here reveals circuits sharing subcortical nodes and underlying the processing of both stress and anxiety. Understanding the neural overlap between these two psychobiological states, might provide alternative strategies to manage disorders such as post-traumatic stress disorder (PTSD).

Daviu N, Bruchas MR, Moghaddam B, Sandi C, Beyeler A. Neurobiological links between stress and anxiety. Neurobiol Stress. 2019;11:100191. Published 2019 Aug 13. doi:10.1016/j.ynstr.2019.100191.

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Sections of Abstract, Introduction, and Perspective are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6712367

Mental health conditions pose a major challenge to healthcare providers and society at large. The World Health Organization predicts that by 2030 mental illnesses will be the leading disease burden globally. Mental health services are struggling to meet the needs of users and arguably fail to reach large proportions of those in need. According to New Zealand Mental Health Foundation, one in five will experience a serious mood disorder, including depression, at some time in their life. Games for Health including those supporting mental health have recently gained a lot of attention. However, game interface preferences for users with a history of mental health conditions have not been systematically studied, making it difficult to determine what game features may attract and further engage users affected by mental health conditions. We present MoodJumper, a prototype Android mobile game, which enables players to jump to the top of the level by steering the avatar from platform to platform, gradually gaining height and collecting coins on the way up. We conducted a preliminary study (n = 25), in which participants were able to modify different settings of the game (background color, dark/light, character movement, gender, and music), while their gaming behavior was tracked. The results show that regardless of self-reported history of mood disorder, the majority of participants prefer the dark and colored layout setting and there were no differences in gaming variables including session duration and high scores. This represents a first indication that history of mood disorder does not affect user preferences for game interface settings. It will be important to follow up with data on users currently affected by low mood. Systematic study of game interface preferences in users with mood disorder constitutes a vital step in being able to harness the potential power of games for supporting mental health.

Baghaei N, Hach S, Liang H-N and Brucker M (2019) MoodJumper: An Exploration of Game Interface Preferences in Users With/Out Mood Disorder. Front. Public Health 7:220. doi: 10.3389/fpubh.2019.00220

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of Abstract, Introduction, Games for Health, MoodJumper Design, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.frontiersin.org/articles/10.3389/fpubh.2019.00220/full

Background: During the reproductive age, the human brain becomes a target for gonadal steroid hormones. Estrogens influence neural function through effects on neurons and affects indirectly the oxidative stress, inflammation, the cerebral vascular and the immune system.

Objective: To evaluate the effect of the traditional hormone replacement therapy (HRT) on the cognitive function in postmenopausal women.

Materials and Methods: In this randomized clinical trial, 140 postmenopausal women, from November 2014 to February 2015, were included. Women were randomly divided into two groups. Each woman in the case group took traditional HRT (0.625mg conjugated equine estrogens+2.5mg medroxyprogesterone acetate daily) plus one Cal+D tablet (500 mg calcium+200 IU vitamin D) daily for four months. Women in the control group received only one Cal+D tablet (500 mg calcium+200 IU vitamin D) daily for four months period. The Montreal Cognitive Assessment (MoCA) and Green Climacteric Scale (GCS) questionnaires filled out after the intervention and compared between the two groups.

Results: The mean points of the MoCA after the intervention indicate that all MoCA domains except for the orientation improved in the case group. There was a significant difference in the memory domain after the treatment between the two groups. MoCA domains and GCS were negatively correlated after the intervention (r=−0.235,p=0.006).

Conclusion: The HRT has affected some of the MoCA factors. The effects of HRT on cognitive function should be studied in a large prospective study in a group of women in their early and late menopausal ages with periodic assessment of their cognitive function during these follow-up years.

Moradi F, Jahanian Sadatmahalleh S, Ziaei S. The effect of hormone replacement therapy on cognitive function in postmenopausal women: An RCT. Int J Reprod Biomed (Yazd). 2019;16(12):ijrm.v16i12.3682. Published 2019 Jan 28. doi:10.18502/ijrm.v16i12.3682.

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sections of Abstract, Introduction, Materials and Methods, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6600282/

Personal health systems (PHS) are designed to provide the individual with tailored care while enabling the healthcare system to deliver high-quality care to large populations and maintain a sustainable system. Solutions using electronic health records (EHRs) that include predictive models for the risk of disease onset and deterioration enable the care provider to better identify and treat patients with chronic disease and provide personalized prevention. These tools are well-accepted by doctors and have been proven to improve health outcomes and reduce costs. Integrated telecare programs were implemented for comorbid patients showing improved clinical outcomes self-management and quality of life (QoL). However, different patient populations benefit in different ways from these care plans, and thus, continuous evaluation, service adaptation in a real-life environment set with clear outcome measures, is required for best results. The challenge of the PHS today is to acquire patient-generated data (PGD) and behavioral and patient-reported outcomes (PROs) for PHS development that can be combined with existing clinical data. Some initiatives of healthcare organizations [health maintenance organizations (HMOs)] in Israel demonstrate how this goal can be achieved with relatively small efforts by using a stepwise and agile approach to service implementation that improve service by enabling adoption and adaptation of the service in the short term while collecting data for advanced PHS development in the long term. This approach, combined with programs and incentive payments at the national level, creates an environment and infrastructure for collaboration between healthcare, academia, and industry for research, development, and implementation of future PHS. This article presents examples of PHS development and implementation from the Israeli healthcare system. We discuss the lessons learned and suggest new approaches for research, development implementation, and evaluation of PHS that will address the needs of future healthcare.

Lewy H, Barkan R, Sela T. Personalized Health Systems-Past, Present, and Future of Research Development and Implementation in Real-Life Environment. Front Med (Lausanne). 2019;6:149. Published 2019 Jul 31. doi:10.3389/fmed.2019.00149.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Sections of Abstract, Background, and Conclusion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684784/

Ensuring quality of care in nursing homes is a public health priority, yet how nursing home quality relates to cost is not well understood. This paper addresses this relationship for 132 VA community living centers (nursing homes), for fiscal years 2014 and 2015. We estimated cost models using the VA Decision Support System which tracks total direct costs and nursing direct costs for individual resident segments of care. We summed residents’ total costs and nursing costs to the community living center level for each year. Annual facility costs then were regressed on quality of care measured with composite scores based on 13 distinct adverse events. Results indicated that higher quality was associated with higher predicted cost. However, we did not find evidence that higher costs were driven by high nurse staffing levels.

Carey K, Zhao S, Snow AL, Hartmann CW. The relationship between nursing home quality and costs: Evidence from the VA. PLoS One. 2018;13(9):e0203764. Published 2018 Sep 19. doi:10.1371/journal.pone.0203764.

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Sections of Abstract, Introduction, and Discussion are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145531/

Graphics are becoming increasingly important for scientists to effectively communicate their findings to broad audiences, but most researchers lack expertise in visual media. We suggest collaboration between scientists and graphic designers as a way forward and discuss the results of a pilot project to test this type of collaboration.

Khoury CK, Kisel Y, Kantar M, et al. Science-graphic art partnerships to increase research impact. Commun Biol. 2019;2:295. Published 2019 Aug 6. doi:10.1038/s42003-019-0516-1.

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Sections of Abstract, Introduction, Test Project Overview, and Recommendations are presented in the Podcast. Link to the full-text article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684576/