New and Noteworthy Information—June 2015

Persistently high depressive symptoms are associated with increased stroke risk, according to a study published May 13 in Journal of the American Heart Association. This research included health information from 16,178 men and women age 50 or older who participated in the Health and Retirement Study between 1998 and 2010. Participants were interviewed every two years about depressive symptoms, history of stroke, and stroke risk factors, among other health measures. Stroke risk was elevated among participants with stable high (hazard ratio [HR], 2.14) or remitted (HR, 1.66) depressive symptoms, compared with participants with stable low or no depressive symptoms. Stable high depressive symptoms predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke risk among women (HR, 1.86) and non-Hispanic white participants (HR, 1.66).

Chronic traumatic encephalopathy (CTE) is associated with altered and accelerated deposition of amyloid β, according to a study published online ahead of print May 6 in Acta Neuropathologica. Researchers studied a heterogeneous cohort of deceased athletes and military veterans with neuropathologically diagnosed CTE. The investigators found that amyloid β deposition was present in 52% of subjects with CTE. Moreover, amyloid β deposition in CTE occurred at an accelerated rate and with altered dynamics in CTE, compared with a normal aging population. In addition, amyloid β deposition was significantly associated with the presence of the APOE e4 allele, older age at symptom onset, and older age at death. Neuritic plaques were significantly associated with increased CTE tauopathy stage, comorbid Lewy body disease, and dementia.

Low-dose tetrahydrocannabinol (THC) does not significantly reduce dementia-related neuropsychiatric symptoms at 21 days, though it is well tolerated, according to a study published online ahead of print May 13 in Neurology. In a double-blind, placebo-controlled study, investigators randomly assigned patients with dementia and clinically relevant neuropsychiatric symptoms to receive 1.5 mg of THC or matched placebo three times daily for three weeks. Neuropsychiatric symptoms were reduced during both treatment conditions. The difference in reduction from baseline between THC and placebo was not significant. Changes in scores for agitation, quality of life, or activities of daily living also were not significantly different between treatment arms. The number of patients experiencing mild or moderate adverse events was similar in both groups. No effects on vital signs, weight, or episodic memory were observed.

Exposure to elevated levels of fine particulate matter is associated with smaller total cerebral brain volume, according to a study published in the May issue of Stroke. Researchers analyzed 943 adults in the Framingham Offspring Study who were relatively healthy and free of dementia and stroke. Investigators evaluated associations between exposure to fine particulate matter and total cerebral brain volume, hippocampal volume, white matter hyperintensity volume, and covert brain infarcts. A 2-μg/m³ increase in fine particulate matter was associated with –0.32% smaller total cerebral brain volume and 1.46 higher odds of covert brain infarcts. Living further away from a major roadway was associated with 0.10 greater log-transformed white matter hyperintensity volume for an interquartile range difference in distance, but no clear pattern of association was observed for extensive white matter.

Higher occupational attainment is associated with longer survival in autopsy-confirmed frontotemporal lobar degeneration, according to a study published online ahead of print April 22 in Neurology. Researchers performed a retrospective chart review of 83 demographically matched patients with autopsy-confirmed frontotemporal lobar degeneration or Alzheimer’s disease. They used linear regression to test for associations among occupational attainment, education, and patient survival. Median survival was 81 months among patients with frontotemporal lobar degeneration and 95 months among patients with Alzheimer’s disease. Years of education and occupational attainment were similar for both groups. Higher occupational attainment was associated with longer survival in frontotemporal lobar degeneration, but not in Alzheimer’s disease. The findings support the theory that education, occupation, and mental activity create cognitive reserve and protect against disease.

Obesity is a major risk factor for the incidence and chronicity of excessive daytime sleepiness (EDS), and weight loss is associated with its remission, according to a study published March 1 in Sleep. Investigators followed up 1,395 people from a random, general population sample of 1,741 participants in the Penn State Adult Cohort after 7.5 years. The incidence of EDS was 8.2%. Of people with EDS, 62% had remission. Significant interactions between depression and polysomnographic parameters on incident EDS showed that in depressed individuals, incident EDS was associated with sleep disturbances. In individuals without depression, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy or asthma, anemia, and sleep complaints also predicted EDS. “EDS has huge implications for public health and policy,” stated the researchers.

Patients with celiac disease have an increased risk of neuropathy, according to a study published online ahead of print May 11 in JAMA Neurology. Between October 27, 2006, and February 12, 2008, researchers collected data on small-intestinal biopsies performed in pathology departments between June 16, 1969, and February 4, 2008. Investigators compared the risk of neuropathy in 28,232 patients with celiac disease with that of 139,473 age- and sex-matched controls. Celiac disease was associated with a 2.5-fold increased risk of subsequent neuropathy. In addition, the investigators found an increased risk of chronic inflammatory demyelinating neuropathy, autonomic neuropathy, and mononeuritis multiplex in patients with celiac disease. They found no association, however, between celiac disease and acute inflammatory demyelinating polyneuropathy. Physicians should screen patients with neuropathy for celiac disease, said the researchers.

A professional life that stimulates verbal intelligence and executive function may help to sustain good cognitive function in people age 75 and older, according to a study published online ahead of print April 29 in Neurology. For the study, 1,054 people age 75 or older underwent the Mini-Mental State Examination every one-and-a-half years for eight years. In multivariate mixed-model analyses, a high level of mentally demanding work tasks stimulating verbal intelligence was significantly associated with better cognitive functioning at baseline and a lower rate of cognitive decline during the eight-year follow-up period, compared with a low level of these tasks. The rate of cognitive decline in old age was also significantly lower in individuals who had a high level of mentally demanding work tasks stimulating executive function.

In Get With the Guidelines-Stroke hospitals, electronic health records are not associated with higher-quality care or better clinical outcomes for stroke care, according to a study published May 12 in Journal of the American College of Cardiology. Researchers studied 626,473 patients from 1,236 US hospitals in Get With the Guidelines-Stroke from 2007 through 2010. They used the American Hospital Association annual survey to determine the presence of electronic health records. Hospitals with electronic health records were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with electronic health records had similar odds of receiving “all-or-none care.” The odds of having a length of stay greater than four days was slightly lower at hospitals with electronic health records.

Off-label use of the Lariat device for left atrial appendage exclusion to prevent stroke in patients with atrial fibrillation entails significant risks of adverse events, according to a study published online ahead of print May 4 in JAMA Internal Medicine. Investigators searched PubMed, EMBASE, CINAHL, and the Cochrane Library from January 2007 through August 2014 to identify all studies reporting use of the Lariat device in three or more patients. They queried the FDA MAUDE database for adverse events reports related to Lariat use. Five reports of Lariat device use in 309 participants were identified. The FDA MAUDE database contained 35 unique reports of adverse events with use of the Lariat device. Among these reports were five adverse event reports that noted pericardial effusion and death and an additional 23 that reported urgent cardiac surgery, but not death.

Insomnia is linked to functional and cognitive impairment among patients with shift work disorder, according to a study published April 15 in Journal of Clinical Sleep Medicine. The analysis included 34 night workers, 26 of whom were diagnosed with shift work disorder. Participants underwent an overnight laboratory protocol including a multiple sleep latency test (MSLT), an event-related brain potential (ERP) task, and various questionnaires. Participants reporting insomnia without sleepiness were the most impaired on the Endicott Work Productivity Scale (EWPS) and significantly more impaired than controls. Participants reporting insomnia and sleepiness were not statistically different from controls. Neither MSLT nor the Epworth Sleepiness Scale correlated with EWPS scores or ERP amplitudes. The mean of the Insomnia Severity Indices measurements, however, correlated with the EWPS.

The measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease, according to a study published online ahead of print May 13 in Lancet. In the Prospective Urban-Rural Epidemiology study, researchers enrolled households that each included at least one member between ages 35 and 70. The investigators measured participants’ grip strength with a Jamar dynamometer. Median follow-up was four years. Grip strength was inversely associated with all-cause mortality, cardiovascular mortality, noncardiovascular mortality, myocardial infarction, and stroke. Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure was. The researchers found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or chronic obstructive pulmonary disease, injury from fall, or fracture.

Sleep deprivation is particularly problematic for decision-making involving uncertainty and unexpected change, according to a study published in the May issue of Sleep. Twenty-six subjects were randomized to 62 hours of total sleep deprivation or to a control condition. Researchers conducted performance testing at baseline, after two nights of total sleep deprivation or rested control, and following two nights of recovery sleep. Participants performed a decision task that involved initial learning of response sets and subsequent reversal of contingencies. Working memory and psychomotor vigilance tests also were administered. Sleep-deprived subjects had difficulty with initial learning of stimuli sets and profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Sleep deprivation did not significantly affect working memory scanning performance.

—Kimberly Williams

Persistently high depressive symptoms are associated with increased stroke risk, according to a study published May 13 in Journal of the American Heart Association. This research included health information from 16,178 men and women age 50 or older who participated in the Health and Retirement Study between 1998 and 2010. Participants were interviewed every two years about depressive symptoms, history of stroke, and stroke risk factors, among other health measures. Stroke risk was elevated among participants with stable high (hazard ratio [HR], 2.14) or remitted (HR, 1.66) depressive symptoms, compared with participants with stable low or no depressive symptoms. Stable high depressive symptoms predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke risk among women (HR, 1.86) and non-Hispanic white participants (HR, 1.66).

Chronic traumatic encephalopathy (CTE) is associated with altered and accelerated deposition of amyloid β, according to a study published online ahead of print May 6 in Acta Neuropathologica. Researchers studied a heterogeneous cohort of deceased athletes and military veterans with neuropathologically diagnosed CTE. The investigators found that amyloid β deposition was present in 52% of subjects with CTE. Moreover, amyloid β deposition in CTE occurred at an accelerated rate and with altered dynamics in CTE, compared with a normal aging population. In addition, amyloid β deposition was significantly associated with the presence of the APOE e4 allele, older age at symptom onset, and older age at death. Neuritic plaques were significantly associated with increased CTE tauopathy stage, comorbid Lewy body disease, and dementia.

Low-dose tetrahydrocannabinol (THC) does not significantly reduce dementia-related neuropsychiatric symptoms at 21 days, though it is well tolerated, according to a study published online ahead of print May 13 in Neurology. In a double-blind, placebo-controlled study, investigators randomly assigned patients with dementia and clinically relevant neuropsychiatric symptoms to receive 1.5 mg of THC or matched placebo three times daily for three weeks. Neuropsychiatric symptoms were reduced during both treatment conditions. The difference in reduction from baseline between THC and placebo was not significant. Changes in scores for agitation, quality of life, or activities of daily living also were not significantly different between treatment arms. The number of patients experiencing mild or moderate adverse events was similar in both groups. No effects on vital signs, weight, or episodic memory were observed.

Exposure to elevated levels of fine particulate matter is associated with smaller total cerebral brain volume, according to a study published in the May issue of Stroke. Researchers analyzed 943 adults in the Framingham Offspring Study who were relatively healthy and free of dementia and stroke. Investigators evaluated associations between exposure to fine particulate matter and total cerebral brain volume, hippocampal volume, white matter hyperintensity volume, and covert brain infarcts. A 2-μg/m³ increase in fine particulate matter was associated with –0.32% smaller total cerebral brain volume and 1.46 higher odds of covert brain infarcts. Living further away from a major roadway was associated with 0.10 greater log-transformed white matter hyperintensity volume for an interquartile range difference in distance, but no clear pattern of association was observed for extensive white matter.

Higher occupational attainment is associated with longer survival in autopsy-confirmed frontotemporal lobar degeneration, according to a study published online ahead of print April 22 in Neurology. Researchers performed a retrospective chart review of 83 demographically matched patients with autopsy-confirmed frontotemporal lobar degeneration or Alzheimer’s disease. They used linear regression to test for associations among occupational attainment, education, and patient survival. Median survival was 81 months among patients with frontotemporal lobar degeneration and 95 months among patients with Alzheimer’s disease. Years of education and occupational attainment were similar for both groups. Higher occupational attainment was associated with longer survival in frontotemporal lobar degeneration, but not in Alzheimer’s disease. The findings support the theory that education, occupation, and mental activity create cognitive reserve and protect against disease.

Obesity is a major risk factor for the incidence and chronicity of excessive daytime sleepiness (EDS), and weight loss is associated with its remission, according to a study published March 1 in Sleep. Investigators followed up 1,395 people from a random, general population sample of 1,741 participants in the Penn State Adult Cohort after 7.5 years. The incidence of EDS was 8.2%. Of people with EDS, 62% had remission. Significant interactions between depression and polysomnographic parameters on incident EDS showed that in depressed individuals, incident EDS was associated with sleep disturbances. In individuals without depression, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy or asthma, anemia, and sleep complaints also predicted EDS. “EDS has huge implications for public health and policy,” stated the researchers.

Patients with celiac disease have an increased risk of neuropathy, according to a study published online ahead of print May 11 in JAMA Neurology. Between October 27, 2006, and February 12, 2008, researchers collected data on small-intestinal biopsies performed in pathology departments between June 16, 1969, and February 4, 2008. Investigators compared the risk of neuropathy in 28,232 patients with celiac disease with that of 139,473 age- and sex-matched controls. Celiac disease was associated with a 2.5-fold increased risk of subsequent neuropathy. In addition, the investigators found an increased risk of chronic inflammatory demyelinating neuropathy, autonomic neuropathy, and mononeuritis multiplex in patients with celiac disease. They found no association, however, between celiac disease and acute inflammatory demyelinating polyneuropathy. Physicians should screen patients with neuropathy for celiac disease, said the researchers.

A professional life that stimulates verbal intelligence and executive function may help to sustain good cognitive function in people age 75 and older, according to a study published online ahead of print April 29 in Neurology. For the study, 1,054 people age 75 or older underwent the Mini-Mental State Examination every one-and-a-half years for eight years. In multivariate mixed-model analyses, a high level of mentally demanding work tasks stimulating verbal intelligence was significantly associated with better cognitive functioning at baseline and a lower rate of cognitive decline during the eight-year follow-up period, compared with a low level of these tasks. The rate of cognitive decline in old age was also significantly lower in individuals who had a high level of mentally demanding work tasks stimulating executive function.

In Get With the Guidelines-Stroke hospitals, electronic health records are not associated with higher-quality care or better clinical outcomes for stroke care, according to a study published May 12 in Journal of the American College of Cardiology. Researchers studied 626,473 patients from 1,236 US hospitals in Get With the Guidelines-Stroke from 2007 through 2010. They used the American Hospital Association annual survey to determine the presence of electronic health records. Hospitals with electronic health records were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with electronic health records had similar odds of receiving “all-or-none care.” The odds of having a length of stay greater than four days was slightly lower at hospitals with electronic health records.

Off-label use of the Lariat device for left atrial appendage exclusion to prevent stroke in patients with atrial fibrillation entails significant risks of adverse events, according to a study published online ahead of print May 4 in JAMA Internal Medicine. Investigators searched PubMed, EMBASE, CINAHL, and the Cochrane Library from January 2007 through August 2014 to identify all studies reporting use of the Lariat device in three or more patients. They queried the FDA MAUDE database for adverse events reports related to Lariat use. Five reports of Lariat device use in 309 participants were identified. The FDA MAUDE database contained 35 unique reports of adverse events with use of the Lariat device. Among these reports were five adverse event reports that noted pericardial effusion and death and an additional 23 that reported urgent cardiac surgery, but not death.

Insomnia is linked to functional and cognitive impairment among patients with shift work disorder, according to a study published April 15 in Journal of Clinical Sleep Medicine. The analysis included 34 night workers, 26 of whom were diagnosed with shift work disorder. Participants underwent an overnight laboratory protocol including a multiple sleep latency test (MSLT), an event-related brain potential (ERP) task, and various questionnaires. Participants reporting insomnia without sleepiness were the most impaired on the Endicott Work Productivity Scale (EWPS) and significantly more impaired than controls. Participants reporting insomnia and sleepiness were not statistically different from controls. Neither MSLT nor the Epworth Sleepiness Scale correlated with EWPS scores or ERP amplitudes. The mean of the Insomnia Severity Indices measurements, however, correlated with the EWPS.

The measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease, according to a study published online ahead of print May 13 in Lancet. In the Prospective Urban-Rural Epidemiology study, researchers enrolled households that each included at least one member between ages 35 and 70. The investigators measured participants’ grip strength with a Jamar dynamometer. Median follow-up was four years. Grip strength was inversely associated with all-cause mortality, cardiovascular mortality, noncardiovascular mortality, myocardial infarction, and stroke. Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure was. The researchers found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or chronic obstructive pulmonary disease, injury from fall, or fracture.

Sleep deprivation is particularly problematic for decision-making involving uncertainty and unexpected change, according to a study published in the May issue of Sleep. Twenty-six subjects were randomized to 62 hours of total sleep deprivation or to a control condition. Researchers conducted performance testing at baseline, after two nights of total sleep deprivation or rested control, and following two nights of recovery sleep. Participants performed a decision task that involved initial learning of response sets and subsequent reversal of contingencies. Working memory and psychomotor vigilance tests also were administered. Sleep-deprived subjects had difficulty with initial learning of stimuli sets and profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Sleep deprivation did not significantly affect working memory scanning performance.

—Kimberly Williams

Persistently high depressive symptoms are associated with increased stroke risk, according to a study published May 13 in Journal of the American Heart Association. This research included health information from 16,178 men and women age 50 or older who participated in the Health and Retirement Study between 1998 and 2010. Participants were interviewed every two years about depressive symptoms, history of stroke, and stroke risk factors, among other health measures. Stroke risk was elevated among participants with stable high (hazard ratio [HR], 2.14) or remitted (HR, 1.66) depressive symptoms, compared with participants with stable low or no depressive symptoms. Stable high depressive symptoms predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke risk among women (HR, 1.86) and non-Hispanic white participants (HR, 1.66).

Chronic traumatic encephalopathy (CTE) is associated with altered and accelerated deposition of amyloid β, according to a study published online ahead of print May 6 in Acta Neuropathologica. Researchers studied a heterogeneous cohort of deceased athletes and military veterans with neuropathologically diagnosed CTE. The investigators found that amyloid β deposition was present in 52% of subjects with CTE. Moreover, amyloid β deposition in CTE occurred at an accelerated rate and with altered dynamics in CTE, compared with a normal aging population. In addition, amyloid β deposition was significantly associated with the presence of the APOE e4 allele, older age at symptom onset, and older age at death. Neuritic plaques were significantly associated with increased CTE tauopathy stage, comorbid Lewy body disease, and dementia.

Low-dose tetrahydrocannabinol (THC) does not significantly reduce dementia-related neuropsychiatric symptoms at 21 days, though it is well tolerated, according to a study published online ahead of print May 13 in Neurology. In a double-blind, placebo-controlled study, investigators randomly assigned patients with dementia and clinically relevant neuropsychiatric symptoms to receive 1.5 mg of THC or matched placebo three times daily for three weeks. Neuropsychiatric symptoms were reduced during both treatment conditions. The difference in reduction from baseline between THC and placebo was not significant. Changes in scores for agitation, quality of life, or activities of daily living also were not significantly different between treatment arms. The number of patients experiencing mild or moderate adverse events was similar in both groups. No effects on vital signs, weight, or episodic memory were observed.

Exposure to elevated levels of fine particulate matter is associated with smaller total cerebral brain volume, according to a study published in the May issue of Stroke. Researchers analyzed 943 adults in the Framingham Offspring Study who were relatively healthy and free of dementia and stroke. Investigators evaluated associations between exposure to fine particulate matter and total cerebral brain volume, hippocampal volume, white matter hyperintensity volume, and covert brain infarcts. A 2-μg/m³ increase in fine particulate matter was associated with –0.32% smaller total cerebral brain volume and 1.46 higher odds of covert brain infarcts. Living further away from a major roadway was associated with 0.10 greater log-transformed white matter hyperintensity volume for an interquartile range difference in distance, but no clear pattern of association was observed for extensive white matter.

Higher occupational attainment is associated with longer survival in autopsy-confirmed frontotemporal lobar degeneration, according to a study published online ahead of print April 22 in Neurology. Researchers performed a retrospective chart review of 83 demographically matched patients with autopsy-confirmed frontotemporal lobar degeneration or Alzheimer’s disease. They used linear regression to test for associations among occupational attainment, education, and patient survival. Median survival was 81 months among patients with frontotemporal lobar degeneration and 95 months among patients with Alzheimer’s disease. Years of education and occupational attainment were similar for both groups. Higher occupational attainment was associated with longer survival in frontotemporal lobar degeneration, but not in Alzheimer’s disease. The findings support the theory that education, occupation, and mental activity create cognitive reserve and protect against disease.

Obesity is a major risk factor for the incidence and chronicity of excessive daytime sleepiness (EDS), and weight loss is associated with its remission, according to a study published March 1 in Sleep. Investigators followed up 1,395 people from a random, general population sample of 1,741 participants in the Penn State Adult Cohort after 7.5 years. The incidence of EDS was 8.2%. Of people with EDS, 62% had remission. Significant interactions between depression and polysomnographic parameters on incident EDS showed that in depressed individuals, incident EDS was associated with sleep disturbances. In individuals without depression, incident EDS was associated with increased physiologic sleep propensity. Diabetes, allergy or asthma, anemia, and sleep complaints also predicted EDS. “EDS has huge implications for public health and policy,” stated the researchers.

Patients with celiac disease have an increased risk of neuropathy, according to a study published online ahead of print May 11 in JAMA Neurology. Between October 27, 2006, and February 12, 2008, researchers collected data on small-intestinal biopsies performed in pathology departments between June 16, 1969, and February 4, 2008. Investigators compared the risk of neuropathy in 28,232 patients with celiac disease with that of 139,473 age- and sex-matched controls. Celiac disease was associated with a 2.5-fold increased risk of subsequent neuropathy. In addition, the investigators found an increased risk of chronic inflammatory demyelinating neuropathy, autonomic neuropathy, and mononeuritis multiplex in patients with celiac disease. They found no association, however, between celiac disease and acute inflammatory demyelinating polyneuropathy. Physicians should screen patients with neuropathy for celiac disease, said the researchers.

A professional life that stimulates verbal intelligence and executive function may help to sustain good cognitive function in people age 75 and older, according to a study published online ahead of print April 29 in Neurology. For the study, 1,054 people age 75 or older underwent the Mini-Mental State Examination every one-and-a-half years for eight years. In multivariate mixed-model analyses, a high level of mentally demanding work tasks stimulating verbal intelligence was significantly associated with better cognitive functioning at baseline and a lower rate of cognitive decline during the eight-year follow-up period, compared with a low level of these tasks. The rate of cognitive decline in old age was also significantly lower in individuals who had a high level of mentally demanding work tasks stimulating executive function.

In Get With the Guidelines-Stroke hospitals, electronic health records are not associated with higher-quality care or better clinical outcomes for stroke care, according to a study published May 12 in Journal of the American College of Cardiology. Researchers studied 626,473 patients from 1,236 US hospitals in Get With the Guidelines-Stroke from 2007 through 2010. They used the American Hospital Association annual survey to determine the presence of electronic health records. Hospitals with electronic health records were larger and were more often teaching hospitals and stroke centers. After controlling for patient and hospital characteristics, patients admitted to hospitals with electronic health records had similar odds of receiving “all-or-none care.” The odds of having a length of stay greater than four days was slightly lower at hospitals with electronic health records.

Off-label use of the Lariat device for left atrial appendage exclusion to prevent stroke in patients with atrial fibrillation entails significant risks of adverse events, according to a study published online ahead of print May 4 in JAMA Internal Medicine. Investigators searched PubMed, EMBASE, CINAHL, and the Cochrane Library from January 2007 through August 2014 to identify all studies reporting use of the Lariat device in three or more patients. They queried the FDA MAUDE database for adverse events reports related to Lariat use. Five reports of Lariat device use in 309 participants were identified. The FDA MAUDE database contained 35 unique reports of adverse events with use of the Lariat device. Among these reports were five adverse event reports that noted pericardial effusion and death and an additional 23 that reported urgent cardiac surgery, but not death.

Insomnia is linked to functional and cognitive impairment among patients with shift work disorder, according to a study published April 15 in Journal of Clinical Sleep Medicine. The analysis included 34 night workers, 26 of whom were diagnosed with shift work disorder. Participants underwent an overnight laboratory protocol including a multiple sleep latency test (MSLT), an event-related brain potential (ERP) task, and various questionnaires. Participants reporting insomnia without sleepiness were the most impaired on the Endicott Work Productivity Scale (EWPS) and significantly more impaired than controls. Participants reporting insomnia and sleepiness were not statistically different from controls. Neither MSLT nor the Epworth Sleepiness Scale correlated with EWPS scores or ERP amplitudes. The mean of the Insomnia Severity Indices measurements, however, correlated with the EWPS.

The measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease, according to a study published online ahead of print May 13 in Lancet. In the Prospective Urban-Rural Epidemiology study, researchers enrolled households that each included at least one member between ages 35 and 70. The investigators measured participants’ grip strength with a Jamar dynamometer. Median follow-up was four years. Grip strength was inversely associated with all-cause mortality, cardiovascular mortality, noncardiovascular mortality, myocardial infarction, and stroke. Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure was. The researchers found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or chronic obstructive pulmonary disease, injury from fall, or fracture.

Sleep deprivation is particularly problematic for decision-making involving uncertainty and unexpected change, according to a study published in the May issue of Sleep. Twenty-six subjects were randomized to 62 hours of total sleep deprivation or to a control condition. Researchers conducted performance testing at baseline, after two nights of total sleep deprivation or rested control, and following two nights of recovery sleep. Participants performed a decision task that involved initial learning of response sets and subsequent reversal of contingencies. Working memory and psychomotor vigilance tests also were administered. Sleep-deprived subjects had difficulty with initial learning of stimuli sets and profound impairment adapting to reversal. Skin conductance responses to outcome feedback were diminished, indicating blunted affective reactions to feedback accompanying sleep deprivation. Sleep deprivation did not significantly affect working memory scanning performance.

—Kimberly Williams