The primary purpose of this study was to examine the relationship between adolescents' sleep-wake patterns and risk-taking behavior. A second goal was to replicate the results obtained by Wolfson and Carskadon (1998) regarding adolescents' sleep habits. Three hundred eighty-eight adolescents (217 males, 171 females) completed the Sleep Habits Survey and the Youth Risk Behavior Survey. The results indicated that adolescents who reported longer weekend delay and higher levels of sleep problems also reported significantly higher levels of risk-taking behaviors, and students' weekend delay was also related to their academic performance in this sample. As in the sample studied by Wolfson and Carskadon (1998), the adolescents in this study exhibited changes in both weekday and weekend sleep habits across grade/age. However in the present study, only school-night total sleep time and weekend delay were related to adolescents' daytime functioning, with no significant relationships being found between weekend oversleep and daytime functioning. This provides partial support for the findings of Wolfson and Carskadon (1998). Overall, sleep-wake patterns were found to relate to risk-taking behavior during adolescence in this study.

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STUDY DESIGN A prospective, observational, human, study was conducted. OBJECTIVES To evaluate the incidence of vascular penetration during fluoroscopically guided, contrast-enhanced transforaminal cervical epidural steroid injections, and to determine whether the observation of blood in the needle hub can be used to predict a vascular injection. SUMMARY OF BACKGROUND DATA Incorrectly placed intravascular cervical spinal injections result in medication flow systemically and not to the desired target. A recently published study demonstrates a high incidence of intravascular injections in transforaminal lumbosacral epidural injections. No studies so far have evaluated the incidence of vascular injections in transforaminal cervical epidural steroid injections, nor have they calculated the ability of observed blood in the needle hub to predict a vascular injection in the cervical spine.METHODS The incidence of fluoroscopically confirmed intravascular uptake of contrast was prospectively observed in 337 patients treated with cervical transforaminal epidural steroid injections. The ability of observed blood in the needle hub to predict intravascular injection was also investigated. For each subject, the injection level was chosen on the basis of the clinical scenario including history, physical examination, and review of imaging studies. Some patients had multilevel injections. Using fluoroscopic guidance, the authors placed a 25-gauge needle into the epidural space using a transforaminal approach according to accepted standard technique. Needle tip location was confirmed with biplanar imaging. The presence or absence of blood in the needle hub spontaneously ("flash") and after attempted aspiration by pulling back on the syringe's plunger was documented. Contrast then was injected under real-time fluoroscopy to determine whether the location of the needle tip was intravascular. The results were recorded in a prospective manner indicating the presence or absence of blood in the needle hub and whether a vascular pattern was noted with contrast injection, and these were correlated. Relevant epidemiologic data also were recorded. RESULTS The study included 504 transforaminal epidural steroid injections. The overall rate of fluoroscopically confirmed intravascular contrast injections was 19.4%. Use of observed blood in the needle hub to predict intravascular injections was 97% specific, but only 45.9% sensitive. There was no significant difference in intravascular rates related to age or gender. CONCLUSIONS As compared with a previous study of lumbosacral epidural steroid injections, there is an overall higher incidence of intravascular injections with cervical transforaminal epidural steroid injections. Use of observed blood in the needle hub to predict an intravascular injection is not sensitive, and therefore the absence of blood in the needle hub despite aspiration is not reliable. The reported sensitivity and specificity rates are similar to lumbar data. Fluoroscopically guided procedures without contrast confirmation i...

There is a high incidence of intravascular injections in transforaminal ESIs that is significantly increased at S1. Using a flash or blood aspiration to predict an intravascular injection is not sensitive, and therefore a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are instilling medications intravascularly and therefore not into the desired epidural location. This finding confirms the need for not only fluoroscopic guidance but also contrast injection instillation in lumbosacral transforaminal ESIs.

A palladium-catalyzed aromatic decarboxylation reaction has been developed. With electron-rich aromatic acids, the reaction proceeds efficiently under fairly mild conditions in good yields. The method was useful with complex functionalized substrates containing hindered carboxylic acids.

These findings suggest that addressing negative mood directly, or by addressing sleep disturbances in chronic pain patients, may have a beneficial impact on patients' pain. As sleep disturbance may be causing negative mood, treating the sleep disturbance may also be beneficial among chronic pain patients. Negative mood may perpetuate the impact of sleep disturbances on pain, possibly through increased arousal or disruptions in diurnal patterns.

Prospective examination supported a bidirectional relationship between sleep and pain among a group of women with chronic pain. Depressive symptoms had a moderating impact on these relationships. These findings suggest that addressing sleep is important in the treatment of individuals with chronic pain.

Prazosin was not effective in treating PTSD symptoms, improving sleep, or reducing alcohol consumption overall in this dually diagnosed group. This does not support the use of prazosin in an actively drinking population and suggests that the presence of a comorbid condition affects the efficacy of this medication. This study highlights the importance of conducting clinical trials in "real-world" patients, as results may vary based on comorbid conditions.