A randomized trial of I‐SLEEP: A patient education and empowerment intervention on inpatient sleep duration and medical sleep disruptions

Journal of Hospital Medicine · 2026-02-06

BACKGROUND: Sleep is essential for recovery in hospitalized patients, yet frequent disruptions from medical care make rest difficult. Most prior efforts have focused on environmental modifications, often overlooking patients' role in advocating for their sleep. OBJECTIVES: This study evaluated the effectiveness of the Inpatient Sleep Loss: Educating and Empowering Patients (I-SLEEP) intervention in improving sleep duration and reducing medical care disruptions among hospitalized patients. METHODS: In this single-center randomized controlled trial (NCT04151251), general medicine patients at the University of Chicago were randomized to either I-SLEEP (sleep education, advocacy questions, and a sleep kit) or standard care (sleep kit alone) between July 2019 and March 2023. The primary outcome was patient-reported sleep duration. Secondary outcomes included actigraphy-measured sleep duration and continuity (efficiency and wake after sleep onset), as well as patient-reported sleep disruptions. Mixed effects models adjusted for covariates were used for analysis. RESULTS: A total of 194 participants were enrolled. There were no significant differences in demographic characteristics between groups. Sleep duration and continuity did not differ significantly between groups. However, patients receiving I-SLEEP reported fewer disruptions from vital sign monitoring (63% vs. 75%, p = .004), medication administration (49% vs. 61%, p = .003), and laboratory draws (57% vs. 68%, p = .009). These findings remained significant after adjusting for covariates. CONCLUSIONS: I-SLEEP did not increase sleep duration or continuity but reduced medical care disruptions. These findings suggest that patient education and empowerment may be effective strategies for reducing preventable care-related sleep disruptions in hospitals. Further research should examine implementation at scale and potential long-term benefits.

Local ancestry-informed GWAS of warfarin dose requirement in African Americans identifies a CYP2C19 splicing QTL

The American Journal of Human Genetics · 2025-09-29 · 1 citations

Abstract 4364099: Electronic Health Literacy Influences Chronic Disease Self-Management among Adults

Circulation · 2025-11-03

Background: Inadequate self-management behaviors (e.g., not taking medications as prescribed) result in poor patient outcomes. eHealth literacy—the digital skills needed to seek and use health information from electronic sources—is critical for interacting with digital health technologies in a meaningful way to effectively manage chronic disease. Yet little is known about how eHealth literacy impacts self-management of chronic disease (e.g., heart disease), especially in minority populations. Methods: Using a cross-sectional observational design and convenience sampling, we enrolled 1259 English-speaking hospitalized patients ≥18 years of age at University of Chicago Medicine. Self-management was measured by a single question: "How well do you manage your illness at home (e.g., adhere to medication, keep track of symptoms)?” Participants responded on a five-point scale ranging from “not at all” (1) to “completely well” (5) (adequate self-management: ≥4; inadequate self-management: <3). eHealth literacy was measured with a validated eight-item questionnaire (composite score: 8–40; low literacy: <24; adequate literacy: ≥24). Associations between eHealth literacy and self-management adequacy were assessed using chi-square tests and logistic regression models, adjusting for age, gender, race, income, and education. Results: The sample was on average 54 (± 17.3) years old and mostly Black (73%), female (53%), and single/widowed/divorced (70%), and reported at least some college education (54%). 54% had hypertension, 29% had diabetes, 27% had heart disease; 54% were hospitalized in the last 12 months excluding current hospitalization. eHealth literacy showed a significant association with self-management adequacy (χ square = 8.2, p = 0.004; effect size = 0.225). Adequate eHealth literacy was linked to greater odds of reporting adequate self-management (OR = 3.62, 95% CI: 1.54–8.78, p = 0.003). After adjusting for covariates, the relationship was attenuated and non-significant (OR = 1.48, 95% CI: 0.34–6.74, p = 0.6), while higher age (OR = 1.06, 95% CI: 1.02–1.12, p = 0.009) and female gender (OR = 3.71, 95% CI: 1.05–14.7, p = 0.048) were independently associated with greater self-management adequacy. Conclusion: Interventions to improve digital health skills may enhance patients' ability to effectively manage their chronic illness. Additionally, demographic factors should be considered when designing interventions to improve self-management of chronic disease.

Tree cover, health care access, Sociome Data Commons, and pediatric asthma: Chicago, 2010-2019

2025-01-20

Background Pediatric asthma exacerbations remain a critical public health concern, particularly in historically underserved urban settings. In Chicago, non-Hispanic Black children 5-19 years old had 2.5 times the emergency visits for asthma as non-Hispanic White children. Objective This study investigates sociome factors – the social context of disease – associated with asthma exacerbations among children living in Chicago’s South Side, leveraging clinical and census tract-level datasets. The aim is to uncover novel influences for potential new interventions. Methods A generalized linear model assessed associations while accounting for clustering at the patient level. Results Predictors of decreased risk included patient age (+4.8 years, -22%), tree crown density (+6% coverage, -17%), parks per acre (+0.41, -8%), and labor market engagement (+0.8 points, -9%). Conversely, predictors or increased risk included increased distance to the nearest pharmacy (+0.28 miles, +12%), limited English skills (+2.3%, +10%), higher inequality (+0.08 points, +8%), and visits in the Spring (+11%) and Fall (+20%). Conclusion The results suggest that tree crown density, a novel finding in the context of asthma exacerbations, may play a protective role. Limited access to health care facilities such as pharmacies continues to complicate care. However, the complexity of neighborhood-level influences require broader geographic sampling; limitations include the study’s restricted geographic and demographic scope. Integrating data from multiple hospitals will be essential for replicating these findings and translating them into actionable strategies for improving pediatric asthma care.

Author response for "Neighborhood sociome factors and pediatric asthma exacerbations: Protective role of tree crown density and importance of pharmacy access in Chicago's south side"

2025-05-28

Disparities in Physical Function and Rehabilitation Utilization: A Cross-sectional Study of Patients Hospitalized for Acute Medical Illness

Journal of General Internal Medicine · 2025-09-18

BACKGROUND: Black patients have poorer physical function and mobility compared to White patients but utilize physical rehabilitation services less. OBJECTIVE: To determine whether racial differences exist in physical function and post-acute care facility utilization and whether neighborhood social disadvantage influences these differences. DESIGN: A cross-sectional study of hospitalized patients at a large urban academic hospital. PARTICIPANTS: We included self-identified Black or White adults who were hospitalized between January 2018 and May 2022. MAIN MEASURES: The main exposure was self-identified race. The exposure in our secondary aim was neighborhood social disadvantage measured by the Area Deprivation Index. Neighborhood disadvantage was categorized as "more" (deciles 6-10) vs. "less" (deciles 1-5). Primary outcomes included inpatient functional measures, inpatient and post-acute physical therapy referral, and discharge location. KEY RESULTS: Compared to White patients, Black patients had more functional impairment on admission [OR 1.52; 95% CI (1.37, 1.69)], poorer mobility change [β-0.83; 95% CI (- 1.16, 0.50)], more mobility loss [OR 1.25; 95% CI (1.12, 1.41)], but no statistically significant difference in inpatient PT referrals after adjusting for physical function. Most differences in function persisted when stratified by neighborhood disadvantage. Despite similar odds of recommendation for discharge to a PAC facility, Black patients had significantly lower odds of discharge to a facility [OR 0.53; 95% CI (0.42, 0.68). This difference persisted when stratified by more neighborhood disadvantage [OR 0.60; 95% CI (0.43, 0.85)] and less neighborhood disadvantage [OR 0.43; 95% CI (0.31, 0.61)]. CONCLUSION: In this study of patients hospitalized at a large urban academic medical center, Black patients had poorer functional outcomes yet nearly half the likelihood of discharging to a post-acute care facility compared to White patients. Race was a more consistent driver of disparities than neighborhood disadvantage. Hospital, healthcare system, and public policy changes are needed to improve discharge location appropriateness and recovery after hospitalization for vulnerable patients.

Author response for "Neighborhood sociome factors and pediatric asthma exacerbations: Protective role of tree crown density and importance of pharmacy access in Chicago's south side"

2025-05-22

Rethinking handoffs to optimize continuity: Four practical lessons from a novel hospitalist model

Healthcare · 2025-05-13

Local ancestry informed GWAS of warfarin dose requirement in African Americans identifies a novel CYP2C19 splice QTL

medRxiv · 2025-03-05

Abstract African Americans (AAs) are underrepresented in pharmacogenomics which has led to a significant gap in knowledge. AAs are admixed and can inherit specific loci from either their African or European ancestor, known as local ancestry (LA). A previous study in AAs identified single nucleotide polymorphisms (SNPs) located in the CYP2C cluster that are associated with warfarin dose. However, LA was not considered in this study. An IWPC cohort (N=340) was used to determine the LA-adjusted association with warfarin dose. Ancestry-specific GWAS’s were conducted with TRACTOR and ancestry tracts were meta-analyzed using METAL. We replicated top associations in the independent ACCOuNT cohort of AAs (N=309) and validated associations in a warfarin pharmacokinetic study in AAs. To elucidate functional roles of top associations, we performed short-read RNA-sequencing from AA hepatocytes carrying each genotype for expression of CYP2C9 and CYP2C19 . We identified 6 novel genome-wide significant SNPs (P<5E-8) in the CYP2C locus (lead SNP, rs7906871 (P=3.14E-8)). These associations were replicated (P≤2.76E-5) and validated with a pharmacokinetic association for S-Warfarin concentration in plasma (P=0.048). rs7906871 explains 6.0% of the variability in warfarin dose in AAs. Multivariate regression including rs7906871, previously associated SNPs, clinical and demographic factors explain 37% of dose variability, greater than previously reported studies in AAs. RNA-seq data in AA hepatocytes identified a significant alternate exon inclusion event between exons 6 and 7 in CYP2C19 for carriers of rs7906871. In conclusion, we have found and replicated a novel CYP2C variant associated with warfarin dose requirement and potential functional consequences to C YP2C19 .

Catapult dynamics and phase transitions in quadratic nets

Journal of Statistical Mechanics Theory and Experiment · 2025-09-01

Abstract Neural networks trained with gradient descent can undergo non-trivial phase transitions as a function of the learning rate. In Lewkowycz et al (2020 arXiv:2003.02218) it was discovered that wide neural nets can exhibit a catapult phase for super-critical learning rates, where the training loss grows exponentially quickly at early times before rapidly decreasing to a small value. During this phase the top eigenvalue of the neural tangent kernel also undergoes significant evolution. In this work, we will prove that the catapult phase exists in a large class of models, including quadratic models and two-layer, homogeneous neural nets. To do this, we show that for a certain range of learning rates the weight norm decreases whenever the loss becomes large. We also empirically study learning rates beyond this theoretically derived range and show that the activation map of ReLU nets trained with super-critical learning rates becomes increasingly sparse as we increase the learning rate.