Save money, download BCNS-CNS free pdf free of cost gives the most current and up to be able to date Practice Tests out with Actual BCNS-CNS PDF Questions and even Answers achievable subject areas of Medical BCNS-CNS Exam. Training our BCNS-CNS real questions and Responses to Improve your current understanding and go your Board Certified Nutrition Specialis test using High Marks. Many of us guarantee your accomplishment in the Test out Center, covering all the points of BCNS-CNS test out and creating your current Knowledge of typically the BCNS-CNS exam. Pass using our actual BCNS-CNS inquiries.

Exam Code: BCNS-CNS Practice exam 2022 by team
BCNS-CNS Board Certified Nutrition Specialis

Our certifying board, the Board for Certification of Nutrition SpecialistsSM (BCNSSM), sets the standard for advanced personalized nutrition practitioners via our Certified Nutrition Specialist® (CNS®) credential.
We certify practitioners in specialty areas of advanced personalized nutrition.
We designate as Fellows those who have distinguished themselves in the area of nutrition science and research.
We partner with universities to instill curriculum standards that equip the next generation of nutrition professionals.

The CNS designation demonstrates to colleagues, clients, employers and the public at large that certified individuals have the knowledge and proficiency required of the professional nutrition practice. BCNS has established qualifying pathways for Nutritionists, APRNs, DCs, DDSs, NDs, PAs, PharmDs, MDs, DOs, and other advanced-degreed health professionals who wish to demonstrate competence as advanced clinical nutrition professionals and/or obtain a potential pathway to state licensure for nutrition practice and Medical Nutrition Therapy. The Certified Nutrition Specialist (CNS) is formal recognition for nutrition professionals who have met rigorous and demanding eligibility requirements, including postgraduate education, subsequent supervised practice in professional nutrition and demonstration of a depth and breadth of knowledge appropriate for effective practice in the profession of nutrition.

The BCNS paper and pencil examination contains 200 multiple-choice, single answer questions, and will cover the broad spectrum of basic and applied nutritional science. Themes such as fundamental principles on nutrition, nutrients and human health, nutrition assessment, clinical intervention and monitoring, professional issues, epidemiology, biochemistry and integration of these areas, are threaded throughout the examination. Detailed information may be found within the published Examination Content Outline. Candidates have four hours to complete the examination.

BCNS complies with the Americans with Disabilities Act (ADA) and will provide reasonable and appropriate testing accommodations for candidates with documented disabilities who request and demonstrate the need for accommodation as required by law. BCNS requires verifiable documentation to ensure the individual qualifies under the ADA as a disabled individual, and to allow accommodations to be specifically matched with the identified functional limitation to provide equal access to all testing functions.

The information provided by candidates and any documentation regarding such disability and special accommodation, will be treated with strict confidentiality and will not be shared with any source, with the exception of BCNS authorized testing consultants and proctors, without the candidates express written permission.

Candidates requiring special accommodations must complete the Special Accommodations Request form, and the Documentation of Disability-Related Needs form before scheduling the examination. These forms must be submitted with the CNS or CNS-S Certification Application to the BCNS by the deadline posted on the BCNS website. Arrangements for special accommodations may take up to 45 days to coordinate.

Requests for accommodations are reviewed by the Executive Administrator to ensure the request can be processed without jeopardizing the integrity or security of the examination. The Executive Administrator, or staff designee, will personally communicate with the candidate to ensure all processes and procedures are explained and that a testing appointment is scheduled to accommodate their needs accordingly, if feasible.
On Examination Day
Testing Sites
BCNS examinations are administered at testing sites located throughout the Unites States. Testing sites have been selected to provide accessibility to the most candidates in the most controlled, secure and consistent environments possible. To ensure that examination results for all candidates are earned under comparable conditions and represent fair and accurate

• Failure to adhere to testing site examination restrictions
• Creating a disturbance, being abusive or being otherwise uncooperative
• Bringing restricted materials into the testingarea
• Using electronic communication equipment such as cellular phones, PDAs or communicating calculators.
• Gaining unauthorized admission into the examination testing area
• Attempting to take the examination for another individual
• Recording or attempting to record examination questions or making notes
• Eating and smoking

Board Certified Nutrition Specialis
Medical Certified exam contents
Killexams : Medical Certified exam contents - BingNews Search results Killexams : Medical Certified exam contents - BingNews Killexams : Proposal seeks to make cannabis products safer. Why do Arizona dispensaries oppose it? cannot provide a good user experience to your browser. To use this site and continue to benefit from our journalism and site features, please upgrade to the latest version of Chrome, Edge, Firefox or Safari.

Thu, 08 Dec 2022 23:00:00 -0600 en-US text/html
Killexams : Pilot students take part in medicine seminar

Students from Pilot Mountain Middle in the Institute for Science Technology Engineering and Math Program.

<p>Layla Lineberry and Kaylen Pennington dissect a squid.</p>

Layla Lineberry and Kaylen Pennington dissect a squid.

<p>Sailor Johnson and Ellie Fitzgerald study a squid.</p>

Sailor Johnson and Ellie Fitzgerald study a squid.

<p>Colby Badgett and Megan Poteat learn about dissecting a squid.</p>

Colby Badgett and Megan Poteat learn about dissecting a squid.

<p>Emery Tilley and Dayton Hanes get a closer look at a squid they are dissecting.</p>

Emery Tilley and Dayton Hanes get a closer look at a squid they are dissecting.

<p>Institute for Science Technology Engineering and Math as part of a Surry County Schools/Wake Forest University School of Medicine pose for a photo.</p>

Institute for Science Technology Engineering and Math as part of a Surry County Schools/Wake Forest University School of Medicine pose for a photo.

Several states at Pilot Mountain Middle School recently were able to participate in the Institute for Science Technology Engineering and Math as part of a Surry County Schools/Wake Forest University School of Medicine program.

The students participated in a fall summit at the medical school on Thursday to learn more about careers in the medical field. They also attended a Saturday morning enrichment program and dissected a squid to examine the anatomy of a living organism.

Tue, 06 Dec 2022 03:17:00 -0600 Mount Airy News en-US text/html
Killexams : Insights into scalp microbiota research

There has been an uptake in the analysis of the scalp microbiome and the microbiota that colonize this ecosystem. Research institutes, academics, and global cosmetic companies are keenly investigating the world of the scalp microbiome.

There is increasing evidence to suggest that scalp microbiota may be affiliated with infections, inflammatory disorders, and other scalp complaints.1 This article's primary goal is to describe the scalp microbiome, assess the microorganisms that colonize the scalp and hair follicles, and learn more about how the microbiota can be associated with common scalp disorders.

Research of the scalp microbiome is still in its infant phase when compared to that of other microbiomes of the body; there is still more to find out regarding how it controls, regulates, and affects functions of the scalp.

However, state-of-the-art analytical technologies are expediting the pace of knowledge obtained on individual scalp microorganisms and opening up new potentialities in the scalp and hair-care markets.

With the onset of human skin equivalent (HSE) models that imitate the scalp microbiome and nullify the need for animal testing, it will be possible to meet the demand for scalp microbiome-friendly products at a much faster rate.

Looking to the future of scalp microbiome research, new and existing products and ingredients can be analyzed at reduced costs, clinically proven as safe and effective, and globally recognized with microbiome-friendly certification.

Insights into scalp microbiota research

Image Credit: Labskin

What is the scalp microbiome?

Scalp microbiome is comprised of a diverse mix of bacteria, fungi, viruses, parasites, other microorganisms, and their respective genes.

Considered the first line of defense against invasive pathogens,2 the scalp microbiome, in combination with individual hair follicle microbiomes, creates a balanced ecosystem. When dysbiosis occurs, which is an imbalance of the microbiome, conditions such as dandruff and other inflammatory disorders commonly seen on the scalp can arise.3

Unlike skin and gut microbiomes, which are predisposed to bacteria, the scalp microbiome are refuge to a greater number of yeasts, in particular the Malassezia species,4 including:

  • M. restricta
  • M. globosa
  • M. furfur

Other uncultured species of Malassezia have been observed on the scalp5 along with a range of bacteria6 that can help maintain a healthy scalp environment or eventually result in the occurrence of cosmetic, dermatological, and auto-immune scalp disorders. These include:

  • Corynebacterium spp.
  • Cut bacterium acnes
  • Staphylococcus spp.

Composition can be related to pH levels, temperature, moisture, and sebum content which is similar to other microbiomes of the body. Therefore, every individual has a specific set of microorganisms inhabiting their scalp.

Insights into scalp microbiota research

Image Credit: Labskin

The history of scalp microbiome research

The earliest documented studies of the scalp microbiome are just 20 years old. However, research into the scalp microbiome is gaining pace, albeit at a much slower rate than other body microbiomes.

Though the number of studies has been underwhelming, the advent of next-generation sequencing7 and associated data analysis has enhanced the understanding surrounding the subject.

Recently, studies have revealed associations between a disparity in the presence of scalp microbiome and common scalp disorders, such as:

  • Seborrheic dermatitis8
  • Pruritus
  • Dandruff
  • Alopecia areata (AA)

While there is still some way to go regarding the functionality and structural aspects of the scalp microbiome, metagenomics has opened the door to deeper analysis to help understand this ecosystem.9 By closely studying communities of the scalp, researchers can now explore potential causative factors for the aforementioned scalp disorders.

What does the scalp microbiome do?

While the scalp microbiome protects the scalp from infections and irritations, it also plays a key role in keeping your hair and scalp healthy.10 It also has an influence over functions of the scalp, such as:

  • Hair follicle regeneration11
  • Sebum production12
  • Pathogenesis of scalp disorders13
  • Immune cell maturation14

Hair follicle regeneration

Hair follicles are crucial for many healthy scalp functions, especially thermal insulation and sebaceous dispersion.15 Any imbalance in the scalp microbiota can be associated with inflammation and result in permanent hair loss.

Moreover, studies have shown that regeneration is dependent on a healthy, balanced microbiome,16 along with the intense cooperation of epithelial and hair-inductive mesenchymal components.15

Sebum production

Numerous factors influence sebum production, such as age, hormones, lifestyle, UV light, diet, and stress. Scalp sebum is comprised of a mixture of cholesterol, triglycerides (TGs), diglycerides (DGs), free fatty acids, and squalene.17

When there is an imbalance of the microbiome, production of the sebum can diminish, which can increase the likelihood of contracting an inflammatory disease, and has even been associated with the progression of androgenetic alopecia (AGA).18

Pathogenesis of scalp disorders

An imbalance of the scalp microbiome can be related to the onset and progression of several different scalp disorders. For example, dandruff scalps are associated with an overabundance of Staphylococcus spp. and Malassezia restricta,19 while a greater proportion of Corynebacterium spp. has been found on the scalps of patients suffering from severe alopecia areata (AA).20

Immune cell maturation

Depending on the depth of penetration and composition of hair follicle microbiota, the direct interaction of bacteria with immune cells can provoke a local immune response. This may ultimately result in acute and chronic scalp inflammatory disorders and impede immune cell maturation in deeper hair follicular zones such as the dermal papilla (DP) and dermal sheath (DS).21

Insights into scalp microbiota research

Image Credit: Labskin

Scalp microbiome and scalp disorders

There are a range of factors that contribute to scalp disorders, including age, lifestyle, geographic location, and genetics.

Research into the treatment of different scalp disorders is rapidly increasing, but there is still much to learn when it comes to establishing causative factors. An imbalance or overabundance of specific microorganisms has been associated with individual disorders.

With this information, technological progress in metagenomics and next-generation sequencing paves the way for therapeutic products that balance the scalp microbiome.

Seborrheic dermatitis

Seborrheic dermatitis (SD), deemed a chronic form of eczema, is prevalent in 11% of the global population.22 Interestingly, this condition is predominant in those with white skin and a higher body fat content.

Recent studies suggest that this is due to an inflammatory response to an imbalance of the scalp microbiome. Potential fungal biomarkers recorded in one particular study are Malassezia spp. and Aspergillus spp., while other possible bacterial biomarkers are Staphylococcus spp. and Pseudomonas spp.23

Scalp pruritus

Scalp pruritus, commonly referred to as an itchy scalp, is simple to diagnose but difficult to treat. Researchers are exploring an imbalance of the microbiome as a potential cause, as studies have shown differences in the microbial communities of itchy and non-itchy parts of the scalp.24

For instance, Lactobacillus, Morganella, and Pseudomonas species have been discovered in itchy regions of the scalp, suggesting that restoring balance with microbiota-targeted treatments can be achieved.


Around 50% of the global population will experience dandruff.25 Characterized by scaly patches and itchy skin, it is associated with a combined interaction between the scalp microbiome, sebum composition, and host susceptibility.

While the majority of studies tend to focus on the surplus of fungal species, particularly Malassezia restricta,26 higher incidences of Staphylococcus spp. can also be found.

Anti-fungal shampoos are usually the go-to treatment for dandruff. However, studies suggest that maintaining an equilibrium between the fungal and bacterial microbiota would be much more impactful.27

Alopecia areata (AA)

With a lifetime incidence risk of over 2%, alopecia areata (AA) is believed to affect 1 in 1000 of the population across the globe.28 Categorized as a non-scarring autoimmune hair disorder, the causative factors are yet to be clinically determined.

Studies have revealed an increase in Actinomycetota and a decrease in Bacillota, while increased levels of Staphylococcus and Cutibacterium species have also been found in the scalps of AA patients.29

Prevotella copri, a bacterium associated with the pathogenesis of rheumatoid arthritis, has also been detected in subepidermal compartments of AA scalps, suggesting that therapeutic treatments that focus on the immune system may be well-suited for managing AA.

Insights into scalp microbiota research

Image Credit: Labskin

Advances in technology allow for greater insights into the scalp microbiome

Recent therapeutic approaches for scalp disorders have been emerging as technology advances. Providing greater sensitivity, resolution, and a more detailed analysis of the scalp microbiome, “omics” techniques are employed to detect the makeup of the genomic community that colonizes the scalp and hair follicle ecosystems.

With the ability to assess the functionality of the microbiome,30 common “omics” techniques employed for analysis of the scalp microbiome include:

  • Metagenomics
  • Metabolomics
  • Metataxonomics
  • Proteomics
  • Transcriptomics

As scalp disorder treatments develop, establishing the efficacy of a product includes evaluating changes in the scalp microbiome after use.

To circumvent the need to perform the controversial method of colonizing human scalps with microbes without appropriate safety data from preclinical studies, a far more ethical approach can be accomplished using human skin equivalent (HSE) technology.

Simulating the scalp microbiome in a laboratory setting enables the study of physiological and environmental exposures in a safe manner. Detailed and reproducible analysis can occur using a variety of other technologies, such as:

  • Next-generation sequencing (NGS)31
  • Polymerase chain reaction(PCR) technology32
  • Amplicon-based NGS33

Insights into scalp microbiota research

Image Credit: Labskin

Establishing the root cause of microbial imbalances is key to the discovery and development of innovative therapeutic treatments for scalp disorders. With this knowledge in hand, microbiome-friendly products can be targeted toward individual conditions, and new avenues for income in the scalp and hair-care markets can be established.

Insights into scalp microbiota research

Image Credit: Labskin

Scalp and hair-care product markets

Increased demand for scalp microbiome-friendly products

As consumers deal with the physical and psychological effects of scalp disorders on a day-to-day basis, the search for effective products is ongoing.

It is expected that the global hair and scalp care markets will reach $121.4 billion dollars by 2027, indicating a market growth of 6.5% CAGR during this period.34

Increased awareness of environmental factors and the impact on hair and scalp disorders are driving the market growth. Moreover, personalized or customized products are offered in line with consumer demand - not only for specific scalp disorders but to address concerns more commonly associated with the hair, including:

  • Frizz control
  • Color retention
  • Cleansing
  • Softening
  • Strengthening
  • Scalp care
  • Moisturization

Harsh chemicals can be found in almost all scalp and hair care products to some extent,35 but consumers are becoming aware of the importance of a balanced scalp microbiome which in turn is having a direct impact on consumer decision-making.

Due to the lack of available scalp microbiome models, most hair and scalp products do not take the microbiome into consideration. As it stands, there is a lack of understanding surrounding the cosmetic and dermatological impact of many ingredients, including:

  • Colorants
  • Surfactants
  • Actives
  • Preservatives
  • Emollients
  • Texture ingredients

With the introduction of human skin equivalent (HSE) models to test the impact of ingredients on the scalp microbiome, a more involved evaluation of said ingredients can take place.

From a financial perspective, R&D costs are reduced dramatically with an HSE model, as clinical trial participant numbers can be reduced by 50%.36 Moreover, new products can be brought to market that meet the safety, regulatory, and efficacy standards at a much faster rate.37

Insights into scalp microbiota research

Image Credit: Labskin

The future of scalp microbiome understanding

In comparison to the skin and gut, research on the scalp microbiome is still considered to be in its infancy. However, as technology progresses and scalp microbiome models become increasingly available, new avenues for personalized hair and scalp care treatments can be explored.

Consumers are becoming acutely aware of how natural ingredients impact skin and scalp health,38 and they want to avoid using chemicals of emerging concern (CECs). Thus, proving claims of safety and efficacy while preventing an imbalance of the scalp microbiome is becoming more important than ever.

In time, hair and scalp products that have been developed to prevent or treat common scalp disorders will take over the market. Consumers will have easier access to scalp microbiome testing, and the growing amount of data will accelerate understanding of how the scalp microbiome interacts or is affiliated with scalp ailments, leading to more targeted solutions for consumers.

As the scalp microbiome movement continues to grow, the hair care industry and regulators are looking for ways to verify microbiome-friendly claims, employing a variety of sophisticated in vitro and in vivo methods.

Global cosmetic companies such as Unilever, L’Oréal, and L’Occitane are paving the way by evaluating and marketing products in this manner.

Insights into scalp microbiota research

Image Credit: Labskin

Labskin: A 3D model for testing the scalp microbiome

Labskin has developed a lab-grown, full-thickness human skin equivalent (HSE) model that simulates the scalp microbiome, eliminating the need for cosmetic testing on animals. With this model, it is easy to establish how almost any product ingredient impacts the microbiota colonizing the scalp.

While similar HSE models are available, Labskin is the first commercially available model with the capacity to allow for the colonizing of scalp microbiota.39 Clinical trial participant numbers, cost issues, and product development time are significantly reduced by using its reproducible and powerful data-generating performance to mimic multiple test subjects.

Commercial clients and research institutions are working in collaboration to expand a repository of scalp microbiome data via Labskin’s platform using predictive analysis and AI technology.

Hair and scalp-care clients can then utilize this groundbreaking real-world environment to test new and existing ingredients, clinically prove safety and efficacy claims, and acquire a world-recognized microbiome-friendly certification.40

Insights into scalp microbiota research

Image Credit: Labskin


  1. Saxena, R., Mittal, P., Clavaud, C., Dhakan, D. B., Hegde, P., Veeranagaiah, M. M., Saha, S., Souverain, L., Roy, N., Breton, L., Misra, N., & Sharma, V. K. (2018). Comparison of Healthy and Dandruff Scalp Microbiome Reveals the Role of Commensals in Scalp Health. Frontiers in cellular and infection microbiology, 8, 346.
  2. Gallo, R. L., & Nakatsuji, T. (2011). Microbial symbiosis with the innate immune defence system of the skin. The Journal of investigative dermatology, 131(10), 1974–1980.
  3. Lin, Q., Panchamukhi, A., Li, P., Shan, W., Zhou, H., Hou, L., & Chen, W. (2021). Malassezia and Staphylococcus dominate the scalp microbiome for seborrheic dermatitis. Bioprocess and biosystems engineering, 44(5), 965–975.
  4. Grimshaw, S. G., Smith, A. M., Arnold, D. S., Xu, E., Hoptroff, M., & Murphy, B. (2019). The diversity and abundance of fungi and bacteria on the healthy and dandruff affected human scalp. PloS one, 14(12), e0225796.
  5. Saxena, R., Mittal, P., Clavaud, C., Dhakan, D. B., Roy, N., Breton, L., Misra, N., & Sharma, V. K. (2021). Longitudinal study of the scalp microbiome suggests coconut oil to enrich healthy scalp commensals. Scientific reports, 11(1), 7220.
  6. Won, E. J., Jang, H. H., Park, H., & Kim, S. J. (2022). A Potential Predictive Role of the Scalp Microbiome Profiling in Patients with Alopecia Areata: Staphylococcus caprae, Corynebacterium, and Cutibacterium Species. Microorganisms, 10(5), 864.
  7. Rogers, G. B., & Bruce, K. D. (2010). Next-generation sequencing in the analysis of human microbiota: essential considerations for clinical application. Molecular diagnosis & therapy, 14(6), 343–350.
  8. Lin, Q., Panchamukhi, A., Li, P., Shan, W., Zhou, H., Hou, L., & Chen, W. (2021). Malassezia and Staphylococcus dominate scalp microbiome for seborrheic dermatitis. Bioprocess and biosystems engineering, 44(5), 965–975.
  9. Pinto, D., Calabrese, F. M., De Angelis, M., Celano, G., Giuliani, G., Gobbetti, M., & Rinaldi, F. (2020). Predictive Metagenomic Profiling, Urine Metabolomics, and Human Marker Gene Expression as an Integrated Approach to Study Alopecia Areata. Frontiers in cellular and infection microbiology, 10, 146.
  10. Polak-Witka, K., Rudnicka, L., Blume-Peytavi, U., & Vogt, A. (2020). The role of the microbiome in scalp hair follicle biology and disease. Experimental dermatology, 29(3), 286–294.
  11. Constantinou, A., Kanti, V., Polak-Witka, K., Blume-Peytavi, U., Spyrou, G. M., & Vogt, A. (2021). The Potential Relevance of the Microbiome to Hair Physiology and Regeneration: The Emerging Role of Metagenomics. Biomedicines, 9(3), 236.
  12. Suzuki, K., Inoue, M., Cho, O., Mizutani, R., Shimizu, Y., Nagahama, T., & Sugita, T. (2021). Scalp Microbiome and Sebum Composition in Japanese Male Individuals with and without Androgenetic Alopecia. Microorganisms, 9(10), 2132.
  13. Won, E. J., Jang, H. H., Park, H., & Kim, S. J. (2022). A Potential Predictive Role of the Scalp Microbiome Profiling in Patients with Alopecia Areata: Staphylococcus caprae, Corynebacterium, and Cutibacterium Species. Microorganisms, 10(5), 864.
  14. Polak-Witka, K., Rudnicka, L., Blume-Peytavi, U., & Vogt, A. (2020). The role of the microbiome in scalp hair follicle biology and disease. Experimental dermatology, 29(3), 286–294.
  15. Ji, S., Zhu, Z., Sun, X., & Fu, X. (2021). Functional hair follicle regeneration: an updated review. Signal transduction and targeted therapy, 6(1), 66.
  16. Ho, B. S., Ho, E., Chu, C. W., Ramasamy, S., Bigliardi-Qi, M., de Sessions, P. F., & Bigliardi, P. L. (2019). Microbiome in the hair follicle of androgenetic alopecia patients. PloS one, 14(5), e0216330.
  17. Downing, D. T., Strauss, J. S., & Pochi, P. E. (1969). Variability in the chemical composition of human skin surface lipids. The Journal of investigative dermatology, 53(5), 322–327.
  18. Suzuki, K., Inoue, M., Cho, O., Mizutani, R., Shimizu, Y., Nagahama, T., & Sugita, T. (2021). Scalp Microbiome and Sebum Composition in Japanese Male Individuals with and without Androgenetic Alopecia. Microorganisms, 9(10), 2132.
  19. Wang, L., Clavaud, C., Bar-Hen, A., Cui, M., Gao, J., Liu, Y., Liu, C., Shibagaki, N., Guéniche, A., Jourdain, R., Lan, K., Zhang, C., Altmeyer, R., & Breton, L. (2015). Characterization of the major bacterial-fungal populations colonising dandruff scalps in Shanghai, China, shows microbial disequilibrium. Experimental dermatology, 24(5), 398–400.
  20. Won, E. J., Jang, H. H., Park, H., & Kim, S. J. (2022). A Potential Predictive Role of the Scalp Microbiome Profiling in Patients with Alopecia Areata: Staphylococcus caprae, Corynebacterium, and Cutibacterium Species. Microorganisms, 10(5), 864.
  21. Polak-Witka, K., Rudnicka, L., Blume-Peytavi, U., & Vogt, A. (2020). The role of the microbiome in scalp hair follicle biology and disease. Experimental dermatology, 29(3), 286–294.
  22. Breunig, J., de Almeida, H. L., Jr, Duquia, R. P., Souza, P. R., & Staub, H. L. (2012). Scalp seborrheic dermatitis: prevalence and associated factors in male adolescents. International journal of dermatology, 51(1), 46–49.
  23. Lin, Q., Panchamukhi, A., Li, P., Shan, W., Zhou, H., Hou, L., & Chen, W. (2021). Malassezia and Staphylococcus dominate scalp microbiome for seborrheic dermatitis. Bioprocess and biosystems engineering, 44(5), 965–975.
  24. Li, X., Yang, F., Yan, H., Shi, Y., Chang, X., Zhang, M., Zhang, Y., & Zhang, M. (2022). Microbiota profiling on itchy scalp with undetermined origin. Archives of microbiology, 204(7), 446.
  25. Manuel, F., & Ranganathan, S. (2011). A new postulate on two stages of dandruff: a clinical perspective. International journal of trichology, 3(1), 3–6.
  26. Sommer, B., Overy, D. P., & Kerr, R. G. (2015). Identification and characterization of lipases from Malassezia restricta, a causative agent of dandruff. FEMS yeast research, 15(7), fov078.
  27. Wang, L., Clavaud, C., Bar-Hen, A., Cui, M., Gao, J., Liu, Y., Liu, C., Shibagaki, N., Guéniche, A., Jourdain, R., Lan, K., Zhang, C., Altmeyer, R., & Breton, L. (2015). Characterization of the major bacterial-fungal populations colonising dandruff scalps in Shanghai, China, shows microbial disequilibrium. Experimental dermatology, 24(5), 398–400.
  28. Villasante Fricke, A. C., & Miteva, M. (2015). Epidemiology and burden of alopecia areata: a systematic review. Clinical, cosmetic and investigational dermatology, 8, 397–403.
  29. Pinto, D., Sorbellini, E., Marzani, B., Rucco, M., Giuliani, G., & Rinaldi, F. (2019). Scalp bacterial shift in Alopecia areata. PloS one, 14(4), e0215206.
  30. Pinto, D., Trink, A., Sorbellini, E., Giuliani, G., & Rinaldi, F. (2020). ‘Omics’ approaches for studying the microbiome in Alopecia areata. Journal of investigative medicine: the official publication of the American Federation for Clinical Research, 68(7), 1292–1294.
  31. Rogers, G. B., & Bruce, K. D. (2010). Next-generation sequencing in the analysis of human microbiota: essential considerations for clinical application. Molecular diagnosis & therapy, 14(6), 343–350.
  32. Grimshaw, S. G., Smith, A. M., Arnold, D. S., Xu, E., Hoptroff, M., & Murphy, B. (2019). The diversity and abundance of fungi and bacteria on the healthy and dandruff affected human scalp. PloS one, 14(12), e0225796.
  33. Wang, L., Yu, T., Zhu, Y., Luo, Y., Dong, F., Lin, X., Zhao, W., He, Z., Hu, S., & Dong, Z. (2022). Amplicon-based sequencing and co-occurrence network analysis reveals notable differences of microbial community structure in healthy and dandruff scalps. BMC genomics, 23(1), 312.
  34. GlobeNewswire (2022, May) Global Hair & Scalp Care Market Size, Share & Industry Trends Analysis Report By Product, By Distribution Channel, By Regional Outlook and Forecast, 2021 - 2027
  35. Chiu, C. H., Huang, S. H., & Wang, H. M. (2015). A Review: Hair Health, Concerns of Shampoo Ingredients and Scalp Nourishing Treatments. Current pharmaceutical biotechnology, 16(12), 1045–1052. 36.Labskin (2020, July) Remote Clinical Skin Trials in a Covid World
  36. Labskin (2020, July) Remote Clinical Skin Trials in a Covid World
  37. Labskin (2020, May) Human Trials vs 3D Skin Model Tests
  38. Ezekwe, N., King, M., & Hollinger, J. C. (2020). The Use of Natural Ingredients in the Treatment of Alopecias with an Emphasis on Central Centrifugal Cicatricial Alopecia: A Systematic Review. The Journal of clinical and aesthetic dermatology, 13(8), 23–27.
  39. Holland, D. B., Bojar, R. A., Jeremy, A. H., Ingham, E., & Holland, K. T. (2008). Microbial colonisation of an in vitro model of a tissue engineered human skin equivalent--a novel approach. FEMS microbiology letters, 279(1), 110–115.
  40. Labskin (2022, May) Microbiome Friendly Seal of Approval

About Labskin

At Labskin we deliver human skin microbiology services to support your product R&D activities in the cosmetic, personal care, medical device and pharmaceutical sectors. With our sector experience and use of technology, you will be accessing industry-focused services supported by world-leading skin science expertise.

Whether you need rapid, focused analysis or flexible, tailor-made research programs we can help you develop and validate skincare ingredients and products which really work.

Our skin model is a 3D human skin equivalent that incorporates vital biological components to model normal skin function. Developed over 12 years with more than 30 scientific journal publications, it is made from young keratinocytes (human skin cells) and adult fibroblasts (metabolically-active, collagen-producing human skin cells).

“An ideal platform for basic or applied skin research, testing compounds or formulated products for the cosmetic, pharmaceutical and chemical sectors.”

Sponsored Content Policy: publishes articles and related content that may be derived from sources where we have existing commercial relationships, provided such content adds value to the core editorial ethos of News-Medical.Net which is to educate and inform site visitors interested in medical research, science, medical devices and treatments.

Wed, 07 Dec 2022 23:36:00 -0600 en text/html
Killexams : Best No-Exam Life Insurance Of December 2022

We scored companies based on these measurements:

Price (50% of score): We averaged the no-exam life insurance rates for males and females in excellent health at ages 30, 40 and 50 for $500,000 and $1 million and a term length of 20 years.

Maximum face amount for lowest eligible age (10% of score): Companies with higher no-exam life insurance coverage amounts for the lowest age earned more points. Note that maximum no-exam coverage can sometimes become lower if you apply at a higher age.

Age eligible for best length/amount (10% of score): Companies offering no-exam life insurance to folks over age 50 earned extra points.

Accelerated death benefit available (10% of score): This important feature lets you access part of your own death benefit in the event you develop a terminal illness

Option to convert to a permanent life insurance policy (10% of score): This is a good option to have in place if you decide you want a longer policy, especially if your health has declined and you don’t want to shop for new life insurance.

Guaranteed renewals (5% of score): This option lets you extend the coverage after your initial level term period has expired, such as at the end of 10, 20 or 30 years.

Renewal rates can be significantly higher, but renewing can provide extended coverage to someone who may no longer qualify for a new life insurance policy because of health.

Median time from application to approval (5% of score): We gave more points to companies with lower no-exam life insurance approval times.

The timeline for approval could be within seconds or a month, depending on the company and possibly even your health.

Sources: Bestow, Ethos, Fabric, Haven Life, Jenny Life, Ladder, Policygenius and Forbes Advisor research.

Looking For Life Insurance?

Compare Policies With Leading Life Insurance Companies

Mon, 05 Dec 2022 20:26:00 -0600 Ashlee Tilford en-US text/html
Killexams : Rural Colorado Tries to Fill Health Worker Gaps With Apprenticeships

GRAND JUNCTION, Colo. — During her 12-hour overnight shift, Brianna Shelton helps residents at BeeHive Homes Assisted Living go to the bathroom. Many of them have dementia, and some can’t get out of bed on their own. Only a few can remember her name, but that doesn’t matter to her.

“They’re somebody’s mom, somebody’s grandma, somebody’s great-grandmother,” Shelton said. “I want to take care of them like I would take care of my family.”

Shelton trained to be a personal care aide through an apprenticeship program designed to meet the increasing need for health care workers in rural western Colorado. Here, far from Denver’s bustling urban corridor, worker shortages mount as baby boomers retire, young people move away from these older communities, and demand for health care in homes and facilities rises.

Rural areas often have larger shares of residents who are 65 or older than urban areas do. And the most rural regions have relatively fewer direct care workers, like personal care aides, to help people with disabilities than less-rural regions do, according to a accurate study in the journal Health Affairs.

Besides increasing the number of direct care workers, the Colorado apprenticeship program offers opportunities for improving earning power to residents who live at or below the poverty line, who lost their jobs during the covid-19 pandemic, or who are unemployed or underemployed. They train to become personal care aides, who help patients with daily tasks such as bathing or housekeeping, or certified nursing assistants, who can provide some direct health care, like checking blood pressure.

Apprentices take training classes at Western Colorado Area Health Education Center in Grand Junction, and the center pays for students who live in more rural areas to attend classes at Technical College of the Rockies in Delta County. The apprentices receive on-the-job training with one of 58 local employers — an assisted living facility, for example — and they are required to work there for one year. Each apprentice has an employer mentor. Staff members at Western Colorado AHEC also provide mentorship, plus the center has a life coach on hand.

“We really just want students to get into health care, get jobs, and retain those jobs,” said Georgia Hoaglund, executive director of Western Colorado AHEC, which has 210 active apprentices and was bolstered by a $2 million grant from the U.S. Labor Department in 2021.

Some apprentices are accurate high school graduates. Others are single mothers or veterans. They often have educational or economic barriers to employment. Hoaglund and her staff of 10 buy the apprentices scrubs so they can start new jobs with the right uniforms; otherwise, they might not be able to afford them. Staff members pay for apprentices’ gas if they can’t afford to fill up their tanks to drive to work. They talk to apprentices on the phone monthly, sometimes weekly.

Even though the apprenticeship program gives these workers a solid start, the jobs can be stressful, and burnout and low pay are the norm. Career advancement is another obstacle, said Hoaglund, because of the logistics or cost of higher education. Hoaglund, who calls her staff family and some of the apprentices her kids, dreams of offering more advanced training — in nursing, for example — with scholarship money.

Apprenticeships are perhaps better known as a workforce training tool among electricians, plumbers, carpenters, and other tradespeople. But they are also viewed as a way of building a needed pipeline of direct care health workers, said Robyn Stone, senior vice president for research at LeadingAge, an association of nonprofit providers of aging services.

“Traditionally, health care employers have hired people after they finish a training program,” said Susan Chapman, a registered nurse and a professor in the school of nursing at the University of California-San Francisco. “Now, we’re asking the employer to take part in that training and pay the person while they’re training.”

The pandemic exacerbated shortages of direct care workers, which could encourage employers to invest in apprenticeships programs, both Chapman and Stone said. Federal investment could help, too, and a Biden administration initiative to Improve the quality of nursing homes includes $35 million in grants to address workforce shortages in rural areas.

Brandon Henry was a student working at a pet store in Grand Junction, Colorado, before he joined the Western Colorado Area Health Education Center’s apprenticeship program to become a certified nursing assistant. He expects to graduate from Colorado Mesa University and become a registered nurse. (Kate Ruder for KHN)

Shelton had never worked in health care before moving to Fruita, a small town that is about 12 miles northwest of Grand Junction and is surrounded by red sandstone towers. She left Fresno, California, a year ago to take care of an uncle who has multiple sclerosis. She and her 16-year-old daughter live in a trailer home on her uncle’s property, where Blackie, her rescue Labrador retriever, roams with the chickens and cats.

Blackie also sometimes accompanies Shelton to BeeHive to visit with the residents. Shelton said that it is more than a job to her and that she is grateful to the apprenticeship program for helping her get there. “It opened a door for me,” Shelton said.

Shelton works three 12-hour shifts a week, in addition to taking care of her uncle and daughter. Yet, she said, she struggles to have enough money for gas, bills, and food and has taken out small loans to make ends meet.

She is not alone. Personal care aides are often underpaid and undervalued, said Chapman, who has found significantly higher poverty rates among these workers than among the general population.

Direct care workers nationwide, on average, make $13.56 an hour, according to a study by nonprofit policy group PHI, and these low wages make recruiting and retaining workers difficult, leading to further shortages and instability.

In an effort to keep workers in the state, Colorado raised the minimum wage for personal care aides and certified nursing assistants to $15 an hour this year with money from the American Rescue Plan Act. And the Colorado Department of Health Care Policy and Financing’s 2023-24 budget request includes a bump to $15.75. Similar efforts to raise wages are underway in 18 other states, including New York, Florida, and Texas, according to a accurate paper from the National Governors Association.

Another way to keep apprentices in jobs, and encourage career and salary growth, is to provide opportunities for specialized training in dementia care, medication management, or behavioral health. “What apprenticeships offer are career mobility and advancement,” Stone said.

To practice in Colorado, new certified nursing assistants complete in-class training, do clinical rotations, and pass a certification exam made up of a written test and a skills test. Hoaglund said the testing requirements can be stressful for students. Shelton, 43, has passed the written exam but must retake the skills test to become licensed as a certified nursing assistant.

Hoaglund’s program started in 2019, but it really took off with the 2021 federal grant. Since then, 16 people have completed the program and have received pay increases or promotions. Twice as many people have left without finishing. The largest hospital in Grand Junction, Intermountain Healthcare-St. Mary’s Medical Center, recruits workers from the program.

Hoaglund said each person who enters the health care field is a win.

Brandon Henry, 23, was a student at Colorado Mesa University in Grand Junction and working at PetSmart before he joined the apprenticeship program in 2019. After enrolling, he trained and worked as a certified nursing assistant through the worst of the pandemic. As an apprentice, he said, he learned the importance of having grace while caring for patients.

He went back for more training at Western Colorado AHEC to earn a license that allows him to dispense medicine in accredited facilities, such as assisted living centers. He now works at Intermountain Healthcare-St. Mary’s Medical Center, where he took training classes in wound care and physical therapy hosted at the hospital. This winter, he’ll graduate from Colorado Mesa with a Bachelor of Science in nursing.

“At the hospital, I’ve found more opportunities for pay raises and job growth,” Henry said.

Mon, 28 Nov 2022 19:00:00 -0600 en-US text/html
Killexams : The Best Vitamin Brands: How to Find the Right One for You Killexams : The 9 Best Vitamin Brands of 2022, According to a Registered Dietitian - SI Showcase - Sports Illustrated Skip to main content Wed, 07 Dec 2022 09:54:00 -0600 en text/html Killexams : Best Database Certifications for 2022
  • Database technology is crucial in multiple applications and computing tasks, and certifications help demonstrate job readiness and core competencies. 
  • Before pursuing a database platform certification, you should have a solid background in relational database management systems and the SQL language. 
  • Valuable certifications are typically tied to specific technology companies and their platforms, such as IBM, Microsoft, Oracle and SAP.
  • This article is for IT professionals considering database certifications to further their careers. 

While database platforms have come and gone through the decades, database technology is still critical for multiple applications and computing tasks. IT professionals often seek database certifications to demonstrate their knowledge and expertise as they navigate their career paths and pursue professional growth. 

While database certifications may not be as bleeding edge as Google cloud certifications, cybersecurity certifications, storage certifications or digital forensics certifications, database professionals at all levels possess in-demand career skills — and a plethora of database-related jobs are waiting to be filled.

We’ll look at some of the most in-demand certifications for database administrators, database developers and anyone else who works with databases.

What to know about database roles and certifications

To get a better grasp of available database certifications, it’s helpful to group these certs around job responsibilities. This reflects the maturity of database technology and its integration into most aspects of commercial, scientific and academic computing. As you read about the various database certification programs, keep these job roles in mind: 

  • Database administrator (DBA). A DBA is responsible for installing, configuring and maintaining a database management system (DBMS). The job is often tied to a specific platform, such as Oracle, MySQL, DB2 or SQL Server.
  • Database developer. A database developer works with generic and proprietary application programming interfaces (APIs) to build applications that interact with a DBMS. Like DBA roles, database developer positions are also often platform-specific.
  • Database designer or database architect. A database designer or architect researches data requirements for specific applications or users and designs database structures and application capabilities to match.
  • Data analyst or data scientist. A data analyst or scientist is responsible for analyzing data from multiple disparate sources to discover previously hidden insights, determine the meaning behind data, and make business-specific recommendations.
  • Data mining or business intelligence (BI) specialist. A data mining or BI specialist focuses on dissecting, analyzing and reporting important data streams, such as customer, supply chain and transaction data and histories.
  • Data warehousing specialist. A data warehousing specialist assembles and analyzes data from multiple operational systems (such as orders, transactions, supply chain information and customer data) to establish data history, analyze trends, generate reports and forecasts, and support general ad hoc queries. 

These database job roles highlight two critical issues to consider if you want to be a database professional:

  1. You need a solid general background. First, a background in relational database management systems, including an understanding of Structured Query Language (SQL), is a fundamental prerequisite for database professionals of all stripes. 
  2. There’s a focus on proprietary technologies. Second, although various efforts to standardize database technology exist, much of the whiz-bang capability that databases and database applications deliver comes from proprietary, vendor-specific technologies. Serious, heavy-duty database skills and knowledge are tied to specific platforms, including various Oracle products (such as the open-source MySQL environment and Oracle itself,) Microsoft SQL Server and IBM DB2. Most of these certifications relate directly to those enormously popular platforms. 

Did you know?Did you know? NoSQL databases — called “not only SQL” or “non-relational” databases — are increasingly used in big data applications associated with some of the best big data certifications for data scientists, data mining and warehousing, and business intelligence.

Best database certifications

Here are details on our five best database certification picks for 2022.

1. IBM Certified Database Administrator — DB2 12

IBM is one of the leaders in the worldwide database market by any objective measure. The company’s database portfolio includes industry-standard DB2, as well as the following:

  • IBM Compose
  • Information Management System (IMS)
  • Informix
  • Cloudant
  • IBM Open Platform with Apache Hadoop

IBM also has a long-standing and well-populated IT certification program that has been around for more than 30 years and encompasses hundreds of individual credentials. 

After redesigning its certification programs and categories, IBM now has a primary data-centric certification category called IBM Data and AI. It includes a range of database credentials: 

  • Database Associate
  • Database Administrator
  • System Administrator
  • Application Developer 

IBM’s is a big and complex certification space, but one where particular platform allegiances are likely to guide readers toward the handful of items most relevant to their interests and needs. 

Database professionals who support DB2 (or aspire to) on IBM’s z/OS should check out the IBM Associate Certified DBA — Db2 12 certification. It’s an entry-level exam that addresses routine planning, working with SQL and XML, security, operations, data concurrency, application design, and concepts around database objects.

This certification requires candidates to pass one exam. Pre-exam training and familiarity with concepts, or hands-on experience, are recommended but not required. 

IBM Certified Database Administrator — DB2 facts and figures

Certification name

IBM Certified Database Administrator — Db2 12 (z/OS)

Prerequisites and required courses

None required; recommended courses are available.

Number of exams

One: C1000-122: Db2 12 for z/OS DBA Fundamentals (63 questions, 90 minutes)

Cost per exam

$200 (or local currency equivalent) per exam. Sign up for exams at Pearson VUE.


Self-study materials

The certification page includes self-study materials, including a study guide and a learning path. 

Did you know? IBM’s certification offerings are among the best system administrator certifications IT professionals can achieve.

2. Microsoft Azure

Microsoft Azure offers a broad range of tools and add-ons for business intelligence. Azure is a cloud computing platform for application management and Microsoft-managed data centers. Microsoft certifications include various Azure offerings based on job role and experience level.

Microsoft’s certification program is role-centric, centered on the skills you need to succeed in specific technology jobs. Because Azure has such a broad scope, Azure certifications span multiple job roles. However, specific certifications exist for the following positions:

  • Data Analysts
  • Data Engineers
  • Data Scientists
  • Database Administrators 

There are also certifications for learners at different experience levels. 

For those looking to take their Azure knowledge to the next level, the Microsoft Certified: Azure Data Fundamentals certification is the perfect place to start. This certification is for beginner database administrators interested in using Azure and mastering data in the cloud. It offers foundational knowledge of core concepts while reinforcing concepts for later use in other Azure role-based certifications, such as those listed below: 

  • Azure Database Administrator Associate
  • Azure Data Engineer Associate
  • Data Analyst Associate 

Azure Data Fundamentals certification facts and figures

Certification name

Microsoft Certified: Azure Data Fundamentals

Prerequisites and required courses 

This certification does not have any prerequisites. However, for absolute beginners, Microsoft offers an Azure Fundamentals certification. 

Number of exams

One exam, DP-900, which is administered via Pearson VUE or Certiport.

Cost per exam

The exam costs $99 in the United States, though the cost changes based on where it is proctored. 


Self-study materials

Microsoft offers one of the world’s largest and best-known IT certification programs, so the exam is well supported with books, study guides, study groups, practice exams and other materials. Microsoft also offers a free online learning path.

3. Oracle Certified Professional, MySQL 5.7 Database Administrator 

Oracle runs its certifications under the auspices of Oracle University. The Oracle Database Certifications page lists separate tracks depending on job role and product. MySQL is perhaps the leading open-source relational database management system (RDBMS). Since acquiring Sun Microsystems in 2010 (which had previously acquired MySQL AB), Oracle has rolled out a paid version of MySQL and developed certifications to support the product. 

If you’re interested in pursuing an Oracle MySQL certification, you can choose between MySQL Database Administration and MySQL Developer. 

The Oracle Certified Professional, MySQL 5.7 Database Administrator (OCP) credential recognizes professionals who can accomplish the following tasks:

  • Install, optimize and monitor MySQL Server.
  • Configure replication.
  • Apply security.
  • Schedule and validate database backups. 

The certification requires candidates to pass a single exam (the same exam can be taken to upgrade a prior certification). Oracle recommends training and on-the-job experience before taking the exam.

Oracle Certified Professional, MySQL 5.7 Database Administrator facts and figures

Did you know? According to Oracle, approximately 1.8 million Oracle Certified professionals globally hold certifications to advance their networking careers and professions to validate their IT expertise. 

4. Oracle Database SQL Certified Associate Certification

For individuals interested in working in the Oracle environment who have the necessary experience to become a database administrator, Oracle’s Database SQL Certified Associate Certification is another top Oracle certification and an excellent starting point. This exam encompasses an understanding of fundamental SQL concepts that individuals must grasp for database projects. 

By earning the certification, individuals demonstrate that they have a range of knowledge in core SQL concepts:

  • Familiarity with queries, data modeling, and normalization
  • Strong base understanding of the underlying SQL language
  • An ability to create and manipulate Oracle Database tables 

This certification also requires candidates to pass a single exam. While Oracle does not specify any prerequisites, the company does state candidates should have familiarity working with the command line. 

Oracle Database SQL Certified Associate Certification facts and figures

5. SAP HANA: SAP Certified Technology Associate — SAP HANA 2.0 SPS05

SAP SE has an extensive portfolio of business applications and analytics software, including cloud infrastructure, applications and storage. The SAP HANA platform’s foundation is an enterprise-grade relational database management system that can be run as an appliance on-premises or in the cloud. The cloud platform lets customers build and run applications and services based on SAP HANA. 

SAP offers a comprehensive certification program built to support its various platforms and products. We’re featuring the SAP Certified Technology Associate — SAP HANA cert because it aligns closely with other certifications we’ve highlighted and is in high demand among employers, according to job board surveys. 

This certification ensures database professionals can install, manage, monitor, migrate and troubleshoot SAP HANA systems. It covers the following skills:

  • Managing users and authorizations
  • Applying security
  • Ensuring high availability 
  • Effective disaster-recovery techniques 

SAP recommends that certification candidates get hands-on practice through formal training or on-the-job experience before attempting this exam. The SAP Learning Hub is a subscription service that gives certification candidates access to a library of learning materials, including e-learning courses and course handbooks. 

The annual subscription rate for individual users on the Professional certification track is $2,760. This online training program is designed for those who run, support, or implement SAP software solutions. Though this may seem like a steep price for online training, you will likely be able to pass any SAP certification exams you put your mind to by leveraging all the learning resources available to SAP Learning Hub Professional subscribers. 

Typically, SAP certifications achieved on one of the two most accurate SAP solutions are considered current and valid. SAP contacts professionals whose certifications are nearing end-of-life status and provides information on maintaining their credentials.

SAP Certified Technology Associate facts and figures

Certification name

SAP Certified Technology Associate — SAP HANA 2.0 SPS05

Prerequisites and required courses    

None required.

Recommended: Hands-on experience and the following courses: 

  • SAP HANA Installation & Operations SPS12 (HA200) 
  • High Availability and Disaster Tolerance Administration SPS05 (HA201)
  • Monitoring and Performance Tools SPS05 (HA215)
  • Database Migration using DMO SPS05 (HA250)

Number of exams

One exam: SAP Certified Technology Associate — SAP HANA 2.0 SPS05, exam code C_HANATEC_17 (80 questions, 180 minutes)

Cost per exam



Self-study materials

The certification web page includes a link to demo questions. SAP HANA trade books and certification guides are available on Amazon. The SAP Help Center offers product documentation and a training and certification FAQs page. The SAP Learning Hub (available on a subscription basis) provides access to online learning content.

Tip: To broaden your skill set, consider pursuing the best sales certifications to better sell and implement various IT solutions, including databases.

Beyond the top 5 database certifications

Additional database certification programs can further the careers of IT professionals who work with database management systems. 

While most colleges with computer science programs offer database tracks at the undergraduate, master and Ph.D. levels, well-known vendor-neutral database certifications exist, including the following: 

  • ICCP certifications. The Institute for the Certification of Computing Professionals (ICCP) offers its unique Certified Data Professional and Certified Data Scientist credentials. Learn more about ICCP certifications from the ICCP website.
  • Enterprise DB certifications. EnterpriseDB administers a small but effective certification program with two primary certs: the EDB Certified Associate and the EDB Certified Professional

These are some additional certifications: 

These credentials represent opportunities for database professionals to expand their skill sets — and salaries. However, such niches in the database certification arena are generally only worth pursuing if you already work with these platforms or plan to work for an organization that uses them.

Key takeaway: Pursuing additional database certifications can be helpful for professional development if you already work with these platforms or plan to work with them in the future. 

Job board search results

Before pursuing certifications, consider their popularity with employers to gain a helpful perspective on current database certification demand. Here’s a job board snapshot to deliver you an idea of what’s trending.




 LinkedIn Jobs 



IBM Certified Database Administrator — DB2






Azure Data Fundamentals






Oracle Certified Professional, MySQL Database Administrator






Oracle Database SQL Certified Associate Certification












If the sheer number of available database-related positions isn’t enough motivation to pursue a certification, consider average salaries for database administrators. SimplyHired reports $91,949 as the national average in the U.S., ranging from $64,171 to over $131,753. Glassdoor’s reported average is somewhat lower at $84,161, with a top rung for experienced senior DBAs right around $134,000.

Choosing the right certification

Choosing the best IT certifications to enhance your skills and boost your career can be overwhelming, especially as many available certifications are for proprietary technologies. While picking a database certification can feel like locking yourself into a single technology family, it is worth remembering that many database skills are transferable. Additionally, pursuing any certification shows your willingness to learn and demonstrates competence to current and future employers. 

Ultimately, choosing which certification to pursue depends on the technologies you use at work or would like to use at a future employer.

Jeremy Bender contributed to the reporting and writing in this article. 

Mon, 05 Dec 2022 10:00:00 -0600 en text/html
Killexams : Vyne Medical Achieves HITRUST Risk-based, 2-year Certification to Further Mitigate Risk in Third-Party Privacy, Security, and Compliance

Vyne Medical®, a leading provider of end-to-end health information exchange and electronic healthcare communication management, today announced their FastAttach®, Trace® Web Application (Hosted), and Refyne™ Denials Management systems have earned Certified status for information security by HITRUST

DUNWOODY, Ga., Nov. 28, 2022 /PRNewswire-PRWeb/ -- HITRUST® Risk-based, 2-year (r2) Certified status demonstrates that the organization's innovative systems have met key regulations and industry-defined requirements and are appropriately managing risk. This achievement places Vyne Medical in an elite group of organizations worldwide that have earned this certification. By including federal and state regulations, standards, and frameworks, and incorporating a risk-based approach, the HITRUST Assurance Program helps organizations address security and data protection challenges through a comprehensive and flexible framework of prescriptive and scalable security controls.

"We welcome this certification by HITRUST as it demonstrates Vyne Medical's commitment to maintaining the industry's highest standards for data protection and information security," said Vyne CEO Steve Roberts. "Vyne remains committed to observing the industry's best practices for information risk management and compliance procedures, and we are delighted that Vyne Medical continues to be part of an elite group of organizations earning this certification."

"In today's ever-changing threat landscape, HITRUST is continually innovating to find new and creative approaches to address challenges," said Jeremy Huval, Chief Innovation Officer, HITRUST. Vyne Medical's HITRUST Risk-based, 2-year Certification is evidence that they are at the forefront of industry best practices for information risk management and compliance."

About Vyne Medical:
Vyne Medical is a recognized industry leader in end-to-end health information exchange and electronic healthcare communication management and is one of the largest CMS Certified Health Information Handlers (HIH). Vyne Medical's robust technology platforms facilitate the electronic capture, storage and submission of healthcare data in virtually any form – voice, fax, image, data or electronic document. Vyne Medical's solutions connect disconnected data to close gaps in documentation and Improve the continuum of care through a more complete and fully accessible patient record. Outcomes include improved financial strength, operational performance and patient experience.

The newly certified Trace solution is the flagship product of Vyne Medical's proven technology platform for effectively managing healthcare communication and facilitating the secure exchange of health information. And the newly certified Refyne Denials Management solution is the lead product for audits and authorizations management streamlining government audit workflows through the electronic submission of medical documentation.

More than 800 leading hospitals and health systems utilize Vyne Medical solutions to manage critical patient information that typically resides outside the electronic health record and leverage the data for improved financial performance, operational efficiency, and patient experience. For more information, visit

Vyne Medical Media Contact:
Amy Mendoza Leonor
Vyne Corp

© 2022 Napa EA/MEDX, LLC. All rights reserved. All third-party trademarks and tradenames (including logos and icons) referenced are and remain the property of their respective owners.

Media Contact

Amy Mendoza Leonor, Vyne Medical, 256-269-1671,

SOURCE Vyne Medical

Mon, 28 Nov 2022 00:01:00 -0600 en-US text/html
Killexams : Ghost Legend Pre-Workout Review: Is This Pre-Workout The Best For You?
Ghost preworkout_hero

The products featured in this article have been independently reviewed. When you buy something through the retail links on this page, we may earn commission at no cost to you, the reader. The Sports Illustrated editorial team is not involved in the creation of this content. Learn more here.

In this supplement review, we are breaking down one of GHOST’s premier products, their Legend pre-workout powder. Originally launched in 2016, their original pre-workout formulation was designed to ‘empower legends far beyond the walls of the gym.’ In 2021, to keep up with the ever-evolving industry standards, GHOST decided it was time for an upgrade and released GHOST LEGEND® V2. This redesigned formula is surely an improvement over the original and boasts several clinically dosed ingredients aimed at increasing energy, focus and performance in the gym. We are going to evaluate these claims, learn more about the ingredients and dosages and see how GHOST Legend stacks up against the other pre-workout supplements.

This content is meant to be informative, but should not be taken as medical advice. It is not intended for use as diagnosis, prevention or treatment of health problems. Always speak with your doctor before starting any new supplement or exercise regimen.

What is GHOST?

Ghost flavors

GHOST is currently one of the most popular supplement companies that specializes in fitness, health and wellness. So we wanted to find out what all the hype was about. Founded in 2016, GHOST, also known as GHOST Lifestyle, distinguishes themselves from other supplement companies as the first “lifestyle sports nutrition brand.” The company has a huge focus on their brand design and identity, and partners with over 60 bodybuilding, fitness, beauty, gaming, automotive and music influencers. As far as their products, they offer a variety of supplements including whey protein powders, pre-workouts, greens powders, hydration, gaming nootropics, energy drinks, GHOST pump and GHOST smart energy.

What are the benefits of GHOST pre-workout?

As the name implies, a pre-workout supplement is meant to be taken prior to a workout session to boost energy levels, focus and drive. Let’s just say that GHOST’s pre-workout Legend delivers on these expectations. The formula contains a wide range of clinically dosed ingredients aimed at enhancing performance including 250 milligrams of caffeine, four grams of L-citrulline, 3.2 grams of beta-alanine and one gram of taurine to name a few. If you are looking for an energy boost before an early morning workout or need a pick-me-up before an evening training session, then GHOST LEGEND® might be the pre-workout for you.

Is GHOST pre-workout safe? Are there any side effects?

Note: It’s always advised to speak to your health care professional before adding a pre-workout supplement to your routine.

Yes, GHOST LEGEND® is safe as long as you follow the label instructions when using this product. The supplement label’s suggested use is mixing two scoops (one serving) of powder with eight to 10 ounces of water and consuming 15-30 minutes before exercise. They advise to not exceed two scoops per day and to never ‘dry-scoop’ the powder, meaning to ingest it without any liquid. This is a dangerous trend that can lead to some serious health problems ranging from choking to cardiac arrest from the acute caffeine dose. 

Other potential side effects include anxiety, headaches and insomnia from the caffeine. These usually only occur if consuming other stimulants such as coffee in addition to your pre-workout. In order to test your tolerance levels, I suggest starting with one scoop of the powder and assessing how you feel. Lastly, there is a side effect known as paresthesia associated with the ingredient beta-alanine in this formula. This is when you feel a tingly or prickly sensation in your skin. This symptom is only temporary and there is no evidence that it is harmful.

Does GHOST work?

Yes, the Legend pre-workout definitely works. Although it isn’t the most robust formula available, I would rank this as an above average pre-workout based on the ingredients, dosages and my personal experience. My first time using this product was before a 5:00 a.m. CrossFit class and I had only taken a single scoop (half-serving). On my drive to the gym, I felt energized and noticed the beta-alanine tingles begin to take effect. The workout was an hour long and at that time of the morning I could tell the pre-workout was absolutely helping me stay engaged and energized. That being said, the effects weren’t anything crazy, keep in mind I have tested more than 40 different pre-workout powders. Much to my surprise, when I returned home and actually read the container, I realized I had only taken half of the recommended serving size. The following day I repeated with the full serving two-scoop dose and now I felt the full effects. The 250-milligram caffeine dose was intense, but I didn't feel any anxiety or jitters. The beta-alanine effects were stronger, and I definitely noticed a better pump after class. My recommendation when trying this product is to start with one-scoop, see how you feel and progress up to two-scoops as needed.

GHOST pre-workout ingredients

ghost ingredients


Caffeine is one of the most common ingredients found in pre-workout supplements. This is due to its ability to stimulate the central nervous system leading to improvements in cognition, performance, power output and endurance through a reduced perception of fatigue. Studies show caffeine supplementation is effective for enhancing athletic performance in dosages of three to six milligrams per kilogram of body weight; for reference most pre-workout supplements have between 150 to 300 milligrams of caffeine per serving. It's important to monitor your total caffeine consumption throughout the day when choosing a pre-workout containing caffeine. The recommended daily allowance of caffeine for adults is 400 milligrams per day.


Beta-Alanine is a non-essential amino acid that is used in conjunction with the essential amino acid l-histidine in the body to create the dipeptide molecule carnosine. Carnosine plays a key role in buffering the lactic acid produced in the muscles during periods of intense exercise. This reduction in lactic acid build up ultimately improves performance and increases total time to exhaustion. An effective dose of four to six grams per day is suggested to elicit performance enhancing benefits. A possible side effect of supplementation is a sensation of prickly or tingly skin called paresthesia.  However, the symptom is temporary and there is no evidence that it is harmful.


L-Citrulline is a non-essential amino acid that acts as a precursor to the amino acid L-arginine and the chemical nitric oxide. Studies show that supplementation with L-Citrulline or citrulline malate (a combination of L-citrulline and malic acid) results in increased muscular endurance, reduced muscle soreness and better aerobic performance through enhanced ATP (adenosine triphosphate) production. Effective dosage ranges for pure L-Citrulline appear to be between three to four grams per day.


L-Tyrosine is a non-essential amino acid that is the precursor to the hormone/neurotransmitter dopamine. Supplementation has been shown to lead to improvement of mood and well-being in people under stress, a common emotion experienced during athletic competition. However, it seems to be unclear if this has a direct relationship to exercise and athletic performance. More research needs to be done before L-Tyrosine can be conclusively called an ergogenic aid, which is anything that an athlete can use to increase energy, performance and recovery.


Taurine is classified as a conditionally essential amino acid with demonstrated antioxidant and potential athletic performance benefits. A meta-analysis of 19 taurine specific studies show potential improvements in VO2max, time to exhaustion, anaerobic performance, reduced muscle damage, electrolyte balance, peak power and recovery. From the analysis, taurine dosages ranging from one to three grams per day appear to be effective.


Nitrosigine, also referred to as ‘inositol stabilized arginine silicate,’ is a patented nitric oxide booster that increases vasodilation (expands blood vessels) allowing for increased skeletal muscle blood flow. This effect results in potential improvements in exercise performance.


Senactiv is a patented plant-based nutrient pharmaceutical designed to promote increased muscle energy expenditure and increased muscular endurance and recovery.

Alpha GPC

Alpha GPC has been shown to both improve mental and physical performance by increasing endurance performance and growth hormone secretion. The study that conducted this research was a randomized double-blind placebo-controlled crossover design and showed positive outcomes at 200 milligrams of Alpha GPC. The GHOST LEGEND® V2 formulation has a dose of 300 milligrams per serving.


Theobromine is a product isolated from the seeds of a cacao tree. It is included in pre-workout supplements as a vasodilator (blood vessel widener) to increase the blood flow and pump to the muscles. It might also have a small stimulating effect similar to caffeine.

Rauwolfia Root Extract

Rauwolfia root extract contains the chemical stimulant rauwolscine. The research as a potential ergogenic aid is somewhat conflicting and unfortunately there are no clinical studies available to ascertain how safe or unsafe it is as an ingredient.

GHOST pre-workout caffeine

A full serving (two-scoops) of Legend pre-workout contains 250 milligrams of caffeine.

GHOST pre-workout flavors



GHOST is one of the only supplement companies that offers a variety of licensed flavors for their products. For example, their Legend pre-workout powder is available in Sour Patch Kids - Redberry, Swedish Fish, Sonic - Cherry Limeade and Ocean Water, Bubblicious - Strawberry Splash and Cotton Candy, Warheads - Sour Watermelon and GHOST original flavors Peach & Blue Raspberry. It is definitely fun and enjoyable having such a wide array of delicious flavor options available.


How long does it take for GHOST pre-workout to hit?

The supplements label suggests consuming 15-30 minutes before exercise for the maximum stim effect. However, you will likely start feeling the effects within 10 minutes of ingestion.

Does GHOST pre-workout have creatine in it?

No, Legend pre-workout doesn’t contain creatine, but you don’t need creatine in a pre-workout formula. In fact, despite it often being included for convenience in other pre-workout supplements such as Cellucor’s C4, I find it superior to have a stand-alone creatine supplement. This is because having a separate creatine supplement allows you to take creatine even on days when you aren’t training and therefore aren’t consuming your pre-workout powder.

Can I take GHOST pre-workout every day?

While it would likely be safe to take GHOST pre-workout everyday there are a few reasons why you might not want to. The first is that pre-workout is only meant to be taken on training days and you should be incorporating rest days into your training regimen. It’s also advised to avoid taking high doses of caffeine on a daily basis to prevent developing a high tolerance.

How long does GHOST pre-workout stay in your system?

Most ingredients in pre-workout can stay in your system anywhere from four to six hours with the exception being caffeine which can remain in your body up to 10 hours depending on the individual. However, you will likely only feel the effects for anywhere between 30 to 90 minutes.

Final Thoughts

All in all, I really like GHOST Legend V2, it's a good pre-workout formula. They have incorporated all of the key ingredients I look for in a pre-workout and at clinically effective dosages. I also actually like the fact that a full serving is two-scoops, this allows consumers to adjust the amount they are taking based on how they are feeling. If you are looking for improved performance, muscle growth and a great pump then I suggest giving GHOST Legend a try. The only thing to consider is the price per serving. Legend is priced at $44.99 for a 25 serving container, however if you are only using single scoops then the product will last you twice as long. If you want to dive deeper into supplements check out our guide on the best pre-workout for women and our ranking of the best protein powders to reach your fitness goals.

Prices are accurate and items in stock as of publish time.

Wed, 07 Dec 2022 10:12:00 -0600 en text/html
Killexams : A Look at the Effect of Sleep Patterns on Cardiovascular Health

Studies have increasingly shown that short and excessively long sleep durations are linked to worse cardiovascular outcomes,1 and accumulating research has begun to shed light on the deleterious effects of other components of poor sleep patterns, such as nighttime waking and increased sleep latency. In light of these findings, the American Heart Association (AHA) has made sleep health 1 of the “Essential 8” factors in reducing cardiovascular disease (CVD) risk, in an update to the previous “Essential 7” list.2

“Poor sleep quality or decreased amounts of sleep can elevate insulin resistance, trigger inflammation, throw off circadian rhythms, and elevate sympathetic nervous system activity,” explained Dr Tamara Horwich, MD, MS, attending cardiologist, clinical professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and medical director of UCLA’s Cardiac Rehabilitation Program.

In a study published in August 2022 in the Journal of the American Heart Association (JAHA), Wang et al examined associations between sleep patterns and CVD risk in 12,268 individuals (mean age, 70.3 years) in the Swedish Twin Registry who were free of CVD at baseline.3 In a follow-up period of up to 18 years, hazard ratios (HRs) for CVDs were 1.14 for less than 7 hours of sleep per night (95% CI, 1.01-1.28) and 1.10 for 10 or more hours per night (95% CI, 1.00-1.21) compared to 7 to 9 hours per night.

Another 2022 study investigated the CVD-sleep connection based on data from 7,850 US adults in the National Health and Nutrition Examination Survey (NHANES).4 According to the results, sleep problems (defined as frequent trouble falling or staying asleep) were associated with an increase in CVD risk (OR, 1.75; 95% CI, 1.41-2.16) after adjustment for confounding variables, with a stronger association noted for individuals younger than 60 years (P =.019).

Chronically sleep-deprived people who regularly sleep less than 6 hours face a greater risk of hypertension, heart attack, arrhythmias, congestive heart failure, stroke, and death.

Prolonged sleep-onset latency was associated with increased risk for CVD (OR, 1.59; 95% CI, 1.17-2.15), congestive heart failure (OR, 2.08; 95% CI, 1.33-3.23), and myocardial infarction (OR, 1.76; 95% CI, 1.29-2.41), while short sleep-onset latency was linked to a reduction in the risk for stroke (OR, 0.64; 95% CI, 0.45-0.90).4

Compared to sufficient sleep, inadequate sleep was associated with greater odds of CVD (OR, 1.42; 95% CI, 1.13-1.78) and myocardial infarction (OR, 1.59; 95% CI, 1.19-2.13).4

In a 2021 cross-sectional study of 521,364 adults, poor self-reported sleep was associated with higher odds of having each CVD risk factor, especially physical inactivity.5 Compared to participants reporting difficulty falling asleep, unrestful sleep, and sleep duration of less than 6 hours per night, those with no difficulty falling asleep, restful sleep, and sleep duration of 6 to 9 hours per night showed a lower CVD risk score (all P < .001).

Findings published in 2020 suggest that irregular sleep schedules may increase CVD risk independently of sleep quality and or duration or traditional CVD risk factors.6 The odds of CVD were as much as roughly 2-fold higher among participants with high variability in the duration or timing of sleep compared with those with less variability. Similar results were found after shift workers were excluded from the analyses.

A 2021 study of 873 patients in China demonstrated that going to bed at 12:00AM or later (OR, 4.005; P <.001), waking at 7:00AM or later (OR, 2.544; P =.011), and sleeping less than 6 hours per night (OR, 2.968; P <.001), were associated with an elevated risk for acute myocardial infarction.7 Additionally, frequent nighttime waking was associated with greater acute myocardial infarction risk among participants older than 65 years.

Short sleep duration was also associated with a higher risk for coronary artery disease as indicated by a high Gensini score (OR, 2.374; P <.001).7

Daytime napping was linked to lower acute myocardial infarction risk (OR, 0.645; P =.046) in participants 65 years or younger, suggesting that regular naps may represent a protective CVD factor in young and middle-aged individuals.7 However, in the 2022 JAHA study, napping 1 to 30 minutes (HR, 1.11; 95% CI, 1.03-1.18) and longer than 30 minutes (HR, 1.23; 95% CI, 1.14-1.33) were associated with an increased risk of CVD compared to no napping.3

In research published in 2021 in Circulation, a lower risk for heart failure was associated with healthy sleep patterns, including early chronotype, sleeping 7 to 8 hours per night, and no frequent insomnia or daytime sleepiness (8%, 12%, 17%, and 34% lower for each component, respectively) in more than 400,000 patients in the UK Blood Biobank.8

In 2 studies drawing from the same cohort, a similar healthy sleep pattern was linked to reduced risk for atrial fibrillation/flutter (HR comparing extreme categories, 0.71; 95% CI, 0.64-0.80) and bradyarrhythmia (HR, 0.65; 95% CI, 0.54-0.77), as well as lower risk of all-cause mortality (HR, 0.94; 95% CI, 0.92–0.96), CVD-related mortality (HR, 0.89; 95% CI, 0.83–0.95), and cancer-related mortality (HR, 0.96; 95% CI, 0.93–0.99).9,10

In other accurate research aiming to further elucidate the sleep-CVD connection, lower physical activity was associated with more pronounced associations between poor sleep and all-cause mortality as well as CVD-related and cancer-related mortality.11 In the 2021 cross-sectional study described above, poor sleep was linked to higher odds (approximately 3-fold) of physical inactivity compared to normal sleep.5

In addition, a laboratory study of 20 healthy adults found that moderate light exposure (100 lx) during sleep increased nighttime heart rate, sympathovagal balance (as indicated by decreased heart rate variability), and next-morning insulin resistance compared to dim light exposure (<3 lx) during sleep.12 In the 2021 study linking sleep patterns to increased acute myocardial infarction risk, lower nighttime light exposure was associated with reduced acute myocardial infarction risk (OR, 0.243; P =.009).7

Dr Horwich emphasizes the need to educate patients on ways to Improve sleep quality and quantity, especially those at risk of CVD. “We can advise patients to prioritize sleep, keep consistent sleep hours, avoid smartphones and other light before bedtime,” she said. “Sleep consultation and sleep studies are important next steps when sleep disorders are suspected.”

To glean further insights regarding sleep patterns and CVD risk, we interviewed Bishnu Subedi, MD, FACC, board-certified cardiologist at the University of Pittsburgh Medical College Heart and Vascular Institute and director of cardiac imaging at UPMC Carlisle, and Steven Holfinger, MD, sleep medicine physician and clinical assistant professor of internal medicine The Ohio State University Wexner Medical Center in Columbus.

What does the current evidence suggest about associations between sleep patterns and CV risk?  

Dr Subedi: Chronically sleep-deprived people who regularly sleep less than 6 hours face a greater risk of hypertension, heart attack, arrhythmias, congestive heart failure, stroke, and death. Various sleep patterns like chronotype, sleep duration, insomnia, snoring, and daytime sleepiness are important indicators for future outcomes.   

Dr Holfinger: The lowest CV risk is at 7 hours sleep duration, with both decreased and increased sleep need increasing risk.13

Healthy sleep patterns have a nocturnal dip in blood pressure, while those without dipping will have higher CV risk and risk for obstructive sleep apnea (OSA).

CVDs including arrhythmias and MI incidence are linked to circadian rhythms. For example, 20% of MI occur between 12:00AM and 6:00AM.14

Patients with CVD are both more likely to have sleep disorders and may have worsening of their CVD by the untreated sleep disorder.

When patients have sleep disorders that cause circadian misalignment – such as shift work, jet lag, or shifts in daylight savings time – there is a higher risk of CVD.

What are some of the proposed mechanisms underlying this connection? 

Dr Subedi: Sleep disorders can cause repeated episodes of nocturnal hypoxemia, oxidative stress, sympathetic nervous system activation, cortical arousal, and endothelial dysfunction, all of which are mediators of CVD. 

Lower sleep times and fragmented sleep are independently associated with subclinical atherosclerosis, as determined by vascular ultrasonography and calcium scoring, and higher atherosclerotic biomarkers like high-sensitivity C-reactive protein.  

Poor sleep can, independent of primary sleep disorders, contribute to several molecular, immune, and neural changes that play a role in disease development. 

Dr Holfinger: For healthy people, during non-REM sleep, parasympathetic activity predominates with reduction in arrhythmias, and this is generally thought to be a restorative state for the heart and body. During REM sleep, CV risk is elevated due to relatively extreme swings in sympathetic and parasympathetic tone compared to wakefulness.

The overall circadian rhythmicity of CVDs is likely related to swings in sympathetic activity, but also related to variations in the peripheral circadian clocks, as peripheral clocks have been linked with platelet aggregation changes and ventricular repolarization abnormalities in animal models.15

A well-studied link is between OSA and systemic hypertension.16 This is likely due to a combination of mechanisms related to the repetitive intrathoracic pressure swings and intermittent hypoxia, with the largest factor being the effect of increased sympathetic activity on hypertension. This is primarily mediated by the peripheral chemoreceptors at the carotid body leading to the increase in sympathetic activity.

What are recommendations for clinicians in terms of advising patients on these issues and screening for sleep problems?  

Dr Subedi: Patients with or at risk of sleep problems should be advised to engage in at least moderate exercise, quit smoking, avoid alcohol and stimulant or sedative medications before bedtime, and to optimize their sleep habits. 

The AHA’s checklist to measure CV health has added healthy sleep as essential for optimal CV health.2 The new sleep metric suggests 7-9 hours of sleep daily for optimal CV health for adults, and more for children depending on age. 

Patients at higher risk for OSA should undergo polysomnography to test for sleep apnea to see if they may benefit from positive airway pressure (PAP) therapy. 

Dr Holfinger: The most pressing issue would be that in patients with CVD the prevalence of sleep apnea is high, and it is underrecognized both in the general population and in those with CVD. This may be in part because there are many ways sleep apnea can present, and those with CVD tend to report less sleepiness than other groups with sleep apnea.

Clinicians should keep an eye out for other clues that the patient may have sleep apnea, such as snoring, witnessed apneas, fragmented sleep, morning headaches, or nocturia. If sleep apnea is suspected, they should either be referred for a sleep study or to a sleep specialist for evaluation.

If patients have reasons for circadian misalignment, they should be addressed if possible. For example, ICU settings should strive to mimic circadian signaling by limiting light and disruptions at night, limiting 24-hour parenteral feeding, and increasing daytime light and activity levels.

For healthy patients, the recommendation should be to allow adequate sleep time to not force sleep restriction, in addition to maintaining a regular sleep schedule. Avoidance of bright light for the couple of hours when winding down before bed is also beneficial.

What should be the focus of future research pertaining to this topic?

Dr Subedi: Although sleep disorders have been linked to CVDs, the association between sleep characteristics – such as REM vs non-REM – and CVDs remains inconclusive. 

Experts are proposing that a transdisciplinary research framework that integrates knowledge, methods, and measures from the fields of psychology and sleep research may be used to catalyze advances in the prevention and treatment of CVD. 

Dr Holfinger: The impact on CV outcomes related to treating OSA using continuous PAP (CPAP) have been negative in large randomized studies, with most positive effects on CVD being reported in observational studies. Many sleep researchers cite methodological flaws in these RCTs – for example, low adherence to CPAP and exclusion of high-risk groups.

The evidence currently shows that use of CPAP can lead to a modest (2 mm Hg) reduction in systemic hypertension. And instead of CV risk, the aggregate evidence from the RCTs would suggest that CPAP reduces cerebrovascular risk.17

Specific strategies to reduce the effects of circadian misalignment are lacking in long-term studies evaluating the impact on CVD.

Thu, 08 Dec 2022 22:58:00 -0600 en-US text/html
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