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And the rate of maternal deaths among Black women in the United States remains even higher, at nearly 50 deaths per 100,000 live births, the new report shows. Meanwhile, half of the high-income nations in the new report had fewer than 5 maternal deaths per 100,000 live births, and one country recorded zero maternal deaths: Norway. The three nations with the lowest maternal death rate were Norway with zero, Switzerland with a rate of 1 death per 100,000 live births and Sweden with about 3 deaths per 100,000 live births. The US maternal mortality rate fell from 32.9 maternal deaths per 100,000 live births in 2021 to 22.3 per 100,000 in 2022, according to data from the CDC. “Maternal deaths are a preventable problem, and this problem can be solved.
Persons: , Munira Gunja, ” Gunja, , Dr, Laurie Zephyrin, Dimes, , , Tochi, Michelle Owens, ” Owens, “ ACOG, Christopher Zahn, ” Zahn, Sanjay Gupta, Roe, Wade Organizations: CNN, Commonwealth Fund, International Program, Health, , US Centers for Disease Control, Organisation for Economic Co, CDC, World Health Organization, , Commonwealth, American Academy of Family Physicians, American College of Obstetricians, CNN Health Locations: United States, Norway, Australia, Canada, Chile, France, Germany, Japan, Korea, Netherlands, New Zealand, Sweden, Switzerland, Covid, U.S, United Kingdom, Long Island , New York, Jackson , Mississippi, States, Commonwealth
CNN —The “fasten seat belt” sign is off, and the time for a nap on your flight is on. On the nights with alcohol, researchers saw a lowered amount of oxygen and an increased heart rate, the study showed. Alcohol gets you sleep — but not good sleepThe study authors didn’t just collect data on heart strain. Alcohol may help you get to sleep, but the quality isn’t as good as sleep while sober, he said. “Many people have witnessed when people drink heavily, their snoring and the sleep apnea is much more severe,” Freeman said.
Persons: , Eva, Maria Elmenhorst, Andrew Freeman, didn’t, , Freeman, ” Freeman, Shalini Paruthi, Paruthi, “ I’ve, , Shalini Organizations: CNN, DLR Institute of Aerospace Medicine, Jewish Health, Alcohol, Saint Louis University School of Medicine, American Academy of Sleep, Foods Locations: Cologne, Germany, Denver
CNN —Reassuring new evidence suggests that feeding children smooth peanut butter during infancy and early childhood can help reduce their risk of developing a peanut allergy even years later. “Peanut allergy develops very early in most children between six and 12 months of life. The LEAP-Trio trial set out to examine whether that reduced risk of peanut allergy would last into adolescence. At that age, peanut allergy remained “significantly more prevalent” among the children who originally avoided peanuts, with about 15% having a peanut allergy. Among those who originally consumed peanuts, about 4% had a peanut allergy, the researchers found.
Persons: ” Gideon Lack, ” Lack, , Dr, Jeanne Marrazzo, , Purvi, ” Parikh, it’s, Sanjay Gupta, Daniel DiGiacomo, ” DiGiacomo Organizations: CNN, King’s College London, American Academy of Pediatrics, AAP, US National Institute of Allergy, immunologist, NYU Langone, Allergy, Asthma Network, CNN Health, Children’s, Jersey Shore University Medical Locations: United Kingdom, Israel, United States, New York, Neptune , New Jersey
A generic high blood pressure drug has become the most commonly prescribed oral medication to treat acne in women, overtaking antibiotics and birth control pills, a new report from Epic Research shows. Prescriptions for oral antibiotics — previously the go-to pill for acne — decreased from 41% to 27% in the same time period. While the drug was approved as a high blood pressure medication in 1960, it was in the 1980s that some doctors began prescribing it to women for acne. Birth control pills can also be an effective treatment for this type of acne, and indeed, can be prescribed by dermatologists for this reason. However, prescriptions of birth control for acne also fell from 2017 to 2023, Epic Research found.
Persons: spironolactone, John Barbieri, epidemiologist, Barbieri, “ There’s, ” Barbieri, Jessica Krant, ” Krant, Patricia Oyetakin, , Oyetakin, , dermatologists, Krant, Deborah Bartz Organizations: Epic Research, NBC, American Academy of, Brigham, Women’s Hospital, Surgery, New, Research, Women’s Locations: Boston, New York, Atlanta
The BackgroundFluoride strengthens tooth enamel, and research suggests that drinking water with added fluoride can reduce cavities by up to 25 percent. Most of the women lived in areas with fluoridated water. The researchers measured the fluoride levels in their urine in a single test during the third trimester. And on average, higher fluoride levels in the mothers’ urine were correlated with a greater risk of behavioral problems in the children. That said, the increases in behavioral scores were relatively small — about two points on a scale from 28 to 100 for overall behavioral problems.
Persons: , Beate Ritz, Patricia Braun, Ashley Malin, Malin, Joseph Braun Organizations: National Institutes of Health, Environmental Protection Agency, JAMA, Fielding School of Public Health, University of Colorado School of Medicine, American Academy of Pediatrics, College of Public Health, Health, University of Florida, Water Watch, Center, Environmental, Brown University Locations: United States, Mexico, Canada, Spain, Denmark, Los Angeles
South Carolina Bans Gender Transition Care for Minors
  + stars: | 2024-05-21 | by ( Adeel Hassan | ) www.nytimes.com   time to read: +2 min
The state now joins about two dozen others that have passed laws restricting or banning what doctors call gender-affirming care for minors. BackgroundSouth Carolina lawmakers tried to pass similar legislation in 2021 and 2022 but failed to get them through the State House of Representatives. In 2022, the clock ran out on a broader bill banning transition care for minors, but lawmakers put a clause in the state budget that banned a pediatric clinic at a public hospital from using state funds on transition care for people under 16. The measure, known as House Bill 4624, was passed by the legislature earlier this month. She added that gender-transition surgery was currently not being performed in South Carolina, and that transition care was being done only after much deliberation between doctors, parents and children.
Persons: Henry McMaster, McMaster, Elizabeth Mack, Organizations: South Carolina’s Republican, State, of, Republicans, South, American Academy of Pediatrics Locations: Carolina, South Carolina
CNN —Human testicles contain microplastics and nanoplastics at levels three times higher than animal testes and human placentas, a new small study found. “They look like little shards, tiny broken bits from very, very old plastics,” said Campen, a regents’ professor of pharmaceutical sciences at the University of New Mexico in Albuquerque. Researchers expected to find more plastic shards in the testicles of older men in the study, but that wasn’t the case, Campen said. “In testes, the levels of plastic was three times as much as we saw in placentas,” Campen said. In studies of pregnant mice, researchers have found plastic chemicals in the brain, heart, liver, kidney and lungs of the developing fetus 24 hours after the pregnant mother ingested or breathed in plastic particles.
Persons: , Matthew Campen, Campen, ” Campen, “ We’re, Adrienne Bresnahan, Kimberly Wise White, Leonardo Trasande, don’t, Trasande Organizations: CNN, micron, Sciences, University of New, Endocrine Society, Getty, American Chemistry Council, placentas, American Academy of Pediatrics, NYU Langone Health, Natural Resources Defense Council, Invest Locations: University of New Mexico, Albuquerque, United States, placentas, Beijing
CNN —The ultraprocessed foods your kids eat now may be putting them a greater risk for cardiometabolic problems – like heart attack, stroke and diabetes – in adulthood, a new study suggests. Researchers divided the data from the children into three groups based on the amount of ultraprocessed food they ate. “This particular topic, ultraprocessed food consumptions and risk, is a very important topic in kids,” he said. The ultraprocessed foods kids eat now may have lasting impacts, a new study suggests. In places where fresh food might be harder to obtain, ultraprocessed foods are more accessible and inexpensive, Freeman said.
Persons: , Stuart Berger, Andrew Freeman, Berger, Robert H, Lurie, Brendan Smialowski, ” Freeman, , Freeman, there’s Organizations: CNN, American Academy of Pediatrics, Food and Agriculture Organization, United Nations, Jewish Health, Ann, Lurie Children’s Hospital, Getty, BMI Locations: Spain, Denver, Chicago, AFP
How to survive sleeping with a sleep talker
  + stars: | 2024-05-09 | by ( Sandee Lamotte | ) edition.cnn.com   time to read: +6 min
“There are some things you, the bed partner, can do to save your sleep,” Schenck said. Medications to treat depression, and other mental health disorders, high blood pressure, seizures, asthma and, oddly, other sleep disorders can also cause sleep talking, according to the Cleveland Clinic. “Cut out alcohol so you can share your consideration for the bed partner who is disturbed by your sleep talking.”What causes sleep talking? Sleep talking is a parasomnia, in the same category as sleep terrors, sleep eating, sleep paralysis and sleep sex. Some people who have sleep talking or walking as children do return to the behavior as adults, but many others do not,” he said.
Persons: Carlos Schenck, ” Schenck, , GERD, Schenck, Jennifer Mundt, , Earplugs, Mundt, ” Mundt, Parasomnias Organizations: CNN, American Academy of Sleep, Hennepin County Medical, University of Minnesota, Cleveland Clinic, Northwestern University’s Feinberg School of Medicine Locations: Hennepin, Chicago
Major public health groups, including the American Dental Association, the American Academy of Pediatrics and the Centers for Disease Control and Prevention, support the use of fluoridated water. “Drinking fluoridated water keeps teeth strong and reduces cavities,” the CDC said in a statement to NBC News. Within the past few months, local leaders in Collier County, Florida, and Amery, Wisconsin, voted to stop adding fluoride to public water systems. As of this year, nearly two-thirds of the U.S. population with public water access use drinking water with fluoride, according to the CDC. “If they didn’t get fluoridated water, they’d be more likely to get cavities.”The science behind fluorideThe fluoride issue goes well beyond medical freedom.
Persons: , Meg Lochary, “ We’ve, Brian Helms, , Abigail Prado, ” Prado, “ That’s, Charlotte Lewis, Lochary, Residents weren’t, Frank Courts, Nash, doesn’t, Julie Morita, Robert Wood Johnson, Bruce Lanphear, ” Lanphear, ” Lewis, Dr, Donald Chi, ” Chi, ” Richard Carpiano, Obstetricians, Nathaniel DeNicola, ” DeNicola, Gary Slade, Slade, ” Slade, “ We’d, ” Lochary, Organizations: American Dental Association, American Academy of Pediatrics, Centers for Disease Control, CDC, NBC News, Liberty, Lawmakers, State College , Pennsylvania, Society, University of Washington School of Medicine, Residents, U.S . Public Health Service, Department of Health, Human Services, , of Health, Robert Wood Johnson Foundation, Pediatrics, Simon Fraser University, Seattle Children’s Hospital, University of California, American College of Gynecologists, OB, University of North, Adams School of Dentistry, UNC, Chapel Locations: U.S, Union County , North Carolina, Union County, Union, Charlotte, Georgia , Kentucky, Nebraska, Collier County , Florida, Amery , Wisconsin, Brushy Creek , Texas, California, East Coast, Colorado Springs , Colorado, Colorado Springs, Grand Rapids , Michigan, Ashe County, Western, Nash County, Raleigh, Ashe, Canada, Seattle, Riverside, Yorba Linda , California, University of North Carolina
The faces that hold social currency on social media — with fox-lift brows and buccal fat removed — are increasingly bleeding into real life. AdvertisementEven before the remote-work boom, writers noticed social media was shaping the way people looked. The shift from surgical procedures to minimally invasive injections has also made cosmetic work safer and more available to average people. "The gap between the identity we present on social media and the self we see in the mirror is growing," Widdows told me. As more people get cosmetic work done, the rest of us lose touch with what's normal.
Persons: it's, Z, It's, Heather Widdows, else's, Snapchat, Anne, Mette Hermans, Widdows, Gen Zers, Hermans, you've, we've Organizations: American Academy of, New Yorker, University of Warwick, American Psychological Association, Boston University School of Medicine, City University of London, Tilburg University Locations: Instagram, United States, Netherlands
CNN —Paul Auster, the acclaimed American author of “The New York Trilogy,” has died at age 77. A host of media outlets reported that Auster’s death was confirmed by his friend and fellow author Jacki Lyden. Auster began translating the works of French writers when he moved to France after graduating from Columbia University in 1970. Major recognition came after the publication of “The New York Trilogy” – a series of experimental detective stories – in 1987. An early experience of how life can change in an instant played a major influence on Auster and his writing.
Persons: CNN — Paul Auster, , Auster, Jacki Lyden, Auster’s, Siri Hustvedt, Hustvedt, , Paul, Timothy Fadek, ” Auster, Prince, Asturias, Booker, Paul Auster Organizations: CNN, The, Columbia University, American Academy of Arts and, Ordre des Arts, des, Booker Locations: Newark , New Jersey, France, “ Cancerland, Brooklyn , New York
Having a routine job with little mental stimulation during your 30s, 40s, 50s and 60s was linked to a 66% higher risk of mild cognitive impairment and a 37% greater risk of dementia after the age of 70, according to the study, when compared with having a job with high cognitive and interpersonal demands. Attending college, for example, reduced the impact of a repetitive job by about 60% but didn’t fully negate the risk. Routine jobs that were not classified as “cognitively protective” often involved repetitive manual and mental tasks, such as is typical of factory work and bookkeeping. “Most people in routine jobs in our sample included housekeepers, custodians, construction workers and mail carriers,” Edwin said. More cognitively demanding jobs were not based on routine tasks, even though repetition was required at times.
Persons: , Dr, Trine Edwin, Edwin said, Richard Isaacson, Isaacson, ” Edwin, Edwin, It’s, ” Isaacson Organizations: CNN, Oslo University Hospital, American Academy of Neurology, Locations: Norway, Florida
CNN —The total solar eclipse has come and gone after creating a celestial spectacle Monday in the skies over Mexico, the US and Canada. But some people may be experiencing eye discomfort, rather than awe, in the aftermath. Looking at the sun without proper eye protection, such as certified eclipse glasses or solar viewers, can result in solar retinopathy, or retinal damage from exposure to solar radiation. During the 2017 total solar eclipse, a young woman was diagnosed with solar retinopathy in both eyes after viewing the eclipse with what doctors believed were eclipse glasses not held to the safety standard. Post-eclipse eye damage symptomsSymptoms of eye damage after viewing the eclipse without proper protection can take hours or days to manifest.
Persons: Ronald Benner, , Michelle Andreoli, ” Benner, , Benner, isn’t, doesn’t Organizations: CNN, American Optometric Association, American Academy of Ophthalmology Locations: Mexico, Canada
What to do with your solar eclipse glasses
  + stars: | 2024-04-09 | by ( Taylor Nicioli | ) edition.cnn.com   time to read: +3 min
For the fortunate folks who witnessed the rare solar event, there may not be a need to throw out gently used pairs of solar eclipse viewing glasses. That means the same glasses worn during the 2024 total solar eclipse will serve as effective protection during the next total solar eclipse in 2026 that will be visible over Greenland, Iceland, Spain, Russia and a small portion of Portugal and appear as a partial eclipse in parts of Europe, Africa and North America. Where to donate solar eclipse glassesIf the owner of a pair of solar eclipse glasses is not planning on globe-trotting to catch a glimpse of the upcoming solar eclipses, there are several organizations collecting viewers with the aim of donating to those who will be on the path of upcoming events. Eclipse Glasses USA, a retailer of eclipse glasses approved by the American Astronomical Society, is collecting used but undamaged glasses to send to schools in Chile and Argentina that will be within the path where the October 2024 annular eclipse, otherwise known as the “ring of fire,” will be visible. Astronomers Without Borders, a nonprofit organization that collected more than 2 million glasses after the 2017 total solar eclipse and redistributed hundreds of thousands of pairs before the 2024 eclipse, has a growing list of drop-off locations for donations of gently used glasses.
Persons: , , Kerry Hensley, Hensley Organizations: CNN, American Astronomical Society, AAS Nova, American Academy of Ophthalmology Locations: North America, Greenland, Iceland, Spain, Russia, Portugal, Europe, Africa, United States, North Dakota, Montana, Chile, Argentina
Read previewIt's not safe to look at a solar eclipse without wearing certified protective glasses. Some people might start to notice vision changes within a few hours, though it's most likely they would become apparent by the next day, according to the American Academy of Ophthalmology. Unlike sunglasses, eclipse glasses are so dark that you shouldn't be able to see through them, he said in a statement. If you are experiencing vision changes or eye pain, even if you wore proper eye protection, call an eye doctor to schedule an appointment. A 4-year-old uses special glasses to look into the sky during a partial solar eclipse in Berlin.
Persons: , it's, It's, Andres Kudacki, David Hinkle, They're, Sean Gallup, Santa Croce Organizations: Service, Business, American Academy of Ophthalmology, National Eye Institute, AP, Tulane University's, European, Ophthalmology, Eye Institute Locations: Berlin, Philadelphia
CNN —A Texas appeals court upheld two injunctions in a pair of legal cases Friday, in an order blocking the state’s Department of Family and Protective Services from investigating families of transgender youth who are seeking gender-affirming medical care for their children. The court of appeals upheld a trial court decision in the Friday order, ruling in favor of LGBTQ+ advocates and families in two related Texas lawsuits asking a state court to block the agency from investigating parents who provide their children with gender-affirming care. Paxton appealed the district court injunction in March and declared investigations could continue during the appeal process under the law. The court, in its opinion, also affirmed Paxton’s opinion does not alter preexisting law or legal obligations of the department. Abbott’s directive to the agency was seen by many as an attack on transgender children and their families.
Persons: CNN —, Greg Abbott, Ken Paxton, Abbott, , , Paxton, Bill, Chase Strangio, ” CNN’s Amir Vera, Ashley Killough Organizations: CNN, state’s Department of Family and Protective Services, Texas Gov, Republican, Department of Family and Protective Services, , Lambda Legal, ACLU, Texas Supreme, Gov, American Medical Association, American Psychiatric Association, American Academy of Pediatrics, HIV Locations: Texas, State of Texas, Travis County
CNN —American gamer and Twitch superstar Tyler “Ninja” Blevins revealed he was diagnosed with melanoma, a form of skin cancer. Skin cancer is the most common form of cancer in the United States; 1 in 5 Americans will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Blevins was diagnosed with melanoma, which is a rare type of skin cancer — only about 1% of skin cancer cases — but accounts for a large majority of skin cancer deaths. However, if people do have suspicious skin spots or any other symptoms concerning for skin cancer, they should talk to their primary care doctor or dermatologist. How to perform a skin self-examAn important part of screening for skin cancer is to document moles and other skin spots and to notice changes, the association says.
Persons: Tyler “, ” Blevins, “ I’m, , Blevins, biopsied, , Jessica Blevins, Dr, Sanjay Gupta Organizations: CNN, PSA, World Health Organization, American Academy of Dermatology, US Centers for Disease Control, American Cancer Society, US Preventive Services, Force, CNN Health Locations: American, United States
One of the most helpful things to do might be to get some exercise, according to a new study. “It gives us an idea of something that maybe we don’t always think about for treatment of insomnia,” Paruthi said. Regular exercise was associated with significantly better sleep, the study showed. There are plenty of reasons why physical activity may help in getting a good night’s rest. Physical activity helps regulate the body’s internal clock and promotes deeper, more restorative sleep,” Björnsdóttir said.
Persons: , Erla, sleepiness, David Neubauer, ” Björnsdóttir, Shalini Paruthi, ” Paruthi, Neubauer, Paruthi Organizations: CNN’s, CNN, Reykjavik University, Johns Hopkins University School of Medicine, Saint Louis University School of Medicine, American Academy of Sleep
Read previewGeneration Alpha — the kids born between 2010 and 2024 — is the first not to know a world without AI or social media. Meanwhile, social media companies, like TikTok, have been in the hot seat regarding their negative effects on youth — from mental health to sexual exploitation. "They're learning who they are, and how to explore, and how to move out into the world," Galinsky said. Galinsky said social media is not all bad, but some parts can be difficult for young people. Set up social media rules with your childrenGalinsky said parents should let children get involved in developing a plan for their social media use.
Persons: , Ellen Galinsky, Galinsky, you've, It's, Eliza Filby, Filby, it's, Alpha's Organizations: Service, The American Academy of Child, Psychiatry, Business, Alpha
2024 Best Grad Schools Rankings Coming April 9
  + stars: | 2024-03-19 | by ( Robert Morse | Eric Brooks | March | ) www.usnews.com   time to read: +3 min
New rankings of business, education, engineering, law, medical and nursing programs will be unveiled on April 9 as part of the 2024 edition of Best Graduate Schools. Finally, U.S. News will again update its annual rankings of graduate programs in public affairs, public health schools and programs, and computer science. That last ranking, referred to as the Most Diverse Medical Schools, takes into account Black, Hispanic, Native American and Native Hawaiian/Pacific Islander enrollment. Prospective students seeking such information, along with the full rankings, should access the subscription-based U.S. News Graduate School Compass. The full law school rankings and data will be free to all users.
Persons: Robert Graham Organizations: Graduate Schools, U.S . News, News, . News, Robert, Robert Graham Center, American Academy of Family Physicians, Medical, News Graduate School Compass Locations: U.S, audiology
For those assigned female at birth, puberty blockers pause the development of breasts, wider hips or a menstrual period. Here’s what else you should know about puberty blockers and, if you’re a parent, whether they’re something your child needs. “Many kids have already completed puberty by the age of 13 or 14 … so we start blockers when puberty starts,” Forcier said. The one right way to do things is to listen to the patient.”How safe are puberty blockers? Some people worry that children who take puberty blockers may change their minds about their gender identity later in life.
Persons: , Michelle Forcier, it’s, Forcier, ” Forcier, , Melina Wald, Wald, Lauren Wilson, who’s, shouldn’t, Wilson, , ” Wilson, There’s, ” CNN’s Tara John Organizations: CNN, Health Service, Warren Alpert Medical, Brown University, Folx Health, Reuters, Health, Columbia University Medical, American Academy of Pediatrics, Columbia University Locations: Rhode Island, United States, Connecticut, New York, Montana, Amsterdam, Netherlands
CNN —England’s National Health Service (NHS) has stopped prescribing puberty blockers for children and young people with gender dysphoria or gender incongruence, saying there is “not enough evidence to support the safety or clinical effectiveness” of puberty-suppressing hormones. Puberty blockers will now only be available to young people in clinical research trials and some private clinics, UK’s PA Media reported Tuesday. Fewer than 100 young people are currently on puberty blockers via the NHS and they will be able to continue the treatment, it added. Puberty blockers will also available through some private gender identity clinics. Gender-affirming care can include puberty blockers, which may not be a part of every association’s treatment.
Persons: CNN —, , Victoria Atkins, Maria Caulfield, Stonewall, endocrinologists, Trevor Organizations: CNN, Health Service, Media, NHS, Social Care, , Republican, American Medical Association, American Psychiatric Association, American Academy of Child, Psychiatry Locations: England
Eating regular, healthy meals, especially shared with loved ones , has also been linked with healthy aging, Thornton-Wood said. Strength training also helps minimize the loss of bone density, which is important for healthy aging, Worthington said. In particular, if you have a strong family history of heart disease, it's important to lay the foundation for a proactive heart health plan now." The American Heart Association recommends following the DASH diet , which stands for Dietary Approaches to Stop Hypertension, for heart health. AdvertisementShe said that giving up smoking is the single most important thing you can do for your heart health.
Persons: It's, , Bryan Johnson, Elaine LaLanne, it's, Clare Thornton, Wood, Thornton, Luke Worthington, Worthington, Nicole Harkin, Harkin, Joanne Whitmore, Whitmore, Charles Puza, Puza, Dale Bredesen, Bredesen Organizations: Service, Business, Getty, Disease Control, Cardiology, American Heart Association, British Heart Foundation, American Academy of Dermatology, Buck Institute for Research, Aging Locations: Thornton, barre, San Francisco, New York, California
Do you have insomnia? Let’s get back to sleep
  + stars: | 2024-03-11 | by ( Madeline Holcombe | ) edition.cnn.com   time to read: +6 min
There are several useful methods to treat the condition, including fixing your sleep hygiene and engaging in cognitive behavioral therapy specifically for insomnia. What do you do on those nights where you just know sleep isn’t coming — or, at least, not without a fight? The condition affects a lot of people, but is often underestimated as a cause of insomnia, Paruthi said. Don’t let bed become a place associated with long stretches of stressing to get to sleep, said Salas, who is also a sleep neurologist at the Johns Hopkins Center for Sleep and Wellness. “The worst thing somebody with insomnia could do is stay in bed and not sleep,” she said.
Persons: Shalini, Rachel Salas, Paruthi, , , ” It’s, isn’t, Salas, , drowsy, I’m, I’ll, ’ ” Organizations: CNN, Sleep Medicine, Research, Luke’s, American Academy of Sleep, Johns Hopkins University School of Medicine, Saint Louis University School of Medicine, Johns Hopkins Center for Sleep Locations: St, Chesterfield , Missouri, Baltimore, hyperarousal
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