Physician burnout is a serious and growing threat to the medical profession and may undermine efforts to maintain a sufficient physician workforce to care for the growing and aging patient population in the U.S. https://www.selleckchem.com/products/azd9291.html Burnout involves a host of complex underlying associations and potential for risk. While prevalence is unknown, recent estimates of physician burnout are quite high, approaching 50% or more, with mid-career physicians at highest risk. Sleep deprivation due to shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been implicated in the genesis and perpetuation of burnout. Maladaptive attitudes regarding sleep and endurance also may increase the risk for sleep deprivation among attending physicians. While duty-hour restrictions have been instituted to protect sleep opportunity among trainees, virtually no such effort has been made for attending physicians who have completed their training or practicing physicians in non-academic settings. It is the position of the AASM that a critical need exists to evaluate the roles of sleep disruption, sleep deprivation, and circadian misalignment in physician well-being and burnout. Such evaluation may pave the way for the development of effective countermeasures that promote healthy sleep, with the goal of reducing burnout and its negative impacts such as a shrinking physician workforce, poor physician health and functional outcomes, lower quality of care, and compromised patient safety. © 2020 American Academy of Sleep Medicine.The AASM Payer Policy Review Committee (PPRC) launched an initiative to assess the alignment between clinical practice guidelines (CPGs) and private payer medical policies. This article summarizes the importance of the initiative, details the scorecard development process, including an analysis of policy scores and subsequent revisions, and discusses the impact of the scorecards particularly as related to the scorecards on the CPG for diagnosis of obstructive sleep apnea (OSA) in adults. This initiative has increased communication and engagement amongst members of the PPRC and private payers, creating opportunities to advocate on behalf of sleep medicine providers and patients with sleep disorders, encouraging payers to modify existing policies so that evidence-based care is provided to patients with sleep disorders. © 2020 American Academy of Sleep Medicine.STUDY OBJECTIVES Low serum vitamin D levels are known to be associated with working conditions and poor sleep, but precedent studies on this issue were limited by the absence of objective sleep measurements or clear distinction between daytime and night shift work. Hence, we aimed to examine serum vitamin D levels and sleep in daytime and night-shift workers using actigraphy. METHODS A total of 412 night-shift and 432 daytime workers at Seoul National University Bundang Hospital were recruited. All participants completed questionnaires regarding demographic and clinical characteristics. They underwent blood tests for serum vitamin D levels. Objective sleep data were obtained from 150 night-shift workers and 203 daytime workers using actigraphy. RESULTS There was no significant difference in serum vitamin D levels between night-shift and daytime workers after controlling for possible confounders. In daytime workers, vitamin D deficiency was closely related to shorter duration of total sleep time [odds ratio (OR) 3.07, 95% confidence interval (CI) 1.51 - 6.26, P = 0.002] and higher risk of excessive daytime sleepiness (OR 2.20, 95% CI 1.30 - 3.74, P = 0.003). Deficient vitamin D was also associated with life quality impairment regarding psychological health (OR 1.83, 95% CI 1.07 - 3.29, P = 0.028) and social relationship (OR 1.78, 95% CI 1.10 - 2.88, P = 0.020). However, in night-shift workers, no significant association was observed between serum vitamin D level and sleep parameters, depressive/anxiety symptoms, or quality of life. CONCLUSIONS The modest adverse impact of poor vitamin D status on sleep could be attenuated by substantial shift work-related sleep disturbances in night-shift workers. Further studies might be needed to clarify the beneficial effect of vitamin D supplementation for improving sleep and daytime sleepiness in workers with various working conditions. © 2020 American Academy of Sleep Medicine.The occurrence of physician burnout is widespread among clinicians and academic faculty, who report indicators such as low quality of life and poor work-life balance. Chronic insufficient sleep, whether due to extended work hours, circadian misalignment, or unrecognized sleep disorders, is a critically important risk factor for burnout that is overlooked and under-studied, and interventions to promote healthy sleep may reduce burnout susceptibility among attending physicians. While strategies to reduce burnout among resident and attending physicians have been under-evaluated, evidence suggests a need to address burnout at both individual and organizational levels. Solutions have been offered that are applicable to many stakeholders, including employers; payers; licensing and certification boards; state and federal regulatory agencies; and physicians and researchers. As more studies are undertaken to evaluate how these approaches impact burnout, two questions need to be addressed 1) What is the role of sleep in the crisis of burnout, specifically among attendings, who are particularly under-studied? 2) Is restoration of healthy sleep the fundamental mechanism by which burnout interventions work? It is essential for key stakeholders to consider the role of sleep, sleepiness, and sleep disorders in order to optimize any efforts to mitigate the present crisis in physician burnout, particularly among attending physicians, an understudied group. © 2020 American Academy of Sleep Medicine.Edwardsiella ictaluri and Edwardsiella piscicida are important fish pathogens affecting cultured and wild fish worldwide. To investigate the genome-level differences and similarities between catfish-adapted strains in these two species, the complete E. ictaluri 93-146 and E. piscicida C07-087 genomes were evaluated by applying comparative genomics analysis. All available complete (10) and non-complete (19) genomes from five Edwardsiella species were also included in a systematic analysis. Average nucleotide identity and core-genome phylogenetic tree analyses indicated that the five Edwardsiella species were separated from each other. Pan-/core-genome analyses for the 29 strains from the five species showed that genus Edwardsiella members have 9474 genes in their pan genome, while the core genome consists of 1421 genes. Orthology cluster analysis showed that E. ictaluri and E. piscicida genomes have the greatest number of shared clusters. However, E. ictaluri and E. piscicida also have unique features; for example, the E.