Poor school performance by adolescent students has been attributed in part to insufficient sleep. It is recognized that a number of factors lead to diminished total sleep time and chief among these are early school start times and sleep phase delay in adolescence. Political initiatives are gaining momentum across the United States to require later school start times with the intent of increasing total sleep time and consequently improving school performance. Later school start times come with significant costs and impact other activities of families and communities. The decision to implement later school start times cannot be made lightly and deserves support of well-performed research on the impact of these changes. A study evaluating the association of academic performance and total sleep time was performed in middle school and high school students in a suburban Maryland school system. Preliminary results of this study show no correlation of total sleep time with academic performance. Before mandating costly changes in school schedules, it would be useful to perform further research to determine the effects of increasing sleep time on the behaviors of adolescent students.

We studied prospectively t h e complications of high-dose corticosteroid administration in 121 consecutive neurosurgicalpatients. Dexamethasone was begun in a daily dosage of 16 mg in 36 patients, 40 mg in 43 patients, and 80 mg in 42 patients, with an antacid, and was appropriately tapered.There were three major complications (incidence, 2.4%), with 1 death definitely attributable to corticosteroid therapy (0.8%). Two of the major complications occurred in patients with previous or concurrent upper gastrointestinal disease. Nineteen patients who were maintained on long-term (mean 206 2 56 days) daily doses of 40 mg or more for the treatment of malignant brain tumors remained free of complications.There was no evidence that increased intracranial pressure, diminished level of consciousness, or higher dosage schedules increased the risk. High-dose dexamethasone therapy is safe in neurosurgical patients. One must use caution, however, when the history suggests gastrointestinal erosive disease.Marshall LF, King J, Langfitt TW: The complications of high-dose corticosteroid therapy in neurosurgical patients: a prospective study. Ann.Neuro1 1: [201][202][203] 1977 The introduction of corticosteroids by Galilich and associates [ 11 was a major breakthrough in the treatment of cerebral edema. As the use of corticosteroids became widespread, there was concern that they might lead to an increase in the incidence of Cushing's ulcer, particularly in neurosurgical patients with im- Corticosteroids were tapered by the responsible clinician, the clinical course being the determiningfactor. Hematocrit and fasting blood glucose were measured on admission and then once weekly or more if indicated. In patients undergoing operation the hematocrit was repeated immediately following the procedure and before discharge. I n patients continued on corticosteroids at discharge, careful follow-up was arranged. The hematocrit in all outpatients was measured periodically.Serum gastrin levels were determined by radioimFrom the Division

This randomized prospective study was designated to test the hypothesis that intraoperative and postoperative administration of a potent antiinflammatory steroid (dexamethasone) would reduce patients' postoperative pain. The hypothesis is based on the concept that inflammation is associated with a lowering of the threshold for nociceptive sense organs and that the inflammatory process is responsible, at least in part, for postoperative pain. The quantity of narcotics requested by the patients during the first 72 hours of the postoperative period was used as the measure of their postoperative pain. Patients treated with steroid who underwent lumbar laminotomy and discectomy used considerably less narcotic during the postoperative period than those not treated with steroid (P value less than 0.01). Less difference was noted in patients who underwent laminectomy, and no statistically significant difference was noted for those who underwent anterior discectomy. It is concluded that the use of an antiinflammatory steroid during and after operation significantly reduces the immediate postoperative pain after lumbar discectomy and may be useful in the postoperative management of other surgical procedures.

Eighteen older adults and 18 younger adults were compared on two quantitative measures describing changes over time in the spatial distribution of running EEG. EEG was collected from 128 electrodes under resting eyes-open and eyes-closed conditions and during performance of a 13 minute sustained attention task. One EEG measure, the recrudescence rate, represented the number of changes in the location of the highest squared voltage per second. A second EEG measure consisted of the algorithmic complexity of changes in the location of the highest squared voltage over time. Regardless of the task condition, older adults had significantly higher scores than younger adults on both the recrudescence rate and the measure of algorithmic complexity. The implications of the results for neurologically-based theories of performance declines in older adults are discussed.

A regression-based meta-analysis examined the degree to which the effects of a family history of hypertension on cardiovascular reactivity are moderated by the magnitude of cardiovascular responses elicited in challenge/task conditions. Mean change scores for negative family history groups were regressed on mean change scores for positive family history groups. The slopes of separate regression lines obtained for systolic and diastolic blood pressure and heart rate were significantly less than 1.0 and the y-intercepts for these regression lines were significantly greater than zero. This pattern indicates that family history differences in cardiovascular reactivity to stress are greatest in situations that elicit the smallest baseline-stressor change scores in non-family-history groups.