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Equal mixture of 2% lidocaine with adrenaline and 0.5% bupivacaine 20 mL provided faster onset of complete conduction blockade during ultrasound-guided supraclavicular brachial plexus block than 20 mL of 0.5% bupivacaine alone: a randomized double-blinded clinical trial. Reg Anesth Pain Med 2024; 49:104-109. [PMID: 37295795 DOI: 10.1136/rapm-2023-104542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Recent evidence has questioned the advantage of local anesthetic (LA) combinations. This study tested the hypothesis that mixing rapid-onset (lidocaine) and long-duration (bupivacaine) LA would provide faster onset of complete conduction blockade (CCB) compared with bupivacaine alone and longer duration of analgesia compared with lidocaine alone during low-volume (20 mL) ultrasound-guided (USG) supraclavicular brachial plexus block (SCBPB). METHODS Sixty-three patients receiving USG-SCBPB were randomly allocated into: group L: 20 mL 2% lidocaine with epinephrine 1:200 000; group B: 20 mL 0.5% bupivacaine; group LB: 20 mL of equi-volume mixture of both drugs. Sensory and motor blockade was recorded on a three point sensory and motor assessment scale at 10 min intervals for up to 40 min and the total composite score (TCS) at each time point was determined. The duration of analgesia was also noted. RESULTS The mean time to CCB of group LB (16±7 min) was comparable (p>0.05) with group L (14±6 min) and group B (21±8 min) in patients who were attained CCB. However, the proportion of patients attaining complete conduction block (TCS=16/16) was significantly lower (p=0.0001) in group B (48%) when compared with group L (95%) and group LB (95%) at the end of 40 min. The median (IQR) duration of postoperative analgesia was longest in group B; 12.2 (12-14.5) hours, followed by group LB 8.3 (7-11) hours and 4 (2.7-4.5) hours in group L. CONCLUSION At 20 mL LA volume, equal mixture of lidocaine and bupivacaine provided significantly faster onset of CCB compared with bupivacaine alone and longer duration of postoperative analgesia compared with lidocaine alone but shorter than bupivacaine alone during low-volume USG-SCBPB. TRIAL REGISTRATION NUMBER CTRI/2020/11/029359.
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Quantitative assessment of ultrasound-guided sciatic nerve block - A comparison of a single-point versus two-point injection technique: A randomised controlled, double-blinded trial. Indian J Anaesth 2023; 67:802-808. [PMID: 37829774 PMCID: PMC10566652 DOI: 10.4103/ija.ija_140_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/17/2023] [Accepted: 07/29/2023] [Indexed: 10/14/2023] Open
Abstract
Background and Aims Sciatic nerve block at the popliteal level for lower limb procedures provides unpredictable success rates even with ultrasonographic (USG) guidance. This study aimed to compare USG-guided single-point versus two-point injection techniques. Methods Sixty patients posted for foot surgeries under USG-guided sciatic nerve block were randomised into Group Single Point, receiving a single injection of 20 mL of 1.5% lignocaine with adrenaline just proximal to the sciatic nerve bifurcation, and Group Double Point, receiving two injections of 10 mL of 1.5% lignocaine with adrenaline, one at the point similar to the first group and a second injection 6 cm above the first point. Sensory blockade onset, time to complete sensory blockade, time to complete motor blockade, length of the nerve exposed and analgesia duration were evaluated. Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) statistics version 20 software. Results Double-point injection technique showed a significantly faster time to complete motor blockade [14.46 (9.93) min], increased length of nerve exposed to local anaesthetic [23.23 (7.209) cm] and extended duration of analgesia [420.40 (99.34) min] compared to the single-point injection technique [20.89 (12.62) min, 18.78 (5.95) cm and 344.28 (125.97) min, respectively]. The onset of sensory blockade and the time to complete sensory blockade were comparable between the two groups. Conclusion USG-guided popliteal sciatic nerve block with a double-point injection technique does not significantly shorten the time to complete the sensory block. However, the time to complete motor nerve block and duration of analgesia are prolonged significantly, which may be clinically beneficial for postoperative analgesia.
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Ultrasound measurement of the distance of the phrenic nerve from the brachial plexus at the classic interscalene point and upper trunk: A volunteer-based observational study. Indian J Anaesth 2023; 67:457-462. [PMID: 37333704 PMCID: PMC10269976 DOI: 10.4103/ija.ija_1052_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/30/2023] [Accepted: 03/30/2023] [Indexed: 06/20/2023] Open
Abstract
Background and Aims The method of blocking the brachial plexus at the level of the upper trunk has been gaining popularity as a phrenic nerve-sparing alternative for interscalene block. We aimed to measure the distance of the phrenic nerve from the upper trunk and compare it with the distance between the phrenic nerve and the brachial plexus at the classic interscalene point by using ultrasound. Method In this study, after ethical approval and trial registration, 100 brachial plexus of 50 volunteers were scanned from the emergence of the ventral rami and its course was traced to the supraclavicular fossa. The distance of the phrenic nerve from the brachial plexus was measured at two levels: the interscalene groove along the cricoid cartilage (classic interscalene block point) and from the upper trunk. The presence of anatomical variations of the brachial plexus, the classic traffic light sign, vessels across the plexus, and the location of the cervical oesophagus were also noted. Results At the classic interscalene point, the C5 ventral ramus was observed to be just emerging or to have fully emerged from the transverse process. The phrenic nerve was identified in 86/100 (86%) of scans. The median (IQR) distance of the phrenic nerve from the C5 ventral ramus was 1.6 (1.1-3.9) mm and that of the phrenic nerve from the upper trunk was 17 (12-20.5) mm. Anatomical variations of the brachial plexus, the classic traffic light sign, and vessels across the plexus were seen in 27/100, 53/100, and 41/100 scans respectively. The oesophagus was consistently located on the left side of the trachea. Conclusions There was a 10-fold increase in the distance of the phrenic nerve from the upper trunk when compared to that from the brachial plexus at the classic interscalene point.
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Corrigendum to "Dietary oxidized linoleic acid lowers triglycerides via APOA5/APOClll dependent mechanisms" [Atherosclerosis 199 (2) (2008) 304-309]. Atherosclerosis 2023; 369:37. [PMID: 36868946 DOI: 10.1016/j.atherosclerosis.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
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A Novel Incremental Framework for Building Classifier Using Constraint Class Association Rules. INTERNATIONAL JOURNAL OF INFORMATION RETRIEVAL RESEARCH 2023. [DOI: 10.4018/ijirr.316125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Associative classification (AC) performs much better than other traditional classifiers. It generates a huge number of class association rules (CARs). Since users are interested in the subset of rules, constraints are introduced in the generation of CARs. Real-world databases are record-based in which data is continuously added which demands incremental mining. Hence, constraint class association rules (CCAR) is mined from incremental data. To limit the number of rules and to remove the duplicate rules, redundant rule pruning and duplicate rule pruning techniques are applied. To improve the accuracy of the classifier, the rule selection using principality metric has been applied and the classifier is constructed with rules possessing high principality. Then, classifier is evaluated using single rule and multiple rule prediction methods and the accuracy of the proposed classifier are measured. Experimental results show that the accuracy of the proposed classifier is relatively higher when compared to other algorithms.
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Single-shot segmental thoracic spinal anesthesia for a giant lipoma of the back of the chest. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2023. [DOI: 10.4103/injms.injms_129_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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A Real-World Study Assessing the Relationship Between Positive Airway Pressure Treatment, Excessive Daytime Sleepiness, and Patient Satisfaction in Obstructive Sleep Apnoea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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The battle against perioperative glycaemic control: Hard to win? Indian J Anaesth 2022; 66:753-756. [PMID: 36590185 PMCID: PMC9795503 DOI: 10.4103/ija.ija_923_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/12/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
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Paradoxical Increase of Permeability and Lipophilicity with the Increasing Topological Polar Surface Area within a Series of PRMT5 Inhibitors. J Med Chem 2022; 65:12386-12402. [PMID: 36069672 DOI: 10.1021/acs.jmedchem.2c01068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
An imidazolone → triazolone replacement addressed the limited passive permeability of a series of protein arginine methyl transferase 5 (PRMT5) inhibitors. This increase in passive permeability was unexpected given the increase in the hydrogen bond acceptor (HBA) count and topological polar surface area (TPSA), two descriptors that are typically inversely correlated with permeability. Quantum mechanics (QM) calculations revealed that this unusual effect was due to an electronically driven disconnect between TPSA and 3D-PSA, which manifests in a reduction in overall HBA strength as indicated by the HBA moment descriptor from COSMO-RS (conductor-like screening model for real solvation). HBA moment was subsequently deployed as a design parameter leading to the discovery of inhibitors with not only improved passive permeability but also reduced P-glycoprotein (P-gp) transport. Our case study suggests that hidden polarity as quantified by TPSA-3DPSA can be rationally designed through QM calculations.
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EP01.06-004 Eliciting Quantitative Smoking History by the Use of Natural Language Processing. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Influence of Season on the Incidence of Postdural Puncture HeadacheA Clinical Audit. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/52223.15946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Postdural Puncture Headache (PDPH), even though becoming uncommon, is still one of the distressing postoperative complications after spinal anaesthesia. The reports on the incidence of PDPH are inconsistent, being 2-40% with different sizes of needles. A previous study conducted by us in the winter months in non obstetric cases, found a low incidence of PDPH and authors had suggested that there is a need to examine the association between PDPH and different seasons. Aim: To find out the incidence of PDPH in obstetric population and any finding to differential incidence with different seasons. Materials and Methods: This study was a single centre clinical audit of lower segment caesarean cases under spinal anaesthesia with 25-gauge Quincke needle. The records of summer and winter months were separated as two groups for each year of 2019 and 2020. The cases done in the months of March, April and May formed the summer group, while the October, November and December patients formed the winter group. Results: There was no significant difference between the groups with regard to age (p-value=0.5). The incidence of PDPH was significantly higher in summer months than winter months in two consecutive years (p-value=0.0068). Fourteen out of 390 patients in the summer group and one out of 392 patients of the winter group suffered from PDPH overall. Conclusion: There should be an urgent need to control ambient temperature in patients at risk of PDPH. The optimisation of coincident dehydration is essential.
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Efficacy of a Novel Face-to-Face Lateral Position (Partha’s Technique) in Children to Aid Identification of Caudal Space during Single Dose Caudal Epidural Anaesthesia for Elective Infraumblical Surgeries- A Feasibility Study. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/58669.17104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Introduction: A single-dose of caudal epidural block accounts for 30-40% of paediatric regional anaesthesia. For infraumblical procedures, it is administered with or without general anaesthesia. The traditional patient position for assisting caudal blocks in children is lateral, with the child's back facing the anaesthesiologist. For caudal epidural block, a novel face-toface orientation of the anaesthesiologist with respect to the child in lateral position was used. Aim: To determine whether a novel face-to-face position of the anesthesiologist and the child is feasible in identification of the caudal epidural space during administration of caudal epidural anaesthesia following general anaesthesia in paediatric patients undergoing elective infraumblical surgery. Materials and Methods: This prospective feasibility study was conducted from November 2020 to November 2021 on 15 children belonging to American Society of Anaesthesiologists (ASA) 1, who were scheduled for elective infraumblical procedures under general anaesthesia, with single dose caudal epidural anaesthesia. While performing caudal block, a novel face-toface orientation of the anaesthesiologist and patient was used. The following variables were recorded: first pass success rate, number of attempts, block performance time, block failure rate, performer satisfaction score, duration of postoperative analgesia, and complications. Results: There were eight males and seven females. The mean age of the population was 6.6±2 years and the mean weight was 20.6±3.4 kilograms. The first pass success rate was 86.6% (13/15) with overall success rate of 100%. Number of attempts for successful block were 1.2±0.5. Block performance time and duration of postoperative analgesia were 31.8±12.1 seconds and 176±31.8 minutes respectively. Performer’s satisfaction score was excellent in 86.6% (13/15) and good in 13.4% (2/15). No incidence of block failure and complications were noted. Conclusion: The novel face-to-face position in child ergonomics with respect to anaesthesiologist during caudal epidural block performance is a feasible and effective method in children undergoing elective infraumblical procedures.
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Effect of costus pictus D don methanolic leaf extract on induced prediabetic behavioral change in albino wistar rats. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_80_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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What Should a Startup Know About Software Customization? INTERNATIONAL JOURNAL OF INFORMATION TECHNOLOGY PROJECT MANAGEMENT 2022. [DOI: 10.4018/ijitpm.313945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to the expansion of new markets, accessible technologies, and venture funding, software startup growth is amazing. Moreover, startups are frequently required to adapt their software products prior to deployment at a customer's location. The authors collected a data set of 30 software projects retrieved from three software businesses using a case study research approach, with each software startup supplying a data set of 10 of its software projects tagged as failure projects in their project repository. The authors quantify and demonstrate the level of substantial software customization in startup software projects. The authors have also presented a simplified technique for quantifying customization requests for startups. Additionally, they offer tips and best practices to assist entrepreneurs in managing software customization.
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Difference Between Erector Spinae Plane Block and Paraspinal Interfascial Plane Block in Analgesia after Posterior Cervical Laminectomy. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/57307.16881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Spine surgeries are associated with severe intraoperative and postoperative pain which need a comprehensive management protocol. It is important to manage postoperative pain in such cases to improve early ambulation and discharge and hence the functional outcomes. A 46-year-old male, weighing 80 kg, was posted for cervical laminectomy with posterior stabilisation. After institution of general anaesthesia before surgical incision, 15 mL of 0.5% bupivacaine on each side at the level of C6 in the erector spinae plane on the left- side and the paraspinal posterior interfascial plane on the right-side was administered. The patient experienced significant postoperative pain relief for 12 hours. However, on clinical examination, there was a mild sensory loss on the left-side from C4 to T1, but no such sensory loss on the right-side. There was a complete recovery of sensory loss the following day. It is proposed that such volume in the Erector Spine plane can provide excellent analgesia for 12 hours, but with sensory loss. The drug may trickle to nerve roots, whereas it is unlikely to do so in the interfascial plane. It is also suggested that such volumes are needed for effective analgesia. It is also suggested that a technique without definitive sensory deficit is ideal in such cases to detect early surgical complication.
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Right sided stellate ganglion block before pneumoperitoneum in laparoscopic surgeries. Does it balance Hemodynamics? A case series. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_10_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ultrasound Guided Acupuncture: A Case Series. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/53674.16349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acupuncture is an ancient system of medicine which involves introduction of specific needles in described sites into prescribed depths. A few apprehensions about this technique are the close proximity of the needles with vital structures and possible injuries. In the present paper, an attempt was made to use ultrasound which is a non invasive technique of identifying vital structures in two cases and to find out its utility. A 35-year-old, male history of alcoholism, presented with a wrist drop, was advised electroacupuncture where the needles were placed in the centre of the muscle bulk with ultrasound guidance to elicit good motor response. Another case, a 45-year-old female patient had tennis elbow where the superficial veins and nerves were avoided before pricking on selected sites. The response was as expected and normal. The first case had satisfactory motor recovery while the second one had adequate pain relief. There was neither bleeding from any site nor any other complications. A survey scan of the puncture site can be advised before inserting acupuncture needles. Ultrasound guided acupuncture is feasible without compromising the traditions. This concept becomes easier as ultrasound and acupuncture have been conveniently handled together by anaesthesiologists.
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Community assessment of incidence of quantitative microalbuminuria at the time of first diagnosis of type 2 diabetes mellitus – kumbakonam urban–rural epidemiological study – kures 9. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_101_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Effect of respiratory muscle stretch gymnastics on chest expansion and peak expiratory flow rate among sawmill workers. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_70_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pulmonary Aspiration Albeit Rapid Sequence Induction in Achalasia CardiaDo We Have an Infallible Technique? J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/52886.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Achalasia cardia is among the conditions that pose a high risk of aspiration during induction of anaesthesia. This report is about a case of 23-year-old male patient, where regurgitation and pulmonary aspiration occurred in a patient with achalasia cardia despite Rapid Sequence Induction (RSI). The risk of aspiration in conditions that cause stasis in the oesophagus is much higher due to the anaesthetic induced relaxation of the upper oesophageal sphincter and the proximity of the pooled contents to the oropharynx. The lower oesophageal sphincter being pathological in achalasia cardia does not relax. In this article, even though it is a case report of such an incidence, the various techniques that can be adopted to negate the risk have been explored. Preinduction oesophagoscopy and suctioning, video-laryngoscope guided intubation and ultrasound confirmation of Tracheal Tube (TT) position before initiating ventilation can be adopted in addition to head up positioning and RSI as an infallible technique to abolish the aspiration risk in patients with achalasia cardia. The case report is highlighted in the way to focus on describing safe ways of induction of anaesthesia where there is a high risk of aspiration.
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Is It Time to Rethink Our Software Development Practices? JOURNAL OF CASES ON INFORMATION TECHNOLOGY 2021. [DOI: 10.4018/jcit.20211001.oa14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Covid-19 has proliferated across the nations with increasing number of cases each day. Thus, IT companies are now forced to operate from remote places with limited IT resources. However, these companies across the globe are on continuous touch with their software development and maintenance teams to ensure that they are productive and are able to deliver their services on the projects on time. We study the challenges faced by the IT companies at this juncture and the need for a different software development approach to complete the projects successfully even during such crisis. In this context, when the IT industries are making attempts to complete their on-going software projects and also to attend to some critical up-gradation in their previously delivered products, the challenges faced by them due to acute shortage of IT resources and transforming the working model from physical setup to remote platform needs to be studied. This calls for studying the existing software development models and practices and defining an alternate one that would suit the present IT scenario.
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Combined cervical plexus and upper trunk block as a regional anaesthesia technique for successful insertion of permanent pacemaker. Indian J Anaesth 2021; 65:496-497. [PMID: 34248199 PMCID: PMC8252995 DOI: 10.4103/ija.ija_1576_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 11/21/2022] Open
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Usefulness of dexmedetomidine as an intravenous adjuvant. J Anaesthesiol Clin Pharmacol 2021; 36:425-426. [PMID: 33487921 PMCID: PMC7812945 DOI: 10.4103/joacp.joacp_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022] Open
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Estimating serum vitamin D levels and assessing its influencing factors among antenatal women in a South Indian town-Kumbakonam urban rural epidemiological study: KURES-5. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2021. [DOI: 10.4103/injms.injms_107_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pagets Disease, is it Common in the South India. Indian J Endocrinol Metab 2020; 24:554. [PMID: 33643874 PMCID: PMC7906099 DOI: 10.4103/ijem.ijem_516_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/15/2022] Open
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Trochanteric Flip (Ganz) Anterior Hip Dislocation for Fixation of Pipkin Fracture-Dislocations. JBJS Essent Surg Tech 2020; 10:ST-D-19-00040. [PMID: 32983603 DOI: 10.2106/jbjs.st.19.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Safe surgical dislocation with a trochanteric flip osteotomy has been shown to be a reliable technique that provides excellent exposure for treating femoral-head fractures with minimal complications. This technique also allows associated labral injuries and acetabular fractures to be treated through the same approach. Description The procedure is performed with use of a conventional Kocher-Langenbeck exposure with the patient in the lateral position. The trochanteric flip is performed, allowing exposure of the anterior capsule, which is incised to dislocate the head anteriorly. Fracture fixation is performed with use of mini-fragment screws followed by relocation of the head, closure of the capsulotomy, and fixation of the osteotomy. Alternatives Fixation of femoral-head fractures can also be performed with use of alternate surgical approaches. Anterior-based surgical approaches like the Hueter approach or the Smith-Petersen approach are preferred with the goal of preserving the posterior extraosseous blood supply to the femoral head. The posterior Kocher-Langenbeck approach can also be utilized because there is no clear evidence suggesting that a properly performed posterior approach affects the blood supply of the femoral head. Rationale Surgical hip dislocation is 1 of the preferred techniques for operative treatment of femoral-head fractures and is a versatile approach that provides circumferential exposure of the femoral head and acetabulum through an anterior dislocation. A compromised blood supply to the femoral head is much less likely with use of this approach compared with posterior-based surgical approaches. Compared with anterior-based surgical approaches, which are often restrictive, surgical dislocation is extensile and provides adequate exposure to treat associated injuries to the acetabulum and the labrum of the hip. Expected Outcomes Outcomes following surgical dislocation for femoral-head fractures are reportedly good to excellent in >80% patients. Urgent reduction of the hip joint followed by anatomical reduction of the fracture and stable fixation of the fracture and osteotomy leads to predictably good results. Notable complications include heterotopic ossification, which has been reported in up to 60% patients, as well as osteonecrosis of the femoral head (often related to the initial injury rather than the approach) and degenerative arthritis of the hip joint. Important Tips The Gibson interval may be utilized to preserve the gluteus maximus.Identify all of the posterior structures starting proximally from the posterior border of the gluteus medius, and continuing to the piriformis, triceps coxae, quadratus femoris, and the vastus lateralis.Aim for a thickness of 1 to 1.5 cm when performing the osteotomy; an osteotomy that is either too thick or too thin can negatively affect outcomes. The osteotomy should begin just anterior to the posterior fibers of the gluteus medius to ensure that the osteotomy is anterior to the piriformis tendon. It should exit distally to the vastus lateralis origin.Carefully elevate the posterior margin of the gluteus minimis from the capsule to avoid the tethering effect during anterior translation of the osteotomized fragment.Capsular tears during the initial dislocation are common and should be incorporated into the anterior capsulotomy.Repair of large posterosuperior labral tears may improve outcomes.Fixation of the fracture can be performed with mini-fragment screws or headless screws. Non-fixable small fragments can be excised.The osteotomy should be reduced and fixed in a stable manner to prevent trochanteric nonunion and preserve abductor function.
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0120 Association Between Sleep Duration and Daytime Memory and Cognition Depends on Sleep Quality: Data from the 2017 Israel Social Survey. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
This study examines the relationship between sleep duration, sleep disturbance, and cognitive problems in a representative sample of the Israeli population.
Methods
7,230 Israelis responded to an Israeli Bureau of Statistics population-based survey of households from the year 2017. All variables were self-reported. Outcome of interest was difficulty with memory/concentration (none, mild, or severe). Predictors included previous month sleep duration (<=5hrs, 6hrs, 7hrs [reference], 8hrs, or >=9hrs) and sleep disturbance (none [reference], mild [1/week], moderate [2–3/week], or severe [>3/week]). Covariates included age, sex, ethnic group, and financial status. Multinomial logistic regressions evaluated the relationships between variables, and post-hoc testing identified relationships within specific subgroups.
Results
72.9% denied cognitive problems, 22.2% reported mild problems, and 4.9% severe problems. In adjusted analyses, Sleep <=5hrs and >=9hrs were associated with mild (RRR=1.39, p<0.0005), (RRR=1.46, p=0.004) and severe (RRR=2.75, p<0.0005), (RRR=3.24, p<0.0005) cognitive problems, respectively. Mild, moderate, and severe sleep difficulties were associated with mild cognitive problems (RRR=2.09, p<0.0005), (RRR=2.22, p<0.0005), (RRR=2.44, p<0.0005), and severe cognitive problems (RRR=1.77, p=0.001), (RRR=3.04, p<0.0005), (RRR=4.22, p<0.0005), respectively. There was an interaction between sleep duration and sleep difficulties (p<0.05). Among those denying sleep difficulties, only >=9hrs of sleep was associated with cognitive problems. Among those with mild, moderate, and severe sleep difficulties, both short and long sleep were associated with cognitive problems.
Conclusion
In an Israeli population sample, both sleep duration and quality were associated with cognitive problems. Among those with sleep difficulties, short and long sleep duration were associated with cognitive problems, but among those denying sleep difficulties, only long sleep was associated with cognitive problems. These results suggest that the impact of sleep loss on real-world cognition may also rely on the presence of poor sleep quality.
Support
Dr. Grandner is supported by R01MD011600
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0701 Positive Airway Pressure Therapy To Treat Sleep Disordered Breathing Impacts Number Of Hospitalizations In Patients With Heart Failure. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Some studies have shown a benefit while others have shown possible harm in patient outcomes when using positive airway pressure therapy (PAP) for treating sleep disordered breathing (SDB) in patients with heart failure (HF). The goal of this study was to evaluate the number of HF-related and all-cause related hospitalizations in patients with HF and SDB on various forms of PAP therapy versus those on no PAP therapy.
Methods
Administrative claims data from the Truven Health MarketScan Database from 1/1/2005- 10/31/2015 were analyzed. Those included were at least 21 years old, were continuously enrolled for 12 months before and 6 months after their index date (date of PAP prescription), had at least two distinct HF-related claims and were prescribed PAP therapy (n=1,324,414). To model the relationship between each device and hospitalization risk, and to account for the longitudinal and correlated nature of these binary outcome data, generalized estimating equations with binomial family, logit link, and unstructured correlation structure were used.
Results
There were a total of 12,538 patients on Bilevel-PAP, 2,700 patients on bilevel-PAP with backup rate, and 57,405 patients on CPAP, and 73,353 patients with HF and comorbid sleep apnea who were not on any treatment. The reduction in HF-related hospitalization for patients with HF and comorbid SDB treated with bilevel-PAP therapy (0.28; 95% CI 0.26, 0.31) was greater than that in patients receiving CPAP (OR 0.46 95% CI 0.43, 0.49), bilevel PAP with back-up rate (0.39; 95% CI 0.32, 0.49), or no PAP treatment (OR 0.54; 95%CI 0.50, 0.57)(P<0.01). Similar trend was observed for all-cause related hospitalizations. All results were adjusted for propensity score and other relevant confounders.
Conclusion
In claims-based analysis of patients with HF and comorbid SDB, bilevel PAP treatment was associated with reduced hospitalizations when compared to CPAP therapy or no PAP treatment.
Support
Phillips Respironics
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0571 Repolarization Variability Predicts Cardiovascular Death in Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Patients with untreated obstructive sleep apnea (OSA) have a 2-3—fold increased risk of cardiovascular mortality (CVD) compared with individuals without OSA. QTc prolongation and increased QT variability among OSA patients may contribute to this association.
Methods
Patients with OSA from the Sleep Heart Health study were identified based on polysomnography criteria and their continuous electrocardiograms (ECG) analyzed for QTc duration and QT variability. Both Fridericia’s and Bazett’s heart rate corrections were used to calculate QTc. QT variability was measured as standard deviation of QT intervals (SDQT) and normalized QT interval variance (QTVN) at 1- and 5-minute intervals and short-term interval beat-to-beat QT variability (STVQT) was measured at 5-minute intervals. Lasso with elastic-net regularization was used as the variable/covariate selection method. Cox proportional hazards regression models were used to determine predictors of CVD.
Results
Data from 365 patients with OSA were screened. Ninety-seven patients were excluded from analysis due to low quality ECG data (n=50) or extremely high (> ln (10)) variability in QT/QTc and/or QT variability (n=12). Fifty two percent of the sample was male with mean age 65 years (±10). Fifty-six of these patients died of CVD. The mean (SD) QTc in the group that died was 411 (30) ms and 416 (34) ms compared to 406 (24) ms and 411 (25) ms using Fridericia (Cox LR p-value 0.055) and Bazett (p=0.090), respectively. Gender, age, race, diabetes, SDQT and STVQT were significant predictors for CVD. We fit models with the covariates and SDQT (at both 1 and 5 min) and STVQT as three models and demonstrate that both SDQT and STVQT are significantly associated with CVD death (p-values of 0.0048, 0.0089, and 0.0113, respectively) and all models had high area under the curve (0.8095, 0.8085, and 0.8125, respectively).
Conclusion
In patients with OSA, QT variability was associated with CVD.
Support
American Academy of Sleep Medicine Foundation
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0404 Jewish-Arab Disparities in Sleep Behaviors and Differential Ethnic Impact on Daytime Functioning, Driving Safety, and Health in Israel. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In Israel, those with Arabic as compared to Jewish ethnicity, exhibit poorer health and motor vehicle safety behaviors. Their ethnic differences in sleep duration and quality may modulate their vulnerabilities to these behaviors.
Methods
7,230 Israeli individuals (N=5,880 Jewish and N=1350 Arabic) responded to the 2017 Israeli Bureau of Statistics population-based survey of households. Variables were self-reported. Outcomes included sleepiness, sleep medications, functional impairment, drowsy driving, overall health, 1-year health change, and obesity. Predictors included categorical sleep duration (<=5, 6, 7, 8 [reference], or >=9 hours) and sleep disturbance in the past month (none [reference], mild [1/week], moderate [2-3/week], or severe [>3/week]). Covariates included age, sex, and financial status. Ethnicity (Jewish/Arabic) was treated as a predictor of sleep and behavioral outcomes.
Results
When compared to normal (8-hour) sleepers, Jewish as compared to Arabic individuals were more likely to to sleep <=5h (RRR=3.99, p<0.0005), 6h (RRR=4.65, p<0.0005), and 7h (RRR=3.34, p<0.0005), and were more likely to report severe sleep difficulties (RRR=1.49, p<0.0005) and sleepiness (oOR=1.52, p< 0.0005). Yet, they were less likely to report functional impairment (oOR=0.65, p<0.0005), drowsy driving (OR=0.58, p<0.0005), worse health (oOR=0.51, p<0005), worsening health (oOR=0.70, p<0.0005), or obesity (OR=0.64, p<0.0005). Significant ethnicity by sleep duration interactions (p<0.05) characterized sleepiness, sleep medications, functional impairment, health, and health change. Moreover, significant ethnicity by sleep disturbance interactions (p<0.05) characterized the same outcomes, in addition to drowsy driving. Overall, the impact of sleep duration and sleep difficulties was generally greater among Arabs for all variables.
Conclusion
Despite Jewish individuals endorsing relatively shorter sleep and more severe sleep difficulties, Arabs seem to be more vulnerable to the health and functional outcomes. This finding may explain some of the discrepancies in the health and safety outcomes between these ethnic groups.
Support
Dr. Grandner is supported by R01MD011600
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0414 Chronotype and Sleep Among Ovarian Cancer Survivors Participating in a Lifestyle Intervention. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Chronotype is defined as an individual’s propensity to sleep at a specific time in a 24-hour cycle with late chronotype associated with poorer health outcomes including cancer. The role of chronotype on lifestyle behaviors remains relatively undefined in ovarian cancer. The Lifestyle Intervention for oVarian cancer Enhanced Survival study is testing whether 1205 women randomized to a diet and physical activity intervention for 24-months will have longer progression-free survival versus attention control. Here we determine the frequency and predictors of late versus early and mid chronotypes in disease-free ovarian cancer survivors.
Methods
894 ovarian cancer survivors with baseline measures were included in analyses. Chronotypes were determined using self-reported time to bed (early- < 9 pm; mid- ≥ 9 pm - ≤12 am; late- >12 am) captured through the Pittsburgh Sleep Quality Index. Demographic, diet and physical activity data were captured with validated questionnaires and BMI measured in clinic. Descriptive statistics and logistic regression, adjusted for smoking status and race, were performed.
Results
12.4% of women were late chronotype with significant differences between chronotypes observed for race, smoking history, sleep duration, and physical activity (p < 0.05). Late chronotype reported fewer hours of sleep per night (6.54 ± 1.51hrs) compared to mid (7.10± 1.31hrs) and early (7.74 ± 1.30hrs) chronotype. Blacks had higher odds of being late chronotype, OR 4.28 (95% CI 2.16-8.46). Late chronotype were more likely to report a history of smoking and lower recreational activity and had a higher mean BMI of 29.1± 6.0 kg/m2 compared to mid and early chronotype 27.8± 6.2 kg/m2 and 27.4± 5.4kg/m2, respectively. No significant differences were observed for sleep or diet quality, age, education or employment status.
Conclusion
Results of this analysis are consistent with other community-based population studies with regard to chronotype and race. Ovarian cancer is aggressive and late chronotype are more likely to have other risk factors that elevate risk of recurrence (obesity, tobacco use and inactivity. Six-month data are being analyzed by treatment arm and will provide important insights as to the role of sleep phase and lifestyle behaviors in this vulnerable population.
Support
NCT00719303; NCI R01CA186700-01A1
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0578 Incident Hypertension Rates in OSA Identified Using American Academy Of Sleep Medicine (AASM) Hypopnea Criteria, but Misclassified by Medicare (CMS) Hypopnea Definition. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The impact of not treating OSA identified using AASM standards (hypopneas scored using a minimum 3% O2 desaturation or arousal), but misclassified by CMS standards (hypopneas scored only if minimum 4% O2 desaturation) remains unclear. This analysis determined the ~5 year incident hypertension rates using the new 2018 ACC/AHA blood pressure (BP) guidelines in these individuals.
Methods
Data were analyzed from all Sleep Heart Health Study exam 2 study participants (N=1219) who were normotensive (BP≤120/80) at exam 1. The apnea hypopnea index (AHI) at exam 1 was classified into 4 categories of OSA severity: <5, 5 ≤15, 15 ≤30 and ≥30/hour using both the AASM or CMS definitions. Three definitions of hypertension were used: Elevated BP (>120/80), Stage 1 (>130/80) and Stage 2 (>140/90) to determine incidence rates at exam 2.
Results
Five year follow-up data were available for 476 participants classified as having OSA (AHI ≥5) by AASM criteria, but not by CMS standards at exam 1. Incident hypertension rates in these misclassified participants for ACC/AHA defined BP categories were 15% (Elevated BP), 15% (Stage 1) and 6% (Stage 2). 4% of normotensive participants used hypertensive medications. Overall incidence rate of at least an elevated BP was 40% (191/476) in those with OSA defined using AASM, but not by CMS criteria and 17% (191/1219) of the overall population at risk. In comparison to those with incident hypertension and OSA identified by CMS standards, BMI (27.7 vs 30.1 kg/m2, p<.001) and % men were lower (45 vs 58%, p=.012), but age and race were not different.
Conclusion
Use of the CMS hypopnea definition as a component of the AHI resulted in the failure to identify a significant number of individuals with OSA who eventually developed hypertension and could have benefited from earlier diagnosis and treatment.
Support
HL53938
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0717 Peer-intervention Can Reduce Health Disparities In Patients With Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients with obstructive sleep apnea (OSA), adherence to continuous positive airway pressure (CPAP) therapy is a major problem. Moreover, up to 20% of patients with suspected OSA who are referred to sleep study testing do not adhere to such diagnostic work-up. Although, peer-driven intervention with an interactive voice response system (PDI-IVR) can improve CPAP adherence, whether such an intervention can improve adherence to sleep study testing is unknown. Also, there remain health disparities with greater levels of CPAP nonadherence disproportionately affecting individuals of lower socioeconomic status. We aimed to determine whether PDI-IVR can improve adherence to sleep study testing and CPAP adherence in a lower income population.
Methods
We performed a prospective, randomized, parallel group, controlled trial wherein patients with suspected OSA were randomly assigned to receive PDI-IVR or provided with educational information regarding OSA and CPAP therapy (attention-control group) while both groups received usual care. The PDI-IVR interactions aimed at promoting adherence to sleep study testing and in patients diagnosed with OSA the peer-intervention was focused on improving CPAP adherence. In the PDI-IVR group, trained peers (peer-buddies) with OSA were paired with randomized patients over a 6-month period combined with an ability to meet in-person, email, text message, or phone an inter-disciplinary team of providers.
Results
In this pilot study, there were 63 patients (48.4 ± 12.5 years; 30 men) who were randomized to intervention (n=31) and attention-control (n=32) arms. There were 36 peer-buddies who mentored the patients in the intervention group. Intention to treat analysis revealed that failure to undergo sleep study testing was 15.6% of patients in the attention-control arm and 9.7% in the PDI-IVR arm (P=0.7). Per protocol analysis revealed that failure to undergo sleep study testing was 18.4% of patients in the attention-control arm and 4% in the PDI-IVR arm (P=0.13). At 6 months, CPAP adherence was greater in PDI-IVR arm (290 ± 45 min [SE]) than attention-control arm (181 ± 43 min; P=0.01).
Conclusion
In a lower income population, PDI-IVR improved CPAP adherence with a tendency for better adherence to sleep-study testing. Peer-intervention can reduce sleep health disparities.
Support
HL138377
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1188 Test Characteristics of a Machine Learned Electronic Medical Record Extractable Tool for OSA Case Identification in a Community-Based Population. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) is a significantly underdiagnosed medical condition. A machine learning method known as SLIM (Supersparse Linear Integer Models) that can be extracted from the Electronic Health Record (EHR) has found to be superior to patient-reported sleep-related symptoms to diagnose OSA. Such an evaluation, however, was previously validated in a laboratory-based population. Our aim was to determine the test characteristics for the EHR-extractable SLIM tool in a community-based population.
Methods
Subjects who participated in the Sleep Heart Health Study (SHHS) were included in this analysis. Variable definitions of OSA were determined using an Apnea Hypopnea Index (AHI) threshold of 5 per hour, 15 per hour, or the presence of any comorbidity (hypertension, ischemic heart disease, stroke, mood disorders, impairment of cognition, or sleepiness) when the AHI was between 5 to 15 per hour. Variable hypopnea definitions based upon degree of oxygen desaturation and associated arousals were considered.
Results
In the SHHS dataset, the Receiver Operating Characteristics (ROC) for a SLIM score threshold of 9 for men and 5 for women was good when OSA was defined by AHI > 5 per hour (hypopneas with either > 3% oxygen desaturation or arousals). Specifically, the ROC was 0.72 (95% Confidence Intervals [CI] 0.70; 0.74) with a Positive Predictive Value [PPV] of 0.98 and Likelihood Ratio of a positive test (LR+) of 11.3. The LR+ (6.0) and PPV (0.92) were also good when an AHI of 5 per hour threshold was adopted with hypopneas scored using the minimum 3% oxygen desaturation alone. Similarly, the ROC was good 0.74 (95%CI 0.73; 0.76) with a Positive Predictive Value [PPV] of 0.98 and Likelihood Ratio of a positive test (LR+) of 11.3. The LR+ (8.9) and PPV (0.81) were also good in the presence of comorbidities when AHI was 5 to 15 per hour using > 4% oxygen desaturation alone.
Conclusion
The EHR-extractable tool can be an actionable tool for case-identification of patients needing a referral for sleep study in a community-based population. Such an approach could facilitate an automated, rather than manual, OSA screening approach aimed at managing population health.
Support
HL138377
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0370 Objective Differences in Sleep Timing Between African Americans and Non-Hispanic Whites. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Prior studies have shown a morning circadian preference for African Americans compared to Non-Hispanic whites, but prior research has shown that self-reported sleep timing is delayed in African Americans compared to whites. No prior studies have evaluated this difference in sleep timing using objective measures of habitual sleep such as actigraphy.
Methods
We analyzed the sleep data from the Multi-Ethnicity Study of Atherosclerosis (MESA), a multi-site community-based cohort with both self-reported and actigraphic measures of habitual sleep variables. Self-reported sleep timing, chronotype as measured by the modified Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ) and actigraphic sleep timing were examined using logistic regression and independent t-tests.
Results
1,430 participants had self-reported sleep data, and 1,405 participants had complete actigraphy data as well. There was no self-reported difference in circadian preference between African Americans and whites (mean MEQ score 17.1 ± 3.6 vs. 17.0 ± 4.0). African Americans were 76% more likely to report a bedtime after midnight on weekdays (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.4, 2.3, p<0.001), and 50% more likely on weekends (OR 1.5, 95% CI 1.2, 1.9, p=0.001) as compared to whites. Actigraphic data showed similar results. African Americans were 80% more likely to have actigraphic sleep onset after midnight on weekdays (OR 1.8, 95% CI 1.4, 2.2) and 137% more likely (OR 2.4,95% CI 1.9, 3.0, p<0.001) on weekends as compared to whites. Actigraphic mid-sleep time was delayed 42 (95% CI 20, 64, p<0.001) minutes on weekdays and 24 (95% CI 6,42, p=0.01) minutes on weekends in African Americans compared to whites.
Conclusion
African Americans had delayed sleep timing compared to whites even though no significant racial differences in chronotype were present. Delayed sleep timing in African Americans may be related to factors other than self-reported circadian preference.
Support
Funding to DC from the American Heart Association, University of Arizona Health Sciences Center and NIH-NHLBI. MESA data obtained from NIH-NHLBI BioLINCC and the National Sleep Research Resource.
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0656 Mortality and Hospitalization in Patients With Heart Failure and Sleep Apnea: A Retrospective Study of Positive Airway Pressure Therapy in Medicare Beneficiaries. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Sleep apnea is common in patients with heart failure (HF) and can be treated with positive airway pressure (PAP) therapy. In patients with both HF and sleep apnea, whether treatment of PAP therapy is associated with reduction in hospitalization or mortality is unclear.
Methods
We used 5% Medicare limited-dataset (LDS) from 2013-2015 to perform a retrospective study of hospitalizations and mortality in HF patients with sleep apnea who received or did not receive PAP therapy over an 18-month time period. All-cause mortality during post-treatment period, any and HF-related hospitalizations in baseline, pre-treatment and post-treatment periods were measured and compared. Propensity score matching, generalized estimating equations (GEE) model for repeated measures analysis and COX-survival analysis adjusted by multiple covariates were used for longitudinal comparisons and mortality.
Results
We have identified 281,161 patients with at least two distinct HF onsets and 62,800 of them had sleep apnea diagnosis (22%). Of these patients, 5,540 of them had initiated their PAP therapy while 12,129 of them only had their sleep apnea diagnosis during the selection time frame from Jan 1st, 2014 to June 30th, 2015 without PAP treatment (control group). After adjusting for various confounders and propensity score matching, bilevel PAP was strongly associated with lower hospitalization and HF-associated hospitalization (Bilevel-PAP vs. Control: Any hospitalization, OR=0.62, 95%CI=0.53-0.74, p<0.0001; HF-associated hospitalization, OR=0.65, 95%CI=0.55-0.78, p<0.0001). Cox proportional hazards survival analysis revealed that all of the PAP-treated groups had a better 6-month survival after treatment initiation when compared to controls (any PAP therapy vs. Control: HR=0.32, 95%CI=0.28-0.37, p<0.0001).
Conclusion
In a retrospective analysis, PAP therapy was associated with lower 6-month all-cause mortality among Medicare beneficiaries with HF and sleep apnea. Bilevel-PAP therapy was consistently associated with significant reduction in hospitalization among these patients. Our observational findings warrant confirmation by future prospective intervention trials.
Support
NIH (HL126140; MD011600; HL138377; HL140144; IPA-014264-00001), PCORI (PPRND-1507-31666; PCS-1504-30430), American Academy of Sleep Medicine Foundation (169-SR-17), and Philips Healthcare/ Philips-Respironics Inc.
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0405 Sleep Duration and Sleep Disturbance Related to Obesity, Health, Motor Vehicle Safety, and Daytime Functioning in Israel: Data From the 2017 Israel Social Survey. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Previous studies suggest the Israeli population exhibits relatively short sleep duration and experiences sleep difficulties. This analysis evaluates the relationships between habitual sleep and outcomes of interest in this population.
Methods
Data were obtained from 7,230 Israeli individuals. The sample consisted a 2017 population-based survey of households, conducted by the Israeli Bureau of Statistics. All variables were self-reported. Outcomes of interest included drowsy driving, sleep medication use, functional impairment, sleepiness, overall health, 1-year health change, and obesity. Predictors included categories of sleep duration (<=5, 6, 7, 8 [reference], or >=9 hours) and sleep disturbance in the past month (none [reference], mild [1/week], moderate [2-3/week], or severe [>3/week]). Covariates included age, sex, ethnic group, and financial status. Binary and ordinal logistic regressions were employed to evaluate the relationship between them and post-hoc analyses evaluated the relationships between subgroups.
Results
Drowsy driving was associated with <=5h, 6h, and 7h sleep duration categories, and severe sleep disturbance. The use of sleep medication use was associated with <=5h and >=9h, and all levels of sleep disturbance. Functional impairment and sleepiness were both associated with <=5h, 6h, 7h, and >=9h, and all levels of sleep disturbance. Their reported overall health was linked to sleep duration of <=5h and >=9h, and all levels of sleep disturbance. Worsening health was associated with <=5h and all levels of sleep disturbance. Obesity was associated with <=5h and severe sleep disturbance. In post-hoc analyses restricted to individuals with no sleep disturbance, habitual sleep duration was still statistically significantly related to drowsy driving, sleep medications, sleepiness, and health change.
Conclusion
Short sleep duration and sleep disturbance are associated with worse motor vehicle safety, health, and functioning in the Israeli population. Effects of sleep duration were generally maintained even for those without sleep disturbance. These results may help focus public health efforts on improving sleep health.
Support
Dr. Grandner is supported by R01MD011600
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1209 Effect Of Wearables On Sleep In Healthy Individuals: A Randomized Cross-over Trial And Validation Study. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
To determine whether a wearable sleep-tracker improves perceived sleep quality in healthy subjects. To test whether wearables reliably measure sleep quantity and quality compared to polysomnography.
Methods
A single-center randomized cross-over trial of community-based participants without medical conditions or sleep disorders. Wearable device (WHOOP, Inc.) that provided feedback regarding sleep information to the participant for 1-week and maintaining sleep logs versus 1-week of maintaining sleep logs alone. Self-reported daily sleep behaviors were documented in sleep logs. Polysomnography was performed on one night when wearing the wearable. PROMIS Sleep disturbance sleep scale was measured at baseline, 7, and 14 days of study participation.
Results
In 32 participants (21 women; 23.8 + 5 years), wearables improved nighttime sleep quality (PROMIS sleep disturbance; B= -1.69; 95% Confidence Interval -3.11, -0.27; P=0.021) after adjusting for age, sex, baseline, and order effect. There was a small increase in self-reported daytime naps when wearing the device (B = 3.2; SE 1.4; P=0.023) but total daily sleep remained unchanged (P=0.43). The wearable had low bias (2.5 minutes) and low precision (5.6 minutes) errors for measuring sleep duration and measured dream sleep and slow wave sleep accurately (Intra-class coefficient 0.74 + 0.28 and 0.85 + 0.15, respectively). Bias and precision error for heart rate (bias -0.17%; precision 1.5%) and respiratory rate (bias 1.8%’ precision 6.7%) were very low when compared to that measured by electrocardiogram and inductance plethysmography during polysomnography.
Conclusion
In healthy people, wearables can improve sleep quality and accurately measure sleep and cardiorespiratory variables.
Support
WHOOP Inc.
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1183 Board-certified Sleep Medicine Physicians See A Greater Proportion Of Complex Sleep Patients Than Non-specialist Providers. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Despite a growing literature regarding the impact of board-certification in sleep medicine, little is known about the complexity of patients seen by board-certified sleep medicine physicians (BCSMPs) relative to non-specialists. To address this gap, the purpose of the current study was to evaluate the differences in sleep complaints among Medicare beneficiaries seen by BCSMPs relative to individuals seen by non-specialists.
Methods
Our data source was a random 5% sample of Medicare administrative claims data from 2006-2013. Sleep disorders were operationalized using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Descriptive analyses were performed to estimate the number of sleep disorder diagnoses patients received by provider status. BCSMPs were identified using a cross-matching procedure based on National Provider Identifier (NPI).
Results
A total of 57,209 Medicare beneficiaries received a sleep disorder diagnosis between 2006-2013. Of these, only 2.2% were seen by BCSMPs. Relative to beneficiaries seen by non-specialists, those seen by BCSMPs were more likely to be diagnosed with more than one sleep disorder (p<0.001). Specifically, 91.0% of individuals seen by non-specialists received only one sleep disorder diagnosis, whereas 75.9% of individuals seen by BCSMPs received only one sleep disorder diagnosis. Among beneficiaries seen by non-specialists, the most common sleep disorders were insomnia (48.2%; n=26,967), obstructive sleep apnea (OSA; 31.4%; n=17,554), and restless legs syndrome (8.7%; n=4,871). Among those seen by BCSMPs, the most common sleep disorders were OSA, (70.4%; n=901), sleep apnea with hypersomnia (16.5%; n=211), and insomnia (11.7%; n=150).
Conclusion
BCSMPs see more complex sleep patients than do non-specialists. These results suggest the possibility that more complex patients are referred for sleep specialty care. Further, these results demonstrate the value of board certification in sleep medicine in caring for complex sleep patients.
Support
This research was supported by an AASM Strategic Research Award from the AASM Foundation to the University of Maryland, Baltimore (PI: EMW).
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PredictSuperFam-PSS-3D1D: A server for predicting superfamily for the annotation of twilight zone protein sequences. J Struct Biol 2020; 210:107479. [PMID: 32081792 DOI: 10.1016/j.jsb.2020.107479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/25/2019] [Accepted: 02/14/2020] [Indexed: 10/25/2022]
Abstract
Annotation of twilight zone protein sequences has been hitherto attempted by predicting the fold of the given sequence. We report here the PredictSuperFam-PSS-3D1D method, which predicts the superfamily for a given twilight zone (TZ) protein sequence. Earlier, we have reported that adding predicted secondary structure information into the threading methods could improve fold prediction especially for the TZ protein sequences. In this study, we have analysed the application of the same method to predict superfamilies. Here, in this method, the twilight zone protein sequence is threaded with the 3D1D profiles of the known protein superfamilies library. In addition, weightage for the predicted secondary structure (PSS) is also employed. The performance of the method is benchmarked with twilight zone sequences. In the benchmarks, 62 and 65 percentages of superfamily predictions are obtained with GOR IV and NPS@ predicted secondary structures, respectively. Receiver Operating Characteristic (ROC) curves indicate that the method is sensitive in predicting the superfamilies. A case study has been conducted with the hypothetical protein sequences of Schistosoma haematobium (Blood Fluke) using this method and the results are analyzed. Our method predicts the superfamily for TZ sequences for which, methods based on sequence similarity alone are inadequate. A web server has been developed for our method and it is available online at http://bioinfo.bdu.ac.in/psfpss.
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A load-sharing nail - cage construct may improve outcome after induced membrane technique for segmental tibial defects. Injury 2020; 51:510-515. [PMID: 31787329 DOI: 10.1016/j.injury.2019.11.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/28/2019] [Accepted: 11/21/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Induced membrane technique (IMT) is a well-established technique for treating segmental bone defects. Different variations of the technique have been described. Our objective was to evaluate radiological and functional outcome with IMT using a nail - graft filled titanium cage construct for segmental traumatic bone defects of the tibia. PATIENTS AND METHODS 26 adult patients with moderate (> 5 cm) or large (> 10 cm) segmental tibial defects after acute open fractures or implant related infected nonunions underwent the procedure. The technique involved 2 stages. After standard debridement +/- implant removal and application of an antibiotic loaded cement spacer in stage 1, the second stage included placement of an intramedullary nail across the defect and an impacted graft filled titanium mesh cage was used to reconstruct the bone defect. Radiographic evidence of bony union, time to painless un-assisted weight bearing, return to work and functional evaluation with lower extremity functional scale (LEFS) were assessed. RESULTS 5/26 cases were excluded due to failure in controlling infection. 100% union rates were achieved in the remaining 21 patients. 2 patients (9.5%) required repeat bone grafting. The mean time to painless un-assisted painless weight bearing was 26 ± 9.2 days and the mean time to return to work was 45 ± 12.5 days. The mean LEFS at a mean follow up of 27 months was 67 ± 4.7. CONCLUSIONS Excellent union rates with good functional restoration can be achieved after IMT using the nail - cage construct for segmental tibial defects. Persistent infection is the biggest impediment for successful execution of the technique. Addition of a cage may also improve short-term functional outcome in terms of ability to weight bear and early return to work.
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A New Non-touch Technique (Partha’s Technique) of Administering Spinal Anaesthesia in Paediatric Age Group- A Pilot Study. J Clin Diagn Res 2020. [DOI: 10.7860/jcdr/2020/44452.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Paediatric spinal anaesthesia is often the technique of choice in many short duration surgeries. However, the failure rate is higher with spinal anaesthesia in children than in adults. Aim: To evaluate if a non-touch technique of paediatric spinal anaesthesia can reduce anaesthetic failure. Materials and Methods: A pilot study was done in 10 paediatric patients from January 2018 to July 2018 in Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Ten children posted for infra-umbilical surgeries in the age group of 4-10 years were given a sedative premedication with a combination of Pethidine and Midazolam They were kept in lateral position with the back much inside the edge of the table so that there was a considerable space between the table edge and the baby. Identification of the L3-L4 space was done by touching the patient. The 25-gauge quincke needle was pricked and the hub was held with the hand in the table without touching the patient. Results: The anaesthesia was successful with adequate level in all the patients; T8 in five patients and T10 in the other five patients. There were no significant side effects. Conclusion: From this pilot study on 10 patients, it can be suggested that the novel non-touch Partha’s technique is feasible and more successful with absent failure rate when administering spinal anaesthesia in the paediatric age group.
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Nerve Blocks of the Head and Face � An Interactive Review of Techniques and Clinical Cases. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2019. [DOI: 10.18311/ajprhc/2019/25136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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�Simulation for Training in Communication Skills:Active Participant vs. Active Observer�- An Interventional Case Control Study. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2019. [DOI: 10.18311/ajprhc/2019/25135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Assessment of predisposing factors in myofascial pain syndrome and the analgesic effect of trigger point injections - A primary therapeutic interventional clinical trial. Indian J Anaesth 2019; 63:300-303. [PMID: 31000895 PMCID: PMC6460974 DOI: 10.4103/ija.ija_6_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims Myofascial pain syndrome (MPS) is a common cause of chronic musculoskeletal pain, characterised by myofascial trigger points (TPs). TP injection is an established technique for management of MPS. In this study, we analysed the efficacy of myofascial TP injection of lignocaine and the influencing biomechanical factors on MPS. Methods After obtaining ethical committee approval, we included the first 100 adult patients of MPS with failed physical therapy aged above 18 years, and with TPs in the trapezius, infraspinatus, and/or the levator scapulae muscles and Visual analog scale (VAS) >4. TP injection of 2% (2 ml) lignocaine was performed. Visual analogue scale (VAS) scores were recorded immediately and after 1 month. Number of repeat TP injections and use of oral analgesic in one month was noted. Results were analysed with the analysis of variance test. Results The mean VAS reduced significantly both immediately and 1 month after therapeutic injections (8.57 ± 0.77, 2.67 ± 1.43 and 2.82 ± 1.4, respectively, P < 0.01). Keeping the palm below the head during sleep was the major contributing factor for myofascial TP, followed by slanting the neck to use mobile phones. Repeat TP injection was used in 4% of cases. Conclusion TP injection of 2 ml of 2% lignocaine along with correction of predisposing biomechanical factors provided significant pain relief for MPS in patients with failed physical therapy without any side effects.
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"Site of Separation of Musculocutaneous Nerve from Axillary Brachial Plexus: Analysis using Ultrasound- Observational Volunteer Study". ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2018. [DOI: 10.18311/ajprhc/2018/21525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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0745 Sleep-disordered Breathing Is Associated With Neurocognitive Impairment In Children With Congenital Heart Disease. Sleep 2018. [DOI: 10.1093/sleep/zsy061.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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0652 Delayed Sleep Time In African Americans And Depression In A Community-Based Population. Sleep 2018. [DOI: 10.1093/sleep/zsy061.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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0545 Comparison of Performance of Four Adaptive Servo Ventilation Devices In Patients With Complex Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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