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Changes in insomnia severity with advanced PAP therapy in patients with posttraumatic stress symptoms and comorbid sleep apnea:A retrospective,nonrandomized controlled study

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Military Medical Research 2019年第4期6卷 308-319页

作者： barry j.krakow Natalia D.McIver jessica j.Obando Victor A.Ulibarri Sleep&Human Health Institute 6739 Academy Rd NE Ste380AlbuquerqueNM 87109USA Maimonides Sleep Arts&Sciences 6739 Academy Rd NE Ste380AlbuquerqueNM 87109USA Los Alamos Medical Center 3917 W RdLos AlamosNM 87544USA Institution:Mozaik Solutions Solana BeachCA 92075USA

Background:Sleep disorders frequently occur in posttraumatic stress disorder(PTSD)patients.Chronic insomnia is a common feature of and criteria for the diagnosis of PTSD.Another sleep disorder,obstructive sleep apnea(OSA),also occurs frequently in PTSD,and emerging research indicates OSA fuels chronic insomnia.Scant research has investigated the impact of OSA treatment on insomnia outcomes(Insomnia Severity Index,ISI)in trauma survivors.Methods:OSA patients with moderately severe posttraumatic stress symptoms were studied in a retrospective chart review.Ninety-six patients who failed CPAP therapy due to expiratory pressure intolerance or complex sleep apnea or both underwent manual titration with advanced PAP modes[autobilevel(ABPAP);adaptive servo-ventilation(ASV)],which were subsequently prescribed.PAP use measured by objective data downloads divided the sample into three groups:compliant regular users(C-RU):n=68;subthreshold users(SC-RU):n=12;and noncompliant users(NC-MU):n=16.The average follow-up was 11.89±12.22 months.Baseline and posttreatment ISI scores were analyzed to assess residual insomnia symptoms as well as cure rates.Results:The C-RU group showed significant improvements in insomnia with very large effects compared to those in the NC-MU reference group(P=0.019).Insomnia severity significantly decreased in all three groups with large effects(C-RU,P=0.001;SC-RU,P=0.027;NC-MU,P=0.007).Hours of weekly PAP use and insomnia severity were inversely correlated(P=0.001,r=–0.321).However,residual insomnia symptoms based on established ISI cut-offs were quite common,even among the C-RU group.Post hoc analysis showed that several categories of sedating medications reported at baseline(hypnotics,anti-epileptic,opiates)as well as actual use of any sedating medication(prescription or nonprescription)were associated with smaller insomnia improvements than those in patients not using any sedating agents.Conclusions:In a retrospective,nonrandomized analysis of a select sample of sleep clinic patients with OSA and P

关键词： Insomnia Obstructive sleep apnea Complex insomnia CBT-I Posttraumatic stress symptoms CPAP Auto bi-level Adaptive servo-ventilation

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Fetal Head Compression: Its Possible Role in Neurologic Injury

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Open journal of Obstetrics and Gynecology 2024年第1期14卷 124-143页

作者： barry S. Schifrin Brian j. Koos Wayne R. Cohen Department of Obstetrics and Gynecology The Western University of Health Sciences Pomona USA The David Geffen School of Medicine at UCLA Los Angeles USA The University of Arizona College of Medicine Tucson USA

It is widely assumed that fetal ischemic brain injury during labor derives almost exclusively from severe, systemic hypoxemia with marked neonatal depression and acidemia. Severe asphyxia, however, is one of several causes of perinatal neurological injury and may not be the most common;most neonates diagnosed with hypoxic-ischemic encephalopathy do not have evidence of severe asphyxia. Sepsis, direct brain trauma, and drug or toxin exposure account for some cases, while mechanical forces of labor and delivery that increase fetal intracranial pressure sufficiently to impair brain perfusion may also contribute. Because of bony compliance and mobile suture lines, the fetal skull changes shape and redistributes cerebrospinal fluid during labor according to constraints imposed by contractions, and bony and soft tissue elements of the birth canal as the head descends. These accommodations, including the increase in intracranial pressure, are adaptive and necessary for efficient descent of the head while safeguarding cerebral blood flow. Autonomic reflexes mediated through central receptors normally provide ample protection of the brain from the considerable pressure exerted on the skull. On occasion, those forces, which are transmitted intracranially, may overcome the various adaptive anatomical, cardiovascular, metabolic, and neurological mechanisms that maintain cerebral perfusion and oxygen availability, resulting in ischemic brain injury. Accepting the notion of a potentially adverse impact of fetal head compression suggests that avoidance of excessive uterine activity and of relentless pushing without steady progress in descent may offer protection for the fetal brain during parturition. Excessive head compression should be considered in the differential diagnosis of ischemic encephalopathy.

关键词： Fetal Brain Injury Fetal Head Compression Ischemic Encephalopathy Neonatal Encephalopathy

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Wiley GAAP. interpretation and application of generally accepted accounting principles / 2005 : barry j.Epstein ...[et al.].

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2004年

作者： barry j.Epstein ...[et al.].

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COVID-19 has triggered a new century of vaccination and infection control for the benefit of all mankind

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Precision Clinical Medicine 2021年第2期4卷 77-79页

作者： barry j.Marshall Helicobacter pylori Research Laboratory School of Biomedical SciencesMarshall Centre for Infectious Disease Research and TrainingUniversity of Western AustraliaNedlands 6009Australia

Modern safe vaccinations were pioneered in 1796 by Edward jenner in England,when he noticed that milkmaids had beautiful complexions,clear of the blemishes from smallpox scars.This was attributed to their exposure to... 详细信息

关键词： vaccination infection attributed

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Changes in otolaryngology application requirements and match outcomes:Are we doing any better?

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World journal of Otorhinolaryngology-Head and Neck Surgery 2023年第2期9卷 144-152页

作者： Emma De Ravin Ariel S.Frost Neal R.Godse Amber D.Shaffer Noel jabbour barry M.Schaitkin jason Newman Leila j.Mady Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Health SystemPhiladelphiaPennsylvaniaUSA Head and Neck Institute Cleveland ClinicClevelandOhioUSA Division of Pediatric Otolaryngology Children's Hospital of Pittsburgh of UPMCPittsburghPennsylvaniaUSA Department of Otolaryngology University of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA Department of Otolaryngology-Head and NeckSurgery Medical Universityof South CarolinaCharlestonSouth CarolinaUSA MUSC Hollings Cancer Center CharlestonSouthCarolinaUSA Department of Otolaryngology-Head and Neck Surgery Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA Cancer Risk and Control Program of Excellence Sidney Kimmel Cancer CenterPhiladelphiaPennsylvaniaUSA

Objectives:Otolaryngology-specific requirements were piloted to minimize applicant and program burdens.We investigated the impact of introducing and then removing these requirements on Match outcomes.Methods:2014-2021 National Resident Matching Program?data were examined.The primary outcome was the impact of Otolaryngology Resident Talent Assessment(ORTA;prematch 2017,postmatch 2019)and Program-Specific Paragraph(PSP;implemented 2016,optional 2018)on applicant numbers and match rates.Secondary survey analysis assessed candidate perceptions of PSP/ORTA.Results:Applicant numbers declined significantly during PSP/ORTA(18.9%;p=0.001).With the optional PSP and postmatch ORTA,applicant numbers increased significantly(39.0%;p=0.002).Examined individually,mandatory PSP was associated with a significant decline in applicants(p=0.007),whereas postmatch ORTA was associated with significant increases in applicants(p=0.010).ORTA and PSP negatively impacted the decision to apply to otolaryngology in 59.8%and 51.3%of applicants,respectively.Conversely,match rate success improved significantly from 74.8%to 91.2%during PSP/ORTA(p=0.014),followed by a significant decline to 73.1%after PSP was made optional and ORTA moved to postmatch(p=0.002).Conclusions:ORTA and PSP correlated with decreased applicant numbers and increased match rate success.As programs seek ways to remove barriers to applying to otolaryngology,the potential consequences of an increasing pool of unmatched candidates must also be considered.

关键词： academic success internship and residency medical students otolaryngology surveys and questionnaires

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Robustness Assessment and Adaptive FDI for Car Engine

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International journal of Automation and computing 2008年第2期5卷 109-118页

作者： Mahavir Singh Sangha j.barry Gomm Control Systems Research Group School of EngineeringLiverpool John Moores University

A new on-line fault detection and isolation （FDI） scheme proposed for engines using an adaptive neural network classifier is evaluated for a wide range of operational modes to check the robustness of the scheme in this paper. The neural classifier is adaptive to cope with the significant parameter uncertainty, disturbances, and environment changes. The developed scheme is capable of diagnosing faults in on-line mode and the FDI for the closed-loop system with can be directly implemented in an on-board crankshaft speed feedback is investigated by diagnosis system （hardware）. The robustness of testing it for a wide range of operational modes including robustness against fixed and sinusoidal throttle angle inputs, change in load, change in an engine parameter, and all these changes occurring at the same time. The evaluations are performed using a mean value engine model （MVEM）, which is a widely used benchmark model for engine control system and FDI system design. The simulation results confirm the robustness of the proposed method for various uncertainties and disturbances.

关键词： On-board fault diagnosis automotive engines adaptive neural networks （ANNs） fault classification robustness assessment

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Multi-Institutional US Experience of the Occlutech AFR Device in Congenital and Acquired Heart Disease

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Congenital Heart Disease 2022年第1期17卷 107-116页

作者： barry O’Callaghan jenny Zablah joseph Vettukattil Daniel Levi Morris Salem Allison Cabalka jason Anderson Makram Ebeid Ryan Alexy Gareth j.Morgan The Heart Institute Children’s Hospital ColoradoAuroraUSA Pediatric Cardiology Helen DeVos Children’s HospitalGrand RapidsUSA Pediatric Cardiology UCLA HealthMattel Children’s HospitalLos AngelesUSA Pediatric Cardiology UCLA Medical CentreLos AngelesUSA Pediatric Cardiology Mayo ClinicRochesterUSA Pediatric Cardiology University of Mississippi Medical CenterJacksonUSA Pediatric Cardiology Riley Hospital for Children at Indiana University HealthIndianapolisUSA

Objectives:To detail the US multi-institutional experience with the Occlutech©(Occlutech International AB,Helsingborg,Sweden)atrial flow regulator(AFR)in children and adults with acquired or congenital heart disease.Background:The creation of a long-term atrial communication is desirable in several cardiovascular disease phenotypes,most notably pulmonary arterial hypertension,disorders of increased left ventricular filling and increased cavopulmonary pressures in patients with a Fontan type circulation.Methods:Patients were identified for inclusion from the AFR device manufacturer database.Data was collected using a RedCap database following IRB approval.8 weeks of follow up data was sought for each patient based on available data.Data was analyzed and summarized using SPSS.Results:We report the experience of 6 US centers in the implantation of AFR devices in 15 patients,across a wide age range,with different disease phenotypes and a variety of indications.Implantation was technically successful in all patients and improvement was noted in both clinical and hemodynamic parameters.There were no immediate or intermediate term complications reported.3 patients died remote from implantation.Their deaths were not felt to be related to the AFR device or related procedural complications.Conclusion:Compassionate use of the AFR device in children and adults with congenital&acquired heart disease is technically feasible and produces beneficial short term hemodynamic and symptomatic improvement.Widespread uptake of this technique and treatment at specialist centers has the potential to provide significant benefits to a variety of complex patients with currently limited treatment options and indeterminate prognosis.

关键词： Congenital heart disease pulmonary hypertension left atrial hypertension single ventricle palliation diastolic heart failure

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A preliminary study of sperm identification in microdissection testicular sperm extraction samples with deep convolutional neural networks

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Asian journal of Andrology 2021年第2期23卷 135-139页

作者： Daniel j Wu Odgerel Badamjav Vikrant V Reddy Michael Eisenberg barry Behr Department of Computer Science Stanford UniversityStanfordCA 94305USA Department of Urology University of Utah HealthSalt Lake CityUT 84108USA Department of Obstetrics and Gynecology Stanford Children’s HealthStanfordCA 94305USA Department of Urology Stanford University School of MedicineStanfordCA 94305USA

Sperm identification and selection is an essential task when processing human testicular samples for in vitro fertilization.Locating and identifying sperm cell(s)in human testicular biopsy samples is labor intensive and time consuming.We developed a new computer-aided sperm analysis(CASA)system,which utilizes deep learning for near human-level performance on testicular sperm extraction(TESE),trained on a custom dataset.The system automates the identification of sperm in testicular biopsy samples.A dataset of 702 de-identified images from testicular biopsy samples of 30 patients was collected.Each image was normalized and passed through glare filters and diffraction correction.The data were split 80%,10%,and 10%into training,validation,and test sets,respectively.Then,a deep object detection network,composed of a feature extraction network and object detection network,was trained on this dataset.The model was benchmarked against embryologists’performance on the detection task.Our deep learning CASA system achieved a mean average precision(mAP)of 0.741,with an average recall(AR)of 0.376 on our dataset.Our proposed method can work in real time;its speed is effectively limited only by the imaging speed of the microscope.Our results indicate that deep learning-based technologies can improve the efficiency of finding sperm in testicular biopsy samples.

关键词： artificial intelligence computer vision male infertility microdissection testicular sperm extraction sperm

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Predicting an Athlete’s Physiological and Haematological Response to Live High-Train High Altitude Training Using a Hypoxic Sensitivity Test

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journal of Science in Sport and Exercise 2022年第4期4卷 371-385页

作者： Gareth Turner Kate L.Spilsbury David j.Green barry W.Fudge jamie S.M.Pringle Alan j.Richardson Neil S.Maxwell Environmental Extreme Laboratory University of BrightonEastbourneUK English Institute of Sport Bisham AbbeyUK Queensland Academy of Sport BrisbaneAustralia English Institute of Sport LoughboroughUK Aspire Academy DohaQatar University of Birmingham BirminghamUK

Purpose Elite endurance runners frequently utilise live high-train high(LHTH)altitude training to improve endurance per-formance at sea level(SL).Individual variability in response to the hypoxic exposure have resulted in contradictory findings.In the present case study,changes in total haemoglobin mass(tHbmass)and physiological capacity,in response to 4-weeks of LHTH were documented.We tested if a hypoxic sensitivity test(HST)could predict altitude-induced adaptations to LHTH.Methods Fifteen elite athletes were selected to complete 4-weeks of LHTH(~2400 m).Athletes visited the laboratory for preliminary testing(PRE),to determine lactate threshold(LT),lactate turn point(LTP),maximal oxygen uptake VO_(2max)and tHbmass.During LHTH,athletes completed daily physiological measures[arterial oxygen saturation(SpO2)and body mass]and subjective wellbeing questions.Testing was repeated,for those who completed the full camp,post-LHTH(POST).Additionally,athletes completed the HST prior to LHTH.Results A difference(Pjury or illness.The HST did however,estimate changes in tHbmass and VO_(2max).HST prior to LHTH could allow coaches and practitioners to better inform the acclimatisation strategies and train-ing load application of endurance runners at altitude.

关键词： Altitude training Runners Endurance Haemoglobin mass Performance Hypoxic sensitivity

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Delayed referral for liver transplant evaluation worsens outcomes in chronic liver disease patients requiring inpatient transplant evaluation

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World journal of Transplantation 2023年第4期13卷 169-182页

作者： Katherine M Cooper Alessandro Colletta Nicholas j Hathaway Diana Liu Daniella Gonzalez Arslan Talat Curtis barry Anita Krishnarao Savant Mehta Babak Movahedi Paulo N Martins Deepika Devuni Department of Medicine UMass Chan Medical SchoolWorcesterMA 01605United States Department of Medicine Division of GastroenterologyUMass Chan Medical SchoolWorcesterMA 01605United States Department of Surgery Transplant DivisionUMass Chan Medical SchoolWorcesterMA 01605United States

BACKGROUND Indications to refer patients with cirrhosis for liver transplant evaluation(LTE)include hepatic decompensation or a model for end stage liver disease(MELDNa)score≥15.Few studies have evaluated how delaying referral beyond these criteria affects patient outcomes.AIM To evaluate clinical characteristics of patients undergoing inpatient LTE and to assess the effects of delayed LTE on patient outcomes(death,transplantation).METHODS This is a single center retrospective cohort study assessing all patients undergoing inpatient LTE(n=159)at a large quaternary care and liver transplant center between 10/23/2017-7/31/2021.Delayed referral was defined as having prior indication(decompensation,MELD-Na≥15)for LTE without referral.Early referral was defined as referrals made within 3 mo of having an indication based on practice guidelines.Logistic regression and Cox Hazard Regression were used to evaluate the relationship between delayed referral and patient outcomes.RESULTS Many patients who require expedited inpatient LTE had delayed referrals.Misconceptions regarding transplant candidacy were a leading cause of delayed referral.Ultimately,delayed referrals negatively affected overall patient outcome and an independent predictor of both death and not receiving a transplant.Delayed referral was associated with a 2.5 hazard risk of death.CONCLUSION Beyond initial access to an liver transplant(LT)center,delaying LTE increases risk of death and reduces risk of LT in patients with chronic liver disease.There is substantial opportunity to increase the percentage of patients undergoing LTE when first clinically indicated.It is crucial for providers to remain informed about the latest guidelines on liver transplant candidacy and the transplant referral process.

关键词： Liver transplantation Liver transplant evaluation Liver transplant referral Patient access Equity Patient outcomes

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