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ContextObstructive sleep apnea (OSA) is associated with diabetes and cardiovascular disease. This association may be related to metabolic changes that transpire during sleep in OSA.ObjectiveTo examine the impact of OSA, elicited by cessation of continuous positive airway pressure (CPAP), on frequently sampled nocturnal metabolic markers including plasma free fatty acids (FFAs), glucose, insulin, triglycerides (TGs), cortisol, and lactate, as well as glucose production, oral glucose tolerance, blood pressure (BP), endothelial function, cholesterol, and high-sensitivity C-reactive protein (hsCRP).Design and SettingRandomized crossover trial of CPAP vs CPAP withdrawal.PatientsThirty-one patients with moderate to severe OSA acclimated to CPAP.InterventionPatients underwent attended polysomnography while sleeping with therapeutic CPAP, or after CPAP withdrawal, in random order. Venous blood was sampled at ∼20-minute intervals on both nights. In 11 patients, we assessed glucose kinetics with an infusion of 6,6-[2H2]glucose.ResultsCPAP withdrawal caused recurrence of OSA associated with hypoxemia, sleep disruption, and heart rate (HR) elevation. CPAP withdrawal dynamically increased nocturnal FFA (P = 0.007), glucose (P = 0.028), and cortisol (P = 0.037), in proportion to respiratory event frequency, HR elevation, or sleep fragmentation. Diabetes predisposed to glucose elevation. CPAP withdrawal also increased systolic BP (P = 0.017) and augmentation index (P = 0.008), but did not affect insulin, TGs, glucose production, oral glucose tolerance, cholesterol, or hsCRP.ConclusionOSA recurrence during CPAP withdrawal increases FFA and glucose during sleep, associated with sympathetic and adrenocortical activation. Recurring exposure to these metabolic changes may foster diabetes and cardiovascular disease.We studied the overnight metabolic profile of patients during sleep, in the presence or absence of sleep apnea. Sleep apnea caused dynamic elevations of plasma FFA and glucose.

Studies have shown a positive correlation between higher physical activity (PA) and health benefits. However, device-based assessment of PA and sedentary time (ST) in people with adolescent idiopathic scoliosis (AIS) has not been deeply investigated. Analysis and comparison of weekend and weekdays PA and ST using multiple accelerometers in people with AIS with different curvature severity compared to healthy controls. 24 participants with AIS divided into 2 groups of 12 with Cobb angles 40°, along with 12 age and BMI matched healthy controls. Daily PA and ST during four consecutive days were measured using four tri-axial accelerometers. Clinical functional assessment was performed using the scoliosis research society (SRS-22) questionnaire. The combined weekend and weekdays average daily step count was found to be 22% and 29% lower in the AIS groups with Cobb angle 40°, respectively, compared to the controls. The average ST was also reported to be 5% and 7% higher in the AIS groups with Cobb angle 40°, respectively, compared to the controls. The reported differences were significant in the AIS group with higher Cobb angle (p[less than or equal to]0.05). No significant differences in PA or ST were reported between the AIS groups based on curvature severity. Decreased PA and increased ST observed in patients with AIS may have long term health implications and may play a role in the disease process. The device-based assessment of PA to understand potential benefits in clinical practice is recommended.

ABSTRACT Background and Aims: The position of the tip of the central venous catheter (CVC) is important to minimise complications. The aim of our study was to compare modified Peres' height formula and landmark method using distance between puncture site and right third intercostal space (PS-RTICS) and to develop a reliable formula for correct positioning of tip of the CVC. Methods: This prospective, randomised study was conducted on 400 patients of either gender, of age 18 years and older, scheduled to undergo right internal jugular venous cannulation. Depending on the technique used for deciding the length of CVC to be inserted, the patients were randomly allocated into two groups: Group A, using modified Peres' height formula, that is, height of patient (cm)/10-2 and Group B, using distance between PS-RTICS and subtracting one from it, that is (PS-RTICS)-1. The carina was taken as the landmark for optimum insertion of CVC, which was confirmed on postprocedure chest X-ray. Data so obtained were tabulated and analysed. P<.05 was considered statistically significant for correlation and regression coefficients. Results: In group A, the mean length of catheter inserted was 15.18 ± 0.73 cm and the catheter tip was found to be 2.41 ± 0.85 cm distal to carina (P =0.001). Over-insertion was found in 98.45% patients in group A. In group B, the mean length of catheter inserted was 14.12 ± 0.85 cm and the catheter tip was found to be 0.20 ± 1.18 cm distal to carina. Conclusion: Though both landmark and modified Peres' height formula has low accuracy, landmark technique is superior in predicting correct depth of right internal jugular venous cannulation catheter.

This study aimed to estimate patient acceptable symptom state (PASS) thresholds in the Forgotten Joint Score (FJS) 1 year following primary total knee arthroplasty (PTKA) while investigating the impact of patients’ characteristics on PASS thresholds. This cohort study used data from patients who underwent PTKA at a public hospital in Scotland between April 2021 and December 2022. Assessment of FJS (0-100, high-low knee awareness) was completed 1 year postoperatively. A single-item question about satisfaction with the operated knee was completed at 1 year and served as the anchor for estimating PASS thresholds. Anchor-based predictive modeling (adjusted and unadjusted) and receiver operating characteristic (ROC) curve methods were used to determine PASS thresholds. The impact of patient characteristics on PASS threshold values was investigated by calculating stratified PASS values based on gender and age groups. A total of 1832 PTKAs were performed between April 2021 and December 2022, of which 1359 (74%) had complete data comprising the study cohort. The median age and body mass index of patients included in the study were 70 years and 31.2 kg/m2, respectively, with 54% being females. The proportion of satisfied patients was 84%. A moderate positive correlation between FJS and patient satisfaction was found (r = 0.64, P < .001), which supports the validity of the external anchor. PASS thresholds for the entire cohort were 31 (ROC method) and ∼33 points (predictive modeling method). Larger PASS values were found for male patients and patients aged ≥70 years compared to their female and younger counterparts. The adjusted predictive modeling estimate was 15.3; given that the data do not meet the assumption of normal distribution, we consider this threshold might be biased and must be interpreted with circumspection. A postoperative FJS of ≥33 points can be used as a reference guide to evaluate successful achievement of a “forgotten joint” in a Scottish population. Patients’ characteristics impact PASS estimates and should be considered when interpreting outcome scores. After knee replacement surgery, patients want their new knee to feel natural. The FJS measures how much a person notices their artificial knee in daily life. The score goes from 0 to 100, with higher numbers meaning the knee feels more natural. We studied data from over 1300 patients in Scotland using modern statistical methods. Our results show that most patients need a score of at least 33 to feel satisfied with their knee 1 year after surgery, while men and people aged ≥70 years seem to need higher scores. [Display omitted] •Men and patients aged 70+ years have higher patient acceptable symptom state values.•Adjusted predictive modeling (APM) method decreased the thresholds by more than 50%.W•New PASS thresholds for the FJS 1 year after TKA based on a large Scottish cohort.•Validity of APM method in skewed data needs robust investigation and establishment.•APM studies should report unadjusted values and data properties to enhance result interpretation.

Obstructive sleep apnea (OSA) is a common disorder that describes recurrent collapse of the upper airway during sleep. Animal models have been pivotal to the understanding of OSA pathogenesis, consequences, and treatment. In this review, we highlight the history of OSA research in animals and include the discovery of animals with spontaneous OSA, the induction of OSA in animals, and the emulation of OSA using exposures to intermittent hypoxia and sleep fragmentation.

To estimate patient acceptable symptom state (PASS) thresholds in the Forgotten Joint Score (FJS) one year following primary total knee arthroplasty (PTKA) while investigating the impact of patients' characteristics on PASS thresholds.OBJECTIVETo estimate patient acceptable symptom state (PASS) thresholds in the Forgotten Joint Score (FJS) one year following primary total knee arthroplasty (PTKA) while investigating the impact of patients' characteristics on PASS thresholds.This cohort study used data from patients who underwent PTKA at a public hospital in Scotland between April 2021 and December 2022. Assessment of FJS (0-100, high-low knee awareness) was completed one year post-operatively. A single-item question about satisfaction with the operated knee was completed at one year and served as the anchor for estimating PASS thresholds. Anchor-based predictive modelling (adjusted and unadjusted) and receiver operating characteristic (ROC) curve methods were used to determine PASS thresholds. The impact of patient characteristics on PASS threshold values was investigated by calculating stratified PASS values based on gender and age groups.STUDY DESIGN AND SETTINGThis cohort study used data from patients who underwent PTKA at a public hospital in Scotland between April 2021 and December 2022. Assessment of FJS (0-100, high-low knee awareness) was completed one year post-operatively. A single-item question about satisfaction with the operated knee was completed at one year and served as the anchor for estimating PASS thresholds. Anchor-based predictive modelling (adjusted and unadjusted) and receiver operating characteristic (ROC) curve methods were used to determine PASS thresholds. The impact of patient characteristics on PASS threshold values was investigated by calculating stratified PASS values based on gender and age groups.A total of 1832 PTKAs was performed between April 2021 and December 2022, of which 1359/1832 (74%) had complete data comprising the study cohort. The median age and BMI of patients included in the study was 70 years and 31.2 kg/m2 with 54% being females. The proportion of satisfied patients was 84%. A moderate positive correlation between FJS and patient satisfaction was found (r = 0.64, P < .001) which supports the validity of the external anchor. PASS thresholds for the entire cohort were 31 (ROC method) and ∼33 points (predictive modelling method). Larger PASS values were found for male patients and patients aged 70+ years compared to their female and younger counterparts. The adjusted predictive modelling estimate was 15.3, given that the data does not meet the assumption of normal distribution, we consider this threshold might be biased and must be interpreted with circumspection.RESULTSA total of 1832 PTKAs was performed between April 2021 and December 2022, of which 1359/1832 (74%) had complete data comprising the study cohort. The median age and BMI of patients included in the study was 70 years and 31.2 kg/m2 with 54% being females. The proportion of satisfied patients was 84%. A moderate positive correlation between FJS and patient satisfaction was found (r = 0.64, P < .001) which supports the validity of the external anchor. PASS thresholds for the entire cohort were 31 (ROC method) and ∼33 points (predictive modelling method). Larger PASS values were found for male patients and patients aged 70+ years compared to their female and younger counterparts. The adjusted predictive modelling estimate was 15.3, given that the data does not meet the assumption of normal distribution, we consider this threshold might be biased and must be interpreted with circumspection.A postoperative FJS of ≥ 33 points can be used as a reference guide to evaluate successful achievement of a \"forgotten joint\" in a Scottish population. Patients' characteristics impact PASS estimates and should be considered when interpreting outcome scores.CONCLUSIONA postoperative FJS of ≥ 33 points can be used as a reference guide to evaluate successful achievement of a \"forgotten joint\" in a Scottish population. Patients' characteristics impact PASS estimates and should be considered when interpreting outcome scores.

The position of the tip of the central venous catheter (CVC) is important to minimise complications. The aim of our study was to compare modified Peres' height formula and landmark method using distance between puncture site and right third intercostal space (PS-RTICS) and to develop a reliable formula for correct positioning of tip of the CVC. This prospective, randomised study was conducted on 400 patients of either gender, of age 18 years and older, scheduled to undergo right internal jugular venous cannulation. Depending on the technique used for deciding the length of CVC to be inserted, the patients were randomly allocated into two groups: Group A, using modified Peres' height formula, that is, height of patient (cm)/10-2 and Group B, using distance between PS-RTICS and subtracting one from it, that is (PS-RTICS)-1. The carina was taken as the landmark for optimum insertion of CVC, which was confirmed on postprocedure chest X-ray. Data so obtained were tabulated and analysed. P<.05 was considered statistically significant for correlation and regression coefficients. In group A, the mean length of catheter inserted was 15.18 ± 0.73 cm and the catheter tip was found to be 2.41 ± 0.85 cm distal to carina (P =0.001). Over-insertion was found in 98.45 patients in group A. In group B, the mean length of catheter inserted was 14.12 ± 0.85 cm and the catheter tip was found to be 0.20 ± 1.18 cm distal to carina. Though both landmark and modified Peres' height formula has low accuracy, landmark technique is superior in predicting correct depth of right internal jugular venous cannulation catheter.

The student experience at educational institutes is affected by a variety of factors – academic as well as non-academic. Certain key factors related to uncertainties during a student’s time at the Institute play an outsized role in determining the quality of the student experience. In spite of knowing the factors affecting student experience and developing solutions to tackle the issues, the problem of stress affecting student experience remains endemic across college campuses. Resources provided by educational institutes to address the problem remain under-advertised and under-utilized among students. The data collected by the University of Cincinnati (UC) Student Wellness Center and the Counseling and Psychological Services show that within the previous year 57.4% of the students felt overwhelming anxiety, 49.9% felt things were hopeless, 36.3% felt so depressed that they difficulty functioning and 59.1% felt very lonely. These statistics point to a problem which is also existent on UC campus. This thesis developed tools to help undergraduate design students at UC deal with stress through interventions focused on positive coping mechanisms. The system is a wellness tool-kit which can be adapted or tailored by students to deal with various other stresses in different situations. The data gathered for this research study was derived from two primary sources, undergraduate Communication Design (CODE) students and experts from wellness experts across campus. Student data for identifying the source of the stress was collected from observations, surveys, focus groups, and poster studies. Data for understanding stress factors came from expert interviews with undergraduate CODE professors, representatives from the UC Student Wellness Center, and researchers and psychologists from the UC Counseling and Psychological Services. Tool development was rooted in understanding how stress affects the students, based on insights derived from the research data. To help students cope with uncertainty the 'Thrive: Student Wellbeing Hub' was created based on insights derived from the research data. Thrive is a four-component, adaptable toolkit. Though each tool can be used by itself, the tools are interconnected to provide a holistic environment for responding to stressors. The tools include - the `Thrive Kiosk,’ aimed at changing the student’s mindset through positive messaging; the `Thrive- Space,’ aimed at creating a space for separating the student from his/her stressors; the `Thrive App’ enables community building of like-minded participants across campus; and the `Thrive Journal’ helps students set and meet goals and provide therapeutic journaling. The `Thrive’ toolkit can be implemented with modifications in various similar educational settings to improve the student experience.

Rural segment also known as the BOP (Bottom of Pyramid) segment, in India has lately become an area that corporates' just can’t afford to ignore. The dynamics of rural segment is worth studying. The products that are offered to rural consumers may or may not be different, but the way these products are marketed ought to be very different. Marketers always look for innovative ways to make their presence felt. But, what could be the possible communication strategy to reach the huge market at Bottom of the Pyramid. The regional disparities are many and there is a need for customized communication strategy. While a lot of thrust is being given to the marketing strategies for rural markets, especially distribution and packaging aspects, little is being talked about the specific communication strategies required there. This article intends to address this specific issue, that is, typical communication strategies that one needs to adopt to reach the consumers at the Bottom of the Pyramid. This article highlights the importance of having a specific communication strategy for the Indian BOP market. Attempts are made to fish-out important learnings' from the analysed cases with the help of which a framework for communicating effectively with the BOP markets can be designed.

Rural segment also known as the BOP (Bottom of Pyramid) segment, in India has lately become an area that corporates' just can't afford to ignore. The dynamics of rural segment is worth studying. The products that are offered to rural consumers may or may not be different, but the way these products are marketed ought to be very different. Marketers always look for innovative ways to make their presence felt. But, what could be the possible communication strategy to reach the huge market at Bottom of the Pyramid. The regional disparities are many and there is a need for customized communication strategy. While a lot of thrust is being given to the marketing strategies for rural markets, especially distribution and packaging aspects, little is being talked about the specific communication strategies required there. This article intends to address this specific issue, that is, typical communication strategies that one needs to adopt to reach the consumers at the Bottom of the Pyramid. This article highlights the importance of having a specific communication strategy for the Indian BOP market. Attempts are made to fish-out important learnings' from the analysed cases with the help of which a framework for communicating effectively with the BOP markets can be designed.