Supine sleep patterns as a part of phenotyping patients with sleep apnea—a pilot study

Purpose Polysomnography (PSG) is considered the best objective study to diagnose and quantify sleep disorders. However, PSG involves multiple electrodes and is usually performed in a sleep laboratory that in itself may change the physiology of sleep. One of the parameters that can change during PSG is the sleep position, leading to more supine sleep. The aim of this study was to quantify the amount of supine sleep during PSG and compare it to consecutive nights of a home sleep apnea test (HSAT) in the same patients. Methods This prospective study evaluated 22 consecutive patients undergoing PSG followed by HSAT. Sleep position was analyzed during PSG and subsequently on 2 to 6 nights (mean 3.7 nights) at home, and the amount of supine sleep was recorded during each night. Results Of 22 patients, there were 12 men (55%). The median age was 60.0 years for women and 45.5 years for men. Median proportion of supine sleep during PSG and HSAT was 61% and 26% (p < 0.001), respectively. Four “phenotypes” were identified according to their sleep position during PSG and HSAT, with 5 patients sleeping mainly supine during all nights, 7 patients sleeping mainly non-supine during all nights, 3 patients sleeping in different positions during each night, and 7 patients sleeping supine during PSG but non-supine at home, during HSAT. Conclusions There is a higher proportion of supine sleep during PSG compared to home sleep. We identified a subgroup of patients who slept mainly supine during PSG and mainly non-supine during HSAT. PSG may overestimate OSA severity in a specific phenotype of patients.

Characterization of Glycosylation-Specific Systemic and Mucosal IgA Antibody Responses to Escherichia coli Mucinase YghJ (SslE)

Efforts to develop broadly protective vaccines against pathogenic Escherichia coli are ongoing. A potential antigen candidate for vaccine development is the metalloprotease YghJ, or SslE. YghJ is a conserved mucinase that is immunogenic, heavily glycosylated, and produced by most pathogenic E. coli. To develop efficacious YghJ-based vaccines, there is a need to investigate to what extent potentially protective antibody responses target glycosylated epitopes in YghJ and to describe variations in the quality of YghJ glycosylation in the E. coli population. In this study we estimated the proportion of anti-YghJ IgA antibodies that targeted glycosylated epitopes in serum and intestinal lavage samples from 21 volunteers experimentally infected with wild-type enterotoxigenic E. coli (ETEC) strain TW10722. Glycosylated and non-glycosylated YghJ was expressed, purified, and then gycosylation pattern was verified by BEMAP analysis. Then we used a multiplex bead flow cytometric assay to analyse samples from before and 10 days after TW10722 was ingested. We found that 20 (95%) of the 21 volunteers had IgA antibody responses to homologous, glycosylated YghJ, with a median fold increase in IgA levels of 7.9 (interquartile range [IQR]: 7.1, 11.1) in serum and 3.7 (IQR: 2.1, 10.7) in lavage. The median proportion of anti-YghJ IgA response that specifically targeted glycosylated epitopes was 0.45 (IQR: 0.30, 0.59) in serum and 0.07 (IQR: 0.01, 0.22) in lavage. Our findings suggest that a substantial, but variable, proportion of the IgA antibody response to YghJ in serum during ETEC infection is targeted against glycosylated epitopes, but that gut IgA responses largely target non-glycosylated epitopes. Further research into IgA targeting glycosylated YghJ epitopes is of interest to the vaccine development efforts.

Determinants of farmland prices and their local variation

The setting of farmland prices in the market not only reflects existing agricultural activities but also expected potential for development. This study decomposes farmland prices into values representative of current agricultural production and the prospective development potential at the county level in South Korea. The income value of farmland is derived by analysing agricultural revenue and production cost, and the sale value of farmland is estimated by reviewing transaction prices filed with the administrative authority. The difference between income value and sale value is adopted as the development value in this study. The results of the estimation show that the proportion of development value in the price of farmland is remarkably high, with a median proportion of 0.78, indicating that the threat of converting land to non-agricultural use is non-trivial because it remains a financially attractive alternative. In addition, the magnitude of the portion of the development value in the price of farmland varies considerably across counties depending on the distance to nearby metropolitan cities. This implies that agricultural policy should be designed in a locally optimised manner to effectively restrain the conversion of farmland for urban use.

T Lymphocyte Maturation Profile in the EBUS-TBNA Lymph Node Depending on the DLCO Parameter in Patients with Pulmonary Sarcoidosis

Sarcoidosis (SA) is a systemic granulomatous disorder of unknown etiology with lung and mediastinal lymph nodes (LNs) as the main location. T lymphocytes play important role in the formation of granulomas in SA, but still little is known about the role of maturation profile in the development of inflammatory changes. The aim of this study was to determine the CD4+ and CD8+ T cells maturation profile in LNs and in peripheral blood (PB) and its relation to disease severity expressed by diffusing capacity of the lung for carbon monoxide (DLCO). 29 patients with newly pulmonary SA were studied. Flow cytometry was used for cells evaluation in EBUS-TBNA samples. We observed lower median proportion of T lymphocytes, CD4+ T and CD8+ T cells in patients with DLCO< 80% than in patients with normal diffusion (DLCO > 80%). Patients with DLCO < 80% had lower median proportion of effector and higher median proportion of central memory CD4+ and CD8+ T cells than patients with DLCO > 80%. We reported for the first time that LNs CD4+ and CD8+ T cells maturation differs depending on the DLCO value in sarcoidosis. Lymphocytes profiles in LNs may reflect the immune status of patients with SA and can be analysed by flow cytometry of EBUS-TBNA samples.

Correlation of long-term care facility vaccination practices between seasons and resident types

ABSTRACTObjectivesInfluenza vaccination varies widely across LTCFs due to staff behaviors, LTCF practices, and patient factors. It is unclear how seasonal LTCF vaccination varies between cohabitating but distinct short-stay and long-stay residents. Thus, we assessed the correlation of LTCF vaccination between these populations and across seasons.DesignNational retrospective cohort using Medicare and Minimum Data Set (MDS) data.Setting and ParticipantsU.S. LTCFs. Short-stay and long-stay Medicare-enrolled residents age ≥65 in U.S. LTCFs from a source population of residents during October 1st-March 31st in 2013-2014 (3,042,881 residents; 15,683 LTCFs) and 2014-2015 (3,143,174, residents; 15,667 LTCFs).MethodsMDS-assessed influenza vaccination was the outcome. Pearson correlation coefficients were estimated to assess seasonal correlations between short-stay and long-stay resident vaccination within LTCFs.ResultsThe median proportion of short-stay residents vaccinated across LTCFs was 70.4% (IQR, 50.0-82.7%) in 2013-2014 and 69.6% (IQR, 50.0-81.6%) in 2014-2015. The median proportion of long-stay residents vaccinated across LTCFs was 85.5% (IQR, 78.0-90.9%) in 2013-2014 and 84.6% (IQR, 76.6-90.3%) in 2014-2015. Within LTCFs, there was a moderate correlation between short-stay and long-stay vaccination in 2013-2014 (r=0.50, 95%CI: 0.49-0.51) and 2014-2015 (r=0.53, 95%CI: 0.51-0.54). Across seasons, there was a moderate correlation for LTCFs with short-stay residents (r=0.54, 95%CI: 0.53-0.55) and a strong correlation for those with long-stay residents (r=0.68, 95%CI: 0.67-0.69).Conclusion and ImplicationsIn LTCFs with inconsistent influenza vaccination across seasons or between populations, targeted vaccination protocols for all residents, regardless of stay type, may improve successful vaccination in this vulnerable patient population.Brief summaryIn LTCFs, influenza vaccination was moderately correlated across all residents, but varied across seasons. Inconsistent vaccination among cohabitating residents may increase infection risk in LTCFs.

The Burden and Risk Factors of Patellar and Achilles Tendinopathy in Youth Basketball: A Cohort Study

This study aimed at evaluating the burden and risk factors of patellar and Achilles tendinopathy among youth basketball players. Patellar and Achilles tendinopathy were prospectively monitored in 515 eligible male and female youth basketball players (11–18 years) through a competitive season. Overall, the season prevalence of patellar tendinopathy was 19.0% (95% CI: 15.7–22.7%), 23.2% (95% CI: 18.6–28.2%) in males and 12.5% (95% CI: 8.3–17.9%) in females. The season prevalence of Achilles tendinopathy was 4.3% (95% CI: 2.7–6.4%), 4.1% (95% CI: 2.2–7.0%) in males and 4.5% (95% CI: 2.1–8.4%) in females. Median proportion of symptoms duration was 83% of average total weeks of basketball exposure for patellar tendinopathy and 75% for Achilles tendinopathy. Median time to patellar tendinopathy onset was 8 weeks for male players and 6 weeks for female players. Higher odds of patellar tendinopathy risk were seen in males (OR: 2.23, 95% CI: 1.10–4.69) and players with previous anterior knee pain had significantly elevated odds (OR: 8.5, 95% CI: 4.58–16.89). The burden and risk of patellar tendinopathy is high among competitive youth basketball players. Risk factors include sex and previous anterior knee pain. These findings provide directions for practice and future research.

Proteins as Mediators of the Association Between Diet Quality and Incident Cardiovascular Disease and All‐Cause Mortality: The Framingham Heart Study

Background Biological mechanisms underlying the association of a healthy diet with chronic diseases remain unclear. Targeted proteomics may facilitate the understanding of mechanisms linking diet to chronic diseases. Methods and Results We examined 6360 participants (mean age 50 years; 54% women) in the Framingham Heart Study. The associations between diet and 71 cardiovascular disease (CVD)‐related proteins were examined using 3 diet quality scores: the Alternate Healthy Eating Index, the modified Mediterranean‐style Diet Score, and the modified Dietary Approaches to Stop Hypertension diet score. A mediation analysis was conducted to examine which proteins mediated the associations of diet with incident CVD and all‐cause mortality. Thirty of the 71 proteins were associated with at least 1 diet quality score ( P <0.0007) after adjustment for multiple covariates in all study participants and confirmed by an internal validation analysis. Gene ontology analysis identified inflammation‐related pathways such as regulation of cell killing and neuroinflammatory response (Bonferroni corrected P <0.05). During a median follow‐up of 13 years, we documented 512 deaths and 488 incident CVD events. Higher diet quality scores were associated with lower risk of CVD ( P ≤0.03) and mortality ( P ≤0.004). After adjusting for multiple potential confounders, 4 proteins (B2M [beta‐2‐microglobulin], GDF15 [growth differentiation factor 15], sICAM1 [soluble intercellular adhesion molecule 1], and UCMGP [uncarboxylated matrix Gla‐protein]) mediated the association between at least 1 diet quality score and all‐cause mortality (median proportion of mediation ranged from 8.6% to 25.9%). We also observed that GDF15 mediated the association of the Alternate Healthy Eating Index with CVD (median proportion of mediation: 8.6%). Conclusions Diet quality is associated with new‐onset CVD and mortality and with circulating CVD‐related proteins. Several proteins appear to mediate the association of diet with these outcomes.

Workforce and Task Sharing of Nurses in the Japanese Intensive Care Unit-Cross-Sectional Postal Survey

This study aimed to estimate the number of nurses who independently care for patients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous extracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. We performed a cross-sectional study using postal questionnaire surveys. The study included 725 Japanese intensive care units (ICUs). Data were analyzed using descriptive statistics. Among the 725 ICUs, we obtained 302 responses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% (IQR: 42.3–77.3). The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7–63.3%) in the ICUs that had experience with VV-ECMO use. With regard to task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always titrated sedative dosage in 44.5% of ICUs. Nurse staffing might be inadequate in all ICUs, especially for the management of patients with severe respiratory failure. The proportion of competent nurses to care for severe respiratory failure in ICUs should be considered when determining the workforce of nurses.

Workforce and Task Sharing For Nurses in the Japanese Intensive Care Unit -Cross Sectional Postal Survey

Aim: The aim of this study was to estimate the number of nurses who independently care for pa-tients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous ex-tracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. Methods: We conducted a cross-sectional study using postal surveys. The study included 725 Japanese intensive care units (ICUs). Descriptive statistics were conducted. Results: Among the 725 ICUs, we obtained 302 re-sponses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% [IQR: 42.3-77.3]. The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7-63.3%) in the ICU experiencing VV-ECMO use. Concerning task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always ti-trated sedatives in 44.5% of ICUs. Conclusion: Nurse staffing might be inadequate in all ICUs, es-pecially for severe respiratory failure. The proportion of competent nurses for caring for severe respiratory failure in ICUs should be considered when determining the work force of nurses.

A microcosting analysis of ICU expenditure in the interval between brain death and organ donation

OBJECTIVE: The cost of providing care in an intensive care unit (ICU) after brain death to facilitate organ donation is unknown. The objective of this study was to estimate expenditure for the care delivered in the ICU between the diagnosis of brain death and subsequent organ donation. DESIGN: Cohort study of direct and indirect costs using bottom-up and top-down microcosting techniques. SETTING: Single adult ICU in Australia. PARTICIPANTS: All patients who met criteria for brain death and proceeded to organ donation during a 13-month period between 1 January 2018 and 31 January 2019. MAIN OUTCOME MEASURES: A comprehensive cost estimate for care provided in the ICU from determination of brain death to transfer to theatre for organ donation. RESULTS: Forty-five patients with brain death became organ donors during the study period. The mean duration of post-death care in the ICU was 37.9 hours (standard deviation [SD], 16.5) at a mean total cost of $7520 (SD, $3136) per donor. ICU staff salaries were the greatest contributor to total costs, accounting for a median proportion of 0.72 of total expenditure (interquartile range, 0.68–0.75). CONCLUSIONS: Substantial costs are incurred in ICU for the provision of patient care in the interval between brain death and organ donation.