Chronic obstructive pulmonary disease and obstructive sleep apnea overlap: who to treat and how?

IntroductionThe co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), or the overlap syndrome, is common and associated with a distinct pattern of nocturnal hypoxemia and worse clinical outcomes than either disease alone. Consequently, identifying who and how to treat these patients is essential.Areas coveredTreatment is recommended in all patients with OSA and symptoms or systemic hypertension, but determining symptoms attributable to OSA can be challenging in patients with COPD. Treatment should be considered in asymptomatic patients with moderate to severe OSA and COPD with pulmonary hypertension and comorbid cardiovascular and cerebrovascular disease, especially if marked hypoxic burden. CPAP is effective, but in patients with the overlap syndrome and daytime hypercapnia, high-intensity noninvasive ventilation aiming to lower PaCO2 may have additional benefits. Additionally, in those with severe resting daytime hypoxemia, supplemental oxygen improves survival and should be added to positive airway pressure. The role of alternative non-positive airway pressure therapies in the overlap syndrome needs further study.Expert opinionBoth COPD and OSA are heterogeneous disorders with a wide range of disease severity and further research is needed to better characterize and prognosticate patients with the overlap syndrome to personalize treatment

The effect of limbic damage on the retention and performance of a runway response

Rats were trained to run a linear runway while hungry for food. Then they were tested for retention, continued performance levels, and extinction after recovery from bilateral damage of the hippocampus, the septal area, or the posterolateral neocortex. Retention losses were observed in animals which had hippocampal or neocortical destruction. Slower running speeds were found in animals with hippocampal destruction, while the running speeds of animals with septal area damage increased. Animals with hippocampal destruction and with septal area damage showed greater resistance to extinction than other groups of animals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/33433/1/0000835.pd

Evaluation of a novel device to assess obstructive sleep apnea and body position.

Study objectivesObstructive sleep apnea is a prevalent disease with well-known complications when left untreated. Advances in sleep-disordered breathing diagnosis may increase detection and appropriate treatment. The Wesper device is a recently developed portable system with specialized wearable patches that can measure respiratory effort, derived airflow, estimated air pressure, and body position. This study sought to compare the diagnostic ability of the novel Wesper device with the gold standard of polysomnography.MethodsPatients enrolled in the study underwent simultaneous polysomnography and Wesper device testing in a sleep laboratory setting. Data were collected and scored by readers blinded to all patient information, and the primary reader was blinded to testing method. The accuracy of the Wesper device was determined by calculation of the Pearson correlation and Bland-Altman limits of agreement of apnea-hypopnea indices between testing methods. Adverse events were also recorded.ResultsA total of 53 patients were enrolled in the study and 45 patients were included in the final analysis. Pearson correlation between polysomnography and Wesper device apnea-hypopnea index determinations was 0.951, which met the primary endpoint goal (P = .0003). The Bland-Altman 95% limits of agreement were -8.05 and 6.38, which also met the endpoint goal (P < .001). There were no adverse events or serious adverse events noted.ConclusionsThe Wesper device compares favorably with gold-standard polysomnography. Given the lack of safety concerns, we advocate for further study regarding its utility in diagnosis and management of sleep apnea in the future.CitationRaphelson JR, Ahmed IM, Ancoli-Israel S, et al. Evaluation of a novel device to assess obstructive sleep apnea and body position. J Clin Sleep Med. 2023;19(9):1643-1649

The Therapeutic Community and the Rehabilitation of Drug Abusers : a Study of the Third Nail, Roxbury, Massachusetts

viii, 78 p.This paper is the product of a four month internship at The Third Nail. The purpose of the internship was to gain experience and understanding about the rehabilitation of drug abusers. My interest included aspects of drug use itself, the nature of hard core drug abusers, the counseling relationship, and the politics and economics of running an inpatient drug rehabilitation program

Code Generating Programs: Using the Computer to Instruct Itself

i, 240 p.Asgrow Seeds, a subsidiary of the Upjohn Company, is a nationwide distributor of corn, sorghum and soybean seeds. In a continuing effort to improve the quality of their products Asgrow helps sponsor tests run by independent agencies, usually agricultural colleges, all over the country. They use the results of these tests in research, advertising and legal cases. The only problem with utilizing so many testing services is that each of them uses their own particular report format which change regularly. This poses a serious problem when trying to record the findings on permanent computer files . Until recently Asgrow would highlight the parts of the report booklet which contained valuable information and send it to the keypuncher, Then, they would hire a programmer, from Upjohn 's Mathematical Services Unit, to write two programs which understood the keypuncher's format . The first program would print an alphabetical listing of all the brands and varieties tested for that report with the mean, minimum and maximum values for their yields. This print-out would be carefully checked for keypunching errors as well as non-standard abbreviations and the keypunched data set would be corrected accordingly. The second program would take the revised data set and transfer its contents to the two permanent computer files. This method was not only simple but allowed the programmer to perform any statistical functions on the data set that the testing service had left out. Not every service reports all the items that Asgrow records on its permanent files, although more often than not they report the information necessary to determine the missing items. Programs that are tailor-made for each data set can fill in the missing values. The disadvantage to this method was that hiring a programmer each time an agency changed its format meant spending a great deal of money in analyst's fees. This disadvantage soon became considerable. The solution was to design a higher order of computer program that could write the programs described above. The theory behind this idea was rather basic. Computers have always been used to produce reports according to very strict formats (pay-checks for example). So why not have the computer produce output that it can understand itself? Further, since programs are written on the same sort of data sets that they write into and read from, the code-generating program could place the code in the data set that would store it later. David Pyne and Teresa Hart, of Upjohn's Biostatistics Unit, wrote a similar program in early 1981. Their program read and processed hospital patient records for research in the analysis of clinical trials. It generated code at the bottom of its own data space and executed the code as soon as it finished executing itself. I started work on my project using the basic technology that Pyne and Hart developed.Upjohn Company. Kalamazoo, Michigan

Imaginative And Direct Verbal Measures Of Anxiety Related To Physiological Reactions In The Competitive Achievement Situation.

PhDExperimentsPsychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/181659/2/0018641.pd