Does Physician Education of Alternative Therapies for Obstructive Sleep Apnea Improve Utilization?

Methods: We conducted a retrospective chart review of patients in the Jefferson Sleep Disorder Center (JSDC) consisting of 2 cohorts of patients. The first was a group of patients undergoing PSG in March, 2014 prior to institution of the UAS program. The second was a cohort of patients undergoing PSG in July 2016 after institution of the UAS program, positive initial results, readily available literature in the JSDC, and a physician in-service including details of the procedure and outcome, quality of life, and complication rate data. We collected demographic and PSG data. We then reviewed the electronic medical record and assessed the first and second followupat the JSDC for CPAP compliance data and referral for oral appliance, body positioning device, or surgical evaluation.https://jdc.jefferson.edu/patientsafetyposters/1058/thumbnail.jp

Cognitive changes in patients treated for Obstructive Sleep Apnea with upper airway stimulation, maxillomandibular advancement, or expansion sphincter pharyngoplasty

Introduction: Obstructive sleep apnea (OSA) is a prevalent diagnosis that has been shown to not only affect sleepiness, but daytime cognitive function — specifically attention, working memory, and executive function. CPAP treatment is troublesome for some patients and it is possible that superior treatment options, specifically novel surgical techniques, are available, though none have been evaluated for their long-term effects on neurocognition. We hypothesize that treating patients with upper airway stimulation surgery (UAS) UAS, maxillomandibular advancement surgery (MMA), and expansion sphincter pharyngoplasty surgery (ESP) for OSA produces a significant improvement in cognition from baseline. Methods: For inclusion in the study, two important criteria must be met: 1) a previous diagnosis of OSA 2) patients have failed CPAP. Exclusion criteria include pediatric population (\u3c18 years of age), and those without ability to complete the NIH Toolbox assessment on an iPad in English. Using the iPad-based NIH Toolbox assessment, the primary outcome of the study is to analyze the effect of UAS, MMA, and ESP treatment on three markers of cognition: the Processing Speed Test, the Inhibitory Control and Attention Test, and Sorting Working Memory Test (15 minutes total). Results: Data reported below is for one timepoint for nine patients receiving UAS: ▪ Age=53.8 ± 15.4 ▪ BMI=29.2 ± 4.2 ▪ Depression diagnosis:3/9 ▪ CCI \u3e 0: 5/9 ▪ Age-adjusted national percentiles: ▪ Processing speed: 61.4±43.7 ▪ Inhibitory Control and Attention Test: 59.1±32.3 ▪ Sorting Working Memory Test: 52.8±23.7 Discussion: The results of this study will give providers additional information in evaluating treatment options for patients with cognitive deficit related to OSA. The gold standard for assessing neurocognitive function is fMRI, as demonstrated by studies done showing improvement in CPAP patients. Success in this study may support further research using fMRI data to support the hypothesis of improvement in cognition

Algal food and fuel coproduction can mitigate greenhouse gas emissions while improving land and water-use efficiency

The goals of ensuring energy, water, food, and climate security can often conflict.Microalgae (algae) are being pursued as a feedstockfor both food and fuels—primarily due to algae’s high areal yield and ability to grow on non-arable land, thus avoiding common bioenergy-food tradeoffs. However, algal cultivation requires significant energy inputs that may limit potential emission reductions.We examine the tradeoffs associated with producing fuel andfood from algae at the energy–food–water–climate nexus.We use the GCAM integrated assessment model to demonstrate that algalfood production can promote reductions in land-use change emissions through the offset of conventional agriculture. However,fuel production, either via co-production of algal food and fuel or complete biomass conversion to fuel, is necessary to ensure long-term emission reductions, due to the high energy costs of cultivation. Cultivation of salt– water algae for food products may lead to substantial freshwater savings; but, nutrients for algae cultivation will need to be sourced from waste streams to ensure sustainability. By reducing the land demand of food production, while simultaneously enhancingfood and energy security, algae can further enable the development of terrestrial bioenergy technologies including those utilizing carbon capture and storage. Our results demonstrate that large-scale algae research and commercialization efforts should focus on developing both food and energy products to achieve environmental goals.https://iopscience.iop.org/article/10.1088/1748-9326/11/11/114006/metaPublished versio

Reduced Recovery Times with Total Intravenous Anesthesia in Patients with Obstructive Sleep Apnea

Introduction: There are currently no specific anesthetic guidelines for patients with obstructive sleep apnea (OSA) undergoing upper airway surgery. Two consistently utilized anesthetic approaches during such procedures include inhalational gas anesthesia and total intravenous anesthesia (TIVA), however whether either is more efficacious remains undefined. We hypothesize that administration of TIVA will lead to reduced post-operative recovery time in patients with comorbid OSA undergoing upper airway surgery. Methods: A retrospective chart review was performed for patients with comorbid OSA that underwent surgery (upper airway stimulation, nasal surgery, palate surgery) between January 2019 and December 2019. Included patients received either inhaled anesthesia or TIVA, and were assessed for time spent in Phase I (main re-stabilization phase) of post-operative recovery. Calculated times were compared using unpaired non-parametric Mann Whitney U tests. Results: Collectively, 86 patients received inhaled anesthesia and 62 patients received TIVA. Phase I times were lessened following the use of TIVA as opposed to inhaled anesthesia when patients were stratified by surgery type. Upper airway stimulation, nasal surgery, and palate surgery patients experienced Phase I time decreases of 42.5 minutes (P \u3c 0.001), 35.5 minutes (P \u3c 0.001), and 36 minutes (P = 0.02), respectively. Discussion: Patients with comorbid OSA experienced significantly reduced time spent in the main phase of post-operative recovery after receiving TIVA, supporting our hypothesis. This study sheds light on potential benefits of TIVA as an anesthetic approach to surgical patients with OSA. Further study is necessary to support this patient population by expanding upon these findings

Comparing Treatment Efficacy of Upper Airway Stimulation to CPAP for Obstructive Sleep Apnea

Introduction Upper airway stimulation (UAS) is newer treatment option for the management of Obstructive Sleep Apnea (OSA) and presents an alternative to the traditional Continuous Positive Airway Pressure (CPAP). Previously published data has shown good control of disease severity utilizing UAS with high patient tolerance and compliance. We aim to compare a cohort of patients treated with UAS and CPAP and evaluate therapy usage and disease control through use of the mean disease alleviation concept. Methods We evaluated demographic, pre and post-treatment sleep study, and therapy utilization data of cohorts of patients with OSA treated with CPAP and UAS. We compared the two groups and used the mean disease alleviation (MDA) concept to assess overall control of disease. Results We included 101 patients undergoing UAS therapy and postoperative PSG. We compared this group to a cohort of 149 patients diagnosed with moderate-severe OSA and treated with CPAP who were undergoing sleep study in our lab. We found the UAS group to be significantly older, with more severe disease, and a lower BMI. Utilizing the MDA concept, we found the UAS group to have a significantly higher utilization of therapy and disease alleviation with lower residual Apnea-Hypopnea Index (AHI) Conclusion UAS is an alternative treatment option to CPAP which is well tolerated by patients and offers good disease control

Intraoperative radiation therapy for advanced cervical metastasis: a single institution experience

<p>Abstract</p> <p>Background</p> <p>The purpose of this study is to review our experience with the use of IORT for patients with advanced cervical metastasis.</p> <p>Methods</p> <p>Between August 1982 and July 2007, 231 patients underwent neck dissections as part of initial therapy or as salvage treatment for advanced cervical node metastases resulting from head and neck malignancies. IORT was administered as a single fraction to a dose of 15 Gy or 20 Gy in most pts. The majority was treated with 5 MeV electrons (112 pts, 50.5%).</p> <p>Results</p> <p>1, 3, and 5 years overall survival (OS) after surgery + IORT was 58%, 34%, and 26%, respectively. Recurrence-free survival (RFS) at 1, 3, and 5 years was 66%, 55%, and 49%, respectively. Disease recurrence was documented in 83 (42.8%) pts. The majority of recurrences were regional (38 pts), as compared to local recurrence in 20 pts and distant failures in 25 pts. There were no perioperative fatalities.</p> <p>Conclusions</p> <p>IORT results in effective local disease control at acceptable levels of toxicity. Our results support the initiation of a phase III trial comparing outcomes for patients with cervical metastasis treated with or without IORT.</p

Marine microalgae commercial production improves sustainability of global fisheries and aquaculture

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Profiles of Biomarkers of Excess Alcohol Consumption in Patients Undergoing Total Hip Replacement: Correlation with Function

Aims. Patients who misuse alcohol may be at increased risk of surgical complications and poorer function following hip replacement. Identification and intervention may lead to harm reduction and improve the outcomes of surgery. The aim of this study was to determine the prevalence of biomarker elevation in patients undergoing hip replacement and to investigate any correlation with functional scores and complications. Methods. We performed a retrospective study that examined the profile of biomarkers of alcohol misuse in 1049 patients undergoing hip replacement. Results. Gamma-glutamyltransferase was elevated in 150 (17.6%), and mean corpuscular volume was elevated in 23 (4%). At one year general physical health was poorer where there was elevation of γGT, and the mental health and hip function was poorer with elevation of MCV. There were no differences in complications. Discussion. Raised biomarkers can alert clinicians to potential problems. They also provide an opportunity to perform further investigation and offer intervention. Future research should focus on the use in orthopaedic practice of validated screening questionnaires and more sensitive biomarkers of alcohol misuse. Conclusion. This study demonstrates a potential substantial proportion of unrecognised alcohol misuse that is associated with poorer functional scores in patients after total hip replacement

Marine Microalgae: Climate, Energy, and Food Security From the Sea

Climate, energy, and food security are three of the greatest challenges society faces this century. Solutions for mitigating the effects of climate change often conflict with solutions for ensuring society’s future energy and food requirements. For example, BioEnergy with Carbon Capture and Storage (BECCS) has been proposed as an important method for achieving negative CO2 emissions later this century while simultaneously producing renewable energy on a global scale. However, BECCS has many negative environmental consequences for land, nutrient, and water use as well as biodiversity and food production. In contrast, large-scale industrial cultivation of marine microalgae can provide society with a more environmentally favorable approach for meeting the climate goals agreed to at the 2015 Paris Climate Conference, producing the liquid hydrocarbon fuels required by the global transportation sector, and supplying much of the protein necessary to feed a global population approaching 10 billion people