Treatment of cardiomyopathy with PAP therapy in a patient with severe obstructive sleep apnea.

Obstructive sleep apnea is common in patients with heart failure. This case illustrates that treatment with PAP therapy can improve cardiac function in patients with both conditions. CPAP-emergent central apnea, as seen in this patient, has multiple etiologies. It is commonly seen in patients with severe sleep apnea, usually resolves over time, and does not need treatment with adaptive servoventilation

Multi-Agent System Interaction in Integrated SCM\ud

Coordination between organizations on strategic, tactical and operation levels leads to more effective and efficient supply chains. Supply chain management is increasing day by day in modern enterprises.. The environment is becoming competitive and many enterprises will find it difficult to survive if they do not make their sourcing, production and distribution more efficient. Multi-agent supply chain management has recognized as an effective methodology for supply chain management. Multi-agent systems (MAS) offer new methods compared to conventional, centrally organized architectures in the scope of supply chain management (SCM). Since necessary data are not available within the whole supply chain, an integrated approach for production planning and control taking into account all the partners involved is not feasible. In this study we show how MAS architecture interacts in the integrated SCM architecture with the help of various intelligent agents to highlight the above problem

Sleep Strategies: Sleep in Women A Changing Perspective

As with many other specialties, sleep medicine has been shifting toward helping clinicians obtain a better understanding of gender-specific issues in disorders and disturbances. It is easier today to appreciate the complex dynamics of biological, psychosocial, and cultural factors that define sleep patterns and problems in women. Sleep in women changes across their life spans, with three major shifts likely due to hormonal differences: at the onset of the menstrual cycle, during pregnancy, and during the perimenopausal period

Severe Obesity Hypoventilation Syndrome Treated with Auto-CPAP

Summary Obesity hypoventilation syndrome (OHS) is a serious medical condition that remains undiagnosed in seriously ill hospitalized patients. Significant improvement of daytime hypercapnia can be achieved with positive airway pressure (PAP) therapy. Bi-level PAP is generally employed with the goal of improving ventilation. A 50-year-old woman with OHS and severe hypercapnia was successfully treated with an auto titrating continuous PAP (Auto-CPAP) device. The major role in the pathogenesis of daytime hypercapnia in patients with OHS, is the progressive accumulation of carbon dioxide (CO2) caused by repetitive obstructive events at night, which can be eliminated with the low cost approach of treating with Auto CPAP. Background OHS, an interaction between sleep disordered breathing and obesity-related respiratory impairment leading to chronic daytime hypercapnia, remains under recognized and definitive treatment is often delayed.[1] Treatment of sleep disordered breathing with PAP therapy results in significant improvement of daytime hypercapnia.[2] Auto-CPAP is generally not recommended to treat obesity hypoventilation syndrome.[3,4] We present a patient with OHS and severe daytime hypercapnia who was successfully treated with Auto CPAP. Case Presentation: A fifty-year-old morbidly obese (BMI 52) non-smoking female with a history of hypertension and untreated obstructive sleep apnea (OSA) was admitted to the hospital with severe dyspnoea on exertion in July 2012. She was hypoxemic at admission. Arterial blood gas (ABG) on 2 liters of supplemental oxygen revealed a pH of 7.34, pCO2 of 88 mm Hg and a pO2 of 79 mm Hg. Serum bicarbonate level was elevated at 44mEq/L. Cardiac enzymes were normal. Brain natriuretic peptide (BNP) was elevated at 2161 pg/ml. D-dimer was normal. Chest x-ray was notable for prominence of main pulmonary artery, suggestive of pulmonary artery hypertension. EKG had non-specific changes. Echocardiogram revealed normal left ventricular systolic and diastolic function with mild pulmonary hypertension. Nuclear medicine stress test was normal. Computed tomography angiogram was normal. Pulmonary/Sleep medicine was consulted, and a presumptive diagnosis of OHS was made given the patient\u27s morbid obesity, previous history of OSA and hypoventilation on ABG. She was placed on CPAP at 10 cm water pressure in the hospital and demonstrated significant clinical improvement with relief of shortness of breath. Supplemental oxygen requirements improved from as high as 4 liters per minute via nasal cannula to 2 liters per minutes

A quality improvement project to reduce the wait time for initial appointment in an urban outpatient sleep center

Project Aim: In this study we aimed to see if replacing one face to face follow up visit after sleep study with a phone call by a trained office staff will -decrease the total number of follow up office visits, thus decreasing health care cost -increase the number of new patients seen during the 6 month follow up period -Did not decrease patient compliance.https://jdc.jefferson.edu/patientsafetyposters/1048/thumbnail.jp

Obstructive sleep apnea syndrome and perioperative complications: a systematic review of the literature.

Obstructive sleep apnea syndrome (OSAS) is a common sleep related breathing disorder. Its prevalence is estimated to be between 2% and 25% in the general population. However, the prevalence of sleep apnea is much higher in patients undergoing elective surgery. Sedation and anesthesia have been shown to increase the upper airway collapsibility and therefore increasing the risk of having postoperative complications in these patients. Furthermore, the majority of patients with sleep apnea are undiagnosed and therefore are at risk during the perioperative period. It is important to identify these patients so that appropriate actions can be taken in a timely fashion. In this review article, we will discuss the epidemiology of sleep apnea in the surgical population. We will also discuss why these patients are at a higher risk of having postoperative complications, with the special emphasis on the role of anesthesia, opioids, sedation, and the phenomenon of REM sleep rebound. We will also review how to identify these patients preoperatively and the steps that can be taken for their perioperative management

Ruscheweyh-Goyal Derivative of Fractional Order, its Properties Pertaining to Pre-starlike Type Functions and Applications

The study of the operators possessing convolution form and their properties is considered advantageous in geometric function theory. In 1975 Ruscheweyh defined operator for analytic functions using the technique of convolution. In 2005, Goyal and Goyal generalized the Ruscheweyh operator to fractional order (which we call here Ruscheweyh-Goyal differential operator) using Srivastava-Saigo fractional differential operator involving hypergeometric function. Inspired by these earlier efforts, we discuss the properties of the Ruscheweyh-Goyal derivative of arbitrary order. We define a class of pre-starlike type functions involving the Ruscheweyh-Goyal fractional derivative and obtain the inclusion relation. Further, we prove that Ruscheweyh-Goyal derivative operator preserve the convexity and starlikeness for an analytic function. The majorization results for fractional Ruscheweyh-Goyal derivative has been discussed using a newly defined subclass

Does A Short, Thick Neck Predict Obstructive Sleep Apnea?: The Role of Physical Examination in OSA Screening

Purpose: The purpose of this study was to determine whether a short neck, alone or together with a thick neck, can predict obstructive sleep apnea (OSA). Methods: The laryngeal heights of 169 new adult patients presenting to a sleep medicine physician were measured over a period of 5 months. Neck circumference, Mallampati score, and body-mass index (BMI) were also determined, together with medical history, smoking status, and serum bicarbonate. Lastly, patients’ polysomnograms were obtained in order to ascertain the presence or absence of OSA as indicated by the apnea-hypopnea index, as well as other sleep study parameters. Results: No association was found between laryngeal height and presence of OSA, bicarbonate concentration or oxygen saturation. Of interest, neck circumference was also not significantly associated with any of the aforementioned parameters, although there was a trend towards significance in its association with OSA (p=0.055). Still, a combined short laryngeal height and large neck circumference was associated with lower nadir SaO2 (p=0.018). Of all clinical parameters we measured, only higher BMI, older age and male sex were positively associated with OSA (p\u3c0.05). Conclusion: This study challenges the popular notion that short necks predict OSA

Families of Multivalent Analytic Functions Associated with the Convolution Structure

The main aim of the present paper is to introduce a new class of multivalent analytic functions by using the familiar concept’s of convolution structure. The results investigated in the present paper include the characterization properties for this class of analytic functions. Some new and interesting consequences of our results are also pointed out

A novel approach in extracting predictive information from water-oil ratio for enhanced water production mechanism diagnosis

Despite the advances in water shutoff technologies, the lack of an efficient diagnostic technique to identify excess water production mechanisms in oil wells is preventing these technologies being applied to deliver the desired results, which costs oil companies a lot of time and money. This paper presents a novel integrated approach for diagnosing water production mechanisms by extracting hidden predictive information from water-oil ratio (WOR)graphs and integrating it with static reservoir parameters. Two common types of excess water production mechanism(coning and channelling) were simulated where a wide range of cases were generated by varying a number of reservoir parameters. Plots of WOR against oil recovery factor were used to extract the key features of the WOR data. Tree-based ensemble classifiers were then applied to integrate these features with the reservoir parameters and build classification models for predicting the water production mechanism. Our results show high rates of prediction accuracy for the range of WOR variables and reservoir parameters explored, which demonstrate the efficiency of the proposed ensemble classifiers. Proactive water control procedures based on proper diagnosis obtained by the proposed technique would greatly optimise oil productivity and reduce the environmental impacts of the unwanted water