Sleep apnoea and cardiac surgery: Screening, prevalence and postoperative outcomes

Introduction: An excess of postoperative complications have been reported in patients with Obstructive Sleep Apnoea (OSA) following surgical procedures, however, studies reporting outcomes in patients with OSA following cardiac surgery are sparse and of limited quality. The cause of worse surgical outcomes in the OSA population is unknown but deleterious effects of opiates/opioids, common pain relieve medication following surgery have previously been proposed. There is a move towards pre-operative screening for OSA prior to surgery but the best screening methodology has not yet been established and more importantly the effect of treatment, in particular Continuous Positive Airway Pressure (CPAP), on surgical outcomes in patients with OSA is unknown. Aim: This thesis examined the prevalence of sleep apnoea and its association with postoperative outcomes in patients undergoing major cardiac surgery. It also explored the usefulness of the STOP-Bang questionnaire, as a screening tool for OSA prior to cardiac surgery. In addition, current evidence regarding the effects of opiates/opioids and sedatives on patients with OSA was investigated and summarised in the Systematic Cochrane Review. The effect of morphine on severity of sleep apnoea in patients with moderate OSA was examined in a separate study. Methods: The prevalence and association of sleep apnoea with postoperative outcomes in patients undergoing cardiac surgery and the usefulness of the STOP-Bang questionnaire in identifying patients at risk of OSA prior surgery was examined in a prospective, observational cohort study. The Systematic Cochrane review included randomised controlled trials examining the effects of opioids and sedatives, compared to placebo on severity of OSA in patients with established diagnosis of OSA. The effect of intravenous morphine sulphate on the severity of sleep apnoea was examined in a prospective, paired design trial which recruited patients with moderate OSA. Results: A high prevalence of sleep apnoea (47%) and a significant association between its severity and postoperative complications was found in 122 participants undergoing major cardiac surgery. The most significant risk factor for complications was found to be oxygen desaturations during the night reflecting the severity of sleep apnoea (OR=1.1 for each unit increase in oxygen desaturation index (ODI), 95% CI 1.02-1.17; p=0.014). It was found that the STOP-Bang scores between 0-2 would with high confidence exclude patients with at least moderate sleep apnoea prior surgery. The best diagnostic performance for diagnosis of at least moderate sleep apnoea was found at higher STOP-Bang scores of ≥6 which could identify those patients who might benefit from a sleep study before cardiac surgery. A systematic Cochrane review found that opiates/opioids, sedatives and hypnotics have no deleterious effect on the severity of OSA but most of the studies included in the review were of short duration, small size and with indiscernible methodological quality. The results of the Systematic Cochrane Review informed the development of my study, studying the effect of opiate, morphine sulphate, on patients with moderate OSA. This showed no change in Apnoea/Hypopnoea Index (AHI) where median difference (MD) was -12.95, IQR 9.45, p=0.173 but showed significant improvement in sleep apnoea indices including: obstructive apnoea index (MD -2.7, IQR 7.37, p=0.03), central apnoea index (MD – 0.35, IQR 0.83, p=0.04 ).However there was a fall in median nocturnal oxygen saturation. Conclusion: This thesis reports high prevalence of sleep apnoea which was also found to be a risk factor for postoperative complications in patients undergoing major cardiac surgery. In this population, STOP-Bang score ≥6 could identify patients in need of a sleep study to identify those who may be at increased risk of postoperative complications. To date there is no strong evidence supporting deleterious effects of opioids/opiates on patients with OSA but larger studies are needed to clarify its effect.Funded by the Royal Papworth Hospital, department of the Respiratory Support and Sleep Centr

THE EFFECTS AND EFFICIENCY OF HEARING STORIES ON VOCABULARY ACQUISITION BY STUDENTS OF GERMAN AS A SECOND FOREIGN LANGUAGE IN JAPAN

The usual approach to vocabulary learning is to present students with a list of words to be memorized, present them in the context of a text, and then provide exercises to “reinforce” the vocabulary. The purpose of these studies with beginning level German-as-a-foreign language university students in Japan was to determine whether beginning level students with limited vocabulary in German could sustain their interest in hearing a story for over 20 minutes, and to determine how much vocabulary could be gained just from hearing stories, without a list to memorize and supplementary vocabulary exercises. The first experiment showed that hearing a story had a higher acquisition/learning rate than a list method. The second and third experiments showed that supplementary focus on form activities were not worthwhile on vocabulary acquisition/learning, and that the rate of acquisition/learning was .10 words per minute during the seven weeks. It appears to be the case that students acquire six words per hour when they hear stories, while they learn 2.4 words per hour in traditional classes. Keywords:    German-as-a-foreign language; vocabulary exercises; acquisition/learning rate; focus on form

the effects and efficiency of hearing stories on vocabulary acquisition by students of German as a second foreign language in Japan

The usual approach to vocabulary learning is to present students with a list of words to be memorized, present them in the context of a text, and then provide exercises to “reinforce” the vocabulary. The purpose of these studies with beginning level German-as-a-foreign language university students in Japan was to determine whether beginning level students with limited vocabulary in German could sustain their interest in hearing a story for over 20 minutes, and to determine how much vocabulary could be gained just from hearing stories, without a list to memorize and supplementary vocabulary exercises. The first experiment showed that hearing a story had a higher acquisition/learning rate than a list method. The second and third experiments showed that supplementary focus on form activities were not worthwhile on vocabulary acquisition/learning, and that the rate of acquisition/learning was .10 words per minute during the seven weeks. It appears to be the case that students acquire six words per hour when they hear stories, while they learn 2.4 words per hour in traditional classes

Combining LoRaWAN and a New 3D Motion Model for Remote UAV Tracking

Over the last few years, the many uses of Unmanned Aerial Vehicles (UAVs) have captured the interest of both the scientific and the industrial communities. A typical scenario consists in the use of UAVs for surveillance or target-search missions over a wide geographical area. In this case, it is fundamental for the command center to accurately estimate and track the trajectories of the UAVs by exploiting their periodic state reports. In this work, we design an ad hoc tracking system that exploits the Long Range Wide Area Network (LoRaWAN) standard for communication and an extended version of the Constant Turn Rate and Acceleration (CTRA) motion model to predict drone movements in a 3D environment. Simulation results on a publicly available dataset show that our system can reliably estimate the position and trajectory of a UAV, significantly outperforming baseline tracking approaches.Comment: 6 pages, 6 figures, in review for IEEE WISARN 2020 (INFOCOM WORKSHOP) 2020 : IEEE WiSARN 2020 (INFOCOM WORKSHOP) 2020: 13th International Workshop on Wireless Sensor, Robot and UAV Network

Real-Life Effectiveness of Adalimumab Biosimilars in Patients with Chronic Plaque Psoriasis

Introduction The real-life effectiveness of adalimumab biosimilars in patients with psoriasis has rarely been investigated. Objective To investigate drug survival of adalimumab biosimilars in patients with chronic plaque psoriasis and factors associated with its discontinuation. Methods We carried out a retrospective observational study including all consecutive patients with chronic plaque psoriasis who initiated adalimumab biosimilar MSB11022 (Idacio), ABP501 (Amgevita), or SB5 (Imraldi) between 1 January 2018 and 1 January 2021. The 1-year drug survival of adalimumab biosimilar and independent factors associated with its discontinuation were investigated. Cox regression models were fit to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the risk of adalimumab discontinuation. A propensity score matching (PSM) model was adopted as sensitivity analysis. Results The study involved a total of 410 patients with follow-up of 549.84 person-years, 271 (66.1%) men, a mean (SD) age of 51.8 (14.5) years, and a baseline PASI of 14.54 (5.02). Among adalimumab biosimilars, 250 (61%) patients received MSB11022, 98 (24%) received ABP501, and 62 (15%) received SB5. Drug survival of adalimumab biosimilars at 1 year was 81.5% in the overall study population. Obesity was associated with increased risk of adalimumab discontinuation (HR = 2.01; 95% CI 1.33-3.03), whereas psoriatic arthritis (aHR = 0.32; 95% CI 0.16-0.64) and receiving adalimumab as first systemic treatment (aHR = 0.44; 95% CI 0.27-0.70) were associated with lower risk. Conclusion The real-life effectiveness of adalimumab biosimilars in patients with psoriasis is consistent with that previously reported for the originator

The Effects And Efficiency Of Hearing Stories On Vocabulary Acquisition By Students Of German AS A Second Foreign Language In Japan

The usual approach to vocabulary learning is to present students with a list of words to be memorized, present them in the context of a text, and then provide exercises to “reinforce” the vocabulary. The purpose of these studies with beginning level German-as-a-foreign language university students in Japan was to determine whether beginning level students with limited vocabulary in German could sustain their interest in hearing a story for over 20 minutes, and to determine how much vocabulary could be gained just from hearing stories, without a list to memorize and supplementary vocabulary exercises. The first experiment showed that hearing a story had a higher acquisition/learning rate than a list method. The second and third experiments showed that supplementary focus on form activities were not worthwhile on vocabulary acquisition/learning, and that the rate of acquisition/learning was .10 words per minute during the seven weeks. It appears to be the case that students acquire six words per hour when they hear stories, while they learn 2.4 words per hour in traditional classes

Mother-child Dyadic Influences of Affect on Everyday Movement Behaviors: Evidence from an Ecological Momentary Assessment Study

Background Research has shown that affect is associated with everyday movement behaviors in children and adults. However, limited work to date has investigated dyadic influences of momentary affect on moderate-to-vigorous physical activity (MVPA) and sedentary time among children and their mothers using ecological momentary assessment (EMA). Methods Mothers and their children (eight to 12-years-old at baseline) from the Los Angeles metropolitan area participated in a longitudinal study with six semi-annual measurement waves across three years. During each measurement wave, mothers and children reported momentary negative and positive affect via a custom smartphone-based EMA application across seven days (randomly sampled up to eight times per day). Each dyad member’s momentary affective states were used to predict their own and the other dyad member’s accelerometer-measured MVPA and sedentary time in the prompt-matched 45-min time window. Multilevel modeling within the actor-partner interdependence model (APIM) framework was applied to accommodate the nested dyadic nature of the data. Results At the within-subject level, when children had higher-than-usual positive affect, they engaged in greater MVPA and less sedentary time in the prompt-matched 45-min window (actor effects; ps \u3c .001). When mothers experienced higher-than-usual positive affect, they engaged in more sedentary time in the same 45-min window (actor effect; p \u3c .001). Children’s higher-than-usual positive affect also predicted more MVPA time of their mothers (partner effect; p \u3c .05). At the between-subjects level, for mothers who reported higher average negative affect than other mothers, their children overall had less MVPA and more sedentary time (partner effects ps \u3c .05). Conclusions This study extends the literature by demonstrating that mothers’ and children’s everyday physical activity and sedentary time are not only associated with their own affective states, but also may be influenced by the affective states of each other. Our findings suggest that affective states have the potential to influence movement behaviors in mother-child dyads’ everyday lives. Affective underpinnings of physical activity and sedentary behaviors should be further studied in order to develop family-based intervention strategies to influence these behaviors

Partner symmetries of the complex Monge-Ampere equation yield hyper-Kahler metrics without continuous symmetries

We extend the Mason-Newman Lax pair for the elliptic complex Monge-Amp\`ere equation so that this equation itself emerges as an algebraic consequence. We regard the function in the extended Lax equations as a complex potential. We identify the real and imaginary parts of the potential, which we call partner symmetries, with the translational and dilatational symmetry characteristics respectively. Then we choose the dilatational symmetry characteristic as the new unknown replacing the K\"ahler potential which directly leads to a Legendre transformation and to a set of linear equations satisfied by a single real potential. This enables us to construct non-invariant solutions of the Legendre transform of the complex Monge-Amp\`ere equation and obtain hyper-K\"ahler metrics with anti-self-dual Riemann curvature 2-form that admit no Killing vectors.Comment: submitted to J. Phys.

Towards Noncommutative Integrable Systems

We present a powerful method to generate various equations which possess the Lax representations on noncommutative (1+1) and (1+2)-dimensional spaces. The generated equations contain noncommutative integrable equations obtained by using the bicomplex method and by reductions of the noncommutative (anti-)self-dual Yang-Mills equation. This suggests that the noncommutative Lax equations would be integrable and be derived from reductions of the noncommutative (anti-)self-dual Yang-Mills equation, which implies the noncommutative version of Richard Ward conjecture. The integrability and the relation to string theories are also discussed.Comment: 13 pages, 1 figure, LaTeX; v2: typos corrected, comments and references added; v3: comments and references added, version to appear in Phys. lett.