Comfort and pressure profiles of two auto-adjustable positive airway pressure devices: a technical report

AbstractStudy objectives: The purpose of this study was to compare comfort parameters and pressure profiles of the AutoSetTM (Resmed) and the SOMNOsmartTM (Weinmann), two auto-adjustable positive airway pressure (APAP) devices. Setting: The sleep disorders center of a university hospital. Design: A single-blind randomized trial protocol was applied. A split night procedure allowed each patient to be treated in a crossover fashion with both APAP devices during one overnight study. Patients and methods: Fifty consecutive obstructive sleep apnea (OSA) patients were recruited. Each patient filled out an evaluation form for both devices after the study night. Visual analogue scales were used to score four comfort measures. Three CPAP outcomes generated by the devices (P50, P95 and Pmax) were assessed, compared with each other and correlated with the individually predicted CPAP (Ppred). Results: Forty-five males and 5 females, mean age 53.0 years, body mass index 31.0, were included. The mean apnea-hypopnea index was 58.7, the mean arousal index was 54.3. Mean CPAP-compliance before the titration study was 4.9h per night. Comparison of the two devices regarding the effect on the subjective sleep quality parameters showed no differences. The AutoSetTM pressure outcomes correlated significantly better with Ppred in comparison with the SOMNOsmartTM. The P50 and P95 but not the Pmax values were significantly lower in the SOMNOsmart™ as compared with the AutoSetTM (P50: 5.1±1.3 vs 7.1±1.9mbar, P<0.0001; P95: 7.8±3.0 vs 9.6±1.9mbar, P<0.0005; Pmax: 10.0±3.4 vs 10.8±1.8mbar, NS). Conclusion: While the subjective tolerance of the two APAP machines was comparable, these devices were characterized by different pressure profiles. The pressure parameters of the AutoSetTM correlated better with Ppred than those of the SOMNOsmartTM

An unstructured parallel least-squares spectral element solver for incompressible flow problems

The parallelization of the least-squares spectral element formulation of the Stokes problem has recently been discussed for incompressible flow problems on structured grids. In the present work, the extension to unstructured grids is discussed. It will be shown that, to obtain an efficient and scalable method, two different kinds of distribution of data are required involving a rather complicated parallel conversion between the data. Once the data conversion has been performed, a large symmetric positive definite algebraic system has to be solved iteratively. It is well known that the Conjugate Gradient method is a good choice to solve such systems. To improve the convergence rate of the Conjugate Gradient process, both Jacobi and Additive Schwarz preconditioners are applied. The Additive Schwarz preconditioner is based on domain decomposition and can be implemented such that a preconditioning step corresponds to a parallel matrix-by-vector product. The new results reveal that the Additive Schwarz preconditioner is very suitable for the p-refinement version of the least-squares spectral element method. To obtain good portable programs which may run on distributed-memory multiprocessors, networks of workstations as well as shared-memory machines we use MPI (Message Passing Interface). Numerical simulations have been performed to validate the scalability of the different parts of the proposed method. The experiments entailed simulating several large scale incompressible flows on a Cray T3E and on an SGI Origin 3800 with the number of processors varying from one to more than one hundred. The results indicate that the present method has very good parallel scaling properties making it a powerful method for numerical simulations of incompressible flows

Parallel Implementation of a Least-Squares Spectral Element Solver for Incomressible Flow Problems

Least-squares spectral element methods are based on two important and successful numerical methods: spectral/{\em hp} element methods and least-squares finite element methods. Least-squares methods lead to symmetric and positive definite algebraic systems which circumvent the Ladyzhenskaya-Babu\v{s}ka-Brezzi stability condition and consequently allow the use of equal order interpolation polynomials for all variables. In this paper, we present results obtained with a parallel implementation of the least-squares spectral element solver on a distributed memory machine (Cray T3E) and on a virtual shared memory machine (SGI Origin 3800)

A parallel, state-of-the-art, least-squares spectral element solver for incompressible flow problems

The paper deals with the efficient parallelization of least-squares spectral element methods for incompressible flows. The parallelization of this sort of problems requires two different strategies. On the one hand, the spectral element discretization benefits from an element-by-element parallelization strategy. On the other hand, an efficient strategy to solve the large sparse global systems benefits from a row-wise distribution of data. This requires two different kinds of data distributions and the conversion between them is rather complicated. In the present paper, the different strategies together with its conversion are discussed. Moreover, some results obtained on a distributed memory machine (Cray T3E) are presented

An Unstructured Parallel Least-Squares Spectral Element Solver for Incompressible Flow Problems

The parallelization of the least-squares spectral element formulation of the Stokes problem has recently been discussed for incompressible flow problems on structured grids. In the present work, the extension to unstructured grids is discussed. It will be shown that, to obtain an efficient and scalable method, two different kinds of distribution of data are required involving a rather complicated parallel conversion between the data. Once the data conversion has been performed, a large symmetric positive definite algebraic system has to be solved iteratively. It is well known that the Conjugate Gradient method is a good choice to solve such systems. To improve the convergence rate of the Conjugate Gradient process, both Jacobi and Additive Schwarz preconditioners are applied. The Additive Schwarz preconditioner is based on domain decomposition and can be implemented such that a preconditioning step corresponds to a parallel matrix-by-vector product. The new results reveal that the Additive Schwarz preconditioner is very suitable for the p-refinement version of the least-squares spectral element method. To obtain good portable programs which may run on distributed-memory multiprocessors, networks of workstations as well as shared-memory machines we use MPI (Message Passing Interface). Numerical simulations have been performed to validate the scalability of the different parts of the proposed method. The experiments entailed simulating several large scale incompressible flows on a Cray T3E and on an SGI Origin 3800 with the number of processors varying from one to more than one hundred. The results indicate that the present method has very good parallel scaling properties making it a powerful method for numerical simulations of incompressible flows

Effects of the dual sodium-glucose linked transporter inhibitor, licogliflozinvsplacebo or empagliflozin in patients with type 2 diabetes and heart failure

Aims Explore the efficacy, safety and tolerability of the dual sodium-glucose cotransporter (SGLT) 1 and 2 inhibitor, licogliflozin in patients with type-2 diabetes mellitus (T2DM) and heart failure. Methods This multicentre, parallel-group phase IIA study randomized 125 patients with T2DM and heart failure (New York Heart Association II-IV; plasma N-terminal pro b-type natriuretic peptide [NT-proBNP] >300 pg/mL) to licogliflozin (2.5 mg, 10 mg, 50 mg) taken at bedtime, empagliflozin (25 mg) or placebo (44 patients completed the study). The primary endpoint was change from baseline in NT-proBNP after 12 weeks. Secondary endpoints included change from baseline in glycated haemoglobin, fasting plasma glucose, weight, blood pressure, fasting lipid profile, high-sensitivity c-reactive protein, and safety and tolerability. Results Licogliflozin 10 mg for 12 weeks significantly reduced NT-proBNPvsplacebo (Geometric mean ratio 0.56 [95% confidence interval: 0.33, 0.95],P =.033). A trend was observed with 50 mg licogliflozin (0.64 [95% confidence interval: 0.40, 1.03],P =.064), with no difference between licogliflozin and empagliflozin. The largest numerical decreases in glycated haemoglobin were with licogliflozin 50 mg (-0.58 +/- 0.34%) and empagliflozin (-0.44 +/- 1.18%)vsplacebo (-0.04 +/- 0.91%). The reduction in body weight was similar with licogliflozin 50 mg (-2.15 +/- 2.40 kg) and empagliflozin (-2.25 +/- 1.89 kg). A numerical reduction in systolic blood pressure was seen with licogliflozin 50 mg (-9.54 +/- 16.88 mmHg) and empagliflozin (-6.98 +/- 15.03 mmHg)vsplacebo (-2.85 +/- 11.97 mmHg). Adverse events (AEs) were mild, including hypotension (6.5%), hypoglycaemia (8.1%) and inadequate diabetes control (1.6%). The incidence of diarrhoea (4.9%) was lower than previously reported. Conclusion The reduction in NT-proBNP with licogliflozin suggests a potential benefit of SGLT1 and 2 inhibition in patients with T2DM and heart failure

Exploring early combination strategy in Latin American patients with newly diagnosed type 2 diabetes : a sub-analysis of the VERIFY study

Background Patients with type 2 diabetes mellitus (T2DM) from Latin American countries face challenges in access to healthcare, leading to under-diagnosis, under-achievement of glycemic target, and long-term complications. Early diagnosis and treatment initiation are of paramount importance in this population due to the high prevalence of risk factors such as obesity and metabolic syndrome. The VERIFY study in patients with newly diagnosed T2DM (across 34 countries), assessed the normoglycemic durability (5 years), with early combination (EC) therapy approach versus the traditional stepwise approach of initiating treatment with metformin monotherapy (MET). Here we present the results from the VERIFY study for participants from eight countries in Latin America. Methods Newly diagnosed adult patients with T2DM, HbA1c 6.5-7.5% and body-mass index (BMI) of 22-40 kg/m(2) were enrolled. The primary endpoint was time to initial treatment failure (TF; HbA1c >= 7.0% at two consecutive scheduled visits 13 weeks apart). Time to second TF was evaluated when patients in both groups were receiving and failing on the vildagliptin combination. Safety and tolerability were also assessed for both treatment approaches during the study. Results A total of 537 eligible patients (female, 58.8%) were randomly assigned to receive either EC (n = 266) or MET (n = 271). EC significantly reduced the relative risk of time to initial TF by 47% versus MET [HR (95% CI) 0.53 (0.4, 0.7) p < 0.0001]. Overall, 46.4% versus 66.3% of patients achieved the primary endpoint in the EC and MET groups, with a median [interquartile range (IQR)] time to TF of 59.8 (27.5, not evaluable) and 33.4 (12.2, 60.1) months, respectively. The risk for time to second TF was 31% lower with EC (p < 0.0092). A higher proportion of patients receiving EC maintained durable HbA1c < 7.0%, < 6.5%, and < 6.0%. Both treatment approaches were well tolerated, and only 3.2% of participants discontinued the study due to adverse events. All hypoglycemic events (EC: n = 7 and MET: n = 3) were single, mild episodes and did not lead to study discontinuation. Conclusion Similar to the global population, long-term clinical benefits were achieved more frequently and without tolerability issues with EC versus standard-of-care MET in this Latin American sub-population. This study is registered with ClinicalTrials.gov, NCT01528254.Peer reviewe

The use of standard calendar software by individuals with acquired brain injury and cognitive complaints: a mixed methods study

PURPOSE: To explore the actual use of standard calendar software by people with acquired brain injury (ABI) and healthy individuals. METHOD: Mixed methods design with qualitative and quantitative analyses of the respondents' use of calendar software. Fifteen individuals with ABI and 15 healthy participants were enrolled. Participants were asked to execute five consecutive tasks using standard calendar software, which resembled everyday use of an electronic calendar. RESULTS: The core processes "task execution" and "information processing" were influenced by internal factors (cognitive and emotional processes and fatigue) as well as environmental factors (software features and distractions). Results obtained by qualitative and quantitative methods showed similar reaction patterns in both groups. However, ABI patients had more cognitive problems and showed stronger emotions during task performance than healthy participants. Healthy participants were more successful and needed less time and mental effort to perform a task. CONCLUSIONS: Although ABI patients were able to use standard calendar software, they became upset more easily, needed more effort, became tired sooner and more suddenly. Strategies to support ABI patients in the use of calendar software are suggested from multi-disciplinary perspectives