Diet as a Risk Factor in Obstructive Sleep Apnea

Rationale: Obstructive sleep apnea (OSA) is a common disease affecting approximately 2% of women and 4% of men. It is independently associated with cardiovascular disease and metabolic syndrome. Established risk factors for OSA include obesity, male gender, post-menopausal state, smoking and increased neck circumference. Sleep deprivation, a common occurrence in OSA, is associated with weight gain and cravings for carbohydrates. Preference for fatty foods has been documented in sleep deprivation. Studies using mouse models have suggested that high fats diets increase the severity of sleep apnea independent of BMI (body mass index). We hypothesized that dietary habits, especially increased fatty food intake, are independently associated with severity of OSA. Methods: 104 patients, diagnosed with obstructive sleep apnea and presenting to the George Washington-Medical Faculty Associates Center for Sleep Disorders, completed a validated diet survey, Rapid Eating Assessment for Patients (REAP). Apnea-hypopnea index (AHI) was used as a measure of the severity of OSA. Subjects were divided using BMI in to obese (BMI \u3e 30 kg/m2) and overweight (BMI \u3e 25 but \u3c 30 kg/m2) categories. Regression analysis was performed to predict severity of OSA from gender, BMI, age, % energy from fat, and the individual dietary components of REAP. Results: Subjects with a BMI(\u3e35% of their total diet) had twice the severity of sleep apnea (AHI 18.2 ± 10.1 vs. 36.6 ± 27.5; p = 0.001). There was a statistically significant difference (p= 0.04) in OSA severity between subjects eating processed meats “often” [AHI 42.5 ± 30.7] versus those eating “rarely/never” [AHI 28.9 ± 22.7], even after adjusting for BMI. Conversely, eating greater than 2 servings of dairy per day conferred protection against sleep apnea [AHI 26.2 ± 15.6 vs. 39.7 ± 31; p = 0.04]. Conclusions: Dietary components may confer increased risk for worsening severity of OSA. Based on these find¬ings, unhealthy dietary patterns warrant further study of their role in OSA associated cardiovascular diseases and metabolic syndrome development

De la mesure de performance des chaines logistiques – Revue de littérature et taxonomie

Depuis l'apparition du concept « chaine logistique » ou « supply chain » ou « chaine d’approvisionnement » et de son adoption par la sphère académique et professionnelle, un besoin éminent de mesure et de contrôle s'en est suivi.  Pour une gestion efficiente de la performance des chaines logistiques, il est fondamentale de développer des systèmes de mesure de performance adaptés au contexte complexe et dynamique de celles-ci. Ce papier présente une revue de la littérature et une taxonomie des travaux traitant de la mesure de performance des chaines logistiques. Cette recherche documentaire s’articule autour de nombreux travaux académiques en relation avec le sujet de recherche visant à identifier les principales approches développés, les outils et les indicateurs choisis par la littérature pour la mesure de performance dans le contexte des chaines logistiques ainsi que d’autres caractéristiques à partir desquels une catégorisation des ce systèmes sera proposée pour mettre en lumière certains champs de recherche encore peu ou pas explorés. Ce travail présente les limites des systèmes de mesure actuels et propose des recommandations de recherche pour le développement de futures démarches adaptées au contexte complexe des chaines logistiques

Conception et simulation de modèle pour la mesure de performance des chaînes logistiques

Malgré la richesse des travaux fournis par la littérature autour de la conception des systèmes de mesure de la performance des chaînes logistiques, nombreuses problématiques restent en suspens. Cette étude recense les principales limites énumérées par les chercheurs ainsi que les recommandations proposées pour la conception des systèmes de mesure efficients. A travers cette revue de littérature conséquente, nous avons également recueillis les différentes configurations des chaînes logistiques retenues par les chercheurs pour évaluer ou concevoir des systèmes de mesure de la performance globale. A partir de ces lignes directrices, un nouveau modèle théorique est introduit. Basé sur la théorie des contraintes, ce modèle propose de regrouper les parties prenantes selon leurs secteurs d’activité réciproques afin de standardiser les mesures et permettre le benchmarking et l’amélioration continue de leurs performances. La performance à mesurer est également répartie en 4 classes, à savoir : la performance organisationnelle, la performance opérationnelle, la performance logistique et la performance commerciale-concurrentielle. Cette dernière répartition permet d’accentuer l’homogénéité des mesures. Une simulation du modèle introduit est réalisée par le biais d’une étude de cas menée sur 16 parties prenantes de la chaîne logistique de Zara. Les résultats de la simulation témoignent de la pertinence du modèle à fournir un intéressant outil de mesure et de comparaison de la performance au sein des chaînes logistiques

Controlled Human Hookworm Infection: Accelerating Human Hookworm Vaccine Development

Background Controlled human hookworm infection (CHHI) is a central component of a proposed hookworm vaccination-challenge model (HVCM) to test the efficacy of candidate vaccines. Critical to CHHI is the manufacture of Necator americanus infective larvae (NaL3) according to current Good Manufacturing Practice (cGMP) and the determination of an inoculum of NaL3 that is safe and reliably induces patent infection. Methods cGMP-grade NaL3 were produced for a phase 1 trial in 20 healthy, hookworm-naïve adults in the United States, who received either 25 or 50 NaL3. Participants were monitored for 12–18 weeks postinfection for safety, tolerability, and patency of N. americanusinfection. Results Both NaL3 doses were well tolerated. Early manifestations of infection included pruritus, pain, and papulovesicular rash at the application site. Gastrointestinal symptoms and eosinophilia appeared after week 4 postinfection. The 50 NaL3 inoculum induced patent N. americanus infection in 90% of this dose group. Conclusions The inoculum of 50 NaL3 was well tolerated and consistently induced patent N. americanus infection suitable for future HVCM trials. Clinical Trials Registration NCT01940757

Cancer-Specific Mortality, Cure Fraction, and Noncancer Causes of Death Among Diffuse Large B-cell Lymphoma Patients in the Immunochemotherapy Era.

BACKGROUND Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown. METHODS Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs). RESULTS Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years. CONCLUSIONS Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017. © 2017 American Cancer Society

Sensory substitution for force feedback recovery: A perception experimental study

Robotic-assisted surgeries are commonly used today as a more efficient alternative to traditional surgical options. Both surgeons and patients benefit from those systems, as they offer many advantages, including less trauma and blood loss, fewer complications, and better ergonomics. However, a remaining limitation of currently available surgical systems is the lack of force feedback due to the teleoperation setting, which prevents direct interaction with the patient. Once the force information is obtained by either a sensing device or indirectly through vision-based force estimation, a concern arises on how to transmit this information to the surgeon. An attractive alternative is sensory substitution, which allows transcoding information from one sensory modality to present it in a different sensory modality. In the current work, we used visual feedback to convey interaction forces to the surgeon. Our overarching goal was to address the following question: How should interaction forces be displayed to support efficient comprehension by the surgeon without interfering with the surgeon’s perception and workflow during surgery? Until now, the use the visual modality for force feedback has not been carefully evaluated. For this reason, we conducted an experimental study with two aims: (1) to demonstrate the potential benefits of using this modality and (2) to understand the surgeons’ perceptual preferences. The results derived from our study of 28 surgeons revealed a strong positive acceptance of the users (96%) using this modality. Moreover, we found that for surgeons to easily interpret the information, their mental model must be considered, meaning that the design of the visualizations should fit the perceptual and cognitive abilities of the end user. To our knowledge, this is the first time that these principles have been analyzed for exploring sensory substitution in medical robotics. Finally, we provide user-centered recommendations for the design of visual displays for robotic surgical systems.Peer ReviewedPostprint (author's final draft

Defense Responses and Metabolic Changes Involving Phenylpropanoid Pathway and PR Genes in Squash (Cucurbita pepo L.) following Cucumber mosaic virus Infection

The current study focuses on the effects of Cucumber mosaic virus (CMV) infection on phytochemical changes and pathogenesis- and phenylpropanoid pathway-associated gene activities in squash (Cucurbita pepo L.) plants during a time course of 2 to 12 days post inoculation (dpi). The identity of the CMV isolate was confirmed by DAS-ELISA, TEM, and coat pr otein gene sequence.The CMV infection initially boosts and then suppresses transcript levels of the defense-related genes PR-1, PR-2, PAL, HQT, and CHS during the investigated time course compared to controls. The expression profile during the time-course study indicated that early, transient induction of PR-1 occurs during CMV infection, while CMV induced the expression of PR-2 in systemically infected squash tissues at all time points and suppressed the expression of PAL and HQT at 8-12 dpi. CHS transcript levels fluctuated between up- and down-regulation, but by 12 dpi, CHS expression reached its peak. The HPLC and GC–MS analyses of CMV-infected squash extracts revealed that different phenolic, flavonoid, and fatty acid compounds could be induced or suppressed upon CMV infection. In particular, CMV could suppress the synthesis of most phenolic compounds, specifically chlorogenic acid, possibly leading to the virus’s rapid spread

Incidence and trends of blastomycosis-associated hospitalizations in the United States

We used the State Inpatient Databases from the United States Agency for Healthcare Research and Quality to provide state-specific age-adjusted blastomycosis-associated hospitalization incidence throughout the entire United States. Among the 46 states studied, states within the Mississippi and Ohio River valleys had the highest age-adjusted hospitalization incidence. Specifically, Wisconsin had the highest age-adjusted hospitalization incidence (2.9 hospitalizations per 100,000 person-years). Trends were studied in the five highest hospitalization incidence states. From 2000 to 2011, blastomycosis-associated hospitalizations increased significantly in Illinois and Kentucky with an average annual increase of 4.4% and 8.4%, respectively. Trends varied significantly by state. Overall, 64% of blastomycosis-associated hospitalizations were among men and the median age at hospitalization was 53 years. This analysis provides a complete epidemiologic description of blastomycosis-associated hospitalizations throughout the endemic area in the United States