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Article ; Online: Rebuttal From Dr Edwards et al.

Edwards, Bradley A / Jordan, Amy S / Schmickl, Christopher N / Owens, Robert L

2023 Volume 163, Issue 1, Page(s) 32–33

Language	English
Publishing date	2023-01-10
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2022.07.035
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Article ; Online: POINT:: Are OSA Phenotypes Clinically Useful? Yes.

Edwards, Bradley A / Jordan, Amy S / Schmickl, Christopher N / Owens, Robert L

Chest

2023 Volume 163, Issue 1, Page(s) 25–28

MeSH term(s)	Humans ; Sleep Apnea, Obstructive/diagnosis ; Sleep Apnea, Obstructive/therapy ; Polysomnography ; Phenotype
Language	English
Publishing date	2023-01-05
Publishing country	United States
Document type	Editorial
ZDB-ID	1032552-9
ISSN	1931-3543 ; 0012-3692
ISSN (online)	1931-3543
ISSN	0012-3692
DOI	10.1016/j.chest.2022.08.2235
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Article: Micro-extraction method for the analysis of flame retardants in dust collected from air filters from HVAC systems.

Schachterle, Morgan L / Lowe, Luis E / Butler, Christopher R / Schoffstall, Allen M / Owens, Janel E

MethodsX

2024 Volume 12, Page(s) 102693

Abstract: Dust is a sink for many semi-volatile compounds including flame retardants of the organophosphate ester (OPE) and brominated flame-retardant (BFR) classes. Given the large amount of time that we spend indoors, our exposure to these compounds via dust is ... ...

Abstract	Dust is a sink for many semi-volatile compounds including flame retardants of the organophosphate ester (OPE) and brominated flame-retardant (BFR) classes. Given the large amount of time that we spend indoors, our exposure to these compounds via dust is of significant interest. Here, we present a novel microextraction approach to determine quantitative levels of selected OPEs and BFRs sampled from residential air filters from HVAC systems using a small volume of solvent. Dust samples (25 mg) is extracted with 1 mL of hexane/acetone (50/50, v/v). Upon solvent extraction of these HVAC dust samples, the analytes (TCPP, TDCPP, TPHP, T24DtBPP, TBBPA, and TriBBPA) were quantified via gas chromatography-mass spectrometry (GC/MS) or liquid chromatography-mass spectrometry (LC/MS). The methods for extracting these compounds from HVAC dust samples are detailed here with extensive method validation data to demonstrate accuracy and precision of these methods. •Dust is a sink for many semi-volatile compounds, including novel or emerging indoor pollutants like the organophosphate ester flame retardant T24DtBPP.•Here, a small amount of dust (25 mg) is extracted with a small volume of solvent (1 mL hexane and acetone) prior to analysis via chromatographic separation and mass spectrometric detection.
Language	English
Publishing date	2024-04-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2830212-6
ISSN	2215-0161
ISSN	2215-0161
DOI	10.1016/j.mex.2024.102693
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Article ; Online: Pathogenesis of sleep disordered breathing in the setting of opioid use: A multiple mediation analysis using physiology.

Orr, Jeremy E / Malhotra, Atul / Gruenberg, Eli / Marin, Traci / Sands, Scott A / Alex, Raichel M / Owens, Robert L / Schmickl, Christopher N

Sleep

2024

Abstract: Study objectives: Opioid medications are commonly used and are known to impact both breathing and sleep, and are linked with adverse health outcomes including death. Clinical data indicate that chronic opioid use causes central sleep apnea, and might ... ...

Abstract	Study objectives: Opioid medications are commonly used and are known to impact both breathing and sleep, and are linked with adverse health outcomes including death. Clinical data indicate that chronic opioid use causes central sleep apnea, and might also worsen obstructive sleep apnea. The mechanisms by which opioids influence sleep-disordered breathing pathogenesis are not established. Methods: Patients who underwent clinically-indicated polysomnography confirming sleep-disordered breathing (SDB) (AHI≥5/hr) were included. Each patient using opioids was matched by sex, age, and BMI to three control individuals not using opioids. Physiology known to influence SDB pathogenesis were determined from validated polysomnography-based signal analysis. PSG and physiology paramters of interest were compared between opioid and control individuals, adjusted for covariates. Mediation analysis was used to evaluate the link between opioids, physiology, and polysomnographic metrics. Results: 178 individuals using opioids were matched to 534 controls (median [IQR] age 59 [50,65] years, BMI 33 [29,41] kg/m2, 57% female, daily morphine equivalent 30 [20,80] mg). Compared with controls, opioids were associated with increased central apneas (2.8 vs 1.7 events/hr; p=0.001) and worsened hypoxemia (5 vs 3% sleep with SpO2<88%; p=0.013), with similar overall AHI. Use of opioids was associated with higher loop gain, a lower respiratory rate and higher respiratory rate variability. Higher loop gain and increased respiratory rate variability mediated the effect of opioids on central apnea, but did not mediate the effect on hypoxemia. Conclusions: Opioids have multi-level effects impacting SDB. Targeting these factors may help mitigate deleterious respiratory consequences of chronic opioid use.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	424441-2
ISSN	1550-9109 ; 0161-8105
ISSN (online)	1550-9109
ISSN	0161-8105
DOI	10.1093/sleep/zsae090
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Article ; Online: An economic analysis of the cost of survival of micro preemies: A systematic review.

Lee, Evelyn / Schofield, Deborah / Owens, Christopher E L / Oei, Ju-Lee

Seminars in fetal & neonatal medicine

2022 Volume 27, Issue 3, Page(s) 101336

Abstract: Objective: This study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g.! ...

Abstract	Objective: This study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g. Method: We searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists. Results: The search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives. Conclusion: Despite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies.
MeSH term(s)	Cost-Benefit Analysis ; Delivery of Health Care ; Humans ; Outcome Assessment, Health Care
Language	English
Publishing date	2022-04-09
Publishing country	Netherlands
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2174416-6
ISSN	1878-0946 ; 1744-165X
ISSN (online)	1878-0946
ISSN	1744-165X
DOI	10.1016/j.siny.2022.101336
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Article ; Online: Impact of a deep learning sepsis prediction model on quality of care and survival.

Boussina, Aaron / Shashikumar, Supreeth P / Malhotra, Atul / Owens, Robert L / El-Kareh, Robert / Longhurst, Christopher A / Quintero, Kimberly / Donahue, Allison / Chan, Theodore C / Nemati, Shamim / Wardi, Gabriel

NPJ digital medicine

2024 Volume 7, Issue 1, Page(s) 14

Abstract: Sepsis remains a major cause of mortality and morbidity worldwide. Algorithms that assist with the early recognition of sepsis may improve outcomes, but relatively few studies have examined their impact on real-world patient outcomes. Our objective was ... ...

Abstract	Sepsis remains a major cause of mortality and morbidity worldwide. Algorithms that assist with the early recognition of sepsis may improve outcomes, but relatively few studies have examined their impact on real-world patient outcomes. Our objective was to assess the impact of a deep-learning model (COMPOSER) for the early prediction of sepsis on patient outcomes. We completed a before-and-after quasi-experimental study at two distinct Emergency Departments (EDs) within the UC San Diego Health System. We included 6217 adult septic patients from 1/1/2021 through 4/30/2023. The exposure tested was a nurse-facing Best Practice Advisory (BPA) triggered by COMPOSER. In-hospital mortality, sepsis bundle compliance, 72-h change in sequential organ failure assessment (SOFA) score following sepsis onset, ICU-free days, and the number of ICU encounters were evaluated in the pre-intervention period (705 days) and the post-intervention period (145 days). The causal impact analysis was performed using a Bayesian structural time-series approach with confounder adjustments to assess the significance of the exposure at the 95% confidence level. The deployment of COMPOSER was significantly associated with a 1.9% absolute reduction (17% relative decrease) in in-hospital sepsis mortality (95% CI, 0.3%-3.5%), a 5.0% absolute increase (10% relative increase) in sepsis bundle compliance (95% CI, 2.4%-8.0%), and a 4% (95% CI, 1.1%-7.1%) reduction in 72-h SOFA change after sepsis onset in causal inference analysis. This study suggests that the deployment of COMPOSER for early prediction of sepsis was associated with a significant reduction in mortality and a significant increase in sepsis bundle compliance.
Language	English
Publishing date	2024-01-23
Publishing country	England
Document type	Journal Article
ISSN	2398-6352
ISSN (online)	2398-6352
DOI	10.1038/s41746-023-00986-6
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Article ; Online: The Effect of Obesity on Sleep Apnea Pathogenesis Differs in Women vs Men: Multiple Mediation Analyses in the Retrospective SNOOzzzE Cohort.

Nokes, Brandon / Orr, Jeremy E / White, Stephanie / Luu, Steven / Chen, Zihan / Alex, Raichel / Sands, Scott A / Wojeck, Brian S / Owens, Robert L / Malhotra, Atul / Schmickl, Christopher N

Journal of applied physiology (Bethesda, Md. : 1985)

2024

Abstract: Background and objective: There are multiple mechanisms underlying obstructive sleep apnea (OSA) development. However, how classic OSA risk factors such as body mass index (BMI) and sex portend to OSA development have not been fully described. Thus, we ... ...

Abstract	Background and objective: There are multiple mechanisms underlying obstructive sleep apnea (OSA) development. However, how classic OSA risk factors such as body mass index (BMI) and sex portend to OSA development have not been fully described. Thus, we sought to evaluate how obesity leads to OSA, and assess how these mechanisms differ between men and women. Methods The San Diego Multi-Outcome OSA Endophenotype (SNOOzzzE) cohort includes 3,319 consecutive adults who underwent a clinical in-laboratory polysomnography at the UCSD sleep clinic between 1/2017-12/2019. Using routine polysomnography signals, we determined OSA endotypes. We then performed mediation analyses stratified by sex to determine how BMI influenced apnea hypopnea index (AHI) using OSA endotypic traits as mediators. Results We included 2,146 patients of whom 919 (43%) were women and 1,227 (57%) were obese. BMI was significantly associated with AHI in both women and men. In men, the effect of BMI on AHI was partially mediated by a reduction in upper airway stiffness (31% of total effect, TE), by a reduction in circulatory delay (16%TE), and by an increase in arousal threshold (7%TE). In women, the effect of BMI on AHI was partially mediated by a reduction in circulatory delay (22%TE). Discussion BMI-related OSA pathogenesis differs by sex. An increase in upper airway collapsibility (in men) is consistent with prior studies. A reduction in circulatory delay may lead to shorter and thus more events per hour (i.e., higher AHI), while the association between a higher arousal threshold and higher AHI may reflect reverse causation.
Language	English
Publishing date	2024-04-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	219139-8
ISSN	1522-1601 ; 0021-8987 ; 0161-7567 ; 8750-7587
ISSN (online)	1522-1601
ISSN	0021-8987 ; 0161-7567 ; 8750-7587
DOI	10.1152/japplphysiol.00925.2023
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Article ; Online: Sleep in young-adult cancer survivors during the COVID-19 pandemic.

Zhou, Eric S / Michaud, Alexis L / Owens, Judith / Recklitis, Christopher J

Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

2020 Volume 16, Issue 11, Page(s) 1991

MeSH term(s)	Adult ; COVID-19/complications ; COVID-19/psychology ; Cancer Survivors/psychology ; Female ; Humans ; Neoplasms/psychology ; Sleep Wake Disorders/psychology ; Young Adult
Keywords	covid19
Language	English
Publishing date	2020-07-27
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural
ZDB-ID	2397213-0
ISSN	1550-9397 ; 1550-9389
ISSN (online)	1550-9397
ISSN	1550-9389
DOI	10.5664/jcsm.8716
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Article: A Longitudinal, Observational Analysis of Neuronal Injury Biomarkers in a Case Report of a Patient With Paraneoplastic Anti-CRMP5 Antibody-Associated Transverse Myelitis.

Mizenko, Christopher / Bennett, Jeffrey L / Owens, Gregory / Vollmer, Timothy L / Piquet, Amanda L

Frontiers in neurology

2021 Volume 12, Page(s) 691509

Abstract: Biomarkers are needed to guide therapeutic decision making in autoimmune and paraneoplastic neurologic disorders. Here, we describe a case of paraneoplastic collapsing response-mediator protein-5 (CRMP5)-associated transverse myelitis (TM) where plasma ... ...

Abstract	Biomarkers are needed to guide therapeutic decision making in autoimmune and paraneoplastic neurologic disorders. Here, we describe a case of paraneoplastic collapsing response-mediator protein-5 (CRMP5)-associated transverse myelitis (TM) where plasma neurofilament light (NfL) chain and glial fibrillary protein (GFAP) levels were observed over a 14-month clinical course, correlating with radiographical and clinical outcome measures in response to treatment. Blood and CSF samples obtained at diagnosis as well as 7 and 14 months into treatment. At the time of initial diagnosis, both plasma NfL (782.62 pg/ml) and GFAP (283.26 pg/ml) were significantly elevated. Initial treatment was with IV steroids and plasma exchange (PLEX) followed by neuroendocrine tumor removal, chemotherapy, and radiation. After initial improvement with chemotherapy, the patient experienced clinical worsening and transient elevation of plasma NfL (103.27 pg/ml and GFAP (211.58 pg/ml) levels. Whole body positron emission tomography PET scan did not demonstrate recurrence of malignancy. Repeat PLEX and rituximab induction resulted in improvements in patient function, neurologic exam, and plasma biomarker levels. To our knowledge, this is the first described longitudinal, prospective analysis of neuronal injury biomarkers and association of clinical treatment outcomes in CRMP5 myelitis. Our findings suggest that clinical improvement correlates with NfL and GFAP concentrations.
Language	English
Publishing date	2021-07-16
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2021.691509
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Article ; Online: Operating Room Traffic in Total Joint Arthroplasty: One Simple Measure Toward Solving a Complex Problem.

Osborn, Nathaniel S / Hoehmann, Christopher L / McCormack, Richard / Owens, Jonathan

JB & JS open access

2020 Volume 5, Issue 3

Abstract: Background: Periprosthetic joint infection remains a devastating complication of total joint arthroplasty (TJA). The literature suggests that unnecessary operating room (OR) traffic increases the risk of surgical site infection by increasing bacterial ... ...

Abstract	Background: Periprosthetic joint infection remains a devastating complication of total joint arthroplasty (TJA). The literature suggests that unnecessary operating room (OR) traffic increases the risk of surgical site infection by increasing bacterial load in the OR. We attempted to determine whether the posting of "restricted access" signs on the outside and inside of OR doors during primary TJA procedures would result in a reduction of OR door openings. Methods: This prospectively designed, 2-phase study investigated the number of door openings per case for primary TJA. An independent observer collected data for each TJA case; the OR staff were blinded to the data collection to avoid bias. The first phase of this study recorded OR traffic without the use of "restricted access" signs. In the second, interventional phase of the study, OR traffic was monitored with the concomitant application of "restricted access" signs on the doors. The number of openings per case, from the time of incision to the time of dressing application, was collected. Results: The average number of openings per case during the first phase was 75, with 0.59 door openings per minute. The average number of openings per case during the second phase was 40, with 0.28 door openings per minute. Therefore, a 47% reduction in openings per case and a 53% reduction in the number of openings per minute during primary TJA cases were observed. Conclusions: We demonstrated that the simple addition of "restricted access" signs on the outside and inside of OR doors produced a significant reduction (p < 0.001) in OR traffic during primary TJA. Clinical relevance: Posting signs can decrease door openings, potentially decreasing infection.
Language	English
Publishing date	2020-07-09
Publishing country	United States
Document type	Journal Article
ISSN	2472-7245
ISSN (online)	2472-7245
DOI	10.2106/JBJS.OA.20.00015
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