Wake Research

Abstract Aims Laboratory studies suggest that caffeine consumption has clear and consistent adverse effects on sleep, but epidemiological studies have yielded mixed findings. This study aimed to examine temporal associations between sleep and caffeine consumption in young adults. Methods Fifty-one New Zealand young adults (aged 18-25 years) wore an actigraph and completed a sleep diary for 7 days to capture objective and self-reported measures of sleep and self-reported caffeine intake, providing 355 observations. Mixed linear models were conducted to assess temporal associations between caffeine intake (dose and timing) and the subsequent night’s sleep. Lagged models were conducted to assess temporal associations between sleep characteristics and next-day caffeine dose. Independent variables for caffeine and sleep were included in models as within-person and between-person variances from the mean. Results Between participants, those who consumed more caffeine per day than the group average had shorter total night time (β=-0.12; p=0.02) and daily (β=-0.12; p=0.02) sleep durations in the subsequent sleep period(s). Conversely, between participants, those with shorter night time (β=-0.06; p=0.004) and daily (β=-0.06; p=0.01) sleep durations consumed more caffeine in total the following day. Within participants, on days with longer night time (β=0.07; p=0. 001)and daily (β=0.05; p=0.02) sleep durations than their personal average, they consumed more caffeine the next day. Conclusion There may be a cycle of activity in young adults whereby higher caffeine consumption leads to shorter sleep, which leads to higher caffeine consumption. Further research that accounts for prior sleep history is needed to elucidate associations with sleep characteristics.

Abstract Brain clearance involves the drainage of waste molecules from the brain, a process that is suggested to be amplified during sleep. Recently proposed MRI-based methods attempt to approximate human brain clearance with surrogate measures. The current study aimed to explore whether two brain clearance surrogates are altered in narcolepsy. We processed diffusion-weighted and functional resting-state images to extract two surrogates: Diffusion Tensor Imaging Along the Perivascular Space (DTI-ALPS index), and dBOLD-CSF coupling. Both measures were analysed in 12 drug-free, awake people with narcolepsy type 1 and 11 age- and sex-matched controls, as well as in relation to clinical features. We also assessed the correlation between the DTI-ALPS index and dBOLD-CSF coupling. The DTI-ALPS index and dBOLD-CSF coupling amplitude identified were similar to previous research and did not show significant differences between narcolepsy and controls, nor significant relations with severity of excessive daytime sleepiness. We found a significant correlation between the DTI-ALPS index and dBOLD-CSF coupling amplitude. The hypothesis of altered brain clearance in narcolepsy type 1 is not supported by evidence from the current study. The two surrogates correlated with each other, suggesting that both offer different perspectives from the same underlying physiology. Yet, the suitability of the surrogates as brain clearance markers remains debatable. Whereas DTI is not exclusively sensitive to perivascular fluid, dBOLD-CSF coupling is reflecting large-scale CSF motion. Future work should explore other surrogate markers, preferably during sleep, to better understand the possible role of altered brain clearance in narcolepsy type 1 symptomatology.

Introduction: Adenoma detection rate (ADR) is a critical quality metric in colonoscopies, directly linked to the prevention of colorectal cancer. High ADR during colonoscopy is directly correlated with a reduced risk of CRC development.1 GI Genius is an emerging, computer-aided polyp detection system designed to assist gastroenterologists in identification of adenomas.2 The system utilizes artificial intelligence (AI) to provide real-time visual cues that highlight polyps with the goal of improving ADR. This study aims to evaluate the impact of GI Genius on ADR in a community GI practice that recently implemented the technology. Methods: A retrospective analysis was conducted on data collected from our community endoscopy centers between October 2022 and May 2023. The study included 13 physicians (labeled A-M) who performed screening colonoscopies with the assistance of GI Genius. The ADR using GI Genius was calculated for both individual physicians and for the entire center in the specified timeframe and compared with respective baseline ADR collected from a control period of March 2022 to September 2022, the prior seven months. Statistical comparison was done with the Student’s T- test. Results: Graph 1 shows the ADR of all physicians. Among all physicians (A-M) using GI GeniusTM, the average ADR amongst all physicians utilizing the tool increased from 33.05% to 44.65%, P=0.0015. The average ADR for the center increased from 37.09% to 42.06%, P=0.0015. Physician J was the only physician who had a decrease in ADR with GI Genius from 40.42% to 37.06, P=NS (Figure 1). Conclusion: The incorporation of GI Genius resulted in a statistically significant improvement in ADR rates for screening colonoscopies in nearly all physicians and within the entire community based endoscopy center. The greatest improvement in individual ADR is among those physicians with low baseline ADR. These statistically significant findings are evident within a short time of using GI Genius, likely reflecting the easy learning curve in using this technology. The physician outlier with a decreased ADR suggests there may be an impact of confounding patient and procedure factors that cannot be identified. Additional study of the impact of these variables on ADR as well as the clinical significance of GI Genius is warranted to further examine these results.Figure 1.: Physician baseline ADR compared to GI Genius ADR.

The Patient Protection and Affordable Care Act (ACA) individual marketplaces are a source of insurance for millions of residents in the US. However, the association between enrollee risk, health spending, and metal tier selection remains unclear. To describe individual marketplace enrollees' metal tier selections by risk score and assess enrollees' health spending by metal tier, risk score, and spending type. This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database, a deidentified claims database built on data voluntarily submitted by insurers. Enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year were included. Data analysis was conducted from March 2021 to January 2023. Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019. Enrollment and claims data were obtained for 1 317 707 enrollees (53.5% female; mean [SD] age, 46.35 [13.43] years) across all census areas, age groups, and sexes. Of these, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Compared with enrollees in bronze plans (17.2%), enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans. The highest share of enrollees with $0 total spending was noted with the catastrophic (26.4%) and bronze (22.7%) plans, while gold plans had the lowest share (8.1%). Median total spending was lower among bronze plan enrollees ($593; IQR, $28-$2100) vs platinum ($4111; IQR, $992-$15 821) or gold ($2675; IQR, $728-$9070). Within the top risk score decile, CSR enrollees had less average total spending than any other metal tier by more than 10%. In this cross-sectional study of the ACA individual marketplace, enrollees who selected plans with higher actuarial value also had greater mean HHS-HCC risk scores and health spending. The findings suggest these differences may be associated with variation in benefit generosity by metal tier, enrollee's perceptions of future health needs, or other barriers to care access.

Distal femoral skeletal traction is a common procedure for the stabilization of fractures of the pelvis, acetabulum, and femur following trauma. Femoral traction pins are traditionally inserted via medial-to-lateral (MTL) entry to accurately direct the pin away from the medial neurovascular bundle. Alternatively, cadaveric studies have demonstrated low risk to the neurovascular bundle using a lateral-to-medial (LTM) approach. The purpose of this study was to compare the incidence of complications of LTM and MTL femoral traction pin placement at a single institution. This was a retrospective review of patients from the orthopaedic consult registry at a academic Level I Trauma Center. We identified 233 LTM femoral traction pin procedures in 231 patients and 29 MTL pin procedures in 29 patients. The two pin placement techniques were compared with respect to complications, specifically the incidence of neurovascular injury, cellulitis, septic arthritis, osteomyelitis, and heterotopic ossification after femoral traction pin placement. Two complications were reported. One patient developed heterotopic ossification along the pin tract after LTM traction pin placement. Another patient developed septic arthritis after LTM pin placement, likely attributable to retrograde intramedullary nailing of his open femur fracture rather than his traction pin. There were no reports of neurovascular injury, cellulitis, or osteomyelitis associated with pin placement. The complication rate was 0.9% for LTM group and 0.0% for MTL group (p = 0.616). LTM femoral traction pin placement is a safe procedure with a similarly low complication rate compared with traditional MTL placement when the limb is positioned in neutral alignment. (Journal of Surgical Orthopaedic Advances 32(4):259-262, 2023).

In this chapter you will learn

In this chapter you will learn