Objective To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among Emergency Medical Services (EMS) workers. Methods We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AE), and safety compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes. Results We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95%CI 6.6, 7.2). Greater than half of respondents were classified as fatigued (55%, 95%CI 50.7, 59.3). Eighteen percent of respondents reported an injury (17.8%, 95%CI 13.5, 22.1), forty-one percent a medical error or AE (41.1%, 95%CI 36.8, 45.4), and 89% (95%CI 87, 92) safety compromising behaviors. After controlling for confounding, we identified 1.9 greater odds of injury (95%CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95%CI 1.4, 3.3), and 3.6 greater odds of safety compromising behavior (95%CI 1.5, 8.3) among fatigued respondents versus non-fatigued respondents. Conclusions In this sample of EMS workers, poor sleep quality and fatigue is common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.

Background Experimental studies support a link between obesity and pulmonary hypertension (PH), yet clinical studies have been limited. This study sought to determine the association of obesity and pulmonary hemodynamic measures and mortality in PH. Methods and Results We examined patients undergoing right‐sided heart catherization (2005–2016) in a hospital‐based cohort. Multivariable regression models tested associations of body mass index and pulmonary vascular hemodynamics, with PH defined as mean pulmonary artery pressure >20 mm Hg, and further subclassified into precapillary, postcapillary, and mixed PH. Multivariable Cox models were used to examine the effect of PH and obesity on mortality. Among 8940 patients (mean age, 62 years; 40% women), 52% of nonobese and 69% of obese individuals had evidence of PH. Higher body mass index was independently associated with greater odds of overall PH (odds ratio, 1.34; 95% CI, 1.29–1.40; P <0.001 per 5‐unit increase in body mass index) as well as each PH subtype ( P <0.001 for all). Patients with PH had greater risk of mortality compared with individuals without PH regardless of subgroup ( P <0.001 for all). We found that obesity was associated with 23% lower hazard of mortality among patients with PH (hazard ratio, 0.77; 95% CI, 0.69–0.85; P <0.001). The effect of obesity was greatest among those with precapillary PH (hazard ratio, 0.57; 95% CI, 0.46–0.70; P <0.001), where obesity modified the effect of PH on mortality ( P for interaction=0.02). Conclusions Obesity is independently associated with PH. PH is associated with greater mortality; this is modified by obesity such that obese patients with precapillary PH have lower mortality compared with nonobese counterparts. Further studies are needed to elucidate mechanisms underlying obesity‐related PH.

Objectives: To characterize the impact of obesity on disease severity in patients with coronavirus disease 2019. Design: This was a retrospective cohort study designed to evaluate the association between body mass index and risk of severe disease in patients with coronavirus disease 2019. Data were abstracted from the electronic health record. The primary endpoint was a composite of intubation or death. Setting: Two hospitals in Massachusetts (one quaternary referral center and one affiliated community hospital). Patients: Consecutive patients hospitalized with confirmed coronavirus disease 2019 admitted between March 13, 2020, and April 3, 2020. Interventions: None. Measurements and Main Results: A total of 305 patients were included in this study. We stratified patients by body mass index category: < 25 kg/m 2 (54 patients, 18%), ≥ 25 kg/m 2 to < 30 kg/m 2 (124 patients, 41%), ≥ 30 kg/m 2 to < 35 kg/m 2 (58 patients, 19%), and ≥ 35 kg/m 2 (69 patients, 23%). In total, 128 patients (42%) had a primary endpoint (119 patients [39%] were intubated and nine died [3%] without intubation). Sixty-five patients (51%) with body mass index greater than or equal to 30 kg/m 2 were intubated or died. Adjusted Cox models demonstrated that body mass index greater than or equal to 30 kg/m 2 was associated with a 2.3-fold increased risk of intubation or death (95% CI, 1.2–4.3) compared with individuals with body mass index less than 25 kg/m 2 . Diabetes was also independently associated with risk of intubation or death (hazard ratio, 1.8; 95% CI, 1.2–2.7). Fifty-six out of 127 patients (44%) with body mass index greater than or equal to 30 kg/m 2 had diabetes, and the combination of both diabetes and body mass index greater than or equal to 30 kg/m 2 was associated with a 4.5-fold increased risk of intubation or death (95% CI, 2.0–10.2) compared with patients without diabetes and body mass index less than 25 kg/m 2 . Conclusions: Among consecutive patients hospitalized with coronavirus disease 2019, obesity was an independent risk factor for intubation or death.

Studies that have investigated prism adaptation (PA) effects on symptoms of visuospatial neglect have primarily used neuropsychological tests as outcome measures. An important question that remains to be answered is whether PA effects translate into improvements in patients' daily life activities. In the present review, we examined systematically the evidence for the effect of PA treatment on daily life activities in patients with neglect. Two authors independently assessed the methodological quality of 25 intervention and 1 follow-up studies using validated scales. PA effects were evaluated for reading/writing, activities of daily living (ADL) direct tests, ADL questionnaires, and navigation tests. Studies were evaluated as being of excellent (n = 1), good (n = 12), fair (n = 10), or poor (n = 3) quality. Among the 26 articles, a total of 32 measurements showed significant PA effects (one measurement from a study of excellent quality, 17 from studies of good quality, 10 from studies of fair quality, four from studies of poor quality), whereas non-significant effects were found in 15 measurements (two from a study of excellent quality, three from studies of good quality, eight from studies of fair quality, two from studies of poor quality). There is some evidence suggesting that PA can improve daily functioning, particularly as measured by reading/writing and ADL direct tests. The impact of several variables on PA effects should be investigated further including sample heterogeneity and time since injury.

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and the loss of hypoxic pulmonary vasoconstriction play a pivotal role in the pathophysiology of coronavirus disease 2019 (COVID-19) respiratory distress. 1,2 Dihydropyridine calcium channel blockers (CCBs), frequently prescribed first-line antihypertensive agents, have the potential to disrupt hypoxic pulmonary vasoconstriction 3 and worsen V_/Q_ mismatch that leads to profound hypoxemia in patients with pulmonary disease. 4 We hypothesized that CCBs would be associated with worse respiratory failure in patients with COVID-19. MethodsAmong 444 consecutively hospitalized patients with confirmed COVID-19 (admitted between March 13 and April 7, 2020, at a quaternary referral center and an affiliated community hospital in Massachusetts), 245 patients had hypertension and were included in the analysis. Data elements were abstracted retrospectively from the electronic health record by trained study personnel who followed standardized protocol. The study was approved by the Partners Healthcare Institutional Review Board with a waiver of informed consent.Dihydropyridine CCB exposure status was based on confirmed home medication list at the time of hospital admission. The primary end point was a composite of intubation or death modeled as a time-to-event analysis. 5 For patients who died after intubation, the time of intubation was considered time of primary end point as with previous studies. 5 Cox models were used to evaluate the association between CCBs and the primary end point. Models were adjusted for age, sex, race/ethnicity, BMI, diabetes mellitus, coronary artery disease, heart failure, pulmonary hypertension, chronic kidney disease, asthma/COPD, peripheral arterial disease, Charlson Comorbidity Index, and the following medications: angiotensinconverting enzyme inhibitor/angiotensin receptor blocker, thiazide diuretic, loop diuretic, beta blocker, aspirin, and statin. To further account for potential confounding, an additional analysis was performed with propensity score matching. The propensity score for CCB use was estimated with a logistic regression model that incorporated the same covariates used in the multivariable Cox model.

The increase in stroke volume with DDD compared with VVI pacing was measured at rest using pulsed Doppler echocardiography in 23 patients at a pacing rate of 70 beats min-1. Stroke volume was assessed by measuring the velocity integral of the flow at the aortic annulus using the apical five-chamber window. Pulsed Doppler echocardiography allowed determination of the least and most favourable AV delay haemodynamically. TVI was also measured at each nominal value of AV delay. The percentage increase in stroke volume was determined in every patient changing from VVI to optimum DDD pacing and was used as a measurement of the 'sensitivity' to optimum DDD pacing; the mean increase was 27 +/- 19%. The increase in stroke volume accompanying the change from DDD pacing with the least favourable to the optimum AV delay was also measured, and used as a measurement of 'sensitivity' to changes in AV delay; the mean increase was 23.7 +/- 16.3%. Clinical and standard echocardiographic parameters were studied in order to determine which variable might best identify the patients more likely to benefit from DDD pacing, and to identify those more sensitive to the AV delay setting. With respect to sensitivity to DDD pacing, three echocardiographic variables were selected by linear discriminant analysis from 11 clinical and echocardiographic variables. These were, in order of importance, left ventricular systolic diameter (LVSD), left ventricular wall thickness (LVWT) and left atrial size (LAS) which allowed the prediction of a good or a bad response to optimal DDD pacing with an accuracy of 91.3%.(ABSTRACT TRUNCATED AT 250 WORDS)

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