Search

BACKGROUND: In preterm infants who require mechanical ventilation (MV), volume-targeted ventilation (VTV) modes are associated with lower rates of bronchopulmonary dysplasia compared with pressure-limited ventilation. Bronchopulmonary dysplasia rates in our NICU were higher than desired, prompting quality improvement initiatives to improve MV by increasing the use of VTV. METHODS: We implemented and tested interventions over a 3-year period. Primary outcomes were the percentage of conventional MV hours when any-VTV mode was used and the percentage of conventional MV hours when an exclusively VTV mode was used. Exclusively VTV modes were modes in which all breaths were volume targeted. We evaluated outcomes during 3 project periods: baseline (May 2016–December 2016); epoch 1 (December 2016–October 2018), increasing the use of any-VTV mode; and epoch 2 (October 2018–November 2019), increasing the use of exclusively VTV modes. RESULTS: Use of any-VTV mode increased from 18 694 of 22 387 (83%) MV hours during baseline to 72 846 of 77 264 (94%) and 58 174 of 60 605 (96%) MV hours during epochs 1 and 2, respectively (P < .001). Use of exclusively VTV increased from 5967 of 22 387 (27%) during baseline to 47 364 of 77 264 (61%) and 46 091 of 60 605 (76%) of all conventional MV hours during epochs 1 and 2, respectively (P < .001). In statistical process control analyses, multiple interventions were associated with improvements in primary outcomes. Measured clinical outcomes were unchanged. CONCLUSIONS: Quality improvement interventions were associated with improved use of VTV but no change in measured clinical outcomes.

Introduction Sleep tracking wearables are increasingly being validation tested against polysomnography (PSG) and actigraphy, but they may not be ideal for long-term epidemiological sleep studies, or for use in operational environments. A given device’s short battery life, limited data storage capacity, inability to detect naps or estimate sleep architecture, or privacy concerns may discourage researchers from using wearables to collect objective sleep data in real-world settings. The Zulu watch (Institutes for Behavior Resources) is designed to collect longitudinal sleep data in operational populations with irregular sleep patterns, such as long-haul pilots or shift workers. It is capable of on-wrist sleep-wake determination, nap detection, on-wrist sleep depth scoring (i.e., interrupted sleep, light sleep, or deep sleep), on-wrist data storage up to 80 sleep intervals, and year-long battery life. Laboratory testing is an important initial step toward establishing the performance of a device for longitudinal real-world sleep evaluation; therefore, the Zulu watch sleep tracking was subjected to testing against gold-standard PSG and actigraphy. Methods Eight healthy young adult participants (30.4±3.2 years; mean±SD) wore a Zulu watch and Philips Respironics Actiwatch 2 simultaneously over a 3-day laboratory PSG sleep study, with 8 hours time-in-bed each night. Overall epoch-by-epoch agreement of sensitivity (for sleep), specificity (for wake), and accuracy of Zulu watch data were tested against PSG and Actiwatch 2. Results Compared with either PSG or actigraphy, both accuracy and sensitivity for Zulu watch sleep-wake determination were >90% while specificity was low (~26% vs. PSG, ~33% vs. actigraphy). Accuracy for sleep scoring vs. PSG was ~87% for interrupted sleep, ~52% for light sleep, and ~49% for deep sleep. Conclusion The Zulu watch showed mixed results but may be a viable candidate for sleep evaluation based on initial laboratory performance testing in healthy adults. The next steps will be to compare the Zulu watch against self-report of sleep in operational and substance use disorder populations. Longitudinal epidemiological sleep studies can become more feasible if technology is tailored to the specific needs of the real-world environment. Support (if any) Medical Technology Enterprise Consortium award MTEC-17-08-Multi-Topic-0104; Office of Naval Research, Code 34.

Background Grade inflation is pervasive in educational settings in the United States. One driver of grade inflation may be faculty concern that assigning lower clinical performance scores to trainees will cause them to retaliate and assign lower teaching scores to the faculty member. The finding of near-zero retaliation would be important to faculty members who evaluate trainees. Methods The authors used a bidirectional confidential evaluation and feedback system to test the hypothesis that faculty members who assign lower clinical performance scores to residents subsequently receive lower clinical teaching scores. From September 1, 2008, to February 15, 2013, 177 faculty members evaluated 188 anesthesia residents (n = 27,561 evaluations), and 188 anesthesia residents evaluated 204 faculty members (n = 25,058 evaluations). The authors analyzed the relationship between clinical performance scores assigned by faculty members and the clinical teaching scores received using linear regression. The authors used complete dyads between faculty members and resident pairs to conduct a mixed effects model analysis. All analyses were repeated for three different epochs, each with different administrative attributes that might influence retaliation. Results There was no relationship between mean clinical performance scores assigned by faculty members and mean clinical teaching scores received in any epoch (P ≥ 0.45). Using only complete dyads, the authors’ mixed effects model analysis demonstrated a very small retaliation effect in each epoch (effect sizes of 0.10, 0.06, and 0.12; P ≤ 0.01). Conclusions These results imply that faculty members can provide confidential evaluations and written feedback to trainees with near-zero impact on their mean teaching scores.

Introduction Heart rate is well-known to be modulated by sleep stages. If clinically useful sleep scoring can be performed using only cardiac rhythms, then existing medical and consumer-grade devices that can measure heart rate can enable low-cost sleep evaluations. Methods We trained a neural network which uses dilated convolutional blocks to learn both local and long range features of heart rate extracted from ECG R-wave timing to predict for every non-overlapping 30s epoch of the input the probabilities of the epoch being in one of four classes—wake, light sleep, deep sleep or REM. The largest probability is chosen as the network’s class prediction and used to form the hypnogram. We used the Sleep Heart Health Study (SHHS) and Multi-Ethnic Study of Atherosclerosis Study (MESA) and Physionet Computing in Cardiology (CinC) dataset (over 10000 nights) for training and evaluation. Then we deployed the algorithm on PPG based heart rate measured by a wrist-worn device worn by subjects in a free-living setting. Results On the held out test SHHS dataset (800 nights, 561 subjects), the overall 4-class staging accuracy was 77% and Cohen’s kappa was 0.66. On the CinC dataset (993 nights, 993 subjects), the overall 4 class accuracy was 72% and Cohen’s kappa was 0.55. The study on free-living subjects is underway and these novel results will be collated and presented upon completion. Conclusion We hope these results build more trust in automated heart rate based sleep staging and encourage further research into its clinical application in screening and diagnosis of sleep disorders. Low cost, high efficacy devices which can be used in longitudinal studies can lead to breakthroughs in clinical applications of sleep staging for early diagnosis of chronic conditions and novel treatment endpoints. Support (if any) We recently published the training/testing of the algorithm as well a population level analysis showing differences in predicted sleep stages between disease cohorts. The article was published in NPJ Digital Medicine in Aug 2020. The study on free living subjects is currently underway and these new results will be presented at the sleep conference. Preliminary results indicate high concordance with our published results.

Introduction Alzheimer’s disease (AD) impacts brain regions that control circadian regulation systems such as wakefulness and daytime physical activity. Recent evidence shows that AD pathology is damaging for wake-promoting neurons. Whether early changes in wakefulness and daytime activity occur during asymptomatic stages of familial AD (fAD) remains unknown. In this study, we aimed to investigate whether daytime activity differs between cognitively-unimpaired carriers of early-onset fAD and age-matched non-carrier family members. Further, we examined the associations between daytime activity and memory performance. Methods A total of 25 members of the large Colombian kindred with the Presenilin1 (PSEN1) E280A mutation were included in the study (9 mutation carriers and 16 non-carriers, mean age=38.2). PSEN1 mutation carriers develop dementia before the age of 50. All subjects underwent wrist actigraphy for 7-14 days to measure daytime activity (average activity per minute and per epoch), and completed the CERAD Word List Learning and the Free and Cued Selective Reminding Test (FCSRT). Results Compared to non-carriers, mutation carriers had less average daytime activity (Mann-Whitney U Test p=.04). Higher average daytime activity was associated with better memory recall in both the CERAD word list delayed recall (r=.47, p=.05) and the FCRST delayed total recall (r=.53, p=.02). No associations with age were observed. Conclusion Our results suggest that cognitively-unimpaired mutation carriers have reduced daytime activity, years before the onset of dementia. Reduced daytime activity in carriers is also associated with lower memory performance. Our preliminary findings add to the growing evidence that circadian dysfunction is present in early AD, and may play an important role in subsequent memory impairment. Future research with large samples is needed to further examine sleep and circadian dysfunction in asymptomatic individuals at genetic risk for AD. Support NIA 5R01AG054671-03 to YTQ

Introduction: Historically, outcomes for BL have improved in adults using dose intensive chemotherapy regimens and early CNS prophylaxis. More recent data using a less intensive regimen, DA-EPOCH, have been reported. We analyzed detailed patient (pt) & disease characteristics and treatment patterns across 26 US CCs over a recent 9 year (yr) period and also determined survival rates & prognostication. Methods: We conducted a large multicenter retrospective study of newly diagnosed (dx) adult BL pts (6/2009 - 6/2018). Dx was established by institutional expert pathology review; all cases were verified for BL based on 2016 WHO criteria (high grade B cell lymphoma, BL like, etc were excluded). Survival rates were estimated by Kaplan-Meier with differences assessed by log rank test. Univariate (UVA) associations were derived via Cox model with variables P ≤0.05 entered stepwise into a multivariate (MVA) model. Using significant factors from the MVA, a prognostic survival model was constructed. Results: Among N=557 verified BL cases, clinical features included: median age 47 yrs (17-88 yrs; 24% ≥60 yrs); male 76%; HIV+ 22%; ECOG PS 0/1 76%; B symptoms 51%; elevated LDH 78% (3, 5, & 10x elevation: 44%, 29% & 15%, respectively); hemoglobin 1 EN 43%; and 76% stage 3-4 disease (10% stage 1). Additionally, 16% and 3% of pts had baseline leptomeningeal (CSF or cranial nerve palsy) or parenchymal CNS involvement, respectively (see Zayac A et al. ASH 2019 for details). For MYC partner, 68% had t(8;14), 4% light chain, 5% negative FISH (otherwise classic BL) and 23% + break apart probe. HIV+ pts had several clinical differences: CSF+ 23% vs 12% P=0.003; CNS 19% vs 8% P1 EN 60% vs 38% P For all pts, 87% had Tx at an academic CC (13% at community CC). Tx regimens were: CODOX-M/IVAC (Magrath) 31%, HyperCVAD/MA 29%, DA-EPOCH 28%, other 10% (mostly CHOP-based & CALGB Tx) & 1% were never treated. 90% of pts received rituximab as part of Tx (69% inpatient (inpt) & 31% outpatient) & 2% had consolidative autologous SCT. Response among all pts were CR 72%, PR 6%, SD 1%, PD 14%, 7% not evaluable. The treatment related mortality (TRM) rate across all pts was 8.9% (HIV+ vs not: 13% vs 8% P=0.09); most common: sepsis 48%, GI bleed/perforation 14% & respiratory failure 12%. TRM by Tx: hyperCVAD/MA 11.5%, EPOCH 6.4%, Magrath 6.3% & other 18.9%. With 39 month median follow-up, 3 year progression-free survival (PFS) and overall survival (OS) were 65% and 72%, respectively (Fig 1A). Among all pts who experienced disease progression, 90% occurred For prognostication, outcomes were inferior for pts ages ≥40 yrs & LDH >3x normal (Fig 1B/C). Notably, survival rates were not different based on HIV status (Fig 1D) or by the 3 most common Tx regimens (Fig 1E). However, there were important Tx differences based on presence of CNS involvement (see Zayac A et al. ASH 2019). Additionally, use of rituximab was associated with improved PFS & OS (Fig 1F), while outcomes were similar whether rituximab was given inpt vs outpatient (inpt PFS HR 1.25, P=0.19). Furthermore, Tx at an academic CC was associated with improved outcomes, which persisted on MVA (PFS HR 0.54, 95%CI 0.33-0.88 P=0.01; OS HR 0.50, 95%CI 0.29-0.87 P=0.01) & achievement of initial CR was strongly prognostic (Fig 1G). Baseline factors significant on UVA for PFS & OS were: age ≥40 yrs; PS 2-4; LDH >3x; anemia, low albumin; BM involvement; Stage 3-4; CSF+; & >1 EN. On MVA, factors associated with inferior survival were: age ≥40 yrs (PFS HR 1.57, P3x (PFS HR 2.28, P Conclusions: Outcomes for adult BL in this contemporary, large, multicenter RW analysis appear inferior to smaller published series. Interestingly, despite increased adverse prognostic factors, survival rates appeared similar in HIV+ pts. In addition, use of rituximab, achievement of initial CR, and Tx at an academic CC were associated with improved survival. Finally, a novel BL-specific survival model identified pts with markedly divergent outcomes. Disclosures Evens: Seattle Genetics: Consultancy, Honoraria, Research Funding; Epizyme: Consultancy, Honoraria; Pharmacyclics: Consultancy, Honoraria; Tesaro: Research Funding; Verastem: Consultancy, Honoraria. Danilov:Janssen: Consultancy; Seattle Genetics: Consultancy; MEI: Research Funding; Abbvie: Consultancy; Pharmacyclics: Consultancy; Takeda Oncology: Research Funding; Janssen: Consultancy; TG Therapeutics: Consultancy; Curis: Consultancy; Pharmacyclics: Consultancy; Aptose Biosciences: Research Funding; Verastem Oncology: Consultancy, Other: Travel Reimbursement , Research Funding; AstraZeneca: Consultancy, Research Funding; Genentech: Consultancy, Research Funding; Bayer Oncology: Consultancy, Research Funding; Celgene: Consultancy; Bristol-Meyers Squibb: Research Funding; MEI: Research Funding; Gilead Sciences: Consultancy, Research Funding; Abbvie: Consultancy; Bristol-Meyers Squibb: Research Funding. Reddy:KITE Pharma: Consultancy; BMS: Consultancy, Research Funding; Celgene: Consultancy; Genentech: Research Funding; Abbvie: Consultancy. Farooq:Celgene: Honoraria; Kite Pharma: Research Funding. Khan:Janssen: Other: Educational Content/Symposium; Abbvie: Membership on an entity's Board of Directors or advisory committees; Bristol Myers: Other: Research Funds; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees. Yazdy:Genentech: Research Funding; Bayer: Honoraria; Abbvie: Consultancy; Octapharma: Consultancy. Karmali:Gilead/Kite; Juno/Celgene: Consultancy, Speakers Bureau; Astrazeneca: Speakers Bureau; Takeda, BMS: Other: Research Funding to Institution. Martin:Janssen: Consultancy; Teneobio: Consultancy; Celgene: Consultancy; Karyopharm: Consultancy; Sandoz: Consultancy; I-MAB: Consultancy. Diefenbach:LAM Therapeutics: Research Funding; Incyte: Research Funding; Genentech: Consultancy, Research Funding; Trillium: Research Funding; Millenium/Takeda: Research Funding; Seattle Genetics: Consultancy, Research Funding; Merck: Consultancy, Research Funding; MEI: Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Denovo: Research Funding. Epperla:Pharmacyclics: Honoraria; Verastem Oncology: Speakers Bureau. Feldman:Eisai: Research Funding; Amgen: Research Funding; Cell Medica: Research Funding; Roche: Research Funding; Corvus: Research Funding; Kyowa Hakko Kirin: Research Funding; Pfizer: Research Funding; Trillium: Research Funding; Viracta: Research Funding; Bayer: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Honoraria, Speakers Bureau; Celgene: Honoraria, Research Funding, Speakers Bureau; Seattle Genetics: Consultancy, Honoraria, Other: Travel expenses, Speakers Bureau; AbbVie: Honoraria, Other: Travel expenses, Speakers Bureau; Pharmacyclics: Honoraria, Other: Travel expenses, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Kite Pharma: Honoraria, Other: Travel expenses, Speakers Bureau; Portola Pharma: Research Funding; Roche: Research Funding. Lossos:Janssen Scientific: Membership on an entity's Board of Directors or advisory committees; NIH: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees. Naik:Celgene: Other: Advisory board. Kamdar:Celgene: Consultancy; AstraZeneca: Consultancy; Seattle Genetics: Speakers Bureau; University of Colorado: Employment; Pharmacyclics: Consultancy. Portell:AbbVie: Research Funding; Pharmacyclics: Consultancy; Janssen: Consultancy; Genentech: Consultancy, Research Funding; Bayer: Consultancy; BeiGene: Consultancy, Research Funding; Kite: Consultancy, Research Funding; Acerta/AstraZeneca: Research Funding; TG Therapeutics: Research Funding; Xencor: Research Funding; Roche/Genentech: Research Funding; Infinity: Research Funding; Amgen: Consultancy. Olszewski:Spectrum Pharmaceuticals: Research Funding; TG Therapeutics: Research Funding; Genentech: Research Funding; Adaptive Biotechnologies: Research Funding. Alderuccio:Agios: Other: Immediate family member; Puma Biotechnology: Other: Immediate family member; Foundation Medicine: Other: Immediate family member; Targeted Oncology: Honoraria; Inovio Pharmaceuticals: Other: Immediate family member; OncLive: Consultancy.

Purpose Atypical cortical sensory waveforms reflecting impaired encoding of auditory stimuli may result from inconsistency in cortical response to the acoustic feature changes within spoken words. Thus, the present study assessed intrasubject stability of the P1-N1-P2 complex and T-complex to multiple productions of spoken nonwords in 48 adults to provide benchmarks for future studies probing auditory processing deficits. Method Response trials were split (split epoch averages) for each of 4 word types for each subject and compared for similarity in waveform morphology. Waveform morphology association was assessed between 50 and 600 ms, the time frame reflecting spectro-temporal feature processing for the stimuli used in the study. Results Using approximately 70 trials in each split epoch, the P1-N1-P2 complex was found to be highly stable, with high positive associations found for all subjects for at least 3 word types. The T-complex was more variable, with high positive associations found for all subjects to at least 1 word type. Conclusions The P1-N1-P2 split epochs at group and individual levels and the T-complex at group level can be used to assess consistency of neural response in individuals with auditory processing deficits. The T-complex relative to the P1-N1-P2 complex in individuals can provide information pertaining to phonological processing.

It is 6 years since we received the tragic news that our great mentor Dr Yasutomi Nishizuka passed away suddenly at the age of 72 years. Dr Nishizuka made several epoch-making discoveries in his life, e.g. the tryptophan metabolism, protein synthesis, ADP-ribosylation, regulation of cAMP-dependent protein kinase and discovery of protein kinase C (PKC). Among them his name will be remembered for a long time as a father of PKC, momentous discoveries in the twentieth century, which are still actively pursued by many laboratories worldwide.

Homogeneous contexts were shown to result in prioritized processing of embedded targets compared to heterogeneous contexts (Duncan & Humphreys, 1989). The present experiment used behavioral and ERP measures to examine whether context homogeneity affects both enhancing relevant information and inhibiting irrelevant in contexts of varying homogeneity. Targets and distractors were presented laterally or on the vertical midline which allowed disentangling target- and distractor-related activity in the lateralized ERP (Hickey, diLollo, & McDonald, 2009). In homogeneous contexts, targets elicited an NT component from 150 ms on and a PD component from 200 ms on, showing early attention deployment at target locations and active suppression of distractors. In heterogeneous contexts, an NT component was also found from 150 ms on and PD was found from 250 ms on, suggesting delayed suppression of the distractor. Before 250 ms, distractors in heterogeneous contexts elicited a contralateral negativity, indicating attentional capture of the distractor prior to active suppression. In sum the present results suggest that top-down control of attention is more pronounced in homogeneous than in heterogeneous contexts.

Background: International Prognostic Index (IPI) has been used as the primary prognostic tool in diffuse large B cell lymphoma (DLBCL) for more than 20 years. Even though the disease is more common in older population, the impact of comorbidities, dose reductions, and treatment-related adverse events (AEs) on the outcome in elderly DLBCL patients has not been well established. In this study, we aimed to investigate the effect of IPI, clinicopathological features, Charlson Comorbidity Index (CCI), AEs and dose reductions on survival of DLBCL patients aged 60 years or above. Methods: We identified 910 DLBCL patients (pts) treated at Cleveland Clinic between 2004-2014 and this analysis includes 413 pts aged ≥60 years. Patient and disease characteristics and treatment data of pts who received at least one cycle of treatment were analyzed for prognostic significance. CCI was calculated, excluding lymphoma, and patients were divided into low CCI (CCI score of 0-2) or high CCI (≥3). For regression analysis, patients were grouped into good or poor risk based on IPI ≤ 2 vs 3-5. Results: Median age of our cohort was 69 years (range, 60-100), 55% were male, and 91% Caucasian. Pts were divided into 3 age groups; 60-69 yrs (N=217), 70-79 yrs (N=124) and >80 yrs (N=72). Most pts had advanced stage disease (59%), high IPI ≥3 (58%) good performance status (PS) ≤1 (74%), and no B symptoms (31%). 15% had high CCI (≥3) with a trend towards higher incidence in >80 yrs (p=0.05). Our cohort had predominantly germinal center (GC) DLBCL (60%) with low incidence of MYC translocation (28%) among the 89 pts tested. Only median BMI (28%, p=0.007) and performance status (≥2: 27%, p=80 yrs) (p=80 yrs, although there was trend observed with IPI (p=0.058) and PS (0.052). Conclusion: In this single center large cohort of DLBCL pts, higher CCI and hospitalization for AE were significant predictors of decreased OS and PFS, especially in pts aged 60-69 years. Although IPI is predictive, a better prognostic model incorporating comorbidities and treatment toxicities may help to better risk stratify older DLBCL patients. Figure Figure. Disclosures Smith: Spectrum: Honoraria; Abbvie: Research Funding; Genentech: Honoraria; Celgene: Honoraria.

OBJECTIVE: The goal was to examine the impact of birth at night, on the weekend, and during July or August (the first months of the academic year) and the impact of resident duty-hour restrictions on mortality and morbidity rates for very low birth weight infants. METHODS: Outcomes were analyzed for 11 137 infants with birth weights of 501 to 1250 g who were enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network registry in 2001–2005. Approximately one-half were born before the introduction of resident duty-hour restrictions in 2003. Follow-up assessments at 18 to 22 months were completed for 4508 infants. Mortality rate, short-term morbidities, and neurodevelopmental outcome were examined with respect to the timing of birth. RESULTS: There was no effect of the timing of birth on mortality rate and no impact on the risks of short-term morbidities except that the risk of retinopathy of prematurity (stage ≥2) was higher after the introduction of duty-hour restrictions and the risk of retinopathy of prematurity requiring operative treatment was lower for infants born during the late night than during the day. There was no impact of the timing of birth on neurodevelopmental outcome except that the risk of hearing impairment or death was slightly lower among infants born in July or August. CONCLUSION: In this network, the timing of birth had little effect on the risks of death and morbidity for very low birth weight infants, which suggests that staffing patterns were adequate to provide consistent care.

We can locate an object more quickly in a real-world scene when a specific target template is held in visual working memory, but it is not known exactly how a target template's specificity affects real-world search. In the present study, we compared word and picture cues in real-world scene search. Using an eye-tracker, we segmented search time into three behaviorally defined epochs: search initiation time, scanning time, and veri. cation time. Results from three experiments indicated that target template specificity affects scanning and veri. cation time. Within the scanning epoch, target template specificity affected the number of scene regions visited and the mean fixation duration. Changes to SOA did not affect this pattern of results. Similarly, the pattern of results did not change when participants were familiarized with target images prior to testing, suggesting that an immediately preceding picture provides a more useful search template than one stored in long-term memory. The results suggest that the specificity of the target cue affects both the activation map representing potential target locations and the process that matches a fixated object to an internal representation of the target.

Oxford Medical has introduced an automatic sleep stager based on the stage-scoring criteria by Rechtschaffen and Kales. With our study we intended to examine whether the results of the stager (version 3.0) match those of the visual evaluation by two independent raters. We also wanted to test the reliability of this automatic sleep stage-scoring system. Ten somnopolygrams of subjects without sleep disturbances served as a basis for the comparison. Each sleep recording was scored twice automatically by the stager, twice visually by the first rater, and once by the second rater. The two automatic analyses of the somnopolygrams differed by 4.3% in a total of 13,850 epochs (1 epoch delta 20 s) regarding sleep stage scoring. The difference between the first and the second visual evaluation by the same rater amounted to 5.7%, whereas the results of the two independent raters deviated by 8.7%. Compared with the results of the visual analysis reached as a consensus by both raters--the so-called optimized visual analysis--the stager showed a 26.9% difference. The automatic analysis scored fewer epochs as stages wake, rapid eye movement (REM), and 2 and more as stages 1, 3, and 4. The sleep stager's frequent difficulty in identifying stage wake correctly as well as its incorrect allocation to other stages--mainly stage REM--could lead to misinterpretations of sleep recordings, whereas the increase in stages 1, 3, and 4, as compared with visual scoring, was negligible.

Polygraphic sleep recordings were made from 46 healthy adult volunteers during 159 nights and evaluated visually. Sleep stages for each 30 sec epoch were entered into a computer data base from which plots of individual nights, as well as color "dormograms" and/or statistical parameters for a set of nights, could be produced. The total mean dormogram in which all the nights were synchronized at sleep onset revealed a dominant sleep pattern, which was found to be very stable even for subgroups. Synchronizing at the beginning of the second REM period allowed the pattern for the last half of the nights to appear more clearly. A large number of different sleep parameters were calculated for each night and statistically analyzed. On the basis of these results a normal "mean" sleep pattern could be reconstructed and related to other studies of normal sleep patterns.

Today begins an epoch in the history of the Academy; for it marks the advent of the first issue of the Academy's own journal-Pediatrics. The journal's title is striking, as are its style and format. All of which have been given much thought and study in order to make them outstanding and meaningful. The contents includes original articles, proceedings and reports from the Academy as well as an informative division composed of feature sections—surely enough to pique the interest of every reader. The birth of pediatrics was not precipitous, but was a result of long and diligent study by a special committee which concluded that the progress made by our organization in the past few years had been so rapid as to require a journal of its own to help record its many activities and to publish reports thereof. Also, so much is happening in the field of pediatrics that a special journal is needed mainly to coordinate the many developments suggested by the various active committees and to transmit these suggestions to the membership. We have long needed a place for reports, exposition and discussion; no longer will mimeographed bulletins satisfy. From time to time, voluminous progress reports have been circulated from Dr. John P. Hubbard on the recent Study of Child Health Services. Here, now,is adequate and proper place for their publication. We are gratified in having been able to persuade Dr. Hubbard to direct a fact finding bureau to be called Trends in Health Legislation and

UNTIL recent years the simple concept which prevailed as to the hormonology of the menopause was that at this phase the ovaries cease to function, bringing about retrogressive and atrophic changes in the tubes, uterus and vagina. As regards the inauguration of the menstrual function at puberty, the general view was equally simple, namely that the awakening of estrogenic activity of the ovaries brings about hypertrophic and developmental changes throughout the genital tract. While there is no doubt as to the development or retrogression which in general parallels ovarian activity or inactivity, respectively, we have come to realize that neither the puberal nor the menopausal epoch is an abrupt one and that there are many individual variations and gradations in the hormonal and histologic phenomena encountered at the two extremes of menstrual life. To appreciate fully the phenomena of the menopause, it is well to contrast them with those which occur at the opposite end of menstrual life, namely puberty, whe...