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1. Comorbidities And Reducing InEquitieS (CARES): Feasibility of self-monitoring and community health worker support in management of comorbidities among Black breast and prostate cancer patients

Author: Laura C. Schubel, Ana Barac, Michelle Magee, Mihriye Mete, Malinda Peeples, Mansur Shomali, Kristen E. Miller, Lauren R. Bangerter, Allan Fong, Christopher Gallagher, Jeanne Mandelblatt, and Hannah Arem
Subjects: Community health workers, Breast cancer, Prostate cancer, Hypertension, Diabetes, mHealth, Medicine (General), R5-920
Abstract: Background: Black individuals with cancer have a higher prevalence of comorbidities and a worse cancer prognosis than other racial groups in the US. As part of a quality improvement project, we aimed to demonstrate feasibility of self-monitoring and community health worker (CHW) support among managing comorbidities for Black individuals with breast or prostate cancer. Methods: In a single arm, pre-post study, we enrolled patients with diabetes and/or hypertension who identified as Black and were diagnosed with 1) stage 0-IV breast cancer, or 2) prostate cancer and on long-term androgen-deprivation therapy. Participants received a home-monitoring device linked to a mobile app and worked with a CHW over six months to track their blood pressure (BP) and/or blood glucose (BG). PROMIS surveys assessed support and self-efficacy. Results: Between May 2021–December 2022, 61 patients with breast or prostate cancer comorbid with hypertension (79 %) or hypertension and diabetes (21 %) enrolled. Once weekly self-recording of BP and BG was achieved in 92 % of individuals (with hypertension) and 77 % of individuals (with diabetes and hypertension). Participants (n = 47) who reported ≥4 readings in Months 1 and 6 demonstrated improved BP control (mean reduction = 4.07 mmHg); too few BG readings were collected to assess change. We observed a slight decrease in PROMIS scores for informational (mean 3.2, sd 8.0) and instrumental support (mean 3.6, sd 8.3). Conclusions: A self-monitoring and CHW intervention is a feasible approach to monitor hypertension among Black cancer patients. Modifications are needed to improve BG monitoring and patient reported outcomes.
Published: 2025
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2. Pilot feasibility and efficacy of a strategy to sustain A1C improvement among diverse adults with type 2 diabetes completing a diabetes care management program

Author: Carine M Nassar, Michelle Magee, Saba Ahmed, and Alex Renato Montero
Subjects: Diseases of the endocrine glands. Clinical endocrinology, RC648-665
Abstract: Introduction Evidence-based strategies are needed to sustain improvements in outcomes following diabetes care management (DCM) programs. We examined the impact of Boot Camp-Plus (BC-Plus), an innovative sustaining strategy, on A1C among adults with type 2 diabetes completing a 3-month Diabetes Boot Camp (DBC). This health system sponsored program consisted of diabetes self-management education and support, medical nutrition therapy and antihyperglycemic medications management.Research design and methods From March 2019 to July 2021, adult DBC completers with Medicare or a health system Medicaid or employee commercial plan were enrolled in BC-Plus for 9 months. DBC completers not meeting insurance eligibility or who declined to participate in BC-Plus acted as controls. During the first 3 months, BC-Plus participants received ongoing daily remote blood glucose (BG) monitoring; and during all 9 months, they received monthly check-in calls with BG review by a medical assistant who addressed needs for supplies/drugs, whether participants were checking BGs, and self-care encouragement. Escalation to a nurse practitioner occurred if the monthly BG trend was >200 mg/dL and/or several BG 9.0% were identified. A1C was followed for an additional 9 months post-BC-Plus. A longitudinal mixed effects analysis was used to assess change in A1C from month 0 to month 21 of follow-up between BC-Plus participants versus controls.Results A total of 838 DCM completers were identified, among whom 281 joined the BC-Plus intervention and 557 acted as controls. Mean age was 55.9 years; 58.2% were women; 66.2% were black; and 30.6% insured by Medicare. BC-Plus participants experienced significantly lower A1C compared with controls and remained below 8.0% to month 18.Conclusions Among completers of a 3-month DCM program, a low intensity 9-month sustaining strategy maintained A1C under 8.0% (HEDIS (Healthcare Effectiveness Data and Information Set) threshold for diabetes control) compared with controls for 15 months after completion of the initial DCM intervention.
Published: 2024
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3. Home‐based biofeedback speech treatment improves dysarthria in repeat‐expansion SCAs

Author: Adam P. Vogel, Lisa H. Graf, Michelle Magee, Ludger Schöls, Natalie Rommel, and Matthis Synofzik
Subjects: Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Neurology. Diseases of the nervous system, RC346-429
Abstract: Abstract CAG repeat‐expansion spinocerebellar ataxias (CAG‐SCAs) are genetically defined multisystemic degenerative diseases, resulting in motor symptoms including dysarthria with a substantial impact on daily living. Whilst speech therapy is widely recommended in ataxia, very limited evidence exists for its use. We evaluated the efficacy of a home‐delivered, ataxia‐tailored biofeedback‐driven speech therapy in CAG‐SCA in 16 individuals with SCA1, 2, 3, or 6. Treatment was delivered intensively over 20 days. Efficacy was evaluated by blinded ratings of intelligibility (primary) and acoustic measures (secondary) leveraging an intra‐individual control design. Intelligibility improved post‐treatment (Z = −3.18, p = 0.004) whilst remaining stable prior to treatment (Z = 0.53, p = 1.00).
Published: 2022
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4. Impact of COVID-19 Pandemic on Food Insecurity in an Urban Emergency Department Patient Population

Author: Donya Enayati, Virginia Chan, Gavin Koenig, Kathryn Povey, Heng Ky Nhoung, Les R. Becker, Kacie J. Saulters, Rebecca Breed, Yumi Jarris, Thomas Zarembka, Michelle Magee, and Munish Goyal
Subjects: Medicine, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Introduction: Food insecurity (FI) has been associated with adverse health outcomes and increased healthcare expenditures. Many families experienced reduced access to food during the coronavirus disease 2019 (COVID-19) pandemic. A 2019 study revealed that the pre-pandemic prevalence of FI at an urban, tertiary care hospital’s emergency department (ED) was 35.3%. We sought to evaluate whether the prevalence of FI in the same ED patient population increased during the COVID-19 pandemic. Methods: We performed a single-center, observational, survey-based study. Surveys assessing for FI were administered to clinically stable patients presenting to the ED over 25 consecutive weekdays from November–December 2020. Results: Of 777 eligible patients, 379 (48.8%) were enrolled; 158 (41.7%) screened positive for FI. During the pandemic, there was a 18.1% relative increase (or 6.4% absolute increase) in the prevalence of FI in this population (P=0.040; OR=1.309, 95% CI 1.012–1.693). The majority (52.9%) of food-insecure subjects reported reduced access to food due to the pandemic. The most common perceived barriers to access to food were reduced food availability at grocery stores (31%), social distancing guidelines (26.5%), and reduced income (19.6%). Conclusion: Our findings suggest that nearly half of the clinically stable patients who presented to our urban ED during the pandemic experienced food insecurity. The prevalence of FI in our hospital’s ED patient population increased by 6.4% during the pandemic. Emergency physicians should be aware of rising FI in their patient population so that they may better support patients who must choose between purchasing food and purchasing prescribed medications.
Published: 2023
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5. Mobile app for personalized sleep–wake management for shift workers: A user testing trial

Author: Jade M. Murray, Michelle Magee, Emma S. Giliberto, Lauren A. Booker, Andrew J. Tucker, Beth Galaska, Sara M. Sibenaller, Sharon A. Baer, Svetlana Postnova, Thijs A.C. Sondag, Andrew J.K. Phillips, Tracey L. Sletten, Mark E. Howard, and Shantha M.W. Rajaratnam
Subjects: Computer applications to medicine. Medical informatics, R858-859.7
Abstract: Objective Development of personalized sleep–wake management tools is critical to improving sleep and functional outcomes for shift workers. The objective of the current study was to test the performance, engagement and usability of a mobile app ( SleepSync ) for personalized sleep–wake management in shift workers that aid behavioural change and provide practical advice by providing personalized sleep scheduling recommendations and education. Methods Shift workers ( n = 27; 20 healthcare and 7 from other industries) trialled the mobile app for two weeks to determine performance, engagement and usability. Primary outcomes were self-reported total sleep time, ability to fall asleep, sleep quality and perception of overall recovery on days off. Secondary performance outcomes included sleep disturbances (insomnia and sleep hygiene symptoms, and sleep-related impairments) and mood (anxiety, stress and depression) pre- and post-app use. Satisfaction with schedule management, integration into daily routine and influence on behaviour were used to determine engagement, while the usability was assessed for functionality and ease of use of features. Results Total sleep time ( P = .04), ability to fall asleep ( P
Published: 2023
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6. Light-based methods for predicting circadian phase in delayed sleep–wake phase disorder

Author: Jade M. Murray, Michelle Magee, Tracey L. Sletten, Christopher Gordon, Nicole Lovato, Krutika Ambani, Delwyn J. Bartlett, David J. Kennaway, Leon C. Lack, Ronald R. Grunstein, Steven W. Lockley, Shantha M. W. Rajaratnam, and Andrew J. K. Phillips
Subjects: Medicine, Science
Abstract: Abstract Methods for predicting circadian phase have been developed for healthy individuals. It is unknown whether these methods generalize to clinical populations, such as delayed sleep–wake phase disorder (DSWPD), where circadian timing is associated with functional outcomes. This study evaluated two methods for predicting dim light melatonin onset (DLMO) in 154 DSWPD patients using ~ 7 days of sleep–wake and light data: a dynamic model and a statistical model. The dynamic model has been validated in healthy individuals under both laboratory and field conditions. The statistical model was developed for this dataset and used a multiple linear regression of light exposure during phase delay/advance portions of the phase response curve, as well as sleep timing and demographic variables. Both models performed comparably well in predicting DLMO. The dynamic model predicted DLMO with root mean square error of 68 min, with predictions accurate to within ± 1 h in 58% of participants and ± 2 h in 95%. The statistical model predicted DLMO with root mean square error of 57 min, with predictions accurate to within ± 1 h in 75% of participants and ± 2 h in 96%. We conclude that circadian phase prediction from light data is a viable technique for improving screening, diagnosis, and treatment of DSWPD.
Published: 2021
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7. Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department

Author: Heng Ky Nhoung, Munish Goyal, Maria Cacciapuoti, Hannah Day, Taymour Hashemzadeh, Michelle Magee, and Yumi S. Jarris
Subjects: Medicine, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Introduction: The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter. Methods: This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing. Results: Of the 85 eligible patients, 76 (89.4%) were enrolled; 35 (46%) screened positive for food insecurity. Food insecure patients were 1.9 times more likely to be hospitalized than non-food insecure patients (relative risk = 1.90 [1.21–2.99], p
Published: 2020
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8. Associations between number of consecutive night shifts and impairment of neurobehavioral performance during a subsequent simulated night shift

Author: Michelle Magee, Tracey L Sletten, Sally A Ferguson, Ronald R Grunstein, Clare Anderson, David J Kennaway, Steven W Lockley, and Shantha MW Rajaratnam
Subjects: night shift, simulated night shift, sustained attention, neurobehavioral performance, sleep, shift work, circadian rhythm, shift worker, circadian phase, Public aspects of medicine, RA1-1270
Abstract: OBJECTIVE: This study aimed to investigate sleep and circadian phase in the relationships between neurobehavioral performance and the number of consecutive shifts worked. METHODS: Thirty-four shift workers [20 men, mean age 31.8 (SD 10.9) years] worked 2–7 consecutive night shifts immediately prior to a laboratory-based, simulated night shift. For 7 days prior, participants worked their usual shift sequence, and sleep was assessed with logs and actigraphy. Participants completed a 10-minute auditory psychomotor vigilance task (PVT) at the start (~21:00 hours) and end (~07:00 hours) of the simulated night shift. Mean reaction times (RT), number of lapses and RT distribution was compared between those who worked 2–3 consecutive night shifts versus those who worked 4–7 shifts. RESULTS: Following 4–7 shifts, night shift workers had significantly longer mean RT at the start and end of shift, compared to those who worked 2–3 shifts. The slowest and fastest 10% RT were significantly slower at the start, but not end, of shift among participants who worked 4–7 nights. Those working 4–7 nights also demonstrated a broader RT distribution at the start and end of shift and had significantly slower RT based on cumulative distribution analysis (5^th, 25^th, 50^th, 75^th percentiles at the start of shift; 75th percentile at the end of shift). No group differences in sleep parameters were found for 7 days and 24 hours prior to the simulated night shift. CONCLUSION: A greater number of consecutive night shifts has a negative impact on neurobehavioral performance, likely due to cognitive slowing.
Published: 2016
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9. Efficacy of melatonin with behavioural sleep-wake scheduling for delayed sleep-wake phase disorder: A double-blind, randomised clinical trial.

Author: Tracey L Sletten, Michelle Magee, Jade M Murray, Christopher J Gordon, Nicole Lovato, David J Kennaway, Stella M Gwini, Delwyn J Bartlett, Steven W Lockley, Leon C Lack, Ronald R Grunstein, Shantha M W Rajaratnam, and Delayed Sleep on Melatonin (DelSoM) Study Group
Subjects: Medicine
Abstract: BackgroundDelayed Sleep-Wake Phase Disorder (DSWPD) is characterised by sleep initiation insomnia when attempting sleep at conventional times and difficulty waking at the required time for daytime commitments. Although there are published therapeutic guidelines for the administration of melatonin for DSWPD, to our knowledge, randomised controlled trials are lacking. This trial tested the efficacy of 0.5 mg melatonin, combined with behavioural sleep-wake scheduling, for improving sleep initiation in clinically diagnosed DSWPD patients with a delayed endogenous melatonin rhythm relative to patient-desired (or -required) bedtime (DBT).MethodsThis randomised, placebo-controlled, double-blind clinical trial was conducted in an Australian outpatient DSWPD population. Following 1-wk baseline, clinically diagnosed DSWPD patients with delayed melatonin rhythm relative to DBT (salivary dim light melatonin onset [DLMO] after or within 30 min before DBT) were randomised to 4-wk treatment with 0.5 mg fast-release melatonin or placebo 1 h before DBT for at least 5 consecutive nights per week. All patients received behavioural sleep-wake scheduling, consisting of bedtime scheduled at DBT. The primary outcome was actigraphic sleep onset time. Secondary outcomes were sleep efficiency in the first third of time in bed (SE T1) on treatment nights, subjective sleep-related daytime impairment (Patient Reported Outcomes Measurement Information System [PROMIS]), PROMIS sleep disturbance, measures of daytime sleepiness, clinician-rated change in illness severity, and DLMO time.FindingsBetween September 13, 2012 and September 1, 2014, 307 participants were registered; 116 were randomised to treatment (intention-to-treat n = 116; n = 62 males; mean age, 29.0 y). Relative to baseline and compared to placebo, sleep onset occurred 34 min earlier (95% confidence interval [CI] -60 to -8) in the melatonin group. SE T1 increased; PROMIS sleep-related impairment, PROMIS sleep disturbance, insomnia severity, and functional disability decreased; and a greater proportion of patients showed more than minimal clinician-rated improvement following melatonin treatment (52.8%) compared to placebo (24.0%) (P < 0.05). The groups did not differ in the number of nights treatment was taken per protocol. Post-treatment DLMO assessed in a subset of patients (n = 43) was not significantly different between groups. Adverse events included light-headedness, daytime sleepiness, and decreased libido, although rates were similar between treatment groups. The clinical benefits or safety of melatonin with long-term treatment were not assessed, and it remains unknown whether the same treatment regime would benefit patients experiencing DSWPD sleep symptomology without a delay in the endogenous melatonin rhythm.ConclusionsIn this study, melatonin treatment 1 h prior to DBT combined with behavioural sleep-wake scheduling was efficacious for improving objective and subjective measures of sleep disturbances and sleep-related impairments in DSWPD patients with delayed circadian phase relative to DBT. Improvements were achieved largely through the sleep-promoting effects of melatonin, combined with behavioural sleep-wake scheduling.Trial registrationThis trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN12612000425897.
Published: 2018
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10. The pupillary light reflex distinguishes between circadian and non-circadian delayed sleep phase disorder (DSPD) phenotypes in young adults.

Author: Elise M McGlashan, Angus C Burns, Jade M Murray, Tracey L Sletten, Michelle Magee, Shantha M W Rajaratnam, and Sean W Cain
Subjects: Medicine, Science
Abstract: This study investigated the utility of the pupillary light reflex as a method of differentiating DSPD patients with delayed melatonin timing relative to desired/required sleep time (circadian type) and those with non-delayed melatonin timing (non-circadian type). All participants were young adults, with a total of 14 circadian DSPD patients (M = 28.14, SD = 5.26), 12 non-circadian DSPD patients (M = 29.42, SD = 11.51) and 51 healthy controls (M = 21.47 SD = 3.16) completing the protocol. All participants were free of central nervous system acting medications and abstained from caffeine and alcohol on the day of the assessment. Two pupillary light reflex measurements were completed by each participant, one with a 1s dim (~10 lux) light exposure, and one with a 1s bright (~1500 lux) light exposure. Circadian DSPD patients showed a significantly faster pupillary light reflex than both non-circadian DSPD patients and healthy controls. Non-circadian patients and healthy controls did not differ significantly. Receiver operating characteristic curves were generated to determine the utility of mean and maximum constriction velocity in differentiating the two DSPD phenotypes, and these demonstrated high levels of sensitivity (69.23--100%) and specificity (66.67-91.67%) at their optimal cut offs. The strongest predictor of DSPD phenotype was the mean constriction velocity to bright light (AUC = 0.87). These results support the potential for the pupillary light reflex to clinically differentiate between DSPD patients with normal vs. delayed circadian timing relative to desired bedtime, without the need for costly and time-consuming circadian assessments.
Published: 2018
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11. Healthcare providers versus patients' understanding of health beliefs and values

Author: Betty Kennedy, Matloob Rehman, William Johnson, Michelle Magee, Robert Leonard, and Peter Katzmarzyk
Subjects: patient experience, communication, patient-centered care, Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract: This study examined how well healthcare providers perceive and understand their patients’ health beliefs and values compared to patients’ actual beliefs, and to determine if communication relationships maybe improved as a result of healthcare providers’ understanding of their patients’ illness from their perspective. A total of 61 participants (7 healthcare providers and 54 patients) were enrolled in the study. Healthcare providers and patients individually completed survey instruments and each participated in a structured focus group. Healthcare provider and patient differences revealed that patients perceived greater meaning of their illness (p = 0.038), and a greater preference for partnership (p = 0.026) compared to providers. The three qualitative themes most important for understanding patients’ health beliefs and values as perceived by healthcare providers were education, trust, and culture. Educating patients was perceived as having the greatest impact and also the easiest method to implement to foster providers’ understanding, with at least one patient focus group in agreement of same. Likewise, three themes were derived from patients’ perspectives as relatively more important in understanding providers’ beliefs and values; bidirectional communication, comprehensive treatment, and discipline. Overwhelmingly, bidirectional communication was perceived as a critical factor as having the greatest impact and may also be easiest to implement according to these patients. When patients and healthcare providers listen and communicate with each other, they are likely to develop a shared understanding that may improve future decision making and quality of care patients receive.
Published: 2017

12. European NCAP Driver State Monitoring Protocols: Prevalence of Distraction in Naturalistic Driving.

Author: Megan Dawn Mulhall, Kyle Wilson, Shiyan Yang, Jonny Kuo, Tracey Sletten, Clare Anderson, Mark E. Howard, Shantha Rajaratnam, Michelle Magee, Allison Collins, and Michael G. Lenné
Published: 2024
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13. 2022 National Standards for Diabetes Self-Management Education and Support

Author: Jody Davis, Amy Hess Fischl, Joni Beck, Lillian Browning, Amy Carter, Jo Ellen Condon, Michelle Dennison, Terri Francis, Peter J. Hughes, Stephen Jaime, Ka Hei Karen Lau, Teresa McArthur, Karen McAvoy, Michelle Magee, Olivia Newby, Stephen W. Ponder, Uzma Quraishi, Kelly Rawlings, Julia Socke, Michelle Stancil, Sacha Uelmen, and Suzanne Villalobos
Subjects: Advanced and Specialized Nursing, Health (social science), Self-Management, Endocrinology, Diabetes and Metabolism, Health Behavior, Diabetes Mellitus, Internal Medicine, Educational Status, Humans, National Standards, Delivery of Health Care, Health Professions (miscellaneous)
Abstract: Purpose: The National Standards for Diabetes Self-Management Education and Support (DSMES) provide guidance and evidence-based, quality practice for all DSMES services. Due to the dynamic nature of health care and diabetes research, the National Standards are reviewed and revised approximately every 5 years by key stakeholders and experts within the diabetes care and education community. For each revision, the Task Force is charged with reviewing the current National Standards for appropriateness, relevance, and scientific basis and making updates based on current evidence and expert consensus. In 2021, the group was tasked with reducing administrative burden related to DSMES implementation across diverse care settings. Conclusion: The evidence supporting the 2022 National Standards clearly identifies the need to provide person-centered services that embrace cultural differences, social determinants of health, and the ever-increasing technological engagement platforms and systems. Payers are invited to review the National Standards as a tool to inform and modernize DSMES reimbursement requirements and to align with the evolving needs of people with diabetes (PWD) and physicians/other qualified health care professionals. The American Diabetes Association and the Association of Diabetes Care & Education Specialists strongly advocate for health equity to ensure all PWD have access to this critical service proven to improve outcomes both related to and beyond diabetes. The 2022 National Standards update is meant to be a universal document that is easy to understand and can be implemented by the entire health care community. DSMES teams in collaboration with primary care have been shown to be the most effective approach to overcome therapeutic inertia.
Published: 2022
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14. Effects of face masks on acoustic analysis and speech perception: Implications for peri-pandemic protocolsa)

Author: Gustavo Noffs, Courtney Lewis, Marja W.J. Caverlé, Camille Paynter, Jess C. S. Chan, Katherine Kenyon, Hannah Reece, Olga Birchall, Sandra Rojas Azocar, Charissa J. Zaga, Benjamin G. Schultz, Adam P. Vogel, Michelle Magee, and Angela Ediriweera
Subjects: Adult, Male, Speech perception, Acoustics and Ultrasonics, Computer science, Voice Quality, Speech recognition, Special Issue on Covid-19 Pandemic Acoustic Effects, Intelligibility (communication), 01 natural sciences, Speech Acoustics, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Arts and Humanities (miscellaneous), 0103 physical sciences, Cepstrum, Humans, 010301 acoustics, SARS-CoV-2, Speech Intelligibility, Masks, COVID-19, Face masks, Female, 030217 neurology & neurosurgery, Sentence
Abstract: Wearing face masks (alongside physical distancing) provides some protection against infection from COVID-19. Face masks can also change how people communicate and subsequently affect speech signal quality. This study investigated how three common face mask types (N95, surgical, and cloth) affected acoustic analysis of speech and perceived intelligibility in healthy subjects. Acoustic measures of timing, frequency, perturbation, and power spectral density were measured. Speech intelligibility and word and sentence accuracy were also examined using the Assessment of Intelligibility of Dysarthric Speech. Mask type impacted the power distribution in frequencies above 3 kHz for the N95 mask, and above 5 kHz in surgical and cloth masks. Measures of timing and spectral tilt mainly differed with N95 mask use. Cepstral and harmonics to noise ratios remained unchanged across mask type. No differences were observed across conditions for word or sentence intelligibility measures; however, accuracy of word and sentence translations were affected by all masks. Data presented in this study show that face masks change the speech signal, but some specific acoustic features remain largely unaffected (e.g., measures of voice quality) irrespective of mask type. Outcomes have bearing on how future speech studies are run when personal protective equipment is worn.
Published: 2020

15. Features of speech and swallowing dysfunction in pre-ataxic spinocerebellar ataxia type 2

Author: Sebastian Contreras Cubillos, Roberto Rodríguez-Labrada, Matthis Synofzik, Tamara Canento, Winfried Ilg, Jacqueline Medrano-Montero, Yaimeé Vázquez-Mojena, Sandra Rojas, Luis Velázquez-Pérez, Melissa P. Cyngler, Fernanda Maldonado, Reidenis Torres-Vega, Megan Kruse, Michelle Magee, and Adam P. Vogel
Subjects: Adult, Male, medicine.medical_specialty, Ataxia, Adolescent, physiopathology [Deglutition Disorders], physiopathology [Speech Disorders], physiopathology [Spinocerebellar Ataxias], Disease, Audiology, Speech Disorders, psychology [Spinocerebellar Ataxias], Young Adult, 03 medical and health sciences, Dysarthria, 0302 clinical medicine, Quality of life, Swallowing, otorhinolaryngologic diseases, medicine, Humans, Spinocerebellar Ataxias, ddc:610, Young adult, 030223 otorhinolaryngology, complications [Spinocerebellar Ataxias], business.industry, Middle Aged, medicine.disease, Dysphagia, Speech Articulation Tests, etiology [Speech Disorders], psychology [Speech Disorders], psychology [Deglutition Disorders], Disease Progression, Quality of Life, Spinocerebellar ataxia, Female, Neurology (clinical), medicine.symptom, Deglutition Disorders, business, Biomarkers, 030217 neurology & neurosurgery, etiology [Deglutition Disorders]
Abstract: ObjectiveTo determine whether objective and quantitative assessment of dysarthria and dysphagia in spinocerebellar ataxia type 2 (SCA2), specifically at pre-ataxic and early disease phases, can act as sensitive disease markers.MethodsForty-six individuals (16 with pre-ataxic SCA2, 14 with early-stage ataxic SCA2, and 16 healthy controls) were recruited in Holguin, Cuba. All participants underwent a comprehensive battery of assessments including objective acoustic analysis, clinician-derived ratings of speech function and swallowing, and quality of life assessments of swallowing.ResultsReduced speech agility manifest at the pre-ataxic stage was observed during diadochokinetic tasks, with the magnitude of speech deficit augmented in the early ataxic stage. Speech rate was slower in early-stage ataxic SCA2 compared with pre-ataxic SCA2 and healthy controls. Reduced speech agility and speech rate correlated with disease severity and time to ataxia onset, verifying that speech deficits occur prior to ataxia onset and increase in severity as the disease progresses. Whereas dysphagia was observed in both pre-ataxic and ataxic SCA2, it was not associated with swallowing-related quality of life, disease severity, or time to ataxia onset.ConclusionsSpeech and swallowing deficits appear sensitive to disease progression in early-stage SCA2, with syllabic rate a viable marker. Findings provide insight into mechanisms of disease progression in early-stage SCA2, signaling an opportunity for stratifying early-stage SCA2 and identifying salient markers of disease onset as well as outcome measures in future early-stage therapeutic studies.
Published: 2020
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16. Erratum. 2022 National Standards for Diabetes Self-Management Education and Support. Diabetes Care 2022;45:484–494

Author: Jody Davis, Amy Hess Fischl, Joni Beck, Lillian Browning, Amy Carter, Jo Ellen Condon, Michelle Dennison, Terri Francis, Peter J. Hughes, Stephen Jaime, Ka Hei Karen Lau, Teresa McArthur, Karen McAvoy, Michelle Magee, Olivia Newby, Stephen W. Ponder, Uzma Quraishi, Kelly Rawlings, Julia Socke, Michelle Stancil, Sacha Uelmen, and Suzanne Villalobos
Subjects: Advanced and Specialized Nursing, Self Care, Endocrinology, Diabetes and Metabolism, Self-Management, Health Behavior, Internal Medicine, Diabetes Mellitus, Educational Status, Humans, Erratum
Published: 2022

17. Posttransplant Complications Predict Alcohol Relapse in Liver Transplant Recipients

Author: Marwan S Abouljoud, Michelle Magee, Toshihiro Kitajima, Atsushi Yoshida, Donna L Ellithorpe, Yusuf Qadeer, Kimberly A. Brown, Shunji Nagai, Antu Segal, Dilip Moonka, Shaundra Blackburn, and Sirisha Yeddula
Subjects: Adult, medicine.medical_specialty, Alcohol Drinking, media_common.quotation_subject, medicine.medical_treatment, Alcoholic hepatitis, 030230 surgery, Liver transplantation, 03 medical and health sciences, Liver disease, 0302 clinical medicine, Sobriety, Recurrence, Risk Factors, Internal medicine, medicine, Humans, Risk factor, Liver Diseases, Alcoholic, media_common, Transplantation, Hepatology, Alcohol Abstinence, Hepatitis, Alcoholic, Proportional hazards model, business.industry, Hazard ratio, Abstinence, medicine.disease, Liver Transplantation, 030211 gastroenterology & hepatology, Surgery, business
Abstract: Alcohol relapse after liver transplantation (LT) in patients with alcohol-related liver disease (ALD) is a major challenge. Although its association with pretransplant psychosocial factors was extensively studied, the impacts of posttransplant courses on alcohol relapse have not been well investigated. The aim of this study is to analyze peritransplant factors associated with posttransplant alcohol relapse in patients with ALD. This study evaluated 190 adult LT patients with ALD from 2013 to 2019. Risk factors for alcohol relapse were analyzed, focusing on posttransplant chronic complications, which were classified as Clavien-Dindo classification 3a or higher that lasted over 30 days. The posttransplant alcohol relapse rate was 13.7% (26/190) with a median onset time of 18.6 months after transplant. Multivariate Cox regression analysis revealed that posttransplant chronic complications were an independent risk factor for posttransplant alcohol relapse (hazard ratio [HR], 5.40; P = 0.001), along with psychiatric comorbidity (HR, 3.93; P = 0.001), history of alcohol relapse before LT (HR, 3.00; P = 0.008), and an abstinence period
Published: 2020
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18. Continuous monitoring of visual distraction and drowsiness in shift-workers during naturalistic driving

Author: Mark E Howard, Jonny Kuo, Allison L Collins, Megan D Mulhall, Michael G. Lenné, Tracey L. Sletten, Shantha M W Rajaratnam, Michelle Magee, and Clare Anderson
Subjects: 05 social sciences, Continuous monitoring, Applied psychology, 0211 other engineering and technologies, Public Health, Environmental and Occupational Health, Context (language use), Monitoring system, 02 engineering and technology, Building and Construction, Task (project management), Distraction, 021105 building & construction, 0501 psychology and cognitive sciences, Visual distraction, Naturalistic driving, Safety, Risk, Reliability and Quality, Psychology, Safety Research, 050107 human factors
Abstract: Driver drowsiness is a significant public health problem and has previously been linked to an increase in drivers’ propensity to engage in visual distraction. This relationship however has yet to be examined under naturalistic driving conditions, where task demands may differ from lab-based experimental studies. This study aimed to examine the behavioural and physiological signals associated with visual distraction in real-world driving through a world-first application of a real-time driver monitoring system. Using a continuous driver monitoring system, shift-workers (N = 20) were observed on their commutes to and from work. Classifying off-road glances into glances to the driver lap and centre console regions of the vehicle revealed differences in the propensity for drivers to look away from the forward roadway toward these regions, with drivers significantly more likely to look toward their lap when drowsy. These glances were subsequently clustered and analysed in the context of visual time-sharing sequences. Our findings carry impact not only within the subjects of drowsiness and distraction but are also broadly applicable in the context of naturalistic driving methodology where real-time assessment of driver state can facilitate the analysis of large naturalistic datasets.
Published: 2019
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19. Application of a Limit-Cycle Oscillator Model for Prediction of Circadian Phase in Rotating Night Shift Workers

Author: Mark E Howard, Julia E. Stone, Tracey L. Sletten, Henning Maass, Xavier L. Aubert, Steven W. Lockley, Andrew J. K. Phillips, Michelle Magee, and Shantha M W Rajaratnam
Subjects: Activity Cycles, Adult, Male, 0301 basic medicine, Evening, Health Personnel, lcsh:Medicine, Adaptation (eye), Article, Shift work, 03 medical and health sciences, 0302 clinical medicine, Rhythm, Statistics, Humans, Computational models, Oscillators, Circadian rhythm, lcsh:Science, Melatonin, Mathematics, Multidisciplinary, lcsh:R, Shift Work Schedule, Middle Aged, Models, Theoretical, Circadian Rhythm, Alertness, Schedule (workplace), 030104 developmental biology, Female, lcsh:Q, Circadian rhythms and sleep, 030217 neurology & neurosurgery
Abstract: Practical alternatives to gold-standard measures of circadian timing in shift workers are needed. We assessed the feasibility of applying a limit-cycle oscillator model of the human circadian pacemaker to estimate circadian phase in 25 nursing and medical staff in a field setting during a transition from day/evening shifts (diurnal schedule) to 3–5 consecutive night shifts (night schedule). Ambulatory measurements of light and activity recorded with wrist actigraphs were used as inputs into the model. Model estimations were compared to urinary 6-sulphatoxymelatonin (aMT6s) acrophase measured on the diurnal schedule and last consecutive night shift. The model predicted aMT6s acrophase with an absolute mean error of 0.69 h on the diurnal schedule (SD = 0.94 h, 80% within ±1 hour), and 0.95 h on the night schedule (SD = 1.24 h, 68% within ±1 hour). The aMT6s phase shift from diurnal to night schedule was predicted to within ±1 hour in 56% of individuals. Our findings indicate the model can be generalized to a shift work setting, although prediction of inter-individual variability in circadian phase shift during night shifts was limited. This study provides the basis for further adaptation and validation of models for predicting circadian phase in rotating shift workers.
Published: 2019
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20. Prediction of shiftworker alertness, sleep, and circadian phase using a model of arousal dynamics constrained by shift schedules and light exposure

Author: Michelle Magee, Mark E Howard, Megan D Mulhall, S. A. Knock, Svetlana Postnova, Saranea Ganesan, Tracey L. Sletten, Shantha M W Rajaratnam, Julia E. Stone, and Steven W. Lockley
Subjects: 0301 basic medicine, medicine.medical_specialty, Evening, Basic Science of Sleep and Circadian Rhythms, Audiology, sleepiness, Affect (psychology), nurses, Arousal, 03 medical and health sciences, 0302 clinical medicine, Sleep Disorders, Circadian Rhythm, Work Schedule Tolerance, Physiology (medical), medicine, Humans, Circadian rhythm, AcademicSubjects/MED00385, sleep, Wakefulness, alertness, AcademicSubjects/SCI01870, Work (physics), Psychomotor vigilance task, healthcare, Circadian Rhythm, quantitative modeling, Alertness, 030104 developmental biology, rotating shiftwork, circadian rhythms, Neurology (clinical), Sleep (system call), Psychology, 030217 neurology & neurosurgery, AcademicSubjects/MED00370
Abstract: Study ObjectivesThe study aimed to, for the first time, (1) compare sleep, circadian phase, and alertness of intensive care unit (ICU) nurses working rotating shifts with those predicted by a model of arousal dynamics; and (2) investigate how different environmental constraints affect predictions and agreement with data.MethodsThe model was used to simulate individual sleep-wake cycles, urinary 6-sulphatoxymelatonin (aMT6s) profiles, subjective sleepiness on the Karolinska Sleepiness Scale (KSS), and performance on a Psychomotor Vigilance Task (PVT) of 21 ICU nurses working day, evening, and night shifts. Combinations of individual shift schedules, forced wake time before/after work and lighting, were used as inputs to the model. Predictions were compared to empirical data. Simulations with self-reported sleep as an input were performed for comparison.ResultsAll input constraints produced similar prediction for KSS, with 56%–60% of KSS scores predicted within ±1 on a day and 48%–52% on a night shift. Accurate prediction of an individual’s circadian phase required individualized light input. Combinations including light information predicted aMT6s acrophase within ±1 h of the study data for 65% and 35%–47% of nurses on diurnal and nocturnal schedules. Minute-by-minute sleep-wake state overlap between the model and the data was between 81 ± 6% and 87 ± 5% depending on choice of input constraint.ConclusionsThe use of individualized environmental constraints in the model of arousal dynamics allowed for accurate prediction of alertness, circadian phase, and sleep for more than half of the nurses. Individual differences in physiological parameters will need to be accounted for in the future to further improve predictions.
Published: 2021
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21. Case 31: A Novel Approach to Achieve Target Time in Range When Using U-500 Regular Insulin in a Continuous Subcutaneous Insulin Infusion (CSII) Pump

Author: Patricia Montesinos and Michelle Magee
Abstract: A 58-year-old African American male had type 2 diabetes and insulin resistance with persistent dysglycemia characterized by high glucose variability and suboptimal blood glucose time in range (TIR) (42.5%). His past medical history was remarkable for hypertension, hyperlipidemia, stage 3–4 chronic kidney disease, peripheral neuropathy, gastroparesis, and coronary artery and peripheral vascular disease.
Published: 2021
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22. A Blue-Enriched, Increased Intensity Light Intervention to Improve Alertness and Performance in Rotating Night Shift Workers in an Operational Setting

Author: Michelle Magee, Shantha M W Rajaratnam, Ronald R. Grunstein, Tracey L. Sletten, Steven W. Lockley, David J. Kennaway, Bhairavi Raman, and Sally A. Ferguson
Subjects: medicine.medical_specialty, media_common.quotation_subject, circadian photoreception, Audiology, Shift work, 03 medical and health sciences, Behavioral Neuroscience, 0302 clinical medicine, Nature and Science of Sleep, vigilance, medicine, Applied Psychology, alertness, media_common, Original Research, business.industry, Psychomotor vigilance task, Repeated measures design, Illuminance, short-wavelength, Alertness, Light intensity, Mood, shift work, 030228 respiratory system, business, light, 030217 neurology & neurosurgery, Vigilance (psychology)
Abstract: Tracey L Sletten,1 Bhairavi Raman,1 Michelle Magee,1 Sally A Ferguson,2 David J Kennaway,3 Ronald R Grunstein,4,5 Steven W Lockley,6,7 Shantha MW Rajaratnam1,6,7 1Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia; 2Central Queensland University, Appleton Institute, Goodwood, SA, Australia; 3Robinson Research Institute, School of Medicine, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia; 4Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; 5Department of Respiratory & Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia; 6Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, USA; 7Division of Sleep Medicine, Harvard Medical School, Boston, MA, USACorrespondence: Tracey L SlettenTurner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Building 2, 270 Ferntree Gully Road, Notting Hill, Victoria, 3168, AustraliaTel + 61 3 990 20734Email tracey.sletten@monash.eduPurpose: This study examined the efficacy of a lighting intervention that increased both light intensity and short-wavelength (blue) light content to improve alertness, performance and mood in night shift workers in a chemical plant.Patients and Methods: During rostered night shifts, 28 workers (46.0± 10.8 years; 27 male) were exposed to two light conditions each for two consecutive nights (∼ 19:00– 07:00 h) in a counterbalanced repeated measures design: traditional-spectrum lighting set at pre-study levels (43 lux, 4000 K) versus higher intensity, blue-enriched lighting (106 lux, 17,000 K), equating to a 4.5-fold increase in melanopic illuminance (24 to 108 melanopic illuminance). Participants completed the Karolinska Sleepiness Scale, subjective mood ratings, and the Psychomotor Vigilance Task (PVT) every 2– 4 hours during the night shift.Results: A significant main effect of time indicated KSS, PVT mean reaction time, number of PVT lapses (reaction times > 500 ms) and subjective tension, misery and depression worsened over the course of the night shift (p< 0.05). Percentage changes in KSS (p< 0.05, partial η2=0.14) and PVT mean reaction time (p< 0.05, partial η2=0.19) and lapses (p< 0.05, partial η2=0.17) in the middle and end of night shift, expressed relative to start of shift, were significantly improved during the lighting intervention compared to the traditional lighting condition. Self-reported mood did not significantly differ between conditions (p> 0.05).Conclusion: Our findings, showing improvements in alertness and performance with exposure to blue-enriched, increased intensity light, provide support for light to be used as a countermeasure for impaired alertness in night shift work settings.Keywords: shift work, circadian photoreception, alertness, vigilance, light, short-wavelength
Published: 2020

23. A PERIOD3 variable number tandem repeat polymorphism modulates melatonin treatment response in delayed sleep‐wake phase disorder

Author: Ronald R. Grunstein, Nicole Lovato, Christopher J. Gordon, Steven W. Lockley, Jade M. Murray, Simon Archer, David J. Kennaway, Delwyn J. Bartlett, Michelle Magee, Tracey L. Sletten, Leon Lack, and Shantha M W Rajaratnam
Subjects: Adult, Male, Sleep Wake Disorders, 0301 basic medicine, medicine.medical_specialty, Placebo, Gastroenterology, Bedtime, Melatonin, Pittsburgh Sleep Quality Index, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Double-Blind Method, Internal medicine, medicine, Humans, Sleep disorder, Polymorphism, Genetic, business.industry, Actigraphy, Period Circadian Proteins, medicine.disease, 030104 developmental biology, Tandem Repeat Sequences, Female, Sleep onset latency, Sleep onset, business, 030217 neurology & neurosurgery, medicine.drug
Abstract: We examined whether a polymorphism of the PERIOD3 gene (PER3; rs57875989) modulated the sleep promoting effects of melatonin in Delayed Sleep-Wake Phase Disorder (DSWPD). One hundred and four individuals (53 males; 29.4±10.0 years) with DSWPD and a delayed dim light melatonin onset (DLMO) collected buccal swabs for genotyping (PER34/4 n=43; PER3 5 allele [heterozygous and homozygous] n=60). Participants were randomised to placebo or 0.5mg melatonin taken 1 hour before desired bedtime (or ~ 1.45 h before DLMO), with sleep attempted at desired bedtime (4 weeks; 5-7 nights/week). We assessed sleep (diary and actigraphy), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Patient-Reported Outcomes Measurement Information System (PROMIS: Sleep Disturbance, Sleep-Related Impairment), Sheehan Disability Scale (SDS), and Patient- and Clinician-Global Improvement (PGI-C, CGI-C). Melatonin treatment response on actigraphic sleep onset time did not differ between genotypes. For PER34/4 carriers, self-reported sleep onset time was advanced by a larger amount and sleep onset latency (SOL) was shorter in melatonin-treated patients compared to those receiving placebo (P=0.008), while actigraphic sleep efficiency in the first third of the sleep episode (SE T1) did not differ. For PER3 5 carriers, actigraphic SOL and SE T1 showed a larger improvement with melatonin (P
Published: 2020
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24. Light-based methods for predicting circadian phase in delayed sleep-wake phase disorder

Author: Tracey L. Sletten, Shantha M W Rajaratnam, Krutika Ambani, Nicole Lovato, Ronald R. Grunstein, Delwyn J. Bartlett, David J. Kennaway, Michelle Magee, Christopher J. Gordon, Leon Lack, Steven W. Lockley, Jade M. Murray, and Andrew J. K. Phillips
Subjects: 0301 basic medicine, Adult, Male, Mean squared error, Adolescent, Light, Science, Phase (waves), Sensitivity and Specificity, Article, Melatonin, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Sleep Disorders, Circadian Rhythm, Linear regression, Statistics, medicine, Humans, Circadian rhythm, Group delay and phase delay, Phase response curve, Mathematics, Multidisciplinary, Trauma Severity Indices, Statistical model, Diagnostic markers, Middle Aged, Prognosis, Circadian Rhythm, 030104 developmental biology, Medicine, Female, Circadian rhythms and sleep, Sleep, 030217 neurology & neurosurgery, Biomarkers, medicine.drug
Abstract: Methods for predicting circadian phase have been developed for healthy individuals. It is unknown whether these methods generalize to clinical populations, such as delayed sleep–wake phase disorder (DSWPD), where circadian timing is associated with functional outcomes. This study evaluated two methods for predicting dim light melatonin onset (DLMO) in 154 DSWPD patients using ~ 7 days of sleep–wake and light data: a dynamic model and a statistical model. The dynamic model has been validated in healthy individuals under both laboratory and field conditions. The statistical model was developed for this dataset and used a multiple linear regression of light exposure during phase delay/advance portions of the phase response curve, as well as sleep timing and demographic variables. Both models performed comparably well in predicting DLMO. The dynamic model predicted DLMO with root mean square error of 68 min, with predictions accurate to within ± 1 h in 58% of participants and ± 2 h in 95%. The statistical model predicted DLMO with root mean square error of 57 min, with predictions accurate to within ± 1 h in 75% of participants and ± 2 h in 96%. We conclude that circadian phase prediction from light data is a viable technique for improving screening, diagnosis, and treatment of DSWPD.
Published: 2020

25. Temporal dynamics of circadian phase shifting response to consecutive night shifts in healthcare workers: role of light-dark exposure

Author: Saranea Ganesan, Mark E Howard, Allison L Collins, Julia E. Stone, Shantha M W Rajaratnam, Megan D Mulhall, Tracey L. Sletten, Michelle Magee, and Steven W. Lockley
Subjects: 0301 basic medicine, Light therapy, Evening, Physiology, medicine.medical_treatment, Circadian clock, Biology, Shift work, 03 medical and health sciences, Light intensity, 030104 developmental biology, 0302 clinical medicine, medicine, Circadian rhythm, Entrainment (chronobiology), 030217 neurology & neurosurgery, Phase response curve, Demography
Abstract: Key points: Shift work is highly prevalent and is associated with significant adverse health impacts. There is substantial inter-individual variability in the way the circadian clock responds to changing shift cycles. The mechanisms underlying this variability are not well understood. We tested the hypothesis that lightâ��dark exposure is a significant contributor to this variability; when combined with diurnal preference, the relative timing of light exposure accounted for 71% of individual variability in circadian phase response to night shift work. These results will drive development of personalised approaches to manage circadian disruption among shift workers and other vulnerable populations to potentially reduce the increased risk of disease in these populations. Abstract: Night shift workers show highly variable rates of circadian adaptation. This study examined the relationship between light exposure patterns and the magnitude of circadian phase resetting in response to night shift work. In 21 participants (nursing and medical staff in an intensive care unit) circadian phase was measured using 6-sulphatoxymelatonin at baseline (day/evening shifts or days off) and after 3â��4 consecutive night shifts. Daily light exposure was examined relative to individual circadian phase to quantify light intensity in the phase delay and phase advance portions of the light phase response curve (PRC). There was substantial inter-individual variability in the direction and magnitude of phase shift after three or four consecutive night shifts (mean phase delay â��1:08Â Â±Â 1:31Â h; range â��3:43Â h delay to +3:07Â h phase advance). The relative difference in the distribution of light relative to the PRC combined with diurnal preference accounted for 71% of the variability in phase shift. Regression analysis incorporating these factors estimated phase shift to within Â±60Â min in 85% of participants. No participants met criteria for partial adaptation to night work after three or four consecutive night shifts. Our findings provide evidence that the phase resetting that does occur is based on individual light exposure patterns relative to an individual's baseline circadian phase. Thus, a â��one size fits allâ�� approach to promoting adaptation to shift work using light therapy, implemented without knowledge of circadian phase, may not be efficacious for all individuals. Â© 2018 Monash University. The Journal of Physiology Â© 2018 The Physiological Society
Published: 2018
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26. Adults with a history of recreational cannabis use have altered speech production

Author: Gabrielle Todd, Michelle Magee, Adam P. Vogel, Verity Pearson-Dennett, Jason M. White, Adrian Esterman, Dominic Thewlis, Robert A Wilcox, Vogel, Adam P, Pearson-Dennett, Verity, Magee, Michelle, Wilcox, Robert A, Esterman, Adrian, Thewlis, Dominic, White, Jason M, and Todd, Gabrielle
Subjects: Adult, Speech production, medicine.medical_specialty, speech, medicine.medical_treatment, media_common.quotation_subject, Audiology, Toxicology, Speech Acoustics, Speech Production Measurement, otorhinolaryngologic diseases, medicine, Humans, Speech, Pharmacology (medical), acoustics, Effects of cannabis, Cannabis, media_common, Pharmacology, vocal control, biology, Abstinence, biology.organism_classification, Gait, Stimulant, Psychiatry and Mental health, speech timing, Vocal effort, Cohort, Hallucinogens, recreational cannabis use, voice quality, Psychology
Abstract: Refereed/Peer-reviewed Stereotypical depictions of speech in cannabis users often suggest slow, laboured output, yet objective evidence supporting this assumption is extremely limited. We know that depressants or hallucinogenic drugs such as cannabis can cause acute changes in communication and speech rate, but the long-lasting effects of cannabis use on speech are not well described. The aim of this study was to investigate speech in individuals with a history of recreational cannabis use compared to non-drug-using healthy controls. Speech samples were collected from a carefully described cohort of 31 adults with a history of cannabis use (but not use of illicit stimulant drugs) and 40 non-drug-using controls. Subjects completed simple and complex speech tasks including a monologue, a sustained vowel, saying the days of the week, and reading a phonetically balanced passage. Audio samples were analysed objectively using acoustic analysis for measures of timing, vocal control, and quality. Subtle differences in speech timing, vocal effort, and voice quality may exist between cannabis and control groups, however data remain equivocal. After controlling for lifetime alcohol and tobacco use and applying a false discovery rate, only spectral tilt (vocal effort and intensity) differed between groups and appeared to change in line with duration of abstinence from cannabis use. Differences between groups may reflect longer term changes to the underlying neural control of speech. Our digital analysis of speech shows there may be a signal differentiating individuals with a history of recreational cannabis use from healthy controls, in line with similar findings from gait and hand function studies.
Published: 2021
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27. Randomised controlled trial of the efficacy of a blue-enriched light intervention to improve alertness and performance in night shift workers

Author: Ronald R. Grunstein, Tracey L. Sletten, Michelle Magee, Sally A. Ferguson, Darren O’Brien, Christian L. Nicholas, Shantha M W Rajaratnam, David J. Kennaway, Steven W. Lockley, and Suzanne Ftouni
Subjects: Adult, Male, 0301 basic medicine, medicine.medical_specialty, Australian/New Zealand, Light, law.invention, Shift work, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Sleep Disorders, Circadian Rhythm, law, Work Schedule Tolerance, Intervention (counseling), medicine, Humans, Attention, Circadian rhythm, Wakefulness, Melatonin, business.industry, Public Health, Environmental and Occupational Health, Actigraphy, Circadian Rhythm, Clinical trial, Alertness, Treatment Outcome, 030104 developmental biology, Physical therapy, Female, Sleep, business, 030217 neurology & neurosurgery
Abstract: Objectives Night workers often experience high levels of sleepiness due to misalignment of the sleep-wake cycle from the circadian pacemaker, in addition to acute and chronic sleep loss. Exposure to light, in particular short wavelength light, can improve alertness and neurobehavioural performance. This randomised controlled trial examined the efficacy of blue-enriched polychromatic light to improve alertness and neurobehavioural performance in night workers. Design Participants were 71 night shift workers (42 males; 32.8Â±10.5 years) who worked at least 6 hours between 22:00 and 08:00 hours. Sleep-wake logs and wrist actigraphy were collected for 1-3 weeks, followed by 48-hour urine collection to measure the circadian 6-sulphatoxymelatonin (aMT6s) rhythm. On the night following at least two consecutive night shifts, workers attended a simulated night shift in the laboratory which included subjective and objective assessments of sleepiness and performance. Workers were randomly assigned for exposure to one of two treatment conditions from 23:00 hours to 07:00 hours: blue-enriched white light (17 000 K, 89 lux; n=36) or standard white light (4000 K, 84 lux; n=35). Results Subjective and objective sleepiness increased during the night shift in both light conditions (p
Published: 2017
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28. Abstracts

Author: Jeanette Tamplin, Zi Hui Su, Michelle Magee (nee Colomiere), Naida Garabova, Jaroslaw Marusiak, Magdalena Siemiatycka, Arturo Iván Pérez Pacheco, Cristina Dominguez, Madina Burzhunova, Istvan Mihaly, Yuliya Shpilyukova, Rostyslav Bubnov, Yasser Mecheri, Sebastian Schade, Ashley Akbari, and Yahya Naji
Subjects: medicine.medical_specialty, Parkinson's disease, Movement disorders, Neurology, business.industry, International congress, Medicine, Neurology (clinical), medicine.symptom, business, medicine.disease, Psychiatry
Published: 2019
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29. Motor speech and non-motor language endophenotypes of Parkinson's disease

Author: Adam P. Vogel, Michelle Magee, and David A. Copland
Subjects: medicine.medical_specialty, Parkinson's disease, Deep brain stimulation, Endophenotypes, medicine.medical_treatment, Disease, Speech Disorders, 03 medical and health sciences, Dysarthria, 0302 clinical medicine, Physical medicine and rehabilitation, Motor speech, medicine, Humans, Pharmacology (medical), Cognitive Dysfunction, Modalities, business.industry, General Neuroscience, Cognition, Parkinson Disease, medicine.disease, 030227 psychiatry, Endophenotype, Disease Progression, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery
Abstract: Introduction: Idiopathic Parkinson's Disease (PD) results in a range of motor and non-motor impairments. Clinical diagnosis commonly occurs after substantial neurophysiological damage limiting the opportunity for neuroprotective treatments. Uncovering sensitive objective markers with the capacity to detect pre-symptomatic disease and track disease progression is therefore a priority. Speech may provide an ideal proxy marker for PD; a quantifiable biometric that displays salient changes in early disease and appears to evolve with disease progression.Areas covered: This review describes the endophenotype of speech, voice, cognition and language modalities in PD and investigates the speech as a 'proxy marker' of PD disease state.Expert opinion: Detailed characterization at different disease stages are needed and must incorporate longitudinal assessment to capture small but significant changes in speech, voice, cognition and language modalities within patient changes over time. Advances in technology are leading to new opportunities for acquiring data remotely and more frequently, offering more ecologically valid testing environments. Combined with automated signal processing and analysis, symptoms may also be tracked in-home readily. Features extracted may provide a 'proxy marker' for early identification of PD and objective monitoring of disease progression.
Published: 2019

30. Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial

Author: Hertzel C Gerstein, Helen M Colhoun, Gilles R Dagenais, Rafael Diaz, Mark Lakshmanan, Prem Pais, Jeffrey Probstfield, Fady T Botros, Matthew C Riddle, Lars Rydén, Denis Xavier, Charles Messan Atisso, Leanne Dyal, Stephanie Hall, Purnima Rao-Melacini, Gloria Wong, Alvaro Avezum, Jan Basile, Namsik Chung, Ignacio Conget, William C Cushman, Edward Franek, Nicolae Hancu, Markolf Hanefeld, Shaun Holt, Petr Jansky, Matyas Keltai, Fernando Lanas, Lawrence A Leiter, Patricio Lopez-Jaramillo, Ernesto German Cardona Munoz, Valdis Pirags, Nana Pogosova, Peter J Raubenheimer, Jonathan E Shaw, Wayne H-H Sheu, Theodora Temelkova-Kurktschiev, Mercedes Abella, Andrea Alebuena, Sandra Almagro, Eduardo Amoroso, Paula Anadon, Elizabeth Andreu, Guillermo Aristimuño, Maria Arzadun, Maria Barbieri, Raul Barcudi, Ines Bartolacci, Gabriel Bolobanich, Anselmo Bordonava, Miguel Bustamante Labarta, Betina Bustos, Alberto Caccavo, Alejandra Camino, Maria Cantero, Maria Carignano, Luis Cartasegna, Marcela Cipullo, Víctor Commendatore, Victoria Conosciuto, Osvaldo Costamagna, Claudia Crespo, Jose Cuello, Carlos Cuneo, Sandra Cusimano, Sofia Dean, Claudio Dituro, Andrea Dominguez, Miguel Farah, Alberto Fernandez, Florencia Fernandez, Adriana Ferrari, Patricia Flammia, Jose Fuentealba, Karina Beatriz Gallardo, Celso Garcia, Ruben Garcia Duran, Marcelo Garrido, Rodolfo Gavicola, Claudio Gerbaudo, Graciela Gilli, Ana Paula Giotto, Pedro Godoy Bolzán, Oscar Gomez Vilamajo, Fernando Guerlloy, Cristian Guridi, Narcisa Gutierrez Garrido, Eduardo Hasbani, Sonia Hermida, Miguel Hominal, Adrian Hrabar, Adrián Ingaramo, Alejandra Izzicupo, Mario Krynski, Mariana Lagrutta, Paulina Lanchiotti, Maria Langhe, Veronica Leonard, Javier Llanos, Ricardo Lopez Santi, Jorge Lowenstein, Cecilia Luquez, Ignacio Mackinnon, Melina Mana, Sara Manzur, Javier Marino, Carolina Martella, Roger Martinez, Re Matias, Javier Matkovich, Monica Meritano, Oscar Montaña, María Mulazzi, Juan Ochoa, Gustavo Paterlini, María Pelagagge, Maria Elena Peralta Lopez, Aldo Prado, Lorena Pruyas, Martín Racca, Carola Ricotti, Carolina Rodriguez, Mariano Romero Vidomlansky, Ricardo Ronderos, Ana Laura Sadowski, Jorgelina Sala, Alejandro Sánchez, Andrea Santoro, Lilia Schiavi, Mariano Sein, Virginia Sernia, Leonardo Serra, Maximiliano Sicer, Tomas Smith, Leonardo Soso, Georgina Sposetti, Andrea Steinacher, Jorge Stival, Jorge Tedesco, Hugo Tonin, Mauro Tortolo, Maria Ulla, Julio Vallejos, Marisa Vico, Luciana Virgillito, Virginia Visco, Daniel Vogel, Florencia Waisman, César Zaidman, Noemi Zucchiatti, Imran Badshah, Neale Cohen, Peter Colman, David Colquhoun, Timothy Davis, Spiros Fourlanos, Greg Fulcher, Jane Hamlyn, Cilla Haywood, Samantha Hocking, Maeve Huchinson, William Jeffries, Mervyn Kyl, Clement Lo, PeakMann Mah, Ashley Makepeace, Dolly Marope, Natalie Nanayakkar, Alison Nankervis, Neil Palmer, Barbara Palolus, Satish Pillai, Sarah Price, Joseph Proietto, Anne Reutens, Natassia Rodrigo, Abdul Sheikh, Greg Smith, Michelle So, Georgia Soldatos, Bronwyn Stuckey, Priya Sumithran, Helena Teede, Parind Vora, Lyn Williams, Eduardo Abib, Christiani Adão Poço, Érica Ferreira Alves, Janaina Andreatta Bernardi Barea, Livia Avezum Oliveira, Denise Ludovico da Costa de Castro, Ivan Correa da Cruz, Midiã Costa, Ivan Cruz, Sidney Cunha, Marco Antonio Vieira Da Silva, Renata de Carvalho Camara Bona, Bruna de Paula, Freddy Eliaschewitz, Guilherme Fazolli, Carlos Alberto Ferreira Filho, Jose Fortes, Cesar França, Denise Reis Franco, Paulo Roberto Genestreti, Flavio Giorgeto, Rodrigo Marques Gonçalves, Michele Elka Grossman, Ana Claudia Henrique Marcelino, Mauro Hernandes, Ana Horta, Cristiano Jaeger, Midia Kaneblai, Cecilia Kauffman Rutenberg, Jose Francisco Kerr Saraiva, Maria Angelica Lemos, Lilia Maia, Euler Roberto Manenti, Mariana Marques, Cynthia Melissa Valerio, Rodrigo Moreira, Flávia Mothé, Osana Maria Mouco, Philip Moura, José Carlos Moura Jorge, Carlos Nakashima, Marcelo Nakazone, Thiago Napoli, Cristiane Nunes, Joao Eduardo Nunes Salles, Karla Oliveira, Marcela Oliveira, Gracielly de Souza Pantano, Fabio Petri, Leonardo Piazza, Andreia Carla Pires, Patricia Pizzato, Sergio Prata, Dalton Precoma, Rafael Rech, Gilmar Reis, Heleno Reis, Elisabete Resende, Jose Ribas Fortes, Sylka Rodovalho, Fabio Rossi dos Santos, Joao Eduardo Salles, Célia Regina Sampaio, Thiago Santos, Vanessa Santos dos Santos, Tulio Silva e Quadros, Daniel Silveira, Katia Nunes Siqueira, M Teireira, Marcelo Uehara, C Valerio, Henrique Vianna, Maria Helena Vidotti, Guilherme de Lima Visconti, Maria Teresa Zanella, Viktoriya Andreeva, Radoslav Borisov, Nikolay Botushanov, Georgi Dimitrov, Kameliya Dimova, Tsvetan Dragoychev, Valentina Grigorova, Valentina Gushterova, Ivaylo Ivanov, Tatyana Kocelova, Dimo Kurktschiev, Milena Miletieva, Neli Nenkova-Gugusheva, Ralitsa Pancheva, Maria Pavlova, Dimitar Raev, Vesela Spasova, Anastas Stoikov, Dimitar Troev, Todor Yanev, Mariana Yoncheva-Mihaylova, Alexander Abitbol, Buki Ajala, Abdullh Alguwaihes, Jean-Luc Ardilouze, Nahla Aris-Jilwan, Amel Arnaout, Ronnie Aronson, Nadeem Aslam, Sandra Babin, Jean-Patrice Bailargeon, Allan Bailey, Harpreet Bajaj, Christian Beauchesne, Sorin Beca, Andre Belanger, Alan Bell, Diego Bellabarba, Lori Berard, Brian Berenbaum, Vincent Bergeron, Joseph Berlingieri, Frédéric Bernier, Phoebe Bishara, David Blank, Ian Blumer, Suzanne Brault, Donald Breton, André Carpentier, James Cha, Prakash Chandra, Jean-Louis Chiasson, James R Conway, Ghyslaine Couture, Nathalie Couture, Gilles Dagenais, Dyotirmoy Datta, Giuseppe D'Ignazio, Richard Dumas, Didier Fay, Andre Frechette, Louise Frenette, Daisy Fung, Nathalie Gagnon, Meri Galter, Jean Garon, Jean Sebastien Gauthier, Christian Geadah, Jeremy Gilbert, Ronald Girard, Ronald Goldenberg, Loren David Grossman, Nikhil Gupta, Jean-Pierre Halle, Marie-France Hivert, Ghislaine Houde, Robyn Houlden, Irene Hramiak, Ted Jablonski, Akshay Jain Jain, Hasnain Khandwala, Munish Khosla, C Lachance, Emilie Laflamme, Marie-France Langlois, Luc Larivee, Joanne Liutkus, Heather Lochnan, Saleem Malik, Charlotte McDonald, Pravinsagar Mehta, John Mihailidis, Alain Milot, Priya Narula, Patrice Nault, Arun Nayar, William Nisker, Gilles Ouellet, Jean Palardy, Minta Patel, Terri Paul, Sue Pedersen, Patrice Perron, Marie-Hélène Pesant, Paul Poirier, Marie-Claude Poulin, Zubin Punthakee, Waheed Rehman, Stuart Ross, P Sagar, Nouhad Saliba, Sam Sandler, Alicia Schiffrin, Robert Schlosser, Anila Seth-Sharma, Mark Sherman, David Sionit, Tharsan Sivakumar, Juan Soto, Eric St-Amour, Oren Steen, Jack Sussman, Adam Telner, Sheldon Tobe, David-Yaw Twum-Barima, Audrey Van Zanten, Nicole VanRossum, Jonathan Vecchiarelli, Rick Ward, John Wessengel, Stanley Weisnagel, Igor Wilderman, Vincent Woo, Natalia Yakubovich, Jean-Francois Yale, Zeina Yared, Monica Acevedo, Maria Loreto Aguirre, Andres Aizman, Maria Soledad Barroso, Leonardo Cobos, Alfredo Danin Vargas, Barbara Descalzi, Gonzalo Godoy, Elio Grumberg, Rodolfo Lahsen, Gladys Larenas, Eugenia Ortiz, Javier Paredes, Sergio Potthoff, Eva Retamal, Luis Rojas, Manuel Salgado, Claudio Santibanez, Carmen Solis, Benjamin Stokins, Jose Accini, Javier Acebedo, Lina Maria Agudelo Baena, Soraya Alarcon, Juliana Angel, Edgar Arcos, M Aroca Martinez, Leonor Atuesta, Jose Balaguera, Doris Ballestas, Sandra Isabel Barrera, Rosmy Barrios Reyes, Adolfo Bayona, Andres Bermudez, Diego Zarate Bernal, Marco Blanquicett, Victor Bravo, Wendy Bueno, Alvaro Burbano Delgado, Alberto Cadena, Andres Cadena, Sandra Caicedo, Carlos Celemin, Ricardo Consuegra, Cristhian Contreras Pimienta, Kelly Johenis Corredor, Carlos Cure, Lizeth Dayana De La Hoz Rueda, Erika Delgado, Sarahy Diaz, Marta Diego, Anabell Donado, William Encinales Sanabria, Juliana Escobar, Gillian Escorcia, Leonardo Forero, Laura Fuentes, Maria Garcia, Henry Garcia Lozada, Luis Garcia Ortiz, Angela Giraldo, Laura Gomez Gonzalez, Javier Granada, Corina Gutierrez, Natalia Henao, Edwin Hernandez, Olga Maria Herrera Uejbe, Juan Diego Higuera Cobos, Jaime Ibarra Gómez, Edwin Hernandez Jaimes, Monica Jaramillo, Nicolas Jaramillo, Carlos Jaramillo Gomez, Monica Jaramillo Sanchez, Ivonne Jarava Durán, Catalina Lopez Ceballos, Claudia Madrid, Elias María Amastha, Jennifer Mercado, Dora Ines Molina, Jessica Molina Soto, Carlos Montoya, Alexander Morales, Carolina Muñoz, Luis Alejandro Orozco, Oscar Osorio, Jorge Mario Palmera Sanchez, Adwar Peña, Jose Perez, Juan Perez Agudelo, Germán Pérez Amador, Carlos Pertuz, Irina Posada, Carlos Puerta, Adalberto Quintero, Diana Quiroz, Carmen Rendon, Alberto Reyes, Alvaro Reyes, Diana Ripoll, Carlos Rivera, Maria Rocha, Jose F Rodriguez, Kervis Asid Rodriguez Villanueva, Javier Emilio Rodriguez Zabala, Sindy Rojas, Maria Romero, Ricardo Rosero, Angelica Rocio Rosillo Cardenas, Lina Rueda, Gregorio Sanchez, Tatiana Sanchez, Arístides Sotomayor Herazo, Monica Suarez, Mariana Torres, Freddy Trujillo, Miguel Urina, Lazaro Van Strahlen, Carlos Velandia, Carolina Velasquez Guzman, Elizabeth Velazquez, Tatiana Vidal Prada, Juan Pablo Yepez Alvaran, Diego Zarate, Jana Andelova, Radka Benesova, Barbara Buzova, Vladimir Cech, Ida Chodova, Miroslav Choura, Antonin Dufka, Andrea Gamova, Jakub Gorgol, Tomas Hala, Hana Havlova, Dagmar Hlavkova, Petra Horanska, Juliana Ilcisin-Valova, Petra Jenickova, Ondrej Jerabek, Ilona Kantorova, Katerina Kolomaznikova, Iva Kopeckova, Miroslava Kopeckova, Karel Linhart, Tomas Linhart, Jan Malecha, Emilia Malicherova, Dana Neubauerova, Martina Oznerova, Radan Partys, Eva Pederzoliova, Maria Petrusova, Vera Prymkova, Eva Racicka, Ida Reissova, Eva Roderova, Libor Stanek, Alena Striova, Dana Svarcova, Petr Svoboda, Emilia Szeghy Malicharova, Jan Urge, Ladislav Vesely, Bedich Wasserburger, Hilde Wasserburgerova, Emil Zahumensky, Vaclav Zamrazil, Hasan Alawi, Ernestos Anastasiadis, Elisabeth Axthelm, Tasso Bieler, Christina Buhrig, Elizaveta Degtyareva, Frank Dellanna, Karl-Michael Derwahl, Stephan Diessel, Barbara Dogiami, Kirsten Dorn-Weitzel, Monika Ernst, Grit Faulmann, Baerbel Fetscher, Thomas Forst, Gabriele Freyer-Lahres, Klaus Funke, Xenia Ganz, Christiane Gleixner, Christoph Hanefeld, Sven Heinrichs, Stephanie Helleberg, Elena Henkel, Gerd Ruediger Hetzel, Caren Hoffmann, Frohmut Jacob, Stephan Jacob, Franziska John, Antonius Jonczyk, Wolfram Kamke, Christiane Klein, Martina Kleinhardt, Werner Kleophas, Christine Kosch, Kristin Kreutzmann, Achim Kühn, Young Hee Lee-Barkey, Alexander Lier, Sarah Maatouk, Joachim Minnich, Michael Mitry, Ilona Muessig, Diana Nicula, Martina Niemann, Joerg Nothroff, Petra Ott, Andreas Pfuetzner, Andreas Pfützner, Frank Pistrosch, Wildgard Pohl, Zdenka Prochazkova, Marlena Retkowska, Heiko Rosin, Daniela Sachsenheimer, Holger Samer, Mazin Sanuri, Axel Schaefer, Frank Schaper, Erik-Delf Schulze, Marita Schulze, Martina Schumann, Thomas Segiet, Veronika Sowa, Hans-Detlev Stahl, Franziska Steinfeldt, Madlen Teige, Bjoern Trieb, Diethelm Tschoepe, Peter Uebel, Bernd Warken, Ingo Weigmann, Klaus Weyland, Klara Wilhelm, Timea Balo, Miklos Balsay, Ilona Bende, Katalin Bezzegh, Zita Birkus, Barbara Buday, Melinda Csomai, Laszlo Deak, Eniko Dezso, Peter Faludi, M Faluvegi, Ilona Fazekas, Agota Feher, Csaba Fejer, Ervin Finta, Agnes Fulcz, Zsolt Gaal, Mihaly Gurzo, Krisztina Hati, Gabriella Herczeg, Ildiko Jozsef, Marta Juhasz, Katalin Keltai, Laszlo Koranyi, Eniko Kulcsar, Krisztina Kun, Andrea Laczko, Botond Literáti-Nagy, Izabella Mezo, Margit Mileder, I Moricz, Károly Nagy, Bela Nagybaczoni, Csaba Nemeth, Agnes Oze, Jozsef Pauer, Eva Peterfai, Bela Polocsanyi, Ferenc Poor, István Reiber, Csaba Salamon, Julia Sebestyen, Ildiko Torok, Marianna Tuu, Andrea Varga, Viktor Vass, Chul Min Ahn, Chulwoo Ahn, Park ByungWon, Hyuk-Jae Chang, Kiyuk Chang, Eui-Young Choi, Han Seok Choi, Jin-Wook Chung, Bum- Kee Hong, Young Joon Hong, Min Su Hyon, Myung Ho Jeong, Shinae Kang, Byeong-Keuk Kim, Ji-Hyun Kim, Ju Han Kim, Kee-Sik Kim, Moo Hyun Kim, Pum-Joon Kim, Soon-Kil Kim, Yong-Seok Kim, Young Kwon Kim, Yoon Seok Koh, Hyuck Moon Kwon, Byoung Kwon Lee, Byung-Wan Lee, Jin Bae Lee, Myoung-Mook Lee, Young-Mee Lim, Pil Ki Min, Jong Sung Park, Jongsuk Park, Keun Ho Park, Sungha Park, Wook Bum Pyun, Se Joong Rim, Dong-Ryeol Ryu, Hong-Seog Seo, Ki Bae Seung, Dong-Ho Shin, Doo Sun Sim, Young Won Yoon, Ilze Andersone, Kristine Babicka, Inga Balcere, Roberts Barons, Inguna Capkovska, Kristine Geldnere, Inese Grigane, Baiba Jegere, Ilze Lagzdina, Lija Mora, Sigita Pastare, Rota Ritenberga, Janina Romanova, Inta Saknite, Natalja Sidlovska, Jelena Sokolova, Sandra Steina, Iveta Strizko, Dace Teterovska, Brigita Vizina, Lina Barsiene, Gintare Belozariene, Laura Daugintyte-Petrusiene, Nijole Drungiliene, Nijole Garsviene, Ala Grigiene, Vytautas Grizas, Virginija Jociene, Dalia Kalvaitiene, Jugeta Kaupiene, Jurate Kavaliauskiene, Dalia Kozloviene, Ilona Lapteva, Birute Maneikiene, Jolanta Marcinkeviciene, Vaidilija Markauskiene, Salomeja Meiluniene, Almantas Norkus, Rita Norviliene, Vladimiras Petrenko, Ruta Radzeviciene, Gintare Sakalyte, Gediminas Urbonas, Skaiste Urbutiene, Donatas Vasiliauskas, Dzilda Velickiene, Carlos Aguilar, Marco Alcocer, Juan Antonio Avalos-Ramirez, Ramiro Banda-Elizondo, Rubria Bricio-Ramirez, Karla Cardenas Mejia, Francisco Cavazos, Jesus Chapa, Erika Cienfuegos, Astrid De la Peña, Gilberto de la Peña Topete, Manuel Odin De los Rios Ibarra, Daniel Elias, Claudia Flores-Moreno, Pedro Garcia Hernandez, Luis Gerardo Gonzalez, Rosa Linda Guerra Moya, Arturo Guerra-Lopez, Raymundo Hernandez Baylon, Carolina Herrera Colorado, Marisol Herrera-Marmolejo, Neri Islas-Palacios, Esteban Lopez, Fernando Lopez, Agustin Lopez Alvarado, Rosa Isela Luna Ceballos, Enrique Morales Villegas, Gualberto Moreno-Virgen, Rosa Linda Parra Perez, Sara Pascoe Gonzalez, Irving Peralta-Cantu, Roopa Previn, Rosa Ramirez, Rubria Ramirez, Maria Guadalupe Ramos Zavala, Monica Rodriguez, Rocio Salgado-Sedano, Ana Claudia Sanchez-Aguilar, Edith Santa Rosa Franco, Leobardo Sauque-Reyna, Rodrigo Suarez Otero, Ivonne Torres, Enrique Velarde-Harnandez, Juan Villagordoa, Efrain Villeda-Espinoza, Jorge Vital-Lopez, Cristian Jair Zavala- Bello, John Baker, Elaine Barrington-Ward, Thomas Brownless, Richard Carroll, Simon Carson, Michelle Choe, Andrew Corin, Brian Corley, Richard Cutfield, Neelam Dalaman, Paul Dixon, Paul Drury, Keith Dyson, Chris Florkowski, Monica Ford, William Frengley, Colin Helm, Colin Katzen, Jane Kerr, Manish Khanolkar, David Kim, Renata Koops, Jeremy Krebs, Robert Leikis, Kwan Low, Alison Luckey, Richard Luke, Susan Macaulay, Rodney Marks, Catherine McNamara, Dean Millar-Coote, Steven Miller, Naomi Mottershead, James Reid, Narcisa Robertson, Ian Rosen, David Rowe, Ole Schmiedel, Russell Scott, Jeffrey Sebastian, Davitt Sheahan, Victoria Stiebel, Ian Ternouth, Chris Tofield, Dirk Venter, Michael Williams, Miles Williams, Fiona Wu, Simon Young, Malgorzata Arciszewska, Anna Bochenek, Piotr Borkowski, Przemyslaw Borowy, Tomasz Chrzanowski, Edward Czerwinski, Marek Dwojak, Agnieszka Grodzicka, Izabela Janiec, Joanna Jaruga, Ewa Krystyna Jazwinska-Tarnawska, Krystyna Jedynasty, Danuta Juzwiak-Czapiewska, Jadwiga Karczewicz-Janowska, Jan Konieczny, Marek Konieczny, Marek Korol, Maciej Kozina, Ewa Krzyzagorska, Ewa Kucharczyk-Petryka, Roman Laz, Anna Majchrzak, Zdzislawa Mrozowska, Michal Mularczyk, Elzbieta Nowacka, Jadwiga Peczynska, Robert Petryka, Radoslaw Pietrzak, Dorota Pisarczyk-Wiza, Aleksandra Rozanska, Zofia Ruzga, Emilia Rzeszotarska, Malgorzata Sacha, Marzenna Sekulska, Anna Sidorowicz-Bialynicka, Teresa Stasinska, Agnieszka Strzelecka-Sosik, Teresa Swierszcz, Katarzyna Miroslawa Szymkowiak, Olga Turowska, Krystyna Wisniewska, Maciej Wiza, Iwona Wozniak, Katarzyna Zelazowska, Bernadetta Ziolkowska-Gawron, Danuta Zytkiewicz-Jaruga, Adrian Albota, Carmina Alexandru, Rodica Avram, Cornelia Bala, Diana Barbonta, Roxana Barbu, Daniela Braicu, Nicoleta Calutiu, Doina Catrinoiu, Anca Cerghizan, Alina Ciorba, Anca Craciun, Rodica Doros, Livia Duma, Ancuta Dumitrache, Ioana Ferariu, Anca Ferician Moza, Alexandrina Ghergan, Gheorghe Ghise, Mariana Graur, Mihaela Gribovschi, Bogdan Mihai, Laura Mihalache, Madalina Mihalcea, Nicoleta Mindrescu, Magdalena Morosanu, Andrea Morosoanu, Maria Mota, Anca Moza, Valerica Nafornita, Narcisa Natea, Simona Nicodim, Cristina Nita, Adriana Onaca, Mircea Onaca, Cristina Pop, Lavinia Pop, Amorin Popa, Alexandrina Popescu, Luchiana Pruna, Gabriela Roman, Mihaela Rosu, Alexandra Sima, Doina Sipciu, Carmen Narcisa Sitterli-Natea, Iosif Szilagyi, Minodora Tapurica, Adrian Tase, Adriana-Carmen Tutescu, Luminita Vanghelie, Ioana Verde, Adrian Vlad, Mihaela Zarnescu, Roman Akhmetov, Irina Allenova, Irina Avdeeva, Oksana Baturina, Irina Biserova, Nikolay Bokovin, Irina Bondar, Natalia Burova, Galina Chufeneva, Elena Chumachek, Marina Demidova, Alexander Demin, Vera Drobysheva, Irina Egorova, Lev Esenyan, Ekaterina Gelig, Sergey Gilyarevsky, Maria Golshmid, Arseniy Goncharov, Anastasia Gorbunova, Ivan Gordeev, Vera Gorelysheva, Tatiana Goryunova, Irina Grebenshchikova, Roman Ilchenko, Maria Ivannikova, Saule Karabalieva, Juliya Karpeeva, Elena Khaykina, Zhanna Kobalava, Irina Kononenko, Oxana Korolik, Anna Korshunova, Victor Kostenko, Irina Krasnopevtseva, Ludmila Krylova, Polina Kulkova, Irina Kuzmina, Alla Ledyaeva, Sergey Levashov, Natalia Lokhovinina, Vadim Lvov, Narine Martirosyan, Sergey Nedogoda, Rostislav Nilk, Yulia Osmolovskaya, Alexey Panov, Olga Paramonova, Ekaterina Pavlova, Elena Pekareva, Nina Petunina, Svetlana Ponamareva, Galina Reshedko, Alla Salasyuk, Malvina Sepkhanyan, Alexandr Serebrov, Olesya Shabelnikova, Andrey Skvortsov, Olga Smirnova, Oxana Spiridonova, Svetlana Strogova, Evgeny Taratukhin, Sergey Tereschenko, Lubov Trukhina, Olga Tsarkova, Vera Tsoma, Farid Tumarov, Natalya Tyan, Tatiana Tyurina, Svetlana Villevalde, Elena Yankovaya, Ludmila Zarutskaya, Elena Zenkova, Aysha Badat, Frederik Bester, Suzanne Blignaut, Dirk Blom, Susan Booysen, Warren Boyd, Brigitte Brice, Susan Brown, Lesley Burgess, Reina Cawood, Kathleen Coetzee, Hillet Conradie, Tanja Cronje, Douwe de Jong, Graham Ellis, Shaunagh Emanuel, Ingrid Engelbrecht, Sharne Foulkes, Done Fourie, Gilbert Gibson, Thirumani Govender, Sumayah Hansa, Allana Colleen Hemus, Firzana Hendricks, Marshall Heradien, Chantelle Holmgren, Zaheer Hoosain, Emile Horak, Johannes Howard, Ignatius Immink, E. Janari, Daksha Jivan, Karl Klusmann, Weik Labuschagne, Yen-yu Lai, Gulam Latiff, J. Lombaard, Hanlie Lottering, Ronel Meeding, Shirley Middlemost, Haroon Mitha, Ismail Mitha, Sandile Mkhwanazi, Rajendran Moodley, Almeri Murray, Dany Musungaie, Yasmin Osman, Kirsten Peacey, Larisha Pillay-Ramaya, Catharina Pretorius, Hans Prozesky, Mahomed Sarvan, E Scholtz, Attila Sebesteny, Bianca Skinner, Michael Skriker, M Smit, Anna-Marie Stapelberg, Nicolaas Swanepoel, Dorothea Urbach, Dina van Aswegen, Francois van Zyl, Louis Van Zyl, Esme Venter, Shahid Wadvalla, Jeffrey Wing, Karen Wolmarans, Cristina Abreu, Pilar Aguilà, Eva Aguilera, Nuria Alonso, Carmen Alvarez, Priscila Cajas, Jose Carlos Castro, Roger Codinachs, Jose Contreras, Maria Jose Coves, Carmen Fajardo, Juan Carlos Ferrer, Neus Font, Mar Garcia, Maria Apolonia Gil, Fernando Gomez, Lluis Alberto Gomez, Jose Gonzalbez, Jose Luis Griera, Luís Masmiquel, Didac Mauricio, Silvia Narejos Perez, Juana Ana Nicolau, Olga Noheda Contreras, Josefina Olivan, Josefina Olivares, Emilio Ortega, Silvia Pellitero, Salvador Pertusa, Ferran Rius, Irene Rodriguez, Carlos Sánchez-Juan, Dolores Santos, Berta Soldevila, David Subias, Manel Terns, Carlos Trescoli, Judith Vilaplana, Alicia Villanueva, Jaan Albo, Kjell Antus, Mattias Axelsson, Lisa Bergström, Emil Binsell-Gerdin, Kurt Boman, Fabian Botond, Annika Dotevall, Anna Graipe, C Jarnet, Jessica Kaminska, Anders Kempe, Michael Korhonen, Carina Linderfalk, Bo Liu, Karl Ljungstroem, Karl Ljungström, Lennart Malmqvist, Linda Mellbin, Thomas Mooe, Peter Nicol, Anders Norrby, Ake Ohlsson, Annika Rosengren, Jan Saaf, Staffan Salmonsson, Olof Strandberg, Karl-Axel Svensson, Bengt-Olov Tengmark, Georgios Tsatsaris, Anders Ulvenstam, Peter Vasko, Chwen-Tzuei Chang, Hsin-Mei Chang, Jung-Fu Chen, To-Pang Chen, Ming-Min Chung, Chia-Po Fu, Te-Lin Hsia, Shih-Che Hua, Ming-Chun Kuo, Chia-ln Lee, I-Te Lee, Kae-Woei Liang, Shih Yi Lin, Chieh-Hsiang Lu, Wen-Ya Ma, Dee Pei, Feng-Chih Shen, Ching-Chieh Su, Shuo-Wei Su, Tsai-Sung Tai, Wan-Ni Tsai, Yi-Ting Tsai, Shih-Chen Tung, Jun-Sing Wang, Hui-I Yu, Ahmed Al-Qaissi, Vijayaraman Arutchelvam, Stephen Atkin, Simon Au, Myint Myint Aye, Stephen Bain, Cristina Bejnariu, Patrick Bell, Deepak Bhatnagar, Rudy Bilous, Neil Black, Ursula Brennan, Barbara Brett, Jana Bujanova, Elaine Chow, Andrew Collier, Amanda Combe, Christopher Courtney, Hamish Courtney, James Crothers, Patrick Eavis, Jackie Elliott, Salvatore Febbraro, Jim Finlayson, Rajiv Gandhi, Sharon Gillings, Jonathan Hamling, Roy Harper, Tim Harris, Kahal Hassan, Simon Heller, Alison Jane, Zeeshan Javed, Tim Johnson, Stephen Jones, Adele Kennedy, David Kerr, Brian Kilgallon, Judith Konya, John Lindsay, Lina Lomova-Williams, Helen Looker, David MacFarlane, Sandra Macrury, Iqbal Malik, Rory McCrimmon, Douglas McKeith, John McKnight, Biswa Mishra, Racha Mukhtar, Ciara Mulligan, Maurice O'Kane, Tolu Olateju, Ian Orpen, Tristan Richardson, Desmond Rooney, Shorsha Bae Ross, Thozhukat Sathyapalan, Naveen Siddaramaiah, Lee Euan Sit, Jeffrey Stephens, Frances Turtle, Ammar Wakil, Emma Walkinshaw, Asem Ali, Robert Anderson, Richard Arakaki, Omar Aref, Mehrdad Kevin Ariani, David Arkin, Salomon Banarer, George Barchini, Arti Bhan, Kelley Branch, Donald Brautigam, Stephen Brietzke, Maridez Brinas, Yudit Brito, Casey Carter, Kimberely Casagni, Sabina Casula, Simon Chakko, Seth Charatz, Dale Childress, Lisa Chow, Malgorzata Chustecka, Subha Clarke, Lisa Cohen, Barry Collins, Gildred Colon Vega, Angel Comulada-Rivera, Gregorio Cortes-Maisonet, Matthew Davis, Jose de Souza, Cyrus Desouza, Mary Dinnan, Bobbi Duffy-Hidalgo, Barbara Dunn, Julia Dunn, Marshall Elman, James Felicetta, Stuart Finkelstein, David Fitz-Patrick, Hermes Florez, Alan Forker, Wayne Fowler, Sonja Fredrickson, Zachary Freedman, Brooke Gainey Narron, Kristin Gainey-Ferree, Michael Gardner, Christian Gastelum, Stephen Giddings, Eve Gillespie, Michael Paul Gimness, Gary Goldstein, Maria Gomes, Nelson Gomez, Timothy Gorman, Ketan Goswami, Arthur Graves, Scott Hacking, Charles Hall, Lenita Hanson, Sherman Harman, David Heber, Robert Henry, Janette Hiner, Irl Hirsch, Priscilla Hollander, Thomas Hooker, Barry Horowitz, Laura Hoste, Loli Huang, Minh Huynh, Dan Hyman, Soha Idriss, Ali Iranmanesh, Dennis Karounos, Moti Kashyap, Lois Katz, William Kaye, Yevgeniy Khaiton, Romesh Khardori, Timothy Kitchen, Andrew Klein, Wendi Knffem, Mikhail Kosiborod, Nicola Kreglinger, Davida Kruger, Anubhav Kumar, Ivan Laboy, Patricia Larrabee, Laura Larrick, Donna Lawson, Mike Ledet, James Lenhard, James Levy, George Li, Zhaoping Li, David Lieb, April Limcolioc, Jane Lions-Patterson, Daniel Lorber, Daniel Lorch, Michael Lorrello, Peter Lu, Kathryn Jean Lucas, Siu-Ling Ma, Michael MacAdams, Michelle Magee, Alexander Magno, Aparna Reddy Mahakala, Jennifer Marks, Anthony McCall, William McClanahan, Carole McClary, Lydia Melendez, John Melish, Deanna Michaud, Christopher Miller, Neil Miller, Pablo Mora, Marriyam Moten, Sunder Mudaliar, Gregory Myrick, Puneet Narayan, Mike Nassif, Karena Neri, Tabitha Newton, Patricia Niblack, Philip Nicol, Ebenezer Nyenwe, A. Ola Odugbesan, Yolanda Okorocha, Ramón Ortiz Carrasquillo, Kwame Osei, Coromoto Palermo, Hiren Patel, Krishna Patel, Cindy Pau, Michael Perley, Sanford Plevin, Elena Plummer, Richard Powell, Mohammed Qintar, Rex Rawls, John Reyes-Castano, Lillian Reynolds, Robert Richards, Julio Rosenstock, Caroline Rowe, Jahandar Saleh, Sony Sam, Alfredo Sanchez, Donald Sander, Bruce Sanderson, Virginia Savin, Elizabeth Seaquist, Jayendra Shah, Serena Shi, Vijay Shivaswamy, Tammi Shlotzhauer, David Shore, Bobbie Skukowski, Kyaw Soe, Vesna Solheim, Joseph Soufer, Helmut Steinberg, Jaime Steinsapir, Phillip Tarkington, Debra Thayer, Stephen Thomson, James Thrasher, Joseph Tibaldi, Jeff Tjaden, Oberto Tores, Dace Trence, Subbulaxmi Trikudanathan, Jagdeesh Ullal, Gabriel Uwaifo, Anthony Vo, Kenny Vu, Damandeep Walia, Karen Weiland, Fred Whitehouse, Thomas Wiegmann, Kathleen Wyne, Alan Wynne, Kevin Yuen, Joel Zaretzky, James Zebrack, Franklin Zieve, William Zigrang, and Everest
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, Recombinant Fusion Proteins, Placebo-controlled study, Glucagon-Like Peptides, 030204 cardiovascular system & hematology, Placebo, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, Internal medicine, Medicine, Albuminuria, Humans, Hypoglycemic Agents, Diabetic Nephropathies, 030212 general & internal medicine, Renal replacement therapy, Aged, Intention-to-treat analysis, business.industry, Hazard ratio, General Medicine, Middle Aged, medicine.disease, Immunoglobulin Fc Fragments, Diabetes Mellitus, Type 2, Creatinine, Dulaglutide, Female, business, medicine.drug, Kidney disease, Glomerular Filtration Rate
Abstract: Digital, Background: Two glucagon-like peptide-1 (GLP-1) receptor agonists reduced renal outcomes in people with type 2 diabetes at risk for cardiovascular disease. We assessed the long-term effect of the GLP-1 receptor agonist dulaglutide on renal outcomes in an exploratory analysis of the REWIND trial of the effect of dulaglutide on cardiovascular disease. Methods: REWIND was a multicentre, randomised, double-blind, placebo-controlled trial at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo and followed up at least every 6 months for outcomes. Urinary albumin-to-creatinine ratios (UACRs) and estimated glomerular filtration rates (eGFRs) were estimated from urine and serum values measured in local laboratories every 12 months. The primary outcome (first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes), secondary outcomes (including a composite microvascular outcome), and safety outcomes of this trial have been reported elsewhere. In this exploratory analysis, we investigate the renal component of the composite microvascular outcome, defined as the first occurrence of new macroalbuminuria (UACR >33·9 mg/mmol), a sustained decline in eGFR of 30% or more from baseline, or chronic renal replacement therapy. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01394952. Findings: Between Aug 18, 2011, and Aug 14, 2013, 9901 participants were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). At baseline, 791 (7·9%) had macroalbuminuria and mean eGFR was 76·9 mL/min per 1·73 m2 (SD 22·7). During a median follow-up of 5·4 years (IQR 5·1-5·9) comprising 51 820 person-years, the renal outcome developed in 848 (17·1%) participants at an incidence rate of 3·5 per 100 person-years in the dulaglutide group and in 970 (19·6%) participants at an incidence rate of 4·1 per 100 person-years in the placebo group (hazard ratio [HR] 0·85, 95% CI 0·77-0·93; p=0·0004). The clearest effect was for new macroalbuminuria (HR 0·77, 95% CI 0·68-0·87; p, Ciencias Médicas y de la Salud
Published: 2019

31. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial

Author: Hertzel C Gerstein, Helen M Colhoun, Gilles R Dagenais, Rafael Diaz, Mark Lakshmanan, Prem Pais, Jeffrey Probstfield, Jeffrey S Riesmeyer, Matthew C Riddle, Lars Rydén, Denis Xavier, Charles Messan Atisso, Leanne Dyal, Stephanie Hall, Purnima Rao-Melacini, Gloria Wong, Alvaro Avezum, Jan Basile, Namsik Chung, Ignacio Conget, William C Cushman, Edward Franek, Nicolae Hancu, Markolf Hanefeld, Shaun Holt, Petr Jansky, Matyas Keltai, Fernando Lanas, Lawrence A Leiter, Patricio Lopez-Jaramillo, Ernesto German Cardona Munoz, Valdis Pirags, Nana Pogosova, Peter J Raubenheimer, Jonathan E Shaw, Wayne H-H Sheu, Theodora Temelkova-Kurktschiev, Mercedes Abella, Andrea Alebuena, Sandra Almagro, Eduardo Amoroso, Paula Anadon, Elizabeth Andreu, Guillermo Aristimuño, Maria Arzadun, Maria Barbieri, Raul Barcudi, Ines Bartolacci, Gabriel Bolobanich, Anselmo Bordonava, Miguel Bustamante Labarta, Betina Bustos, Alberto Caccavo, Alejandra Camino, Maria Cantero, Maria Carignano, Luis Cartasegna, Marcela Cipullo, Víctor Commendatore, Victoria Conosciuto, Osvaldo Costamagna, Claudia Crespo, Jose Cuello, Carlos Cuneo, Sandra Cusimano, Sofia Dean, Claudio Dituro, Andrea Dominguez, Miguel Farah, Alberto Fernandez, Florencia Fernandez, Adriana Ferrari, Patricia Flammia, Jose Fuentealba, Karina Beatriz Gallardo, Celso Garcia, Ruben Garcia Duran, Marcelo Garrido, Rodolfo Gavicola, Claudio Gerbaudo, Graciela Gilli, Ana Paula Giotto, Pedro Godoy Bolzán, Oscar Gomez Vilamajo, Fernando Guerlloy, Cristian Guridi, Narcisa Gutierrez Garrido, Eduardo Hasbani, Sonia Hermida, Miguel Hominal, Adrian Hrabar, Adrián Ingaramo, Alejandra Izzicupo, Mario Krynski, Mariana Lagrutta, Paulina Lanchiotti, Maria Langhe, Veronica Leonard, Javier Llanos, Ricardo Lopez Santi, Jorge Lowenstein, Cecilia Luquez, Ignacio Mackinnon, Melina Mana, Sara Manzur, Javier Marino, Carolina Martella, Roger Martinez, Re Matias, Javier Matkovich, Monica Meritano, Oscar Montaña, María Mulazzi, Juan Ochoa, Gustavo Paterlini, María Pelagagge, Maria Elena Peralta Lopez, Aldo Prado, Lorena Pruyas, Martín Racca, Carola Ricotti, Carolina Rodriguez, Mariano Romero Vidomlansky, Ricardo Ronderos, Ana Laura Sadowski, Jorgelina Sala, Alejandro Sánchez, Andrea Santoro, Lilia Schiavi, Mariano Sein, Virginia Sernia, Leonardo Serra, Maximiliano Sicer, Tomas Smith, Leonardo Soso, Georgina Sposetti, Andrea Steinacher, Jorge Stival, Jorge Tedesco, Hugo Tonin, Mauro Tortolo, Maria Ulla, Julio Vallejos, Marisa Vico, Luciana Virgillito, Virginia Visco, Daniel Vogel, Florencia Waisman, César Zaidman, Noemi Zucchiatti, Imran Badshah, Neale Cohen, Peter Colman, David Colquhoun, Timothy Davis, Spiros Fourlanos, Greg Fulcher, Jane Hamlyn, Cilla Haywood, Samantha Hocking, Maeve Huchinson, William Jeffries, Mervyn Kyl, Clement Lo, PeakMann Mah, Ashley Makepeace, Dolly Marope, Natalie Nanayakkar, Alison Nankervis, Neil Palmer, Barbara Palolus, Satish Pillai, Sarah Price, Joseph Proietto, Anne Reutens, Natassia Rodrigo, Abdul Sheikh, Greg Smith, Michelle So, Georgia Soldatos, Bronwyn Stuckey, Priya Sumithran, Helena Teede, Parind Vora, Lyn Williams, Eduardo Abib, Christiani Adão Poço, Érica Ferreira Alves, Janaina Andreatta Bernardi Barea, Livia Avezum Oliveira, Denise Ludovico da Costa de Castro, Ivan Correa da Cruz, Midiã Costa, Ivan Cruz, Sidney Cunha, Marco Antonio Vieira Da Silva, Renata de Carvalho Camara Bona, Bruna de Paula, Freddy Eliaschewitz, Guilherme Fazolli, Carlos Alberto Ferreira Filho, Jose Fortes, Cesar França, Denise Reis Franco, Paulo Roberto Genestreti, Flavio Giorgeto, Rodrigo Marques Gonçalves, Michele Elka Grossman, Ana Claudia Henrique Marcelino, Mauro Hernandes, Ana Horta, Cristiano Jaeger, Midia Kaneblai, Cecilia Kauffman Rutenberg, Jose Francisco Kerr Saraiva, Maria Angelica Lemos, Lilia Maia, Euler Roberto Manenti, Mariana Marques, Cynthia Melissa Valerio, Rodrigo Moreira, Flávia Mothé, Osana Maria Mouco, Philip Moura, José Carlos Moura Jorge, Carlos Nakashima, Marcelo Nakazone, Thiago Napoli, Cristiane Nunes, Joao Eduardo Nunes Salles, Karla Oliveira, Marcela Oliveira, Gracielly de Souza Pantano, Fabio Petri, Leonardo Piazza, Andreia Carla Pires, Patricia Pizzato, Sergio Prata, Dalton Precoma, Rafael Rech, Gilmar Reis, Heleno Reis, Elisabete Resende, Jose Ribas Fortes, Sylka Rodovalho, Fabio Rossi dos Santos, Joao Eduardo Salles, Célia Regina Sampaio, Thiago Santos, Vanessa Santos dos Santos, Tulio Silva e Quadros, Daniel Silveira, Katia Nunes Siqueira, M Teireira, Marcelo Uehara, C Valerio, Henrique Vianna, Maria Helena Vidotti, Guilherme de Lima Visconti, Maria Teresa Zanella, Viktoriya Andreeva, Radoslav Borisov, Nikolay Botushanov, Georgi Dimitrov, Kameliya Dimova, Tsvetan Dragoychev, Valentina Grigorova, Valentina Gushterova, Ivaylo Ivanov, Tatyana Kocelova, Dimo Kurktschiev, Milena Miletieva, Neli Nenkova-Gugusheva, Ralitsa Pancheva, Maria Pavlova, Dimitar Raev, Vesela Spasova, Anastas Stoikov, Dimitar Troev, Todor Yanev, Mariana Yoncheva-Mihaylova, Alexander Abitbol, Buki Ajala, Abdullh Alguwaihes, Jean-Luc Ardilouze, Nahla Aris-Jilwan, Amel Arnaout, Ronnie Aronson, Nadeem Aslam, Sandra Babin, Jean-Patrice Bailargeon, Allan Bailey, Harpreet Bajaj, Christian Beauchesne, Sorin Beca, Andre Belanger, Alan Bell, Diego Bellabarba, Lori Berard, Brian Berenbaum, Vincent Bergeron, Joseph Berlingieri, Frédéric Bernier, Phoebe Bishara, David Blank, Ian Blumer, Suzanne Brault, Donald Breton, André Carpentier, James Cha, Prakash Chandra, Jean-Louis Chiasson, James R Conway, Ghyslaine Couture, Nathalie Couture, Gilles Dagenais, Dyotirmoy Datta, Giuseppe D'Ignazio, Richard Dumas, Didier Fay, Andre Frechette, Louise Frenette, Daisy Fung, Nathalie Gagnon, Meri Galter, Jean Garon, Jean Sebastien Gauthier, Christian Geadah, Jeremy Gilbert, Ronald Girard, Ronald Goldenberg, Loren David Grossman, Nikhil Gupta, Jean-Pierre Halle, Marie-France Hivert, Ghislaine Houde, Robyn Houlden, Irene Hramiak, Ted Jablonski, Akshay Jain Jain, Hasnain Khandwala, Munish Khosla, C Lachance, Emilie Laflamme, Marie-France Langlois, Luc Larivee, Joanne Liutkus, Heather Lochnan, Saleem Malik, Charlotte McDonald, Pravinsagar Mehta, John Mihailidis, Alain Milot, Priya Narula, Patrice Nault, Arun Nayar, William Nisker, Gilles Ouellet, Jean Palardy, Minta Patel, Terri Paul, Sue Pedersen, Patrice Perron, Marie-Hélène Pesant, Paul Poirier, Marie-Claude Poulin, Zubin Punthakee, Waheed Rehman, Stuart Ross, P Sagar, Nouhad Saliba, Sam Sandler, Alicia Schiffrin, Robert Schlosser, Anila Seth-Sharma, Mark Sherman, David Sionit, Tharsan Sivakumar, Juan Soto, Eric St-Amour, Oren Steen, Jack Sussman, Adam Telner, Sheldon Tobe, David-Yaw Twum-Barima, Audrey Van Zanten, Nicole VanRossum, Jonathan Vecchiarelli, Rick Ward, John Wessengel, Stanley Weisnagel, Igor Wilderman, Vincent Woo, Natalia Yakubovich, Jean-Francois Yale, Zeina Yared, Monica Acevedo, Maria Loreto Aguirre, Andres Aizman, Maria Soledad Barroso, Leonardo Cobos, Alfredo Danin Vargas, Barbara Descalzi, Gonzalo Godoy, Elio Grumberg, Rodolfo Lahsen, Gladys Larenas, Eugenia Ortiz, Javier Paredes, Sergio Potthoff, Eva Retamal, Luis Rojas, Manuel Salgado, Claudio Santibanez, Carmen Solis, Benjamin Stokins, Jose Accini, Javier Acebedo, Lina Maria Agudelo Baena, Soraya Alarcon, Juliana Angel, Edgar Arcos, M Aroca Martinez, Leonor Atuesta, Jose Balaguera, Doris Ballestas, Sandra Isabel Barrera, Rosmy Barrios Reyes, Adolfo Bayona, Andres Bermudez, Diego Zarate Bernal, Marco Blanquicett, Victor Bravo, Wendy Bueno, Alvaro Burbano Delgado, Alberto Cadena, Andres Cadena, Sandra Caicedo, Carlos Celemin, Ricardo Consuegra, Cristhian Contreras Pimienta, Kelly Johenis Corredor, Carlos Cure, Lizeth Dayana De La Hoz Rueda, Erika Delgado, Sarahy Diaz, Marta Diego, Anabell Donado, William Encinales Sanabria, Juliana Escobar, Gillian Escorcia, Leonardo Forero, Laura Fuentes, Maria Garcia, Henry Garcia Lozada, Luis Garcia Ortiz, Angela Giraldo, Laura Gomez Gonzalez, Javier Granada, Corina Gutierrez, Natalia Henao, Edwin Hernandez, Olga Maria Herrera Uejbe, Juan Diego Higuera Cobos, Jaime Ibarra Gómez, Edwin Hernandez Jaimes, Monica Jaramillo, Nicolas Jaramillo, Carlos Jaramillo Gomez, Monica Jaramillo Sanchez, Ivonne Jarava Durán, Catalina Lopez Ceballos, Claudia Madrid, Elias María Amastha, Jennifer Mercado, Dora Ines Molina, Jessica Molina Soto, Carlos Montoya, Alexander Morales, Carolina Muñoz, Luis Alejandro Orozco, Oscar Osorio, Jorge Mario Palmera Sanchez, Adwar Peña, Jose Perez, Juan Perez Agudelo, Germán Pérez Amador, Carlos Pertuz, Irina Posada, Carlos Puerta, Adalberto Quintero, Diana Quiroz, Carmen Rendon, Alberto Reyes, Alvaro Reyes, Diana Ripoll, Carlos Rivera, Maria Rocha, Jose F Rodriguez, Kervis Asid Rodriguez Villanueva, Javier Emilio Rodriguez Zabala, Sindy Rojas, Maria Romero, Ricardo Rosero, Angelica Rocio Rosillo Cardenas, Lina Rueda, Gregorio Sanchez, Tatiana Sanchez, Arístides Sotomayor Herazo, Monica Suarez, Mariana Torres, Freddy Trujillo, Miguel Urina, Lazaro Van Strahlen, Carlos Velandia, Carolina Velasquez Guzman, Elizabeth Velazquez, Tatiana Vidal Prada, Juan Pablo Yepez Alvaran, Diego Zarate, Jana Andelova, Radka Benesova, Barbara Buzova, Vladimir Cech, Ida Chodova, Miroslav Choura, Antonin Dufka, Andrea Gamova, Jakub Gorgol, Tomas Hala, Hana Havlova, Dagmar Hlavkova, Petra Horanska, Juliana Ilcisin-Valova, Petra Jenickova, Ondrej Jerabek, Ilona Kantorova, Katerina Kolomaznikova, Iva Kopeckova, Miroslava Kopeckova, Karel Linhart, Tomas Linhart, Jan Malecha, Emilia Malicherova, Dana Neubauerova, Martina Oznerova, Radan Partys, Eva Pederzoliova, Maria Petrusova, Vera Prymkova, Eva Racicka, Ida Reissova, Eva Roderova, Libor Stanek, Alena Striova, Dana Svarcova, Petr Svoboda, Emilia Szeghy Malicharova, Jan Urge, Ladislav Vesely, Bedich Wasserburger, Hilde Wasserburgerova, Emil Zahumensky, Vaclav Zamrazil, Hasan Alawi, Ernestos Anastasiadis, Elisabeth Axthelm, Tasso Bieler, Christina Buhrig, Elizaveta Degtyareva, Frank Dellanna, Karl-Michael Derwahl, Stephan Diessel, Barbara Dogiami, Kirsten Dorn-Weitzel, Monika Ernst, Grit Faulmann, Baerbel Fetscher, Thomas Forst, Gabriele Freyer-Lahres, Klaus Funke, Xenia Ganz, Christiane Gleixner, Christoph Hanefeld, Sven Heinrichs, Stephanie Helleberg, Elena Henkel, Gerd Ruediger Hetzel, Caren Hoffmann, Frohmut Jacob, Stephan Jacob, Franziska John, Antonius Jonczyk, Wolfram Kamke, Christiane Klein, Martina Kleinhardt, Werner Kleophas, Christine Kosch, Kristin Kreutzmann, Achim Kühn, Young Hee Lee-Barkey, Alexander Lier, Sarah Maatouk, Joachim Minnich, Michael Mitry, Ilona Muessig, Diana Nicula, Martina Niemann, Joerg Nothroff, Petra Ott, Andreas Pfuetzner, Andreas Pfützner, Frank Pistrosch, Wildgard Pohl, Zdenka Prochazkova, Marlena Retkowska, Heiko Rosin, Daniela Sachsenheimer, Holger Samer, Mazin Sanuri, Axel Schaefer, Frank Schaper, Erik-Delf Schulze, Marita Schulze, Martina Schumann, Thomas Segiet, Veronika Sowa, Hans-Detlev Stahl, Franziska Steinfeldt, Madlen Teige, Bjoern Trieb, Diethelm Tschoepe, Peter Uebel, Bernd Warken, Ingo Weigmann, Klaus Weyland, Klara Wilhelm, Timea Balo, Miklos Balsay, Ilona Bende, Katalin Bezzegh, Zita Birkus, Barbara Buday, Melinda Csomai, Laszlo Deak, Eniko Dezso, Peter Faludi, M Faluvegi, Ilona Fazekas, Agota Feher, Csaba Fejer, Ervin Finta, Agnes Fulcz, Zsolt Gaal, Mihaly Gurzo, Krisztina Hati, Gabriella Herczeg, Ildiko Jozsef, Marta Juhasz, Katalin Keltai, Laszlo Koranyi, Eniko Kulcsar, Krisztina Kun, Andrea Laczko, Botond Literáti-Nagy, Izabella Mezo, Margit Mileder, I Moricz, Károly Nagy, Bela Nagybaczoni, Csaba Nemeth, Agnes Oze, Jozsef Pauer, Eva Peterfai, Bela Polocsanyi, Ferenc Poor, István Reiber, Csaba Salamon, Julia Sebestyen, Ildiko Torok, Marianna Tuu, Andrea Varga, Viktor Vass, Chul Min Ahn, Chulwoo Ahn, Park ByungWon, Hyuk-Jae Chang, Kiyuk Chang, Eui-Young Choi, Han Seok Choi, Jin-Wook Chung, Bum- Kee Hong, Young Joon Hong, Min Su Hyon, Myung Ho Jeong, Shinae Kang, Byeong-Keuk Kim, Ji-Hyun Kim, Ju Han Kim, Kee-Sik Kim, Moo Hyun Kim, Pum-Joon Kim, Soon-Kil Kim, Yong-Seok Kim, Young Kwon Kim, Yoon Seok Koh, Hyuck Moon Kwon, Byoung Kwon Lee, Byung-Wan Lee, Jin Bae Lee, Myoung-Mook Lee, Young-Mee Lim, Pil Ki Min, Jong Sung Park, Jongsuk Park, Keun Ho Park, Sungha Park, Wook Bum Pyun, Se Joong Rim, Dong-Ryeol Ryu, Hong-Seog Seo, Ki Bae Seung, Dong-Ho Shin, Doo Sun Sim, Young Won Yoon, Ilze Andersone, Kristine Babicka, Inga Balcere, Roberts Barons, Inguna Capkovska, Kristine Geldnere, Inese Grigane, Baiba Jegere, Ilze Lagzdina, Lija Mora, Sigita Pastare, Rota Ritenberga, Janina Romanova, Inta Saknite, Natalja Sidlovska, Jelena Sokolova, Sandra Steina, Iveta Strizko, Dace Teterovska, Brigita Vizina, Lina Barsiene, Gintare Belozariene, Laura Daugintyte-Petrusiene, Nijole Drungiliene, Nijole Garsviene, Ala Grigiene, Vytautas Grizas, Virginija Jociene, Dalia Kalvaitiene, Jugeta Kaupiene, Jurate Kavaliauskiene, Dalia Kozloviene, Ilona Lapteva, Birute Maneikiene, Jolanta Marcinkeviciene, Vaidilija Markauskiene, Salomeja Meiluniene, Almantas Norkus, Rita Norviliene, Vladimiras Petrenko, Ruta Radzeviciene, Gintare Sakalyte, Gediminas Urbonas, Skaiste Urbutiene, Donatas Vasiliauskas, Dzilda Velickiene, Carlos Aguilar, Marco Alcocer, Juan Antonio Avalos-Ramirez, Ramiro Banda-Elizondo, Rubria Bricio-Ramirez, Karla Cardenas Mejia, Francisco Cavazos, Jesus Chapa, Erika Cienfuegos, Astrid De la Peña, Gilberto de la Peña Topete, Manuel Odin De los Rios Ibarra, Daniel Elias, Claudia Flores-Moreno, Pedro Garcia Hernandez, Luis Gerardo Gonzalez, Rosa Linda Guerra Moya, Arturo Guerra-Lopez, Raymundo Hernandez Baylon, Carolina Herrera Colorado, Marisol Herrera-Marmolejo, Neri Islas-Palacios, Esteban Lopez, Fernando Lopez, Agustin Lopez Alvarado, Rosa Isela Luna Ceballos, Enrique Morales Villegas, Gualberto Moreno-Virgen, Rosa Linda Parra Perez, Sara Pascoe Gonzalez, Irving Peralta-Cantu, Roopa Previn, Rosa Ramirez, Rubria Ramirez, Maria Guadalupe Ramos Zavala, Monica Rodriguez, Rocio Salgado-Sedano, Ana Claudia Sanchez-Aguilar, Edith Santa Rosa Franco, Leobardo Sauque-Reyna, Rodrigo Suarez Otero, Ivonne Torres, Enrique Velarde-Harnandez, Juan Villagordoa, Efrain Villeda-Espinoza, Jorge Vital-Lopez, Cristian Jair Zavala- Bello, John Baker, Elaine Barrington-Ward, Thomas Brownless, Richard Carroll, Simon Carson, Michelle Choe, Andrew Corin, Brian Corley, Richard Cutfield, Neelam Dalaman, Paul Dixon, Paul Drury, Keith Dyson, Chris Florkowski, Monica Ford, William Frengley, Colin Helm, Colin Katzen, Jane Kerr, Manish Khanolkar, David Kim, Renata Koops, Jeremy Krebs, Robert Leikis, Kwan Low, Alison Luckey, Richard Luke, Susan Macaulay, Rodney Marks, Catherine McNamara, Dean Millar-Coote, Steven Miller, Naomi Mottershead, James Reid, Narcisa Robertson, Ian Rosen, David Rowe, Ole Schmiedel, Russell Scott, Jeffrey Sebastian, Davitt Sheahan, Victoria Stiebel, Ian Ternouth, Chris Tofield, Dirk Venter, Michael Williams, Miles Williams, Fiona Wu, Simon Young, Malgorzata Arciszewska, Anna Bochenek, Piotr Borkowski, Przemyslaw Borowy, Tomasz Chrzanowski, Edward Czerwinski, Marek Dwojak, Agnieszka Grodzicka, Izabela Janiec, Joanna Jaruga, Ewa Krystyna Jazwinska-Tarnawska, Krystyna Jedynasty, Danuta Juzwiak-Czapiewska, Jadwiga Karczewicz-Janowska, Jan Konieczny, Marek Konieczny, Marek Korol, Maciej Kozina, Ewa Krzyzagorska, Ewa Kucharczyk-Petryka, Roman Laz, Anna Majchrzak, Zdzislawa Mrozowska, Michal Mularczyk, Elzbieta Nowacka, Jadwiga Peczynska, Robert Petryka, Radoslaw Pietrzak, Dorota Pisarczyk-Wiza, Aleksandra Rozanska, Zofia Ruzga, Emilia Rzeszotarska, Malgorzata Sacha, Marzenna Sekulska, Anna Sidorowicz-Bialynicka, Teresa Stasinska, Agnieszka Strzelecka-Sosik, Teresa Swierszcz, Katarzyna Miroslawa Szymkowiak, Olga Turowska, Krystyna Wisniewska, Maciej Wiza, Iwona Wozniak, Katarzyna Zelazowska, Bernadetta Ziolkowska-Gawron, Danuta Zytkiewicz-Jaruga, Adrian Albota, Carmina Alexandru, Rodica Avram, Cornelia Bala, Diana Barbonta, Roxana Barbu, Daniela Braicu, Nicoleta Calutiu, Doina Catrinoiu, Anca Cerghizan, Alina Ciorba, Anca Craciun, Rodica Doros, Livia Duma, Ancuta Dumitrache, Ioana Ferariu, Anca Ferician Moza, Alexandrina Ghergan, Gheorghe Ghise, Mariana Graur, Mihaela Gribovschi, Bogdan Mihai, Laura Mihalache, Madalina Mihalcea, Nicoleta Mindrescu, Magdalena Morosanu, Andrea Morosoanu, Maria Mota, Anca Moza, Valerica Nafornita, Narcisa Natea, Simona Nicodim, Cristina Nita, Adriana Onaca, Mircea Onaca, Cristina Pop, Lavinia Pop, Amorin Popa, Alexandrina Popescu, Luchiana Pruna, Gabriela Roman, Mihaela Rosu, Alexandra Sima, Doina Sipciu, Carmen Narcisa Sitterli-Natea, Iosif Szilagyi, Minodora Tapurica, Adrian Tase, Adriana-Carmen Tutescu, Luminita Vanghelie, Ioana Verde, Adrian Vlad, Mihaela Zarnescu, Roman Akhmetov, Irina Allenova, Irina Avdeeva, Oksana Baturina, Irina Biserova, Nikolay Bokovin, Irina Bondar, Natalia Burova, Galina Chufeneva, Elena Chumachek, Marina Demidova, Alexander Demin, Vera Drobysheva, Irina Egorova, Lev Esenyan, Ekaterina Gelig, Sergey Gilyarevsky, Maria Golshmid, Arseniy Goncharov, Anastasia Gorbunova, Ivan Gordeev, Vera Gorelysheva, Tatiana Goryunova, Irina Grebenshchikova, Roman Ilchenko, Maria Ivannikova, Saule Karabalieva, Juliya Karpeeva, Elena Khaykina, Zhanna Kobalava, Irina Kononenko, Oxana Korolik, Anna Korshunova, Victor Kostenko, Irina Krasnopevtseva, Ludmila Krylova, Polina Kulkova, Irina Kuzmina, Alla Ledyaeva, Sergey Levashov, Natalia Lokhovinina, Vadim Lvov, Narine Martirosyan, Sergey Nedogoda, Rostislav Nilk, Yulia Osmolovskaya, Alexey Panov, Olga Paramonova, Ekaterina Pavlova, Elena Pekareva, Nina Petunina, Svetlana Ponamareva, Galina Reshedko, Alla Salasyuk, Malvina Sepkhanyan, Alexandr Serebrov, Olesya Shabelnikova, Andrey Skvortsov, Olga Smirnova, Oxana Spiridonova, Svetlana Strogova, Evgeny Taratukhin, Sergey Tereschenko, Lubov Trukhina, Olga Tsarkova, Vera Tsoma, Farid Tumarov, Natalya Tyan, Tatiana Tyurina, Svetlana Villevalde, Elena Yankovaya, Ludmila Zarutskaya, Elena Zenkova, Aysha Badat, Frederik Bester, Suzanne Blignaut, Dirk Blom, Susan Booysen, Warren Boyd, Brigitte Brice, Susan Brown, Lesley Burgess, Reina Cawood, Kathleen Coetzee, Hillet Conradie, Tanja Cronje, Douwe de Jong, Graham Ellis, Shaunagh Emanuel, Ingrid Engelbrecht, Sharne Foulkes, Done Fourie, Gilbert Gibson, Thirumani Govender, Sumayah Hansa, Allana Colleen Hemus, Firzana Hendricks, Marshall Heradien, Chantelle Holmgren, Zaheer Hoosain, Emile Horak, Johannes Howard, Ignatius Immink, E. Janari, Daksha Jivan, Karl Klusmann, Weik Labuschagne, Yen-yu Lai, Gulam Latiff, J. Lombaard, Hanlie Lottering, Ronel Meeding, Shirley Middlemost, Haroon Mitha, Ismail Mitha, Sandile Mkhwanazi, Rajendran Moodley, Almeri Murray, Dany Musungaie, Yasmin Osman, Kirsten Peacey, Larisha Pillay-Ramaya, Catharina Pretorius, Hans Prozesky, Mahomed Sarvan, E Scholtz, Attila Sebesteny, Bianca Skinner, Michael Skriker, M Smit, Anna-Marie Stapelberg, Nicolaas Swanepoel, Dorothea Urbach, Dina van Aswegen, Francois van Zyl, Louis Van Zyl, Esme Venter, Shahid Wadvalla, Jeffrey Wing, Karen Wolmarans, Cristina Abreu, Pilar Aguilà, Eva Aguilera, Nuria Alonso, Carmen Alvarez, Priscila Cajas, Jose Carlos Castro, Roger Codinachs, Jose Contreras, Maria Jose Coves, Carmen Fajardo, Juan Carlos Ferrer, Neus Font, Mar Garcia, Maria Apolonia Gil, Fernando Gomez, Lluis Alberto Gomez, Jose Gonzalbez, Jose Luis Griera, Luís Masmiquel, Didac Mauricio, Silvia Narejos Perez, Juana Ana Nicolau, Olga Noheda Contreras, Josefina Olivan, Josefina Olivares, Emilio Ortega, Silvia Pellitero, Salvador Pertusa, Ferran Rius, Irene Rodriguez, Carlos Sánchez-Juan, Dolores Santos, Berta Soldevila, David Subias, Manel Terns, Carlos Trescoli, Judith Vilaplana, Alicia Villanueva, Jaan Albo, Kjell Antus, Mattias Axelsson, Lisa Bergström, Emil Binsell-Gerdin, Kurt Boman, Fabian Botond, Annika Dotevall, Anna Graipe, C Jarnet, Jessica Kaminska, Anders Kempe, Michael Korhonen, Carina Linderfalk, Bo Liu, Karl Ljungstroem, Karl Ljungström, Lennart Malmqvist, Linda Mellbin, Thomas Mooe, Peter Nicol, Anders Norrby, Ake Ohlsson, Annika Rosengren, Jan Saaf, Staffan Salmonsson, Olof Strandberg, Karl-Axel Svensson, Bengt-Olov Tengmark, Georgios Tsatsaris, Anders Ulvenstam, Peter Vasko, Chwen-Tzuei Chang, Hsin-Mei Chang, Jung-Fu Chen, To-Pang Chen, Ming-Min Chung, Chia-Po Fu, Te-Lin Hsia, Shih-Che Hua, Ming-Chun Kuo, Chia-ln Lee, I-Te Lee, Kae-Woei Liang, Shih Yi Lin, Chieh-Hsiang Lu, Wen-Ya Ma, Dee Pei, Feng-Chih Shen, Ching-Chieh Su, Shuo-Wei Su, Tsai-Sung Tai, Wan-Ni Tsai, Yi-Ting Tsai, Shih-Chen Tung, Jun-Sing Wang, Hui-I Yu, Ahmed Al-Qaissi, Vijayaraman Arutchelvam, Stephen Atkin, Simon Au, Myint Myint Aye, Stephen Bain, Cristina Bejnariu, Patrick Bell, Deepak Bhatnagar, Rudy Bilous, Neil Black, Ursula Brennan, Barbara Brett, Jana Bujanova, Elaine Chow, Andrew Collier, Amanda Combe, Christopher Courtney, Hamish Courtney, James Crothers, Patrick Eavis, Jackie Elliott, Salvatore Febbraro, Jim Finlayson, Rajiv Gandhi, Sharon Gillings, Jonathan Hamling, Roy Harper, Tim Harris, Kahal Hassan, Simon Heller, Alison Jane, Zeeshan Javed, Tim Johnson, Stephen Jones, Adele Kennedy, David Kerr, Brian Kilgallon, Judith Konya, John Lindsay, Lina Lomova-Williams, Helen Looker, David MacFarlane, Sandra Macrury, Iqbal Malik, Rory McCrimmon, Douglas McKeith, John McKnight, Biswa Mishra, Racha Mukhtar, Ciara Mulligan, Maurice O'Kane, Tolu Olateju, Ian Orpen, Tristan Richardson, Desmond Rooney, Shorsha Bae Ross, Thozhukat Sathyapalan, Naveen Siddaramaiah, Lee Euan Sit, Jeffrey Stephens, Frances Turtle, Ammar Wakil, Emma Walkinshaw, Asem Ali, Robert Anderson, Richard Arakaki, Omar Aref, Mehrdad Kevin Ariani, David Arkin, Salomon Banarer, George Barchini, Arti Bhan, Kelley Branch, Donald Brautigam, Stephen Brietzke, Maridez Brinas, Yudit Brito, Casey Carter, Kimberely Casagni, Sabina Casula, Simon Chakko, Seth Charatz, Dale Childress, Lisa Chow, Malgorzata Chustecka, Subha Clarke, Lisa Cohen, Barry Collins, Gildred Colon Vega, Angel Comulada-Rivera, Gregorio Cortes-Maisonet, Matthew Davis, Jose de Souza, Cyrus Desouza, Mary Dinnan, Bobbi Duffy-Hidalgo, Barbara Dunn, Julia Dunn, Marshall Elman, James Felicetta, Stuart Finkelstein, David Fitz-Patrick, Hermes Florez, Alan Forker, Wayne Fowler, Sonja Fredrickson, Zachary Freedman, Brooke Gainey Narron, Kristin Gainey-Ferree, Michael Gardner, Christian Gastelum, Stephen Giddings, Eve Gillespie, Michael Paul Gimness, Gary Goldstein, Maria Gomes, Nelson Gomez, Timothy Gorman, Ketan Goswami, Arthur Graves, Scott Hacking, Charles Hall, Lenita Hanson, Sherman Harman, David Heber, Robert Henry, Janette Hiner, Irl Hirsch, Priscilla Hollander, Thomas Hooker, Barry Horowitz, Laura Hoste, Loli Huang, Minh Huynh, Dan Hyman, Soha Idriss, Ali Iranmanesh, Dennis Karounos, Moti Kashyap, Lois Katz, William Kaye, Yevgeniy Khaiton, Romesh Khardori, Timothy Kitchen, Andrew Klein, Wendi Knffem, Mikhail Kosiborod, Nicola Kreglinger, Davida Kruger, Anubhav Kumar, Ivan Laboy, Patricia Larrabee, Laura Larrick, Donna Lawson, Mike Ledet, James Lenhard, James Levy, George Li, Zhaoping Li, David Lieb, April Limcolioc, Jane Lions-Patterson, Daniel Lorber, Daniel Lorch, Michael Lorrello, Peter Lu, Kathryn Jean Lucas, Siu-Ling Ma, Michael MacAdams, Michelle Magee, Alexander Magno, Aparna Reddy Mahakala, Jennifer Marks, Anthony McCall, William McClanahan, Carole McClary, Lydia Melendez, John Melish, Deanna Michaud, Christopher Miller, Neil Miller, Pablo Mora, Marriyam Moten, Sunder Mudaliar, Gregory Myrick, Puneet Narayan, Mike Nassif, Karena Neri, Tabitha Newton, Patricia Niblack, Philip Nicol, Ebenezer Nyenwe, A. Ola Odugbesan, Yolanda Okorocha, Ramón Ortiz Carrasquillo, Kwame Osei, Coromoto Palermo, Hiren Patel, Krishna Patel, Cindy Pau, Michael Perley, Sanford Plevin, Elena Plummer, Richard Powell, Mohammed Qintar, Rex Rawls, John Reyes-Castano, Lillian Reynolds, Robert Richards, Julio Rosenstock, Caroline Rowe, Jahandar Saleh, Sony Sam, Alfredo Sanchez, Donald Sander, Bruce Sanderson, Virginia Savin, Elizabeth Seaquist, Jayendra Shah, Serena Shi, Vijay Shivaswamy, Tammi Shlotzhauer, David Shore, Bobbie Skukowski, Kyaw Soe, Vesna Solheim, Joseph Soufer, Helmut Steinberg, Jaime Steinsapir, Phillip Tarkington, Debra Thayer, Stephen Thomson, James Thrasher, Joseph Tibaldi, Jeff Tjaden, Oberto Tores, Dace Trence, Subbulaxmi Trikudanathan, Jagdeesh Ullal, Gabriel Uwaifo, Anthony Vo, Kenny Vu, Damandeep Walia, Karen Weiland, Fred Whitehouse, Thomas Wiegmann, Kathleen Wyne, Alan Wynne, Kevin Yuen, Joel Zaretzky, James Zebrack, Franklin Zieve, William Zigrang, and Everest
Subjects: Male, medicine.medical_specialty, Recombinant Fusion Proteins, Population, Placebo-controlled study, Glucagon-Like Peptides, Myocardial Infarction, Type 2 diabetes, 030204 cardiovascular system & hematology, Placebo, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Double-Blind Method, law, Internal medicine, medicine, Humans, Hypoglycemic Agents, 030212 general & internal medicine, education, Aged, education.field_of_study, business.industry, Semaglutide, Hazard ratio, General Medicine, Middle Aged, medicine.disease, Immunoglobulin Fc Fragments, Stroke, Diabetes Mellitus, Type 2, Cardiovascular Diseases, Dulaglutide, Female, business, medicine.drug
Abstract: Digital, Background Three different glucagon-like peptide-1 (GLP-1) receptor agonists reduce cardiovascular outcomes in people with type 2 diabetes at high cardiovascular risk with high glycated haemoglobin A1c (HbA1c) concentrations. We assessed the effect of the GLP-1 receptor agonist dulaglutide on major adverse cardiovascular events when added to the existing antihyperglycaemic regimens of individuals with type 2 diabetes with and without previous cardiovascular disease and a wide range of glycaemic control. Methods This multicentre, randomised, double-blind, placebo-controlled trial was done at 371 sites in 24 countries. Men and women aged at least 50 years with type 2 diabetes who had either a previous cardiovascular event or cardiovascular risk factors were randomly assigned (1:1) to either weekly subcutaneous injection of dulaglutide (1·5 mg) or placebo. Randomisation was done by a computer-generated random code with stratification by site. All investigators and participants were masked to treatment assignment. Participants were followed up at least every 6 months for incident cardiovascular and other serious clinical outcomes. The primary outcome was the first occurrence of the composite endpoint of non-fatal myocardial infarction, non-fatal stroke, or death from cardiovascular causes (including unknown causes), which was assessed in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT01394952. Findings Between Aug 18, 2011, and Aug 14, 2013, 9901 participants (mean age 66·2 years [SD 6·5], median HbA1c 7·2% [IQR 6·6–8·1], 4589 [46·3%] women) were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). During a median follow-up of 5·4 years (IQR 5·1–5·9), the primary composite outcome occurred in 594 (12·0%) participants at an incidence rate of 2·4 per 100 person-years in the dulaglutide group and in 663 (13·4%) participants at an incidence rate of 2·7 per 100 person-years in the placebo group (hazard ratio [HR] 0·88, 95% CI 0·79–0·99; p=0·026). All-cause mortality did not differ between groups (536 [10·8%] in the dulaglutide group vs 592 [12·0%] in the placebo group; HR 0·90, 95% CI 0·80–1·01; p=0·067). 2347 (47·4%) participants assigned to dulaglutide reported a gastrointestinal adverse event during follow-up compared with 1687 (34·1%) participants assigned to placebo (p, Ciencias Médicas y de la Salud
Published: 2019

32. Sleepiness and driving events in shift workers: the impact of circadian and homeostatic factors

Author: Clare Anderson, Megan D Mulhall, Saranea Ganesan, Shantha M W Rajaratnam, Michelle Magee, Tracey L. Sletten, Mark E Howard, Allison L Collins, Steven W. Lockley, and Julia E. Stone
Subjects: Adult, Male, Automobile Driving, medicine.medical_specialty, Sleepiness, Evening, Population, Nurses, Transportation, Audiology, Shift work, Young Adult, 03 medical and health sciences, Cognition, 0302 clinical medicine, Sleep Disorders, Circadian Rhythm, Work Schedule Tolerance, Physiology (medical), medicine, Homeostasis, Humans, Circadian rhythm, Wakefulness, education, Melatonin, education.field_of_study, business.industry, Shift Work Schedule, Actigraphy, Middle Aged, Circadian Rhythm, Alertness, 030228 respiratory system, Female, Neurology (clinical), Sleep, business, 030217 neurology & neurosurgery
Abstract: We aimed to characterize objective and subjective sleepiness and driving events during short work commutes and examine the impact of circadian and homeostatic factors across different shift types in a shift worker population. Thirty-three nurses were monitored for 2 weeks over day (07:00-15:30), evening (13:00-21:30), and night shifts (21:00-07:30). Sleep was measured via daily sleep logs and wrist actigraphy. Driving logs were completed for each work commute, reporting driving events and a predrive Karolinska Sleepiness Scale (KSS). Ocular data from a subset of participants (n = 11) assessed objective sleepiness using infrared oculography during commutes. Circadian phase was assessed at three time points via urinary 6-sulphatoxymelatonin (aMT6s) collected over 24-48 hours. Subjective and objective sleepiness and sleep-related and hazardous driving events significantly increased following night shift compared with preshift. There were significant shift differences with KSS, sleep-related and inattention-related events highest during the postnight shift commute, compared with day and evening shifts. Sleep-related events were highest following the first night shift, while inattention-related events were most frequent after consecutive night shifts. KSS, sleep-related and hazardous events were increased during drives following â�¥16 hours of wakefulness. KSS and sleep-related events increased during drives within Â±3 hours of aMT6s acrophase. An interaction between homeostatic and circadian processes was observed, with KSS and sleep-related events highest within Â±3 hours of acrophase, when wakefulness was â�¥16 hours. In naturalistic conditions, subjective and objective sleepiness and driving events are increased following night shifts, even during short (â�¼30 minutes) commutes and exacerbated by an interaction between circadian phase and duration of wakefulness. Â© Sleep Research Society 2019.
Published: 2019
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33. The Impact of Shift Work on Sleep, Alertness and Performance in Healthcare Workers

Author: Megan D Mulhall, Shantha M W Rajaratnam, Julia E. Stone, Steven W. Lockley, Mark E Howard, Michelle Magee, Allison L Collins, Tracey L. Sletten, and Saranea Ganesan
Subjects: 0301 basic medicine, Adult, Male, medicine.medical_specialty, Evening, Health Personnel, lcsh:Medicine, Audiology, Article, Shift work, 03 medical and health sciences, 0302 clinical medicine, Sleep Disorders, Circadian Rhythm, Intensive care, Work Schedule Tolerance, Reaction Time, Medicine, Humans, Attention, Circadian rhythm, Wakefulness, lcsh:Science, Fatigue, Sleep restriction, Melatonin, Multidisciplinary, business.industry, lcsh:R, Shift Work Schedule, Middle Aged, Circadian Rhythm, Alertness, 030104 developmental biology, lcsh:Q, Female, business, Sleep, 030217 neurology & neurosurgery, Psychomotor Performance
Abstract: Shift work is associated with impaired alertness and performance due to sleep loss and circadian misalignment. This study examined sleep between shift types (day, evening, night), and alertness and performance during day and night shifts in 52 intensive care workers. Sleep and wake duration between shifts were evaluated using wrist actigraphs and diaries. Subjective sleepiness (Karolinska Sleepiness Scale, KSS) and Psychomotor Vigilance Test (PVT) performance were examined during day shift, and on the first and subsequent night shifts (3rd, 4th or 5th). Circadian phase was assessed using urinary 6-sulphatoxymelatonin rhythms. Sleep was most restricted between consecutive night shifts (5.74 ± 1.30 h), consecutive day shifts (5.83 ± 0.92 h) and between evening and day shifts (5.20 ± 0.90 h). KSS and PVT mean reaction times were higher at the end of the first and subsequent night shift compared to day shift, with KSS highest at the end of the first night. On nights, working during the circadian acrophase of the urinary melatonin rhythm led to poorer outcomes on the KSS and PVT. In rotating shift workers, early day shifts can be associated with similar sleep restriction to night shifts, particularly when scheduled immediately following an evening shift. Alertness and performance remain most impaired during night shifts given the lack of circadian adaptation to night work. Although healthcare workers perceive themselves to be less alert on the first night shift compared to subsequent night shifts, objective performance is equally impaired on subsequent nights.
Published: 2019

34. Generalizability of A Neural Network Model for Circadian Phase Prediction in Real-World Conditions

Author: Mark E Howard, Svetlana Postnova, Shantha M W Rajaratnam, Suzanne Ftouni, Julia E. Stone, Michelle Magee, Steven W. Lockley, Tracey L. Sletten, Andrew J. K. Phillips, and Clare Anderson
Subjects: 0301 basic medicine, Adult, Male, Schedule, Light, lcsh:Medicine, Models, Biological, Article, Melatonin, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Rhythm, Work Schedule Tolerance, Statistics, Machine learning, medicine, Humans, Effects of sleep deprivation on cognitive performance, Circadian rhythm, lcsh:Science, Mathematics, Multidisciplinary, lcsh:R, Shift Work Schedule, Middle Aged, Circadian Rhythm, Alertness, 030104 developmental biology, lcsh:Q, Female, Neural Networks, Computer, Circadian rhythms and sleep, Skin Temperature, Sleep, 030217 neurology & neurosurgery, Biomarkers, medicine.drug
Abstract: A neural network model was previously developed to predict melatonin rhythms accurately from blue light and skin temperature recordings in individuals on a fixed sleep schedule. This study aimed to test the generalizability of the model to other sleep schedules, including rotating shift work. Ambulatory wrist blue light irradiance and skin temperature data were collected in 16 healthy individuals on fixed and habitual sleep schedules, and 28 rotating shift workers. Artificial neural network models were trained to predict the circadian rhythm of (i) salivary melatonin on a fixed sleep schedule; (ii) urinary aMT6s on both fixed and habitual sleep schedules, including shift workers on a diurnal schedule; and (iii) urinary aMT6s in rotating shift workers on a night shift schedule. To determine predicted circadian phase, center of gravity of the fitted bimodal skewed baseline cosine curve was used for melatonin, and acrophase of the cosine curve for aMT6s. On a fixed sleep schedule, the model predicted melatonin phase to within ± 1 hour in 67% and ± 1.5 hours in 100% of participants, with mean absolute error of 41 ± 32 minutes. On diurnal schedules, including shift workers, the model predicted aMT6s acrophase to within ± 1 hour in 66% and ± 2 hours in 87% of participants, with mean absolute error of 63 ± 67 minutes. On night shift schedules, the model predicted aMT6s acrophase to within ± 1 hour in 42% and ± 2 hours in 53% of participants, with mean absolute error of 143 ± 155 minutes. Prediction accuracy was similar when using either 1 (wrist) or 11 skin temperature sensor inputs. These findings demonstrate that the model can predict circadian timing to within ± 2 hours for the vast majority of individuals on diurnal schedules, using blue light and a single temperature sensor. However, this approach did not generalize to night shift conditions.
Published: 2019

35. Speech is a Sensitive Marker of Neuropsychiatric and Neurodegenerative Conditions (in the Right Context)

Author: Michelle Magee, Felicity A. Baker, Brian Harel, James C. Mundt, Jeanette Tamplin, Isaac R. Galatzer-Levy, and Adam P. Vogel
Subjects: Context (language use), Psychology, Neuroscience, Biological Psychiatry
Published: 2021
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36. SYNTAX Score and Long-Term Outcomes

Author: Fumiaki Ikeno, Maria Mori Brooks, Kaori Nakagawa, Min-Kyu Kim, Hideaki Kaneda, Yoshiaki Mitsutake, Helen A. Vlachos, Leonard Schwartz, Robert L. Frye, Sheryl F. Kelsey, Katsuhisa Waseda, Mark A. Hlatky, Katherine M. Detre, Trevor J. Orchard, Stephen B. Thomas, Kim Sutton Tyrrell, Jamal S. Rana, Frani Averbach, Joan M. MacGregor, Scott M. O’Neal, Kathleen Pitluga, Veronica Sansing, Mary Tranchine, Sharon W. Crow, Marianne (Marnie) Bertolet, Regina Hardison, Kevin Kip, Manuel Lombardero, Jiang Lu, Sue Janiszewski, Darina Protivnak, Sarah Reiser, Stephen Barton, Ping Guo, Yulia Kushner, Owen Michael, Jeffrey P. Martin, Christopher Kania, Michael Kania, Jeffrey O’Donnell, Rae Ann Maxwell, Suzanne Goldberg, Yves Rosenberg, Patrice Desvigne-Nickens, Abby Ershow, David Gordon, Dina Paltoo, Teresa L.Z. Jones, Whady Hueb, José Ramires, Neuza Lopes, Bernardo Léo Wajchenberg, Eulogio E. Martinez, Sergio A. Oliveira, Expedito E. Ribeiro, Marcos Perin, Roberto Betti, George Steiner, Alan Barolet, Yolanda Groenewoud, Lisa Mighton, Kathy Camelon, Robert O’Rourke, Janet Blodgett, Edward Sako, Judith Nicastro, Robin Prescott, Charanjit Rihal, Frank Kennedy, Gregory Barsness, Amanda Basu, Alfredo Clavell, Robert Frye, David R. Holmes, Amir Lerman, Charles Mullaney, Guy Reeder, Robert Rizza, Hartzell Schaff, Steven Smith, Virend Somers, Thoralf Sundt, Henry Ting, R. Scott Wright, Pam Helgemoe, Diane Lesmeister, Deborah Rolbiecki, Luis Lepe-Montoya, Jorge Escobedo, Rafael Barraza, Rubén Baleón, Arturo Campos, Paula García, Carlos Lezama, Carlos Miramontes, Salvador Ocampo, Joaquín V. Peñafiel, Aquiles Valdespino, Raúl Verdín, Héctor Albarrán, Fernando Ayala, Eduardo Chávez, Héctor Murillo, Luisa Virginia Buitrón, Beatriz Rico-Verdin, Fabiola Angulo, Dale Adler, Austin Arthur Halle, Faramarz Ismail-Beigi, Suvinay Paranjape, Stacey Mazzurco, Karen Ridley, Kodangudi Ramanathan, Solomon Solomon, Barry Wall, Darryl Weinman, Tammy Touchstone, Lillie Douglas, Martial Bourassa, Jean-Claude Tardif, Jean-Louis Chiasson, Marc Andre Lavoie, Rémi Rabasa-Lhoret, Hélène Langelier, Suzy Foucher, Johanne Trudel, Scott Monrad, Vankeepuram Srinivas, Joel Zonszein, Jill Crandall, Helena Duffy, Eugen Vartolomei, Spencer King, Carl Jacobs, David Robertson, Marty Porter, Melanie Eley, Emmalee Nichols, Jennifer LaCorte, Melinda Mock, William Rogers, Fernando Ovalle, David Bell, Vijay K. Misra, William B. Hillegass, Raed Aqel, Penny Pierce, Melanie Smith, Leah Saag, Ashley Vaughn, Dwight Smith, Tiffany Grimes, Susan Rolli, Roberta Hill, Beth Dean Barrett, Clarinda Morehead, Ken Doss, Charles J. Davidson, Mark Molitch, Nirat Beohar, Elaine Massaro, Lynne Goodreau, Fabiola Arroyo, Petr Neužil, Lenka Pavlickova, Štĕpánka Stehlíková, Jaroslav Benedik, Liz Coling, Richard Davies, Christopher Glover, Michel LeMay, Thierry Mesana, Teik Chye Ooi, Mark Silverman, Alexander Sorisky, Colette Favreau, Susan McClinton, Melvin Weiss, Irene Weiss, Leo Saulle, Harichandra Kannam, Joanne C. Kurylas, Lorraine Vasi, John Douglas, Ziyad Ghazzal, Laurence Sperling, Priya Dayamani, Suzanne Gebhart, Sabreena Basu, Tarek Helmy, Vin Tangpricha, Pamela Hyde, Margaret Jenkins, Barbara P. Grant, Kenneth Kent, William Suddath, Michelle Magee, Patricia Julien-Williams, Vida Reed, Carine Nassar, Gilles Dagenais, Claude Garceau, Dominique Auger, Christopher Buller, Tom Elliott, Krishnan Ramanathan, Donald Ricci, Rebecca Fox, Daniela Kolesniak, Michael Attubato, Frederick Feit, Stephen Richardson, Ivan Pena Sing, James Slater, Angela Amendola, Bernardo Vargas, Nicholas Tsapatsaris, Bartholomew Woods, Gary Cushing, Martin Rutter, Premranjan Singh, Gail DesRochers, Gail Woodhead, Deborah Gannon, Nancy Shinopulos Campbell, Michael Ragosta, Ian Sarembock, Eric Powers, Eugene Barrett, Linda Jahn, Karen Murie, Gladwin Das, Gardar Sigurdsson, Carl White, John Bantle, J. Bruce Redmon, Christine Kwong, Jacqueline Tamis-Holland, Jeanine Albu, Judith S. Hochman, James Wilentz, Sylvaine Frances, Deborah Tormey, Carl Pepine, Karen Smith, Laurence Kennedy, Karen Brezner, Tempa Curry, Frank Bleyer, Stewart Albert, Arshag Mooradian, Sharon Plummer, Francisco Fuentes, Roberto Robles, Victor Lavis, Jaime Gomez, Cesar Iliescu, Carol Underwood, Maria Selin Fulton, Julie Gomez Ramirez, Jennifer Merta, Glenna Scott, Ashok Krishnaswami, Lynn Dowdell, Sarah Berkheimer, Adam Greenbaum, Fred Whitehouse, Raquel Pangilinan, Kelly Mann, Alice K. Jacobs, Elliot Sternthal, Susana Ebner, Zoran Nedeljkovic, Paula Beardsley, David Schneider, Richard Pratley, William Cefalu, Joel Schnure, Michaelanne Rowen, Linda Tilton, Alan Niederman, Cristina Mata, Terri Kellerman, John Farmer, Alan J. Garber, Neal Kleiman, Nancy Howard, Debra Nichols, Madonna Pool, Christopher Granger, Mark Feinglos, George Adams, Jennifer Green, Bernadette Druken, Dani Underwood, J. Lawrence Stafford, Thomas Donner, Warren Laskey, Dana Beach, John Lopez, Andrew Davis, David Faxon, Sirimon Reutrakul, Emily Bayer, Oscar Marroquin, Howard Cohen, Mary Korytkowski, Glory Koerbel, Lisa Baxendell, Debbie Rosenfelder, Louise DeRiso, Carole Farrell, Tina Vita, Janet McGill, Ronald Krone, Richard Bach, Carol Recklein, Kristin M. Luepke, Mary Jane Clifton, Michael E. Farkouh, Michael C. Kim, Donald A. Smith, Ida Guzman, Arlene Travis, James O’Keefe, Alan Forker, William Isley, Richard Moe, Paul Kennedy, Margaret Rosson, Aimee Long, Eric Bates, William Herman, Rodica Pop-Busui, Claire Duvernoy, Martin Stevens, Ann Luciano, Cheryl Majors, Sheldon H. Gottlieb, Annabelle Rodriguez, Melanie Herr, David Williams, Robert J. Smith, J. Dawn Abbott, Marc J. Laufgraben, Mary Grogan, Janice Muratori, Gabriel Habib, Marco Marcelli, Issam Mikati, Emilia Cordero, Gina Caldwell, David Schechter, Daniel Lorber, Phyllis August, Maisie Brown, Patricia Depree, Kurt Huber, Ursula Hanusch-Enserer, Nelly Jordanova, Dilek Cilesiz, Birgit Vogel, Ben McCallister, Michael Kleerekoper, Kelly Mandagere, Robert Urbanic, James Bengston, Bobby K. Kong, Andrew Pruitt, Jeffrey Sanfield, Carol Carulli, Ruth Churley-Strom, Raymond Magorien, Kwame Osei, Cecilia Casey Boyer, Richard Lee, Pasquale Palumbo, Joyce Wisbey, Edwin Alderman, Anne Schwarzkopf Michael Steffes, Maren Nowicki, Jean Bucksa, Bernard Chaitman, Jane Eckstein, Karen Stocke, Derek B. Boothroyd, Kathryn A. Melsop, Burton E. Sobel, Dagnija Neimane, Ami E. Iskandrian, Mary Beth Schaaf, Saul Genuth, Theresa Bongarno, Richard Nesto, Karen Hultberg, Helene Rosenhouse-Romeo, Georgia Pambianco, Michael Mock, Sheryl Kelsey, Trevor Orchard, Thomas Ryan, Harold Lebovitz, Robert Brown, Gottlieb Friesinger, Edward Horton, Jay Mason, Renu Virmani, Lawrence Wechsler, C. Noel Bairey-Merz, J. Ward Kennedy, Elliott Antman, John Colwell, Sarah Fowler, Curt Furberg, Lee Goldman, Bruce Jennings, and Scott Rankin
Subjects: medicine.medical_specialty, business.industry, medicine.medical_treatment, Hazard ratio, Percutaneous coronary intervention, 030204 cardiovascular system & hematology, medicine.disease, Revascularization, humanities, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Angioplasty, Conventional PCI, medicine, Cardiology, 030212 general & internal medicine, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Stroke
Abstract: Background The extent of coronary disease affects clinical outcomes and may predict the effectiveness of coronary revascularization with either coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI). The SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score quantifies the extent of coronary disease. Objectives This study sought to determine whether SYNTAX scores predicted outcomes and the effectiveness of coronary revascularization compared with medical therapy in the BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial. Methods Baseline SYNTAX scores were retrospectively calculated for BARI-2D patients without prior revascularization (N = 1,550) by angiographic laboratory investigators masked to patient characteristics and outcomes. The primary outcome was major cardiovascular events (a composite of death, myocardial infarction, and stroke) over 5 years. Results A mid/high SYNTAX score (≥23) was associated with a higher risk of major cardiovascular events (hazard ratio: 1.36, confidence interval: 1.07 to 1.75, p = 0.01). Patients in the CABG stratum had significantly higher SYNTAX scores: 36% had mid/high SYNTAX scores compared with 13% in the PCI stratum (p Conclusions Among patients with diabetes and stable ischemic heart disease, higher SYNTAX scores predict higher rates of major cardiovascular events and were associated with more favorable outcomes of revascularization compared with medical therapy among patients suitable for CABG. (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes; NCT00006305)
Published: 2017
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37. Diagnosis, Cause, and Treatment Approaches for Delayed Sleep-Wake Phase Disorder

Author: Shantha M W Rajaratnam, Kenneth P. Wright, Emily M. Marbas, Michelle Magee, and Josiane L. Broussard
Subjects: medicine.medical_specialty, Sleep wake, Poison control, Excessive daytime sleepiness, Delayed sleep phase, Phase (combat), Melatonin, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Sleep Disorders, Circadian Rhythm, Injury prevention, Humans, Medicine, 030212 general & internal medicine, Circadian rhythm, business.industry, General Medicine, medicine.disease, Psychiatry and Mental health, Clinical Psychology, Neuropsychology and Physiological Psychology, Neurology (clinical), Medical emergency, medicine.symptom, business, psychological phenomena and processes, 030217 neurology & neurosurgery, medicine.drug
Abstract: Delayed sleep-wake phase disorder (DSWPD) is commonly defined as an inability to fall asleep and wake at societal times resulting in excessive daytime sleepiness. Although the cause is multifaceted, delays in sleep time are largely driven by misalignment between the circadian pacemaker and the desired sleep-wake timing schedule. Current treatment approaches focus on correcting the circadian delay; however, there is a lack of data investigating combined therapies for treatment of DSWPD.
Published: 2016
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38. A pre-drive ocular assessment predicts alertness and driving impairment: A naturalistic driving study in shift workers

Author: Michael G. Lenné, Clare Anderson, Shantha M W Rajaratnam, Megan D Mulhall, Mark E Howard, Jonny Kuo, Allison L Collins, Marie-Antoinette Spina, Tracey L. Sletten, Jennifer M Cori, and Michelle Magee
Subjects: Adult, Male, medicine.medical_specialty, Sleepiness, Evening, Microsleep, Poison control, Human Factors and Ergonomics, Physical medicine and rehabilitation, Work Schedule Tolerance, Distraction, 0502 economics and business, Injury prevention, medicine, Humans, Distracted driving, 0501 psychology and cognitive sciences, Wakefulness, Safety, Risk, Reliability and Quality, 050107 human factors, 050210 logistics & transportation, Blinking, 05 social sciences, Accidents, Traffic, Public Health, Environmental and Occupational Health, Psychomotor vigilance task, Alertness, Distracted Driving, Female, Self Report, Psychology
Abstract: Sleepiness is a major contributor to motor vehicle crashes and shift workers are particularly vulnerable. There is currently no validated objective field-based measure of sleep-related impairment prior to driving. Ocular parameters are promising markers of continuous driver alertness in laboratory and track studies, however their ability to determine fitness-to-drive in naturalistic driving is unknown. This study assessed the efficacy of a pre-drive ocular assessment for predicting sleep-related impairment in naturalistic driving, in rotating shift workers. Fifteen healthcare workers drove an instrumented vehicle for 2 weeks, while working a combination of day, evening and night shifts. The vehicle monitored lane departures and behavioural microsleeps (blinks >500 ms) during the drive. Immediately prior to driving, ocular parameters were assessed with a 4-min test. Lane departures and behavioural microsleeps occurred on 17.5 % and 10 % of drives that had pre-drive assessments, respectively. Pre-drive blink duration significantly predicted behavioural microsleeps and showed promise for predicting lane departures (AUC = 0.79 and 0.74). Pre-drive percentage of time with eyes closed had high accuracy for predicting lane departures and behavioural microsleeps (AUC = 0.73 and 0.96), although was not statistically significant. Pre-drive psychomotor vigilance task variables were not statistically significant predictors of lane departures. Self-reported sleep-related and hazardous driving events were significantly predicted by mean blink duration (AUC = 0.65 and 0.69). Measurement of ocular parameters pre-drive predict drowsy driving during naturalistic driving, demonstrating potential for fitness-to-drive assessment in operational environments.
Published: 2020
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39. Sleep regularity is associated with sleep-wake and circadian timing, and mediates daytime function in Delayed Sleep-Wake Phase Disorder

Author: Delwyn J. Bartlett, Michelle Magee, Simon A. Joosten, Edward M. Armstrong, Brendon J. Yee, Ju Whei Lee, K. Chohan, Leon Lack, Kris P T Yu, B. Raman, E. Roese, Gorica Micic, Tracey L. Sletten, E. Verberne, M. Hardy, Ronald R. Grunstein, Christopher J. Gordon, Mark D. Salkeld, Jade M. Murray, Kirsty L. Dodds, A. Yeo, Nicole Lovato, S. Gunaratnam, Andrew J. K. Phillips, Shantha M W Rajaratnam, Y. Djavadkhani, Bei Bei, David J. Kennaway, Keith H. Wong, and Steven W. Lockley
Subjects: Adult, Male, Sleep Wake Disorders, medicine.medical_specialty, Population, Audiology, Severity of Illness Index, Melatonin, 03 medical and health sciences, 0302 clinical medicine, Sleep Disorders, Circadian Rhythm, Sleep Initiation and Maintenance Disorders, Insomnia, Medicine, Humans, Circadian rhythm, education, education.field_of_study, business.industry, Mood Disorders, Australia, Central Nervous System Depressants, General Medicine, medicine.disease, Circadian Rhythm, Circadian rhythm sleep disorder, 030228 respiratory system, Mood disorders, Biological Variation, Population, Latent Class Analysis, Case-Control Studies, Female, Sleep onset, medicine.symptom, business, Sleep, 030217 neurology & neurosurgery, medicine.drug
Abstract: Background: In healthy populations, irregular sleep patterns are associated with delayed sleep and poor functional/mood outcomes. Currently, it is unknown whether irregular sleep contributes to poor functional/mood outcomes in individuals with Delayed Sleep-Wake Phase Disorder (DSWPD). Methods: In 170 patients with DSWPD, we collected sleep-wake patterns, dim light melatonin onset (DLMO), and functional/mood outcomes. The Sleep Regularity Index (SRI)and other sleep timing metrics were computed. Correlations of SRI were computed with phase angle (difference between DLMO and desired bedtime), sleep timing and quality variables, daytime function, sleep-related daytime impairment, mood, and insomnia symptom severity. Path analyses assessed whether SRI or total sleep time mediated the associations between sleep onset time and phase angle with daytime functioning, sleep-related impairment, and mood outcomes. Results: Higher SRI was associated with earlier sleep and longer total sleep time, but did not relate to sleep quality, daytime function, or mood outcomes. Path analysis showed that phase angle was directly associated with all outcome variables, whereas sleep onset time was not directly associated with any. SRI mediated the effects of sleep onset time and phase angle on daytime function. Total sleep time mediated the effects of sleep onset time and phase angle on sleep-related impairment. Conclusion: Individuals with DSWPD who have more delayed sleep and a greater phase angle also have more irregular sleep. This suggests that it is not delayed sleep timing per se that drives poor functional outcomes in DSWPD, but rather the timing of sleep relative to circadian phase and resultant irregular sleep patterns. Â© 2019 Elsevier B.V.
Published: 2018

40. The pupillary light reflex distinguishes between circadian and non-circadian delayed sleep phase disorder (DSPD) phenotypes in young adults

Author: Michelle Magee, Sean W. Cain, Elise M. McGlashan, Shantha M W Rajaratnam, Angus C. Burns, Tracey L. Sletten, and Jade M. Murray
Subjects: 0301 basic medicine, Male, Light, Physiology, lcsh:Medicine, Delayed sleep phase, Reflex, Pupillary, Biochemistry, 0302 clinical medicine, Reflexes, Medicine and Health Sciences, Medicine, Young adult, lcsh:Science, Melatonin, Light Pulses, Chronobiology, Multidisciplinary, Physics, Electromagnetic Radiation, Circadian Rhythm, Circadian Oscillators, Phenotype, Neurology, Physical Sciences, Cardiology, Female, medicine.drug, Research Article, Adult, Sleep Wake Disorders, medicine.medical_specialty, Adolescent, Immunology, Bedtime, Diagnosis, Differential, 03 medical and health sciences, Young Adult, Sleep Disorders, Circadian Rhythm, Internal medicine, Hypersensitivity, Humans, Pupillary light reflex, Circadian rhythm, Diagnostic Errors, business.industry, lcsh:R, Biology and Life Sciences, medicine.disease, Hormones, 030104 developmental biology, ROC Curve, Case-Control Studies, Reflex, lcsh:Q, Clinical Immunology, Clinical Medicine, business, Sleep Disorders, Physiological Processes, Sleep, 030217 neurology & neurosurgery, Neuroscience
Abstract: This study investigated the utility of the pupillary light reflex as a method of differentiating DSPD patients with delayed melatonin timing relative to desired/required sleep time (circadian type) and those with non-delayed melatonin timing (non-circadian type). All participants were young adults, with a total of 14 circadian DSPD patients (M = 28.14, SD = 5.26), 12 non-circadian DSPD patients (M = 29.42, SD = 11.51) and 51 healthy controls (M = 21.47 SD = 3.16) completing the protocol. All participants were free of central nervous system acting medications and abstained from caffeine and alcohol on the day of the assessment. Two pupillary light reflex measurements were completed by each participant, one with a 1s dim (~10 lux) light exposure, and one with a 1s bright (~1500 lux) light exposure. Circadian DSPD patients showed a significantly faster pupillary light reflex than both non-circadian DSPD patients and healthy controls. Non-circadian patients and healthy controls did not differ significantly. Receiver operating characteristic curves were generated to determine the utility of mean and maximum constriction velocity in differentiating the two DSPD phenotypes, and these demonstrated high levels of sensitivity (69.23–-100%) and specificity (66.67–91.67%) at their optimal cut offs. The strongest predictor of DSPD phenotype was the mean constriction velocity to bright light (AUC = 0.87). These results support the potential for the pupillary light reflex to clinically differentiate between DSPD patients with normal vs. delayed circadian timing relative to desired bedtime, without the need for costly and time-consuming circadian assessments.
Published: 2018

41. Temporal dynamics of circadian phase shifting response to consecutive night shifts in healthcare workers: role of light-dark exposure

Author: Julia E, Stone, Tracey L, Sletten, Michelle, Magee, Saranea, Ganesan, Megan D, Mulhall, Allison, Collins, Mark, Howard, Steven W, Lockley, and Shantha M W, Rajaratnam
Subjects: Adult, Male, Spatio-Temporal Analysis, Light, Health Personnel, Humans, Female, Darkness, Sleep, Adaptation, Physiological, Circadian Rhythm, Perspectives
Abstract: Shift work is highly prevalent and is associated with significant adverse health impacts. There is substantial inter-individual variability in the way the circadian clock responds to changing shift cycles. The mechanisms underlying this variability are not well understood. We tested the hypothesis that light-dark exposure is a significant contributor to this variability; when combined with diurnal preference, the relative timing of light exposure accounted for 71% of individual variability in circadian phase response to night shift work. These results will drive development of personalised approaches to manage circadian disruption among shift workers and other vulnerable populations to potentially reduce the increased risk of disease in these populations.Night shift workers show highly variable rates of circadian adaptation. This study examined the relationship between light exposure patterns and the magnitude of circadian phase resetting in response to night shift work. In 21 participants (nursing and medical staff in an intensive care unit) circadian phase was measured using 6-sulphatoxymelatonin at baseline (day/evening shifts or days off) and after 3-4 consecutive night shifts. Daily light exposure was examined relative to individual circadian phase to quantify light intensity in the phase delay and phase advance portions of the light phase response curve (PRC). There was substantial inter-individual variability in the direction and magnitude of phase shift after three or four consecutive night shifts (mean phase delay -1:08 ± 1:31 h; range -3:43 h delay to +3:07 h phase advance). The relative difference in the distribution of light relative to the PRC combined with diurnal preference accounted for 71% of the variability in phase shift. Regression analysis incorporating these factors estimated phase shift to within ±60 min in 85% of participants. No participants met criteria for partial adaptation to night work after three or four consecutive night shifts. Our findings provide evidence that the phase resetting that does occur is based on individual light exposure patterns relative to an individual's baseline circadian phase. Thus, a 'one size fits all' approach to promoting adaptation to shift work using light therapy, implemented without knowledge of circadian phase, may not be efficacious for all individuals.
Published: 2017

42. Individual vulnerability to insomnia, excessive sleepiness and shift work disorder amongst healthcare shift workers. A systematic review

Author: Tracey L. Sletten, Lauren A Booker, Shantha M W Rajaratnam, Michelle Magee, and Mark E Howard
Subjects: Pulmonary and Respiratory Medicine, Sleepiness, Excessive daytime sleepiness, Shift work, Pittsburgh Sleep Quality Index, 03 medical and health sciences, 0302 clinical medicine, Quality of life (healthcare), Sleep Disorders, Circadian Rhythm, Physiology (medical), Sleep Initiation and Maintenance Disorders, Work Schedule Tolerance, Insomnia, Medicine, Humans, 030212 general & internal medicine, Exercise, business.industry, Epworth Sleepiness Scale, Age Factors, medicine.disease, Neuroticism, Circadian Rhythm, Circadian rhythm sleep disorder, Neurology, Neurology (clinical), medicine.symptom, business, 030217 neurology & neurosurgery, Clinical psychology
Abstract: Shift workers often experience reduced sleep quality, duration and/or excessive sleepiness due to the imposed conflict between work and their circadian system. About 20-30% of shift workers experience prominent insomnia symptoms and excessive daytime sleepiness consistent with the circadian rhythm sleep disorder known as shift work disorder. Individual factors may influence this vulnerability to shift work disorder or sleep-related impairment associated with shift work. This paper was registered with Prospero and was conducted using recommended standards for systematic reviews and meta-analyses. Published literature that measured sleep-related impairment associated with shift work including reduced sleep quality and duration and increased daytime sleepiness amongst healthcare shift workers and explored characteristics associated with individual variability were reviewed. Fifty-eight studies were included. Older age, morning-type, circadian flexibility, being married or having children, increased caffeine intake, higher scores on neuroticism and lower on hardiness were related to a higher risk of sleep-related impairment in response to shift work, whereas physical activity was a protective factor. The review highlights the diverse range of measurement tools used to evaluate the impact of shift work on sleep. Use of standardised and validated tools would enable cross-study comparisons. Longitudinal studies are required to establish causal relationships between individual factors and the development of shift work disorder.
Published: 2017

43. Prevalence of Circadian Misalignment and Its Association With Depressive Symptoms in Delayed Sleep Phase Disorder

Author: Christopher J. Gordon, Ronald R. Grunstein, Steven W. Lockley, Nicole Lovato, Jade M. Murray, Leon Lack, Shantha M W Rajaratnam, David J. Kennaway, Tracey L. Sletten, Delwyn J. Bartlett, and Michelle Magee
Subjects: 0301 basic medicine, Adult, Male, medicine.medical_specialty, Pediatrics, Adolescent, Light, Delayed sleep phase, Bedtime, Melatonin, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Sleep Disorders, Circadian Rhythm, Physiology (medical), medicine, Prevalence, Humans, Circadian rhythm, Young adult, Psychiatry, Depression (differential diagnoses), business.industry, Depression, Middle Aged, medicine.disease, Circadian Rhythm, PER3, Affect, 030104 developmental biology, Mood, Female, Neurology (clinical), business, Sleep, 030217 neurology & neurosurgery, medicine.drug
Abstract: Study Objective: To examine the prevalence of circadian misalignment in clinically diagnosed delayed sleep phase disorder (DSPD) and to compare mood and daytime functioning in those with and without a circadian basis for the disorder. Methods: One hundred and eighty-two DSPD patients aged 16-64 years, engaged in regular employment or school, underwent sleep-wake monitoring in the home, followed by a sleep laboratory visit for assessment of salivary dim light melatonin onset (DLMO). Based on the DLMO assessments, patients were classified into two groups: circadian DSPD, defined as DLMO occurring at or after desired bedtime (DBT), or non-circadian DSPD, defined as DLMO occurring before DBT. Results: One hundred and three patients (57%) were classified as circadian DSPD and 79 (43%) as non-circadian DSPD. DLMO occurred 1.66 hours later in circadian DSPD compared to non-circadian DSPD (p < .001). Moderate-severe depressive symptoms (Beck Depression Inventory-II) were more prevalent in circadian DSPD (14.0%) than in non-circadian DSPD (3.8%; p < .05). Relative to non-circadian DSPD patients, circadian DSPD patients had 4.31 times increased odds of at least mild depressive symptoms (95% CI 1.75 to 10.64; p < .01). No group differences were found for daytime sleepiness or function, but DSPD symptoms were rated by clinicians to be more severe in those with circadian DSPD. Conclusions: Almost half of patients clinically diagnosed with DSPD did not show misalignment between the circadian pacemaker and the DBT, suggesting that the reported difficulties initiating sleep at the DBT are unlikely to be explained by the (mis)timing of the circadian rhythm of sleep propensity. Circadian misalignment in DSPD is associated with increased depressive symptoms and DSPD symptom severity.
Published: 2017

44. Delayed Sleep Phase Disorder: Mechanisms and Treatment Approaches

Author: Jade M. Murray, Tracey L. Sletten, Michelle Magee, and Shantha M W Rajaratnam
Subjects: business.industry, medicine.medical_treatment, Chronotherapy (sleep phase), Treatment outcome, Exogenous melatonin, Dysfunctional family, Delayed sleep phase, medicine.disease, Etiology, medicine, Sleep onset, business, Depression (differential diagnoses), Clinical psychology
Abstract: This chapter will introduce the basic characteristics of delayed sleep phase disorder and provide an overview of the current methods for diagnosis. Current theories on the etiology and mechanisms of the disorder are described, and a review of treatment options is presented. In summary: DSPD is characterized by a delay in the timing of the sleep-wake cycle, such that sleep onset is difficult to achieve at a desired or required time. Difficulty waking is also experienced, particularly when sleep is attenuated to maintain required schedules. DSPD is associated with a number of negative health consequences, including a high prevalence of comorbid depression. Significant functional impairments are associated with DSPD, including poor school or job performance, dysfunctional relationships, and negative health behaviors such as smoking and excessive alcohol use. Prevalence rates vary between cultures and between adolescents and middle-aged adults. It is likely multiple factors, such as genetic, environmental, and physiological, contribute to the etiology of the disorder, although the underlying basis of the disorder has not been fully elucidated. Assessment of circadian phase is an important diagnostic tool and may improve treatment outcomes. Exogenous melatonin and bright light therapy, both separately and combined, are emerging as effective treatments for DSPD, while further research is required for other promising pharmacological approaches.
Published: 2017
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45. Temporal dynamics of circadian phase shifting response to consecutive night shifts in healthcare workers: role of light-dark exposure

Author: Michelle Magee, Tracey L. Sletten, Shantha M W Rajaratnam, Mark E Howard, Steven W. Lockley, and Julia E. Stone
Subjects: Circadian phase, business.industry, Medicine, General Medicine, business, Neuroscience
Published: 2017
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46. 0175 Shift Work and its Impact on Sleep, Alertness and Performance in Intensive Care Health Workers

Author: Julia E. Stone, Tracey L. Sletten, Steven W. Lockley, Saranea Ganesan, Mark E Howard, Megan D Mulhall, Michelle Magee, Shantha M W Rajaratnam, and Allison L Collins
Subjects: Shift work, Sleep deprivation, medicine.medical_specialty, Alertness, business.industry, Physiology (medical), Intensive care, medicine, Neurology (clinical), medicine.symptom, business, Psychiatry, Sleep in non-human animals
Published: 2018
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47. 27: Patient Education

Author: Kellie Rodriguez, Luigi Meneghini, Jane Jeffrie Seley, and Michelle Magee
Published: 2016
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48. 28: Nursing Education

Author: Jane Jeffrie Seley, Michelle Magee, and Robert Rushakoff
Abstract: Coordinating diabetes care and self-management education to ensure optimal glycemic control and effective care delivery within workflow processes in the hospital setting can be challenging for nurses. When hospitalized, the majority of diabetes self-management tasks performed by the patient at home are primarily handed off to nursing. No longer in charge of the timing of their own blood glucose monitoring, meals, and insulin delivery or making dosing decisions often leads to patient frustration and conflict, with comments such as “I can take better care of my diabetes at home.” Unfortunately, because of a variety of circumstances encountered in the hospital setting, this statement may be true as coordination of the timing of glucose monitoring, medication administration, and meals can be demanding.
Published: 2016
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49. 19: Emergency Department Management of Diabetes Patients with Non-crisis Hyperglycemia

Author: Michelle Magee, Carine Nassar, John Reyes-Castano, and Marie McDonnell
Abstract: Annually in the U.S., adults over 18 years of age with diabetes accrue over 12 million visits to hospital emergency departments (EDs). Although the primary reason for the majority of these visits is not glycemic control, the ED setting presents an opportunity to intervene in and initiate evidence-based care for the patient with either known or previously unrecognized diabetes. Such interventions have the potential to affect both short- and long-term health-related clinical, behavioral, and economic outcomes, including resources utilization, and will be the main focus of this chapter.
Published: 2016
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50. 0029 BDNF VAL66MET POLYMORPHISM IMPACTS ALERTNESS AND PERFORMANCE IN SHIFT WORKERS

Author: SW Rajaratnam, Sean W. Cain, Z Hawi, Ronald R. Grunstein, Suzanne Ftouni, Angus C. Burns, David J. Kennaway, Richa Saxena, Christian L. Nicholas, Steven W. Lockley, Michelle Magee, Sally A. Ferguson, and Tracey L. Sletten
Subjects: Alertness, medicine.medical_specialty, business.industry, Physiology (medical), Medicine, Val66met polymorphism, Neurology (clinical), business, Psychiatry, Clinical neurology
Published: 2017
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