Our data show, for the first time, that saccadic velocity is a reliable indicator of the subjective fatigue of health care professionals during prolonged time-on-duty. These findings have potential impacts for the development of neuroergonomic tools to detect fatigue among health professionals and in the specifications of future guidelines regarding residents' duty hours.

Background. Achalasia, a rare esophageal motility disorder that may cause malnutrition during pregnancy, can result in fetal and maternal morbidity and mortality. Many medical treatment regimens are contraindicated or not tolerated during pregnancy, and surgery is generally avoided due to potential risks to the fetus. Case Report. Severe, medically refractory achalasia in a 23-year-old pregnant woman that caused malnutrition was successfully managed by administering a botulinum toxin A injection to the lower esophageal sphincter. The injection was performed at approximately 14 weeks' gestation and the patient reported clinically significant relief from dysphagia. She gained weight and ultimately delivered a healthy baby girl at term, but her symptoms returned a few months postpartum. She underwent a second treatment of botulinum toxin A injection, but it offered only one month of relief. Roughly eight months after delivery, the patient underwent a laparoscopic extended Heller myotomy and Dor fundoplication. The patient resumed a normal diet one week postoperatively, and her baby has had no complications. Conclusion. This is only the second reported case of botulinum toxin A injection being used to treat achalasia in pregnancy. This treatment proved to be a safe temporary alternative without the risks of surgery and anesthesia during pregnancy.

aPTT may be falsely elevated and may lead to insufficient anticoagulation if dosing UFH from aPTT levels.This is a preliminary report in a small number of patients. However, the incidence of thrombosis is high in LVAD patients and all potential causes need to be reported quickly so that they can be investigated in larger numbers and at multiple institutions. Several hypotheses need to be tested in LVAD patients, including: exclusive monitoring of anti-Xa levels (or a combination of anti-Xa and aPTT) and the increased risk of bleeding when monitoring anti-Xa levels. Our results suggest that aPTT levels underestimate anti-coagulation in LVAD patients and monitoring UFH with anti-Xa levels more accurately reflects the level of anti-coagulation.

Therapeutic/care management study, level V.