human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES To compare conventional and self-adjusting nasal continuous positive airway pressure ( nCPAP ) therapy in patients with severe obstructive sleep apnea syndrome with respect to suppression of respiratory disturbances , quality of sleep , mean mask pressure , and patient compliance . DESIGN Cohort study of consecutive patients with obstructive sleep apnea syndrome , single-blinded . SETTING Clinical sleep laboratory in Germany . PATIENTS Fifty patients ( 44 men , 6 women who ranged in age from 35 to 71 years ) with polysomnographically confirmed severe obstructive sleep apnea syndrome ( respiratory disturbance index [ RDI ] , > 20/h ) . MEASUREMENTS AND INTERVENTIONS After baseline polysomnography , patients were r and omly treated with nCPAP either in conventional ( group 1 ) or in automatically adjusting ( group 2 ) mode . Three to 6 months after adjustment , all patients underwent polysomnography again . They also were examined with a portable monitoring device and received a question naire on subjective well-being and device evaluation . RESULTS Anthropometric and respiratory data were comparable in both groups ; body mass index had not changed significantly in the follow-up . RDI dropped by 91.5 % ( from 38.3+/- 13.9/h to 3.6+/-4.4/h ) in conventional and by 93.6 % ( from 35.5+/-9.6/h to 2.4+/-1.6/h ) in self-adjusting mode ( statistically not significant [ NS ] ) . Sleep efficiency decreased by 4.0 % in conventional and increased by 2.0 % in self-adjusting mode ( NS ) . In both groups , normal sleep structure was largely restored . Mean mask pressure was 8.1+/-2.5 cm H2O in group 1 and 6.5+/-1.7 cm H2O in group 2 ( p<0.01 ) . Patient compliance in terms of nights per week of mask appliance was better in the self-adjusting mode ( 5.7+/-0.7 to 6.5+/-0.4 ; p<0.01 ) . CONCLUSION Self-adjusting nCPAP demonstrates the same reliability in suppression of respiratory disturbances as fixed-mask pressure therapy .  Sleep quality is slightly superior , patient compliance is highly significantly better Autoadjusting  nasal continuous positive airway pressure ( CPAP )  greatly reduces the apnoea/hypopnoea index ( AHI ) , and affords a significant reduction in median pressure ( P50 ) compared-with manually titrated conventional nasal CPAP . The aim of the present study was to test whether these benefits were maintained in the medium term at home , in a double-blind crossover study . Ten sequential subjects ( mean AHI 52.9 x h(-1 ) ) were enrolled . After a manual titration , subjects were r and omly allocated to 2 months autoadjusting nasal CPAP ( AutoSet ) , followed by 2 months with the AutoSet device in fixed pressure mode at the manually titrated pressure , or vice versa . The machine-scored AHI , P50 , and median leak were recorded on 12 nights in each arm , and averaged . Mean+/-SEM AHI was 4.0+/-0.3 x h(-1 ) in auto mode , and 3.7+/-0.3 x h(-1 ) in manual mode ( NS ) . Mean+/-SEM P50 was 7.2+/-0.4 cmH2O auto , 9.4+/-0.6 cmH2O manual , average reduction 23+/-4 % ( p<0.0001 ) . Auto " recommended " pressure was ( mean+/-SEM ) 10.1+/-0.5 cmH2O ( p=0.04 with respect to manual ) and peak pressure typically 1 cmH2O higher . Median ( + /-SEM ) leak was 0.181+/-0.006 L x s(-1 ) auto ( and uncorrelated with AHI or pressure ) , 0.20+/-0.006 L x s(-1 ) manual ( p=0.003 ) . Compliance was 6.3+/-0.4 h in auto mode and 6.1+/-0.5 h in fixed mode ( NS ) . Apnoea/hypopnoea index during 2 months of home autoadjusting nasal continuous positive airway pressure is comparable to that during conventionally titrated fixed pressure continuous positive airway pressure , while affording a 23 % reduction in median pressure but no increase in compliance . Leak did not importantly affect autoadjustment Background : The simplest method of initiating and maintaining therapeutic continuous positive airways pressure ( CPAP ) therapy for obstructive sleep apnoea ( OSA ) has not been established . Methods : Ninety eight subjects with OSA requiring CPAP treatment ( more than 10 dips in oxygen desaturation of > 4 % per hour of sleep study and Epworth Sleepiness Score ( ESS ) > 9 ) were r and omised prospect ively to three different methods of CPAP delivery for 6 months : ( 1 ) autotitration pressure throughout ; ( 2 ) autotitration pressure for 1 week followed by fixed pressure ( 95th centile ) thereafter ; and ( 3 ) fixed pressure determined by algorithm ( based on neck size and dip rate ) . Patients and investigators were blind to group allocation . One week after initiation the patients were routinely review ed by sleep nurses . Study assessment s took place before starting CPAP treatment and 1 and 6 months after to assess ESS , maintenance of wakefulness test , 24 hour blood pressure , general health ( SF-36 ) , and sleep apnoea related quality of life . CPAP internal monitoring data were also collected . Results : There were no significant differences in any of the outcome measures or CPAP monitoring data between the three groups . The 95th centile CPAP pressures delivered in the 6 month and 1 week autotitration groups were higher than in the algorithm group , but the median pressures were lowest in the 6 month autotitration group . Conclusions : The method of determining CPAP pressure for treatment of moderate to severe OSA makes no significant difference to clinical outcome measures . The autotitration CPAP machine used has no advantage in this setting over simpler methods of pressure determination STUDY OBJECTIVES To compare the efficacy and patient tolerance , compliance , and preference between auto-continuous positive airway pressure ( CPAP ) and constant CPAP . DESIGN Single-blinded , crossover , cohort study of consecutive patients with obstructive sleep apnea syndrome , with two treatment periods of 2 months each . PATIENTS Twenty-five patients ( 22 men , 3 women ) with sleep apnea syndrome confirmed by ambulatory polysomnography . MEASUREMENTS AND INTERVENTIONS After baseline polysomnography , patients underwent in-laboratory polysomnography for titration of constant CPAP . The order of treatment was r and omly allocated , either auto-CPAP and then constant CPAP , or vice versa . The auto-CPAP pressure range was 6 to 16 cm H(2)O. At the end of each 2-month period , patients underwent a control ambulatory polysomnography and received a question naire on subjective well-being and device evaluation . Duration of use was checked through CPAP device monitoring . RESULTS No differences were found in apnea/hypopnea index ( constant CPAP , 9.7+/-1.9 events/h vs auto-CPAP , 10.6+/-9.3 events/h ) , awakening/arousal index ( constant CPAP , 13.7 + /- 8.0 events/h vs auto-CPAP , 15.5 + /- 8.9 events/h ) , slow-wave sleep duration , nocturnal saturation , or complaint of daytime sleepiness . The mean pressure required was significantly lower during auto-CPAP than during constant CPAP ( 8.8+/-1.8 cm H(2)O vs. 9.7+/-2.6 cm H(2)O , respectively ) . Patient tolerance , compliance , and duration of use were similar with both treatments . CONCLUSIONS Auto-CPAP is as effective as constant CPAP . A wide pressure range for auto-CPAP can be used in all patients , suggesting that , in the future , use of a broad pressure range in the auto-CPAP mode could obviate the need for the titration night BACKGROUND The aims of this study were to compare compliance to treatment with fixed CPAP and with autoCPAP , subjective preference for type of CPAP treatment , and factors associated to preference for autoCPAP in patients with OSAS . PATIENTS AND METHODS Twenty-two subjects were studied in a r and omized , single blind cross-over fashion . They were treated for one month by fixed CPAP ( Elite Sullivan V , ResMed , Sydney , Australia ) and one month by autoCPAP ( Autoset T , ResMed , Sydney , Australia ) . RESULTS Four subjects who stated a preference for fixed CPAP and four who expressed no preference were pooled together ; fourteen preferred autoCPAP .  Compliance to treatment using the two machines did not differ in the first group ( 3.8 ( 1.9 ) vs. 3.8 (1.5)h/day , fixed vs autoCPAP ) , but was higher with autoCPAP in the second group ( 4.8 ( 1.8 ) vs 5.5 (1.5)h/day , P<0.05 ) . Baseline apnea/hypopnea index ( AHI ) was high in both groups , but was higher in the second group P<0.02 . First treatment was always  fixed CPAP  in patients who preferred fixed CPAP , while it was either in the other subjects . CONCLUSIONS Compliance to autoCPAP differs among OSAS patients . As long as factors predicting higher compliance to autoCPAP are not found , a trial with autoCPAP in patients poorly compliant to fixed CPAP may be warranted The obstructive sleep apnea syndrome ( OSAS ) is highly prevalent ; it is found in 4 % of middle-aged men and 2 % of middle-aged women [ 1 ] . The increase in the rate of illness and death associated with this disease emphasizes the need for effective treatment [ 2 - 5 ] . Approaches to therapy include weight loss [ 6 ] , upper airway surgery [ 7 ] , oral appliances [ 8 ] , and nasal continuous positive airway pressure ( CPAP ) [ 9 ] . Therapy with CPAP decreases the rate of illness and death associated with sleep apnea [ 5 , 10 , 11 ] . Before CPAP therapy is started at home , a polysomnographic study must be done to determine the pressure needed to resolve apnea , hypopnea , snoring , and respiratory-related arousals in all sleep stages and body positions . The CPAP device is then set to this level . Effective pressure can also be estimated by using a regression model that takes into account anthropometric characteristics , neck circumference , and the frequency of nocturnal breathing abnormalities [ 12 ] . However , the regression model often underestimates the positive pressure requirements . A recent report [ 13 ] suggested that effective pressure can be reliably estimated during unattended sleep studies by using automatic adjustments of the positive pressure made on the basis of a record of respiratory variables . Because the optimal CPAP comprises several factors , the effective pressure can change within one night and from one night to another depending on changes in body position [ 14 , 15 ] , sleep stage [ 14 ] , neck and m and ibular position [ 16 , 17 ] , nasal patency , upper airway edema [ 18 ] , and other factors . This variability has led to the development of automatic CPAP devices that continuously adapt the positive pressure in response to varying needs . We compared the efficacy of conventional CPAP therapy with that of automatic CPAP therapy administered by an automatic CPAP machine ( Morphee Plus , Pierre Medical , Verrieres-Le-Buisson , France ) for OSAS [ 19 ] . With this machine , the user must establish a reference pressure that usually corresponds to the effective pressure determined by a conventional titration sleep study . However , the effective pressure can be estimated by the user 's characteristics ; we hypothesized that the ability of the automatic CPAP machine to automatically adjust the positive pressure should compensate for the uncertainty in effective pressure determination obtained by the regression model . This procedure may provide effective treatment of OSAS without doing a CPAP titration sleep study . We compared the efficacy of automatic CPAP given at an estimated reference pressure , automatic CPAP given at a measured reference pressure , and conventional CPAP therapy . Methods Patients The study was conducted between 30 May 1995 and 16 May 1996 . Thirty-nine patients were asked to participate , but 3 refused to participate because of their work schedules . Therefore , 36 patients ( age range , 36 to 65 years ; mean body mass index SD , 36.4 7.6 kg/m2 ) with previously untreated OSAS were included . All patients were seen at the sleep clinic at Hopital Laval . A diagnosis was made on the basis of clinical features and was confirmed by a polysomnographic study ( mean apnea + hypopnea index [ events per hour ] SD , 43.6 19.8 ) . After this diagnostic study , all patients who chose to be treated with nasal CPAP and had no exclusion criteria were asked to participate in the study . Patients were excluded if they had life-threatening forms of OSAS ( such as severe hypersomnolence ) that required immediate treatment , OSAS associated with nonobstructive sleep-related breathing disorders ( such as periodic breathing and hypoventilation ) or with nonrespiratory sleep disorders ( such as narcolepsy and periodic leg movements ) , or an estimated pressure above 15 cm H2O . Treatment with Continuous Positive Airway Pressure A titration sleep study was conducted within 1 week after the diagnostic sleep study to determine the effective pressure in all patients . Patients were then r and omly assigned to one of three treatment groups in a single-blind fashion . The Morphee Plus automatic CPAP device will soon be distributed in North America by Nellcor Puritan-Bennett ( Eden Prairie , Minneapolis , Minnesota ) under the name of Cloudnine . The device has not yet been approved by the U.S. Food and D 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: STUDY OBJECTIVES To compare conventional and self-adjusting nasal continuous positive airway pressure ( nCPAP ) therapy in patients with severe obstructive sleep apnea syndrome with respect to suppression of respiratory disturbances , quality of sleep , mean mask pressure , and patient compliance . DESIGN Cohort study of consecutive patients with obstructive sleep apnea syndrome , single-blinded . SETTING Clinical sleep laboratory in Germany . PATIENTS Fifty patients ( 44 men , 6 women who ranged in age from 35 to 71 years ) with polysomnographically confirmed severe obstructive sleep apnea syndrome ( respiratory disturbance index [ RDI ] , > 20/h ) . MEASUREMENTS AND INTERVENTIONS After baseline polysomnography , patients were r and omly treated with nCPAP either in conventional ( group 1 ) or in automatically adjusting ( group 2 ) mode . Three to 6 months after adjustment , all patients underwent polysomnography again . They also were examined with a portable monitoring device and received a question naire on subjective well-being and device evaluation . RESULTS Anthropometric and respiratory data were comparable in both groups ; body mass index had not changed significantly in the follow-up . RDI dropped by 91.5 % ( from 38.3+/- 13.9/h to 3.6+/-4.4/h ) in conventional and by 93.6 % ( from 35.5+/-9.6/h to 2.4+/-1.6/h ) in self-adjusting mode ( statistically not significant [ NS ] ) . Sleep efficiency decreased by 4.0 % in conventional and increased by 2.0 % in self-adjusting mode ( NS ) . In both groups , normal sleep structure was largely restored . Mean mask pressure was 8.1+/-2.5 cm H2O in group 1 and 6.5+/-1.7 cm H2O in group 2 ( p<0.01 ) . Patient compliance in terms of nights per week of mask appliance was better in the self-adjusting mode ( 5.7+/-0.7 to 6.5+/-0.4 ; p<0.01 ) . CONCLUSION Self-adjusting nCPAP demonstrates the same reliability in suppression of respiratory disturbances as fixed-mask pressure therapy .  Sleep quality is slightly superior , patient compliance is highly significantly better Autoadjusting  nasal continuous positive airway pressure ( CPAP )  greatly reduces the apnoea/hypopnoea index ( AHI ) , and affords a significant reduction in median pressure ( P50 ) compared-with manually titrated conventional nasal CPAP . The aim of the present study was to test whether these benefits were maintained in the medium term at home , in a double-blind crossover study . Ten sequential subjects ( mean AHI 52.9 x h(-1 ) ) were enrolled . After a manual titration , subjects were r and omly allocated to 2 months autoadjusting nasal CPAP ( AutoSet ) , followed by 2 months with the AutoSet device in fixed pressure mode at the manually titrated pressure , or vice versa . The machine-scored AHI , P50 , and median leak were recorded on 12 nights in each arm , and averaged . Mean+/-SEM AHI was 4.0+/-0.3 x h(-1 ) in auto mode , and 3.7+/-0.3 x h(-1 ) in manual mode ( NS ) . Mean+/-SEM P50 was 7.2+/-0.4 cmH2O auto , 9.4+/-0.6 cmH2O manual , average reduction 23+/-4 % ( p<0.0001 ) . Auto " recommended " pressure was ( mean+/-SEM ) 10.1+/-0.5 cmH2O ( p=0.04 with respect to manual ) and peak pressure typically 1 cmH2O higher . Median ( + /-SEM ) leak was 0.181+/-0.006 L x s(-1 ) auto ( and uncorrelated with AHI or pressure ) , 0.20+/-0.006 L x s(-1 ) manual ( p=0.003 ) . Compliance was 6.3+/-0.4 h in auto mode and 6.1+/-0.5 h in fixed mode ( NS ) . Apnoea/hypopnoea index during 2 months of home autoadjusting nasal continuous positive airway pressure is comparable to that during conventionally titrated fixed pressure continuous positive airway pressure , while affording a 23 % reduction in median pressure but no increase in compliance . Leak did not importantly affect autoadjustment Background : The simplest method of initiating and maintaining therapeutic continuous positive airways pressure ( CPAP ) therapy for obstructive sleep apnoea ( OSA ) has not been established . Methods : Ninety eight subjects with OSA requiring CPAP treatment ( more than 10 dips in oxygen desaturation of > 4 % per hour of sleep study and Epworth Sleepiness Score ( ESS ) > 9 ) were r and omised prospect ively to three different methods of CPAP delivery for 6 months : ( 1 ) autotitration pressure throughout ; ( 2 ) autotitration pressure for 1 week followed by fixed pressure ( 95th centile ) thereafter ; and ( 3 ) fixed pressure determined by algorithm ( based on neck size and dip rate ) . Patients and investigators were blind to group allocation . One week after initiation the patients were routinely review ed by sleep nurses . Study assessment s took place before starting CPAP treatment and 1 and 6 months after to assess ESS , maintenance of wakefulness test , 24 hour blood pressure , general health ( SF-36 ) , and sleep apnoea related quality of life . CPAP internal monitoring data were also collected . Results : There were no significant differences in any of the outcome measures or CPAP monitoring data between the three groups . The 95th centile CPAP pressures delivered in the 6 month and 1 week autotitration groups were higher than in the algorithm group , but the median pressures were lowest in the 6 month autotitration group . Conclusions : The method of determining CPAP pressure for treatment of moderate to severe OSA makes no significant difference to clinical outcome measures . The autotitration CPAP machine used has no advantage in this setting over simpler methods of pressure determination STUDY OBJECTIVES To compare the efficacy and patient tolerance , compliance , and preference between auto-continuous positive airway pressure ( CPAP ) and constant CPAP . DESIGN Single-blinded , crossover , cohort study of consecutive patients with obstructive sleep apnea syndrome , with two treatment periods of 2 months each . PATIENTS Twenty-five patients ( 22 men , 3 women ) with sleep apnea syndrome confirmed by ambulatory polysomnography . MEASUREMENTS AND INTERVENTIONS After baseline polysomnography , patients underwent in-laboratory polysomnography for titration of constant CPAP . The order of treatment was r and omly allocated , either auto-CPAP and then constant CPAP , or vice versa . The auto-CPAP pressure range was 6 to 16 cm H(2)O. At the end of each 2-month period , patients underwent a control ambulatory polysomnography and received a question naire on subjective well-being and device evaluation . Duration of use was checked through CPAP device monitoring . RESULTS No differences were found in apnea/hypopnea index ( constant CPAP , 9.7+/-1.9 events/h vs auto-CPAP , 10.6+/-9.3 events/h ) , awakening/arousal index ( constant CPAP , 13.7 + /- 8.0 events/h vs auto-CPAP , 15.5 + /- 8.9 events/h ) , slow-wave sleep duration , nocturnal saturation , or complaint of daytime sleepiness . The mean pressure required was significantly lower during auto-CPAP than during constant CPAP ( 8.8+/-1.8 cm H(2)O vs. 9.7+/-2.6 cm H(2)O , respectively ) . Patient tolerance , compliance , and duration of use were similar with both treatments . CONCLUSIONS Auto-CPAP is as effective as constant CPAP . A wide pressure range for auto-CPAP can be used in all patients , suggesting that , in the future , use of a broad pressure range in the auto-CPAP mode could obviate the need for the titration night BACKGROUND The aims of this study were to compare compliance to treatment with fixed CPAP and with autoCPAP , subjective preference for type of CPAP treatment , and factors associated to preference for autoCPAP in patients with OSAS . PATIENTS AND METHODS Twenty-two subjects were studied in a r and omized , single blind cross-over fashion . They were treated for one month by fixed CPAP ( Elite Sullivan V , ResMed , Sydney , Australia ) and one month by autoCPAP ( Autoset T , ResMed , Sydney , Australia ) . RESULTS Four subjects who stated a preference for fixed CPAP and four who expressed no preference were pooled together ; fourteen preferred autoCPAP .  Compliance to treatment using the two machines did not differ in the first group ( 3.8 ( 1.9 ) vs. 3.8 (1.5)h/day , fixed vs autoCPAP ) , but was higher with autoCPAP in the second group ( 4.8 ( 1.8 ) vs 5.5 (1.5)h/day , P<0.05 ) . Baseline apnea/hypopnea index ( AHI ) was high in both groups , but was higher in the second group P<0.02 . First treatment was always  fixed CPAP  in patients who preferred fixed CPAP , while it was either in the other subjects . CONCLUSIONS Compliance to autoCPAP differs among OSAS patients . As long as factors predicting higher compliance to autoCPAP are not found , a trial with autoCPAP in patients poorly compliant to fixed CPAP may be warranted The obstructive sleep apnea syndrome ( OSAS ) is highly prevalent ; it is found in 4 % of middle-aged men and 2 % of middle-aged women [ 1 ] . The increase in the rate of illness and death associated with this disease emphasizes the need for effective treatment [ 2 - 5 ] . Approaches to therapy include weight loss [ 6 ] , upper airway surgery [ 7 ] , oral appliances [ 8 ] , and nasal continuous positive airway pressure ( CPAP ) [ 9 ] . Therapy with CPAP decreases the rate of illness and death associated with sleep apnea [ 5 , 10 , 11 ] . Before CPAP therapy is started at home , a polysomnographic study must be done to determine the pressure needed to resolve apnea , hypopnea , snoring , and respiratory-related arousals in all sleep stages and body positions . The CPAP device is then set to this level . Effective pressure can also be estimated by using a regression model that takes into account anthropometric characteristics , neck circumference , and the frequency of nocturnal breathing abnormalities [ 12 ] . However , the regression model often underestimates the positive pressure requirements . A recent report [ 13 ] suggested that effective pressure can be reliably estimated during unattended sleep studies by using automatic adjustments of the positive pressure made on the basis of a record of respiratory variables . Because the optimal CPAP comprises several factors , the effective pressure can change within one night and from one night to another depending on changes in body position [ 14 , 15 ] , sleep stage [ 14 ] , neck and m and ibular position [ 16 , 17 ] , nasal patency , upper airway edema [ 18 ] , and other factors . This variability has led to the development of automatic CPAP devices that continuously adapt the positive pressure in response to varying needs . We compared the efficacy of conventional CPAP therapy with that of automatic CPAP therapy administered by an automatic CPAP machine ( Morphee Plus , Pierre Medical , Verrieres-Le-Buisson , France ) for OSAS [ 19 ] . With this machine , the user must establish a reference pressure that usually corresponds to the effective pressure determined by a conventional titration sleep study . However , the effective pressure can be estimated by the user 's characteristics ; we hypothesized that the ability of the automatic CPAP machine to automatically adjust the positive pressure should compensate for the uncertainty in effective pressure determination obtained by the regression model . This procedure may provide effective treatment of OSAS without doing a CPAP titration sleep study . We compared the efficacy of automatic CPAP given at an estimated reference pressure , automatic CPAP given at a measured reference pressure , and conventional CPAP therapy . Methods Patients The study was conducted between 30 May 1995 and 16 May 1996 . Thirty-nine patients were asked to participate , but 3 refused to participate because of their work schedules . Therefore , 36 patients ( age range , 36 to 65 years ; mean body mass index SD , 36.4 7.6 kg/m2 ) with previously untreated OSAS were included . All patients were seen at the sleep clinic at Hopital Laval . A diagnosis was made on the basis of clinical features and was confirmed by a polysomnographic study ( mean apnea + hypopnea index [ events per hour ] SD , 43.6 19.8 ) . After this diagnostic study , all patients who chose to be treated with nasal CPAP and had no exclusion criteria were asked to participate in the study . Patients were excluded if they had life-threatening forms of OSAS ( such as severe hypersomnolence ) that required immediate treatment , OSAS associated with nonobstructive sleep-related breathing disorders ( such as periodic breathing and hypoventilation ) or with nonrespiratory sleep disorders ( such as narcolepsy and periodic leg movements ) , or an estimated pressure above 15 cm H2O . Treatment with Continuous Positive Airway Pressure A titration sleep study was conducted within 1 week after the diagnostic sleep study to determine the effective pressure in all patients . Patients were then r and omly assigned to one of three treatment groups in a single-blind fashion . The Morphee Plus automatic CPAP device will soon be distributed in North America by Nellcor Puritan-Bennett ( Eden Prairie , Minneapolis , Minnesota ) under the name of Cloudnine . The device has not yet been approved by the U.S. Food and D 
    Output:
    