Comparison Resmed S8 AutoSet II vs Remstar M Series

[-SWS]

So above to 10cm when an apnea occurs the Resmed in the absence of snores and FL's will ignore the event.

That's exactly right. Statistically, that's the smart thing to do.

I would add clarity to the above statement by saying that A10 will not respond to any detected apneas above 10 cm in either the absence or presence of snores or FL.

Very simply restated, Resmed's A10 won't respond to any detected apneas above 10 cm as a matter of "statistical observance". It doesn't matter what snore and FL are up to prior to that detected apnea. Again, that statistical strategy is because A10 does not differentiate central apneas from obstructive apneas at any pressure. So A10 plays a safe-and-wise bet by responding to all detected apneas that occur below 10 cm----but by intentionally holding off on all detected apneas occurring above 10 cm. Snore and FL receive pressure responses above and below 10 cm.

That's a darn good algorithmic strategy IMHO. But let's nail it down for exactly what it is.

Bangy,
"Apneas" "Hyopopneas" and flow limitations are defined differently by the various manufacturers. So any data you have on the Respironics may be helpful, but may just as well turn out to be misleading. Velbor has compiled some of the differences here:
viewtopic.php?f=1&t=40350&p=356255#p356255

What it boils down to, in practical terms is:
Is it worth your while to switch from an algorithm that works well for you, with software that lets you track the data, to another algorithm, that may necessitate an investment in new software too?

The probability that the unknown algorithm may be good for you is very big - but it's not a certainty. Are you curious, Adventurous, capable of saying: well, that was great try, but the machine didn't fit me? If you are, go for it. Try the ResMed. I don't think there's any way for you to know for sure without trying.

O.

I agree, ozij.

[Georgio]

I tried to switch to a DevilBiss Auto Intellipap machine, and while I don't think anyone knows what kind of algorithm it has, it did not seem to provide therapy for me. I only lasted 11 days and felt so poorly I had to revent to my trusty M-Series auto. I have tweeked the Intellipaps apnea and hypopnea interpretation settings, and plan to give it another try. But, I'm not holding my breath......

Georgio

[Wulfman]

Here's the whole (text version without graphics) of the section from the S8 Autoset II Provider Manual in case someone wants to read it in its entirety.

Den



Operating Information
Principles of Operation
The S8 AutoSet II system is designed for clinical use and home treatment of
adult patients with obstructive sleep apnea (OSA). The system has two therapy
modes for treating OSA: CPAP mode and AutoSet mode.
CPAP mode
In CPAP mode, the S8 AutoSet II device provides fixed-positive-pressure room
air via tubing to the mask worn by your patient. The continuous air stream
“splints” open the upper airway, preventing airway collapse.
The S8 AutoSet II delivers pressure within the range 4 to 20 cm H2O, depending
on the patency of the upper airway. To make the beginning of treatment more
comfortable, you may set a ramp so the pressure starts low and gradually
increases to full treatment pressure over the ramp time.
AutoSet mode
The treatment pressure required by your patient may vary through the night, and
from night to night, due to changes in sleep state, body position, and airway
resistance. In AutoSet mode S8 AutoSet II provides only that amount of pressure
required to maintain upper airway patency.
You can set the minimum and maximum allowable treatment pressures. The
device analyzes the state of the patient’s upper airway on a breath-by-breath
basis, and delivers pressure within the allowed range according to the degree of
obstruction. The AutoSet algorithm adjusts treatment pressure as a function of
three parameters: inspiratory flow limitation, snore, and apnea.
The flow sensor, located in the S8 AutoSet II device, enables detection of
inspiratory flow limitation and apneas. The pressure sensor, also located in the
device, enables measurement of pressure and snore.
Inspiratory flow limitation indicates silent partial obstruction. When your
patient is breathing normally, the inspiratory flow measured by the device as a
function of time shows a typically rounded curve for each breath.
As the upper airway begins to collapse, the shape of the inspiratory flow-time
curve changes and the central section flattens.
The AutoSet algorithm analyzes the shape of the central part of the curve for
each breath. If the inspiratory flow-time curve falls below a certain threshhold,
the pressure is increased.
Inspiratory flow limitation, or partial airway closure, usually precedes snoring and
obstruction. Detection of this flow limitation enables the device to increase the
pressure before obstruction occurs, making treatment pre-emptive. If no further
flow limitation is detected, therapy is reduced towards the minimum pressure
with a 20-minute time constant.
Flattening is a measure of silent inspiratory airflow limitation. Flow limitation with
loud snoring is handled by the snore detector. When a patient snores, sound is
generated and the inspiratory flow/time curve is distorted by the frequency of the
sound.
The AutoSet algorithm assigns an arbitrary value between 0.0 and 2.0 to the
average amplitude of the snoring detected for the past 5 breaths. A value of 1.0
is equivalent to approximately 75 dBA measured 10 cm from the nares.
Treatment pressure increases by up to 0.2 cm H2O per second (proportional to
the severity of the snore) for snore above 0.2 snore units. When snore is less
than 0.2 snore units, therapy is reduced towards the minimum pressure with a
20-minute time constant.
An apnea is defined as a greater than 75% decrease in ventilation. The AutoSet
algorithm scores an apnea if the 2-second moving average ventilation drops
below 25% of the recent time average (time constant 100 seconds) for at least
10 consecutive seconds. Treatment pressure increases based on the duration of
the apnea. The pressure will not rise above 10 cm H2O when an apnea is
detected, to prevent an inappropriate response to central apneas. Initial pressure
increases are rapid, but the rate of increase diminishes as the pressure
approaches 10 cm H2O. When no further apneas are detected, therapy is
reduced towards the minimum pressure with a 20-minute time constant.
A hypopnea is defined as a 50 to 75% drop in ventilation. A hypopnea is scored
if the 8-second moving average ventilation drops below 50%, but not below
25%, of the recent average for 10 consecutive seconds. In order to avoid falsely
responding to central hypopneas, the AutoSet algorithm does not respond to
hypopneas but rather to the associated snore or flow limitation.
Expiratory Pressure Relief (EPR)
In either CPAP or AutoSet mode you can select expiratory pressure relief (EPR).
EPR is designed to maintain optimal treatment for the patient during inhalation
and reduce the delivered mask pressure during exhalation. The desired result of
EPR is to decrease the pressure the patient must breathe out against, making
the overall therapy more comfortable.
The features of EPR are:
• EPR is disabled automatically in the event of an apnea.
• EPR resumes automatically when the apnea event has passed.
• You can select an EPR pressure drop of OFF, 1, 2, or 3 cm H2O.
• You can set EPR to be off, delivered only during ramping (CPAP mode) or
settling (AutoSet mode), or delivered throughout therapy.
• Pressure drop is limited, to avoid sub-optimal treatment (maximum drop is
3 cm H2O).
• When EPR is enabled, the delivered pressure will not drop below a minimum
pressure of 4 cm H2O, regardless of the settings.
• Either the clinician alone, or both the clinician and the patient can access the
EPR level. You can enable or disable patient access to the EPR level setting.

.

[Velbor]

A pox on all your houses!

I would point out that the "latest" wording from ResMed is NO DIFFERENT from it's historical wording:

An apnoea is defined as a greater than 75% decrease in ventilation. The AutoSet algorithm scores an apnoea if the 2-second moving average ventilation drops below 25% of the recent time average (time constant 100 seconds) for at least 10 consecutive seconds. Treatment pressure increases based on the duration of the
apnoea. The pressure will not rise above 10 cmH2O when an apnoea is detected, to prevent an inappropriate response to central apnoeas. Initial pressure increases are rapid, but the rate of increase diminishes as the pressure approaches 10 cmH2O. When no further apnoeas are detected, therapy is reduced towards the minimum pressure with a 20-minute time constant.

Neither the algorithm, nor its description, have changed. Whether the wording is "new" or "old", and acknowledging that it is both "correct" and "authoritative" (as may be claimed of Biblical statements), that does not guarantee that the wording is "clear" and "precise" and both "necessary and sufficient" (a situation arguably shared with many Biblical statements). Yes, there is much semantic "swirling" in this thread. I think that most of the "senior protagonists" here agree on what the machine DOES but disagree on how best to STATE and DESCRIBE what it does. I propose that even ResMed's own verbiage is not ideal in this regard; it can be (and has been in this thread) misunderstood and/or misrepresented to suggest that the ResMed algoirthm is "ineffective" above 10cm and/or is "worthless" for persons whose baseline pressure is above 10cm. The succint editorial "clarifications" made by Ozij a few pages back deserve repeating:

1) Resmed's A10 algorithm will directly respond to FL above 10 cm (according to Resmed) (edit by ozij: attemp to preempt apnea)
2) Resmed's A10 algorithm will directly respond to snores above 10 cm (according to Resmed) (edit by ozij: attemp to preempt apnea)
3) Resmed's A10 algorithm will not directly respond to any apneas above 10 cm (according to Resmed)

Following her example, I would offer my own emendation of the "Sacred Text" in an effort to improve clarity:

The pressure will not rise
(edit by Velbor: any higher than it already is, if it is already at or)
above 10 cmH2O when an apnoea is detected
(edit by Velbor: SOLELY in response to that apnea,
but it WILL rise above 10cm in response to other key indicators of sleep-disordered breathing
(i.e., flattening or snore) which often precede apneas) ....

Blessings, Velbor

[dsm]

Now that we have had time to settle down I will restate my position (yet again).

My issue in regard to the A10 comment is that it is misleading and repeatedly misconstrued by newcomers because they see the word apnea & think it means OSA therapy. When I first saw the comment posted here a few years ago, that was how I saw it & it sent me off into a lot of research & then I learned that the Resmed algorithm tracks precursor events but as technically stated "A10 won't raise pressure in response to a (no-flow) APNEA" (as defined in the Resmed manual), but will raise pressure when it detects flattening of the insp curve & snores which anyone of us knows, precedes a no-flow apnea.

We have debated this again & again over the years.

To SWS & Ozij, if you stick solely to the wording re A10, yes technically that statement is correct but what I keep repeating, and feel is being ignored (by some who should know better), is that us old timers do know what it means, but newcomers don't and end up doing as we have seen many times, misinterpreting the word apnea to mean OSA therapy.

So you can go into endless posts restating that A10 comment and asserting its veracity but, ignoring its impact (which is my bone of contention), or we can acknowledge that newcomers do misinterpret it because they have not yet learned of the way one brand monitors flow curve (flattening & snores) while another brand monitors its own definition of hypopnea & apnea & each applies that interpretation in its own way & achieves effective therapy results.

The whole reason Georgio brought the A10 comment up was because he thought it meant the S8 wouldn't raise pressure for apneas (as osa events) when over 10 CMs & the original poster is on 14. Again, I make the case that any time that A10 comment is raised in a general non professional forum, it becomes either inadvertently or deliberately, a scare tactic or is raised due to (easy to understand) ignorance of the issues.

I believe we have done this aspect to death as I don't detect any attempts (from SWS) to reach common ground on the matter of how people interpret the A10 comment vs what it really means to therapy.

So lets all smile & move on

DSM

[-SWS]

House Epoxy? Velbor, I see you have my points one through three quoted above. Would you mind explaining how the essence of your clarification differs from my fourth point that you omitted?

I would point out that the "latest" wording from ResMed is NO DIFFERENT from it's historical wording

That was precisely my point as well. Resmed very clearly updated their text descriptions to reflect EPR changes. And in 2008 Resmed very clearly describes A10 as being the same, while adding other updates to that text. Read Den's post above to see the updated text, where Resmed nicely explains EPR and A10. So we cried balk at a 1999 description for being too old, and now we're crying balk at a 2008 description for vague reasons as well? Come on, guys.

So the day that SWS comes clean and states 'yes DSM, the S8 II machine does address 'OSA events' above 10 cms' is the day hell will freeze over cause SWS just ain't gonna admit it.

Huh? How much clearer could I have possibly described exactly what A10 is doing with snore and FL above 10 cm, based on Resmed's own very clear wording. in 1999, 2000, 2004, and 2008. Resmed keeps saying the same exact thing about what snore, FL, and apnea do both above and below 10 cm.

He would rather stick to his technical position that Berthon-Jones knew exactly who his audience was when he made the comment quoted back in 1999/2000 & later in 2004 - (Note: after that Resmed muzzled him because people like SWS were exploiting double meanings in his answer. ) - Berthon-Jones is a simply open uncomplicated man who does not expect others to manipulate his comments for commercial or other reasons).

More blatant fiction, a.k.a. "rubbish". Resmed freely propagates that same A10 information even to this day. Read Den's post above to see that lacking gag order.

How many times have I stated in this thread exactly what A10 does with snore, FL, and apnea----and then went on to praise it as wise and smart, guys? Resmed doesn't spin their words when they clearly state that red text above.

[Fredman]

Okay, I think we all get it now!

Perhaps to be too simplistic if you suffer from Central Sleep Apnea or other complicated type of sleep disorder (there I avoided the word)...vs....Obstructive Sleep Apnea, you may want to look at a different machine. If you have OSA, Resmed should do the trick with their A10. Now if I as a relative newbie have figured it out (it took me awhile...and I have to agree with DSM, it is too easy for some of us to lump Apnea into one big basket!)

Sheesh guys! Now let's go get a virtual beer or if you got one handy, a real one. Cheers!

[-SWS]

Perhaps to be too simplistic if you suffer from Central Sleep Apnea or other complicated type of sleep disorder (there I avoided the word)...vs....Obstructive Sleep Apnea, you may want to look at a different machine. If you have OSA, Resmed should do the trick with their A10.

That statement is also true about the Remstar M Series and DeVilbiss AutoAdjust APAP machines that were mentioned in this thread---not just the Resmed S8 AutoSet II or its A10 algorithm.

BTW, has anybody been able to find any Resmed text describing signal-processing changes to A10 since 1999? I know the claim has been made, but I'm just trying to find any Resmed-sourced material substantiating that claim. The suggested wave shape analysis techniques DSM suggested on page one of this thread were standard fare signal-processing techniques when I studied signal processing even as far back as the eighties.

[dsm]

Okay, I think we all get it now!

Perhaps to be too simplistic if you suffer from Central Sleep Apnea or other complicated type of sleep disorder (there I avoided the word)...vs....Obstructive Sleep Apnea, you may want to look at a different machine. If you have OSA, Resmed should do the trick with their A10. Now if I as a relative newbie have figured it out (it took me awhile...and I have to agree with DSM, it is too easy for some of us to lump Apnea into one big basket!)

Sheesh guys! Now let's go get a virtual beer or if you got one handy, a real one. Cheers!

Fred,

I really appreciate your feedback. Actually both Respironics and Resmed have excellent Auto algorithms. They both address OSA therapy very well for people on all the usual titrated pressures (typically 6-20). The fact is both brands go about the obstruction detection differently and that has been the trigger for many debates, arguments fights etc: etc: over the years. It does get very emotional and partisan. But as always if we learn more from the points being made than from who is more successfully 'biffing' who, then goodness will come from it.

I am sure that if we were to conduct this same issue in a face-to-face forum, the common ground and understanding would be easier to reach. In a text forum it gets to be a bit harder.

Here is a simple attempted summary of how an Auto works & why. Autos were introduced (as stated in several patents) to help improve the patient experience. It was a given in the early days that mask management & battling with exhale, led to a very poor compliance rate among people on cpap therapy.

Manufacturers were keen to come up with therapy ideas & innovations that improved the user compliance rate. For example, in the 1990s Respironics introduced the 1st bilevel (the Bipap S) a big box of a machine but so expensive it was only used for special needs cases. Then in the late 1990s Resmed introduced an Auto (the Autoset-T). Ver quickly Respironics, Healthdyne, Puritan Bennett all had their own models on the market just as these same group of companies introduced their own bilevels.

Then Respironics introduced a novel exhale relief feature to their cpaps called C-Flex. That proved enormously popular & gave their US sales a massive boost.

Re Autos, the Respironics Auto patent states that the goal was to improve therapy for the patient. The idea behind the Auto was to keep pressure as low as possible to minimize mask leaks & other bad side effects from the higher pressures (say 11-20). The machines originally had a microphone that listened for snores & would slowly raise the pressure in the expectation the machine could prevent apneas (meaning hypopneas & apneas) from getting worse. As the technology improved the microphone was swapped for a pressure transducer & a pair of similar devices were used to measure flow.

These advances allowed for much more sophisticated sampling of the data. Autos quickly became the most sophisticated machines due to the sampling of pressure & flow information. The data was later written to data cards and could be extracted and a nights information analyzed. Resmed went in one direction in how they analyzed the data & Respironics in another. Resmed concentrated on the shape of the inspiration curve which in normal breathing looks like a sine wave (almost), they developed algorithms for analyzing the shape of that curve & combined with pressure vibrations from snores, used the data to adjust pressure in an attempt to pre-empt any more serious events (hypopneas & apneas). Resmed also take the position that at 10 CMs most airways are successfully held open & thus if a no-flow event (apnea) occurs & it has no pre-cursor events (flattening of the curve and/or snores) then it is likely to be a central. Respironics also change tactics for no-flow apneas at about 11 CMs, IIRC a different algorithm kicks in and the machine uses its different approach to determine if the no-flow is a central or an obstructive apnea.

It is pretty common these days for patients put on cpap to start to exhibit centrals when on higher pressures (say 15-20) this is called complex apnea. An Auto may not be the best machine to resolve complex apnea. The modern thinking is that a bilevel machine or perhaps an ASV machine may do a better
job for complex apnea.

Autos are not intended to deal with Central apneas as raising pressure in response to a central is totally counter productive unless done in a special way (as exemplified by a timed bilevel). So it is an important part of both brands (all brands) that they differentiate a no-flow apnea between being an obstructive event vs a central event.

The Respironics machines look at the flow & monitor for FLs, hypopneas & apneas plus snore vibration, their Auto algorithm focuses more on tracking the hypopneas & snores to pre-empt no-flow apneas. The detailed descriptions are all in patents that many of us have discussed over the years. A lot of our common wisdom on these matters came from us looking at the patents & debating them. In this area SWS has been a shining light in helping analyze the patent information. Understanding the intricacies of the language in patents is one of his great strengths.

But, any debate on one brand vs another still triggers flare ups as evidenced in this very thread.

DSM

[Georgio]

No response as yet from ResMed clarifying their A10 algorithm. I think that most newcomers maybe deserve a little more credit, and are capable of understanding ResMeds explaination of how their equipment works. I don't believe that ResMed is publishing scare tactics or falsehoods about their equipment.

Georgio

[dsm]

No response as yet from ResMed clarifying their A10 algorithm. I think that most newcomers maybe deserve a little more credit, and are capable of understanding ResMeds explaination of how their equipment works. I don't believe that ResMed is publishing scare tactics or falsehoods about their equipment.

Georgio

Gergio,

Yup, Ok, then can you explain what you believed you were conveying to the thread when you posted your original A10 reference. What was it you believed people would learn from that post ?

Thanks

DSM

[Georgio]

I will preface this response with an acknowledgement that I fall into the apparently misguided newcomer category and am attempting to learn the truth with respect to SA therapy. For Instance, if a patient has a documented history of apneas (as defined by ResMed) that require an excess of 10 cm to resolve, how would such a patient benefit most from equipment that does not respond to apneas that require an excess of 10 cm? (For purposes of discussion, let's assume that the patient's apnea events are not proceeded by flow limitations or snores or anything else.....aren't these considered frank apneas?)

I am learning a good deal that is of value to my own therapy, so your patience, understanding and contributions are appreciated.

Georgio

[rested gal]

Gergio,
Yup, Ok, then can you explain what you believed you were conveying to the thread when you posted your original A10 reference. What was it you believed people would learn from that post ?
Thanks
DSM

DSM, what you were conveying when you wrote your first two sentences in this thread was a twisting of Georgio's correct statement using the word "apnea" into a catch-all phrase "OSA events" in this misleading statement of yours:

Sadly this is an oft repeated falsehood (I know many folk don't realize they are propagating it as such but it is just not true!).

The A10 algorith *does* respond to OSA events over 10 CMs pressure.

If anything has been conveying misleading information to readers who are earnestly trying to learn more, it's been your continued twisting of the phrase "OSA events", Doug, throughout this thread, as you've stubbornly tried to dance and swirl your way to escape two simple facts:

1. Obstructive apneas are a type of "OSA events."
2. ResMed autopaps do not respond with more pressure when presented with an "apnea" -- with or without any flow limitation or flattening before the apnea happens -- if the apnea occurs when the machine is already using at least 10 cm pressure.

You've chided people who've stated fact for what you deem misleading statement, while you've swirled and muddied the waters with leaps to conclusions as if you were stating fact when you were wrong...repeatedly in this thread. There's nothing wrong with being wrong. We all make mistakes. Some more than others. There's a reason why I leave your name out when I occasionally mention the names of people on this board whose posts and opinions I pay special attention to.

I do understand (scary thought, that! ) that the point you'd like to make, Doug...and it is a good point..is this: Just because ResMed chooses to use the "A10" algorithm to keep their autopaps from raising pressure past 10 cm when an APNEA occurs, it doesn't mean the machine cannot treat people perfectly well even if the person has been prescribed a higher pressure. If you think it's misleading to new people for that statement to not be followed up with a further explanation of what the machine does do to try to prevent apneas that would need higher pressure, then all you have to do is keep a polite stock reply of your own ready. Hit reply and paste it in for clarification anytime you see "A10" or "won't raise pressure above 10 cm."

From what I've seen of your shaky explanations in this thread, I'd suggest you run it by -SWS first, to be sure you're stating it correctly before you trot it out.

The preemptive pressure increases (even beyond 10) that the machine does in response to snores and flow limitations will most likely prevent most obstructive apneas for most people -- even people who have been prescribed a higher pressure than 10. I've not seen any of the people who have tried to explain to you (or quote ResMed's explanation of it) of A10 say otherwise.

You've tried to say that those precursor events (snores and flow limitations) can raise pressure above 10 and those pressure increases will probably prevent an apnea from happening, which is true. But gosh, it's the way you've tried to say it that's muddied the water and then swirled muddy water of your own making repeatedly in this thread.

You've tossed so many incorrect statements and garbled definitions of your own into this, you've been your own worst enemy in attempting to make a good point about how ResMed machines attempt to, and succeed at, preventing apneas for most people by responding to snores and flow limitations with pressure increases above 10 cm.

Accusing people who make a factual statement of (these are your words) "deception, exploitation, dodging, 'which if you answered honestly', 'ploy to scare', spinning" .... is not a very smart way, imho, to handle what you object to regarding mention of good ol' A10.

[rested gal]

For Instance, if a patient has a documented history of apneas (as defined by ResMed) that require an excess of 10 cm to resolve, how would such a patient benefit most from equipment that does not respond to apneas that require an excess of 10 cm? (For purposes of discussion, let's assume that the patient's apnea events are not proceeded by flow limitations or snores or anything else.....aren't these considered frank apneas?)

With that assumption -- sudden apneas with no warning, so to speak -- I'd think if you're going to use any brand of autopap (not just ResMed) you might want to set the minimum pressure up at or fairly close under (no more than two cm's under) the pressure the sleep study found prevented apneas for you. The pressure that prevented apneas during worst case scenario -- on your back and in REM.

Or, even just go to straight cpap mode at the prescribed pressure.

And get software to monitor how things go.

Come to think of it, that's pretty much the way I'd set the minimum pressure on an autopap anyway, even if there were plenty of precursor events.

Results: 1st night with Auto A-Flex (topic started by TSSleepy)
Two nights graphs posted using pressure range 4 - 20 and 10 - 20
viewtopic.php?p=348963#p348963

November 2008 Just got an APAP (topic started by turbosnore)
viewtopic.php?p=319619#p319619

October 2008 Turning off Aflex and Cflex (topic started by DoriC)
viewtopic.php?p=307265#p307265

September 2008 New Guy - Need Help w/Settings (topic started by alanhj13)
viewtopic.php?p=294319#p294319

Wulfman, DreamStalker, and ozij explain why autopaps make changes slowly.
December 2008 Why adjust APAP. Isn't it auto? (topic started by oxygenium65)
viewtopic.php?p=323218#p323218

[dsm]

Rested Gal
Before we start round two of the you said I said he said you swirled he twisted etc: etc: etc:

Just consider a yes or no to this question & if it can be taken further lets do it. I do appreciate part of what you are trying to say - but I always made the point that it was the misinterpretation that was the problem. That point was repeatedly ignored by one or 2 folk.

Do you believe newcomers to cpap therapy could or would misconstrue either of the following 2 statements ...

1) The A10 algorithm increases pressure in response to Flow Limitation, Snore, and Apnea up to 10cm H2O. Above 10cm H2O, pressure response to Flow Limitation and Snore continues, but there is no response to Apnea.

2) "I understand that the ResMed machines do not respond to apneas over 10, because they are considered centrals."

If your answer is no then I can see that is where we differ.
If your answer is yes then can we discuss why (although I see you have pretty well answered the relevant points, it was very kind of you to do that for SWS).

Thanks

DSM