Research Topics
| Charles A CzeislerSummaryAffiliation: Harvard University Country: USA Publications
| Collaborators
|
Detail Information
Publications
Risks of complications by attending physicians after performing nighttime proceduresJeffrey M Rothschild
Division of General Medicine and Primary Care, Brigham and Women s Hospital, 1620 Tremont St, Boston, MA 02120 1613, USA
JAMA 302:1565-72. 2009..Few data exist on the relationships between experienced physicians' work hours and sleep, and patient safety...
US public opinion regarding proposed limits on resident physician work hoursAlexander B Blum
Department of Health and Evidence Policy, Mount Sinai School of Medicine, New York, NY, USA
BMC Med 8:33. 2010..In 2008, the Institute of Medicine (IOM) recommended a reduction in resident physician work hours. We sought to assess the American public perspective on this issue...- Armodafinil for treatment of excessive sleepiness associated with shift work disorder: a randomized controlled studyCharles A Czeisler
Division of Sleep Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Mayo Clin Proc 84:958-72. 2009.... - Medical and genetic differences in the adverse impact of sleep loss on performance: ethical considerations for the medical professionCharles A Czeisler
Division of Sleep Medicine, Department of Medicine, Brigham andWomen s Hospital, Harvard Medical School, 221 Longwood Avenue, Suite 438, Boston, MA 02115, USA
Trans Am Clin Climatol Assoc 120:249-85. 2009.... 
Low-dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulnessJames K Wyatt
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital and Harvard Medical School, Boston, Massachusetts, USA
Sleep 27:374-81. 2004....- Effects of health care provider work hours and sleep deprivation on safety and performanceSteven W Lockley
Department of Medicine, Brigham and Women s Hospital, Boston, USA
Jt Comm J Qual Patient Saf 33:7-18. 2007..To reduce the unacceptably high rate of preventable fatigue-related medical error and injuries among health care workers, the United States must establish and enforce safe work-hour limits... - Effect of reducing interns' work hours on serious medical errors in intensive care unitsChristopher P Landrigan
Division of Sleep Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
N Engl J Med 351:1838-48. 2004..Although sleep deprivation has been shown to impair neurobehavioral performance, few studies have measured its effects on medical errors... - Effective implementation of work-hour limits and systemic improvementsChristopher P Landrigan
Department of Medicine, Brigham and Women s Hospital, Boston, USA
Jt Comm J Qual Patient Saf 33:19-29. 2007..Implementation of evidence-based work-hour limits, scientifically designed work schedules, and infrastructural changes, such as the development of standardized handoff systems, are urgently needed... - Sleep-facilitating effect of exogenous melatonin in healthy young men and women is circadian-phase dependentJames K Wyatt
Division of Sleep Medicine, Department of Medicine, Brigham and Women a Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
Sleep 29:609-18. 2006..To investigate the effects of a physiologic and a pharmacologic dose of exogenous melatonin on sleep latency and sleep efficiency in sleep episodes initiated across a full range of circadian phases... - Uncovering residual effects of chronic sleep loss on human performanceDaniel A Cohen
Division of Sleep Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
Sci Transl Med 2:14ra3. 2010..quot; Thus, extended wake during the circadian night reveals the cumulative detrimental effects of chronic sleep loss on performance, with potential adverse health and safety consequences... - Effect of modafinil on impairments in neurobehavioral performance and learning associated with extended wakefulness and circadian misalignmentScott Grady
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Neuropsychopharmacology 35:1910-20. 2010..These features suggest that modafinil might be a particularly relevant countermeasure against the deleterious effects of prolonged work hours, shift work, and transmeridian travel... - Modafinil for excessive sleepiness associated with shift-work sleep disorderCharles A Czeisler
Division of Sleep Medicine, Harvard Medical School, and Brigham and Women s Hospital, Boston, MA 02115, USA
N Engl J Med 353:476-86. 2005..Patients with shift-work sleep disorder chronically have excessive sleepiness during night work and insomnia when attempting to sleep during the day. We evaluated the use of modafinil for treating sleepiness in patients with this disorder... - Amplitude reduction and phase shifts of melatonin, cortisol and other circadian rhythms after a gradual advance of sleep and light exposure in humansDerk Jan Dijk
Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
PLoS ONE 7:e30037. 2012..The extent to which the phase and amplitude of multiple rhythms are similarly affected during altered timing of light exposure and the sleep-wake cycle has not been fully characterized... - Scheduling of sleep/darkness affects the circadian phase of night shift workersNayantara Santhi
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, 221 Longwood Avenue, BL 438M, Boston, MA 02115, USA
Neurosci Lett 384:316-20. 2005..These results have applications to night shift workers, particularly in occupations in which alterations in the timing of light exposure cannot be achieved during working hours... - Impact of extended-duration shifts on medical errors, adverse events, and attentional failuresLaura K Barger
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
PLoS Med 3:e487. 2006..These results have important public policy implications for postgraduate medical education... - The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive careJeffrey M Rothschild
Divisions of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Crit Care Med 33:1694-700. 2005..Although many types of errors were identified, failure to carry out intended treatment correctly was the leading category... - Sex difference in the near-24-hour intrinsic period of the human circadian timing systemJeanne F Duffy
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Proc Natl Acad Sci U S A 108:15602-8. 2011..0 h (35% vs. 14%; P < 0.01). The shorter average intrinsic circadian period observed in women may have implications for understanding sex differences in habitual sleep duration and insomnia prevalence... - Extended work shifts and the risk of motor vehicle crashes among internsLaura K Barger
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
N Engl J Med 352:125-34. 2005..These results have implications for medical residency programs, which routinely schedule physicians to work more than 24 consecutive hours... - Sex differences in phase angle of entrainment and melatonin amplitude in humansSean W Cain
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Division of Sleep Medicine, Harvard Medical School, Boston, MA 02115 5817, USA
J Biol Rhythms 25:288-96. 2010.... - Plasticity of the intrinsic period of the human circadian timing systemFrank A J L Scheer
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
PLoS ONE 2:e721. 2007..Both findings have important implications for the treatment of circadian rhythm sleep disorders and human space exploration... - Extended work duration and the risk of self-reported percutaneous injuries in internsNajib T Ayas
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA
JAMA 296:1055-62. 2006..04; 95% CI, 1.98-2.11). CONCLUSION: Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training... - Sleep and wakefulness out of phase with internal biological time impairs learning in humansKenneth P Wright
Harvard Medical School, USA
J Cogn Neurosci 18:508-21. 2006..In addition, our results demonstrate that exposure to dim light (approximately 25 lx) is sufficient to expand the range of entrainment in humans... - Recovery from medical errors: the critical care nursing safety netJeffrey M Rothschild
Harvard Medical School, Boston, USA
Jt Comm J Qual Patient Saf 32:63-72. 2006..Patient surveillance and preventing errors from harming patients represent essential nursing responsibilities but have received relatively little study... - Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humansJoshua J Gooley
Division of Sleep Medicine, Brigham and Women s Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, Massachusetts 02115, USA
J Clin Endocrinol Metab 96:E463-72. 2011..Millions of individuals habitually expose themselves to room light in the hours before bedtime, yet the effects of this behavior on melatonin signaling are not well recognized... - The impact of sleep timing and bright light exposure on attentional impairment during night workNayantara Santhi
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Boston, MA, USA
J Biol Rhythms 23:341-52. 2008..These results have important implications for managing patients with shift work disorder... - Effect of reducing interns' weekly work hours on sleep and attentional failuresSteven W Lockley
Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
N Engl J Med 351:1829-37. 2004..CONCLUSIONS: Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours... - Short-wavelength sensitivity for the direct effects of light on alertness, vigilance, and the waking electroencephalogram in humansSteven W Lockley
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Sleep 29:161-8. 2006..To assess the wavelength-dependent sensitivity of the acute effects of ocular light exposure on alertness, performance, waking electroencephalogram (EEG), and cortisol... - When policy meets physiology: the challenge of reducing resident work hoursSteven W Lockley
Division of Sleep Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
Clin Orthop Relat Res 449:116-27. 2006..An evidence-based approach is needed to minimize the well-documented risk that current work hour practices confer on resident health and patient safety while optimizing education and continuity of care... - Exercise distributed across day and night does not alter circadian period in humansSean W Cain
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
J Biol Rhythms 22:534-41. 2007..Exercise distributed across biological day and night does not appear to affect circadian period... - Does simulator-based clinical performance correlate with actual hospital behavior? The effect of extended work hours on patient care provided by medical internsJames A Gordon
Gilbert Program in Medical Simulation, Harvard Medical School, Boston, Massachusetts, USA
Acad Med 85:1583-8. 2010..This study explored whether the effects of extended work hours on clinical performance, as reported in prior hospital-based studies, could be observed in a simulator-based testing environment... - Intrinsic period and light intensity determine the phase relationship between melatonin and sleep in humansKenneth P Wright
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts, USA
J Biol Rhythms 20:168-77. 2005..This finding has important implications for understanding physiological organization by the brain's master circadian clock and may have implications for understanding mechanisms underlying circadian sleep disorders... - Sleep disorders, health, and safety in police officersShantha M W Rajaratnam
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
JAMA 306:2567-78. 2011..Sleep disorders often remain undiagnosed. Untreated sleep disorders among police officers may adversely affect their health and safety and pose a risk to the public... - The influence of subjective alertness and motivation on human performance independent of circadian and homeostatic regulationJoseph T Hull
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
J Biol Rhythms 18:329-38. 2003..Such studies also may aid in the development of countermeasures to improve human performance... - Addition of a non-photic component to a light-based mathematical model of the human circadian pacemakerMelissa A St Hilaire
Analytic and Modeling Unit, Division of Sleep Medicine, Brigham and Women s Hospital Harvard Medical School, Boston, MA 02115, USA
J Theor Biol 247:583-99. 2007..Further experiments are required to validate fully our model and to understand the exact effect of the sleep-wake cycle as a non-photic stimulus for the human circadian pacemaker... - Acute sleep deprivation and circadian misalignment associated with transition onto the first night of work impairs visual selective attentionNayantara Santhi
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
PLoS ONE 2:e1233. 2007.... - Interns' compliance with accreditation council for graduate medical education work-hour limitsChristopher P Landrigan
Harvard Work Hours, Health and Safety Group, Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Boston, Mass 02115, USA
JAMA 296:1063-70. 2006..The Accreditation Council for Graduate Medical Education (ACGME) introduced duty-hour standards in 2003 to reduce work hours... - Spectral responses of the human circadian system depend on the irradiance and duration of exposure to lightJoshua J Gooley
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
Sci Transl Med 2:31ra33. 2010..These results suggest that light therapy for sleep disorders and other indications might be optimized by stimulating both photoreceptor systems... - EEG sleep spectra in older adults across all circadian phases during NREM sleepMirjam Munch
Division of Sleep Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
Sleep 33:389-401. 2010..We aimed to examine the electroencephalographic (EEG) sleep spectra during non-rapid eye movement (NREM) sleep when sleep was scheduled at all times of day... - Human responses to bright light of different durationsAnne Marie Chang
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital Harvard Medical School, 221 Longwood Avenue, Suite 438, Boston, MA 02115, USA
J Physiol 590:3103-12. 2012..These results provide strong evidence for a non-linear resetting response of the human circadian pacemaker to light duration... - Revisiting spontaneous internal desynchrony using a quantitative model of sleep physiologyAndrew J K Phillips
Division of Sleep Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
J Biol Rhythms 26:441-53. 2011..Our findings suggest that feedback from behavioral choices to physiology could play an important role in spontaneous internal desynchrony... - The human circadian system adapts to prior photic historyAnne Marie Chang
Department of Medicine, Brigham and Women s Hospital Harvard Medical School, 221 Longwood Avenue, Suite 438, Boston, MA 02115, USA
J Physiol 589:1095-102. 2011..This plasticity has important implications for the optimization of light therapy for the treatment of circadian rhythm sleep disorders... - A phase response curve to single bright light pulses in human subjectsSat Bir S Khalsa
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
J Physiol 549:945-52. 2003..Phase shifts derived using the melatonin onsets showed larger magnitudes than those derived from the melatonin offsets. These data provide a comprehensive characterization of the human PRC under highly controlled laboratory conditions... - Human phase response curve to a single 6.5 h pulse of short-wavelength lightMelanie Rüger
Circadian Physiology Program, Division of Sleep Medicine, Brigham and Women s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
J Physiol 591:353-63. 2013..The 480 nm PRC induced ∼75% of the response of the 10,000 lux white light PRC. These results may contribute to a re-evaluation of dosing guidelines for clinical light therapy and the use of light as a fatigue countermeasure... - Survival analysis indicates that age-related decline in sleep continuity occurs exclusively during NREM sleepElizabeth B Klerman
Division of Sleep Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Neurobiol Aging 34:309-18. 2013..Interventions to improve age-related sleep complaints should thus target this change in awakenings... - Melanopsin and rod-cone photoreceptors play different roles in mediating pupillary light responses during exposure to continuous light in humansJoshua J Gooley
Program in Neuroscience and Behavioral Disorders, Duke National University of Singapore Graduate Medical School Singapore, Singapore 169857
J Neurosci 32:14242-53. 2012..Moreover, our results suggest that it might be possible to enhance nonvisual light responses to low-irradiance exposures by using intermittent light to activate cone photoreceptors repeatedly in humans... - Human phase response curve to a 1 h pulse of bright white lightMelissa A St Hilaire
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA
J Physiol 590:3035-45. 2012..7 h PRC despite representing only 15% of the light exposure duration, consistent with previous studies showing a non-linear duration–response function for the effects of light on circadian resetting... - Searching night and day: a dissociation of effects of circadian phase and time awake on visual selective attention and vigilanceTodd S Horowitz
Division of Sleep Medicine, Brigham and Women s Hospital, and Harvard Medical School, Boston, MA 02115, USA
Psychol Sci 14:549-57. 2003..The locus of sleepiness effects on search is probably downstream from the bottleneck of attentional selection. Observers did trade accuracy for speed when sleepy. This implicates decision-stage impairments... - Healthy older adults better tolerate sleep deprivation than young adultsJeanne F Duffy
Brigham and Women s Hospital General Clinical Research Center, Boston, Massachusetts, USA
J Am Geriatr Soc 57:1245-51. 2009..To determine whether healthy aging is associated with increased sleepiness and whether healthy older adults experience more sleepiness when acutely sleep deprived... - Absence of circadian phase resetting in response to bright light behind the kneesKenneth P Wright
Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Suite 438, Boston, MA 02115, USA
Science 297:571. 2002 - Relationship between alertness, performance, and body temperature in humansKenneth P Wright
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
Am J Physiol Regul Integr Comp Physiol 283:R1370-7. 2002..These results support the hypothesis that body temperature modulates neurobehavioral function in humans... - Daily exercise facilitates phase delays of circadian melatonin rhythm in very dim lightLaura K Barger
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Am J Physiol Regul Integr Comp Physiol 286:R1077-84. 2004..73, P < 0.05) such that the closer to the DLMO(25%), the greater the phase shift. These data suggest that exercise may help to facilitate circadian adaptation to schedules requiring a delay in the sleep-wake cycle... - Decreased sensitivity to phase-delaying effects of moderate intensity light in older subjectsJeanne F Duffy
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Neurobiol Aging 28:799-807. 2007..These findings suggest an age-related reduction in the phase-delaying response to moderate light levels. However, our findings alone do not explain the altered phase relationship between sleep and circadian rhythms associated with aging... - Improved Neurobehavioral Performance during the Wake Maintenance ZoneJulia A Shekleton
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Boston, MA Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA School of Psychology and Psychiatry, Monash University, Melbourne, Australia
J Clin Sleep Med 9:353-62. 2013..The study examined the influence of the WMZ on neurobehavioral performance under normal conditions and following sleep deprivation... - Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruptionOrfeu M Buxton
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Boston, MA 02115, USA
Sci Transl Med 4:129ra43. 2012..Thus, in humans, prolonged sleep restriction with concurrent circadian disruption alters metabolism and could increase the risk of obesity and diabetes... - Adaptation of human pineal melatonin suppression by recent photic historyKurt A Smith
Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Suite 438, Boston, MA 02115, USA
J Clin Endocrinol Metab 89:3610-4. 2004..Further elucidation of these properties could prove useful in potentiating light therapies for circadian and affective disorders... - Entrainment of the human circadian pacemaker to longer-than-24-h daysClaude Gronfier
Division of Sleep Medicine, Department of Sleep Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Proc Natl Acad Sci U S A 104:9081-6. 2007..The implications of these findings are important because they could be used to treat circadian misalignment associated with space flight and circadian rhythm sleep disorders such as shift-work disorder... - Peak of circadian melatonin rhythm occurs later within the sleep of older subjectsJeanne F Duffy
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
Am J Physiol Endocrinol Metab 282:E297-303. 2002..In healthy older subjects, the relative timing of the melatonin rhythm with respect to sleep may not play a causal role in sleep disruption... - Evaluation of a single-channel nasal pressure device to assess obstructive sleep apnea risk in laboratory and home environmentsKate E Crowley
Division of Sleep Medicine, Brigham and Women s Hospital, Boston, MA, USA
J Clin Sleep Med 9:109-16. 2013.... - Deterioration of neurobehavioral performance in resident physicians during repeated exposure to extended duration work shiftsClare Anderson
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Boston, MA, USA
Sleep 35:1137-46. 2012..In this study, the authors quantify the time course of neurobehavioral deterioration due to repeated exposure to EDWS during a 3-week residency rotation... - Impact of sleepiness and sleep deficiency on public health--utility of biomarkersCharles A Czeisler
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital and Division of Sleep Medicine, Harvard Medical School, Boston, MA 02215, USA
J Clin Sleep Med 7:S6-8. 2011..It is important to recognize that sleepiness and sleep deficiency are not synonymous... - Bilateral oculosympathetic paresis associated with loss of nocturnal melatonin secretion in patients with spinal cord injuryJamie M Zeitzer
Division of Sleep Medicine, Harvard Medical School Boston, Massachusetts, USA
J Spinal Cord Med 28:55-9. 2005..CONCLUSION: The presence of bilateral oculosympathetic paresis can be predictive of the complete loss of the nocturnal production of melatonin... - High sensitivity of the human circadian melatonin rhythm to resetting by short wavelength lightSteven W Lockley
Division of Sleep Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA
J Clin Endocrinol Metab 88:4502-5. 2003..Thus photopic lux, the standard unit of illuminance, is inappropriate when quantifying the photic drive required to reset the human circadian pacemaker... - A common polymorphism near PER1 and the timing of human behavioral rhythmsAndrew S P Lim
Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
Ann Neurol 72:324-34. 2012..However, no common polymorphism has been associated with the timing of directly observed human behavioral rhythms or other physiological markers of circadian timing at the population level... - Sleep- and circadian-dependent modulation of REM densitySat Bir S Khalsa
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital, Harvard Medical School, Boston, MA 02115, USA
J Sleep Res 11:53-9. 2002.... - Sleep deficit: the performance killer. A conversation with Harvard Medical School Professor Charles A. CzeislerCharles A Czeisler
Harvard Medical School, USA
Harv Bus Rev 84:53-9, 148. 2006..A sidebar to this article summarizes the latest developments in sleep research... - Age-related change in the relationship between circadian period, circadian phase, and diurnal preference in humansJeanne F Duffy
Division of Sleep Medicine, Department of Medicine, Brigham and Women s Hospital and Harvard Medical School, Boston, MA 02115, USA
Neurosci Lett 318:117-20. 2002....