Comparison of Auto-adjusting and Fixed Level Continuous Positive Airway Pressure Therapy in Patients with Mild to Moderate Obstructive Sleep Apnoea Hypopnoea Syndrome

Obstructive Sleep Apnoea Hypopnoea syndrome (OSAHS) is a potentially serious medical disorder associated with increased morbidity and mortality. It is estimated to affect 4% of males and 2% of females between the ages of forty and sixty. Nasal continuous positive airway pressure (CPAP) is the first choice treatment for this condition and it is extremely effective at controlling OSAHS. However, not all patients can tolerate this therapy, in particular those within the mild to moderate category, and there are also many others who are unable to comply with the minimum usage requirements of at least four hours every night. A new type of positive airway treatment, auto adjusting positive airway pressure (APAP) has been developed in the last decade, which theoretically should improve tolerance and therefore lead to higher compliance rates. The aim of this study was to determine whether patients with mild to moderate OSAHS tolerated auto-adjusting positive airway pressure better than traditional fixed positive airway pressure therapy by using the device for longer. No differences were found in respiratory abnormalities or daytime sleepiness, as assess by the Epworth Sleepiness Score (ESS) between the two modes of treatment, but all measured parameters were significantly improved form the baseline, untreated valued. Mean APAP pressure was significantly lower than CPAP pressure (6.2+-1.4 v 8.4+-1.7 cmH2O, p8 cm H2O), who preferred APAP while those requiring lower pressure (H2O) preferred CPAP. In conclusion APAP and CPAP are equally effective in resolving sleep related breathing disturbance and improving daytime sleepiness in patients with mild to moderate OSAHS, although compliance may be affected by fixed CPAP pressure requirements

Epidemiological indicators for meat inspection of bovine animals

n/

Coagulation profiles are associated with early clinical outcomes in neonatal encephalopathy

Introduction: Neonatal encephalopathy (NE) is associated with coagulation abnormalities. We aimed to investigate the serial alterations in coagulation profiles in term infants with NE and correlate with their clinical outcomes. This was a prospective cohort study in a tertiary referral, university-affiliated maternity hospital. Neonates exposed to perinatal asphyxia were recruited (n = 82) and 39 received therapeutic hypothermia. Infants had serial coagulation tests including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen in the first week of life. The main outcome measures included MRI brain and EEG seizures. Our results show that mortality was predicted on day 1 by decreased Fibrinogen (AUC = 0.95, p = 0.009) and by PT on day 2 with a cutoff of 22 s. An abnormal MRI was predicted by Fibrinogen on day 3 with a cut-off value of 2 g/L. For prediction of grade II/III NE, PT on day 2 of life was strongest with a cut-off value of 14 s. Only elevated APTT levels on day 1 of life were predictive of seizures (AUC = 0.65, p = 0.04). Conclusion: Coagulation parameters are strong predictors of outcomes such as abnormal NE grade, seizures, and mortality

Affirmative Action Programs in Social Service Agencies: Status of the Female M.S.W.

Job status and salary inequities between men and women have only recently been documented (Kravetz 1976). The federal government, over the past few decades, through various acts and executive orders, has created legislation to prohibit discrimination based on race, sex, color, religion or national origin in all employment practices. The question is to what extent this legislation has permeated social service agencies and affected their employment patterns, particularly with respect to administrative positions. In 1976, the Women\u27s Issues Committee of the Oregon Chapter of the National Association of Social Workers (NASW), addressed this question by initiating a study of social work employment in Oregon. The first part of the study examined the salaries and positions of NASW members in this state. The second part of the study was designed to study more specifically the employment patterns of women MSWs in Oregon\u27s social service agencies. Under the auspices of the Women\u27s Issues Committee, the second part of the study was designed and conducted by eight graduate students at the School of Social Work at Portland State University. One objective of the study was to find out the proportion of men and women filling the management positions in local social service agencies. But the primary purpose of the study was to examine the management-executive employment patterns in agencies before and after affirmative action programs were instituted. An attempt was then made to determine the effects, if any, of such programs. It was hoped that the results would clarify how agencies implement their affirmative action programs, the effects of implementation, and the barriers to the employment of women in management positions

Complete Genome Sequence of Pseudomonas aeruginosa Reference Strain PAK.

We report the complete genome of Pseudomonas aeruginosa strain PAK, a strain which has been instrumental in the study of a range of P. aeruginosa virulence and pathogenesis factors and has been used for over 50 years as a laboratory reference strain

Weight Care Project: Health professionals' attitudes and ability to assess body weight status - Study protocol

<p>Abstract</p> <p>Background</p> <p>Health professionals working in primary care and public health have opportunities to address body weight status issues with their patients through face-to-face contact. The objectives of this all-Ireland project are: 1. to assess the attitudes, current practices/behaviours and knowledge of key health professional groups on body weight status; 2. to assess the health professional groups' ability to identify body weight status in both adults and children. The health professional groups are: (a) community related public health nurses; (b) school public health nurses; (c) GPs and practice nurses (primary care); and (d) occupational health nurses (workplace) from both Northern Ireland and the Republic of Ireland.</p> <p>Methods/Design</p> <p>This all-Ireland multi-disciplinary project follows a mixed methods approach using both quantitative and qualitative methodologies, and consists of four components:</p> <p>1. Literature review - to explore the role of health professionals in managing obesity through spontaneous intervention in a variety of health promotion settings.</p> <p>2. Telephone interviews and focus groups - to gain an in-depth insight into the views of health professionals in assessing body weight status.</p> <p>3. Survey (primarily online but also paper-based) - to determine the attitudes, current practices/behaviours and knowledge of health professionals in assessing body weight status.</p> <p>4. Online evaluation study - an online interactive programme will be developed to assess health professionals' ability to identify the body weight status of adults and children.</p> <p>Discussion</p> <p>This project will assess and report the attitudes, current practices/behaviours and knowledge of key health professional groups within Northern Ireland and the Republic of Ireland on body weight status, and their ability to identify body weight status in both adults and children. The results of this project will generate recommendations for clinical practice in managing obesity, which may inform policy guidelines.</p

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570