Trends in use of neonatal CPAP: a population-based study

<p>Abstract</p> <p>Background</p> <p>Continuous positive airway pressure (CPAP) is used widely to provide respiratory support for neonates, and is often the first treatment choice in tertiary centres. Recent trials have demonstrated that CPAP reduces need for intubation and ventilation for infants born at 25-28 weeks gestation, and at > 32weeks, in non-tertiary hospitals, CPAP reduces need for transfer to NICU. The aim of this study was to examine recent population trends in the use of neonatal continuous positive airway pressure.</p> <p>Methods</p> <p>We undertook a population-based cohort study of all 696,816 liveborn neonates ≥24 weeks gestation in New South Wales (NSW) Australia, 2001-2008. Data were obtained from linked birth and hospitalizations records, including neonatal transfers. The primary outcome was CPAP without mechanical ventilation (via endotracheal intubation) between birth and discharge from the hospital system. Analyses were stratified by age ≤32 and > 32 weeks gestation.</p> <p>Results</p> <p>Neonates receiving any ventilatory support increased from 1,480 (17.9/1000) in 2001 to 2,486 (26.9/1000) in 2008, including 461 (5.6/1000) to 1,465 (15.8/1000) neonates who received CPAP alone. There was a concurrent decrease in mechanical ventilation use from 12.3 to 11.0/1000. The increase in CPAP use was greater among neonates > 32 weeks (from 3.2 to 11.8/1000) compared with neonates ≤32 weeks (from 18.1 to 32.7/1000). The proportion of CPAP > 32 weeks initiated in non-tertiary hospitals increased from 6% to 30%.</p> <p>Conclusions</p> <p>The use of neonatal CPAP is increasing, especially > 32 weeks gestation and among non-tertiary hospitals. Recommendations are required regarding which infants should be considered for CPAP, resources necessary for a unit to offer CPAP and monitoring of longer term outcomes.</p

Genetics and Pathogenesis of Feline Infectious Peritonitis Virus

Feline coronavirus (FCoV) is endemic in feral cat populations and cat colonies, frequently preceding outbreaks of fatal feline infectious peritonitis (FIP). FCoV exhibits 2 biotypes: the pathogenic disease and a benign infection with feline enteric coronavirus (FECV). Uncertainty remains regarding whether genetically distinctive avirulent and virulent forms coexist or whether an avirulent form mutates in vivo, causing FIP. To resolve these alternative hypotheses, we isolated viral sequences from FCoV-infected clinically healthy and sick cats (8 FIP cases and 48 FECV-asymptomatic animals); 735 sequences from 4 gene segments were generated and subjected to phylogenetic analyses. Viral sequences from healthy cats were distinct from sick cats on the basis of genetic distances observed in the membrane and nonstructural protein 7b genes. These data demonstrate distinctive circulating virulent and avirulent strains in natural populations. In addition, 5 membrane protein amino acid residues with functional potential differentiated healthy cats from cats with FIP. These findings may have potential as diagnostic markers for virulent FIP-associated FCoV

Comparison of Quarterly and Yearly Calibration Data for Propensity Score Adjusted Web Survey Estimates

While web surveys have become increasingly popular as a method of data collection, there is concern that estimates obtained from web surveys may not reflect the target population of interest. Web survey estimates can be calibrated to existing national surveys using a propensity score adjustment, although requirements for the size and collection timeline of the reference data set have not been investigated. We evaluate health outcomes estimates from the National Center for Health Statistics’ Research and Development web survey. In our study, the 2016 National Health Interview Survey as well as its quarterly subsets are considered as reference datasets for the web data. It is demonstrated that the calibrated health estimates overall vary little when using the quarterly or yearly data, suggesting that there is flexibility in selecting the reference dataset. This finding has many practical implications for constructing reference data, including the reduced cost and burden of a smaller sample size and a more flexible timeline

A framework for conceptualizing how narratives from health-care consumers might improve or impede the use of information about provider quality

Consumers choosing a health-care provider have access to diverse information including narratives by patients about their prior experiences. However, little research has examined how narratives might improve or impede the use of information about the quality of providers’ performance. This paper describes a conceptual framework for examining mechanisms by which narrative information might influence consumer judgments and decisions about providers. We conducted a conceptual review of risk communication and behavioral decision research. We synthesized the literature to form the foundation of a conceptual framework for assessing how narrative information about provider quality impacts consumer decisions about providers. We identified four key characteristics of narratives (convey emotion; explain logic; provide relational information; and capture naturalistic experience) that may address four consumer needs (avoid surprise and regret; recognize dominant options; motivate to act or not act; and make multi-attribute tradeoff decisions). We also identified three main functions of narratives (provide a simple, powerful cue; imbue quality information with meaning; and stimulate cognition and behavior) in four decision contexts (short-term treatments; external disruptions; chronic illness; problematic experiences). A rigorous research program can be derived from the conceptual framework to generate evidence-based recommendations about whether and how patient narratives might encourage: (1) more reasoned decisions; (2) consistency with a patient’s own values/preferences; and (3) engagement with provider quality information. Research results can be used then to develop robust guidance for health communicators reporting diverse and often incommensurate performance metrics

Determining the Effects of Past Negative Experiences Involving Patient Care

As the cost of healthcare continues to raise, the need to address nurse attrition, which is a contributing factor, also rises. While there are various factors that influence nurses’ decision to leave or stay, job satisfaction and ethical climate are significant variables. This study examined the effects of negative previous work experiences on job satisfaction and ethical climate. The results showed previous work experiences moderated both job satisfaction and ethical climate. In addition, ethical climate mediated the effects of previous experiences on job satisfaction. The implications include identifying nurses who may have had negative experiences prior to their current employment and providing them with ongoing support

Correction to: Improved X-ray baggage screening sensitivity with 'targetless' search training.

Funder: Defence and Security Accelerator; doi: http://dx.doi.org/10.13039/100012339Abstract: When searching for a known target, mental representations of target features, or templates, guide attention towards matching objects and facilitate recognition. When only distractor features are known, distractor templates allow irrelevant objects to be recognised and attention to be shifted away. This is particularly true in X-ray baggage search, a challenging real-world visual search task with implications for public safety, where targets may be unknown, difficult to predict and concealed by an adversary, but distractors are typically benign and easier to identify. In the present study, we draw on basic principles of distractor suppression and rejection to investigate a counterintuitive ‘targetless’ approach to training baggage search. In a simulated X-ray baggage search task, we observed significant benefits to target detection sensitivity (d′) for targetless relative to target-based training, but no effects of performance-contingent rewards or the inclusion of superordinate semantic categories during training. The benefits of targetless search training were most apparent for stimuli involving less spatial overlap (occlusion), which likely represents the difficulty and greater individual variation involved in searching more visually complex images. Together, these results demonstrate the effectiveness of a counterintuitive targetless approach to training target detection in X-ray baggage search, based on basic principles of distractor suppression and rejection, with potential for use as a real-world training tool

Maternal fucosyltransferase 2 status affects the gut bifidobacterial communities of breastfed infants.

BackgroundIndividuals with inactive alleles of the fucosyltransferase 2 gene (FUT2; termed the 'secretor' gene) are common in many populations. Some members of the genus Bifidobacterium, common infant gut commensals, are known to consume 2'-fucosylated glycans found in the breast milk of secretor mothers. We investigated the effects of maternal secretor status on the developing infant microbiota with a special emphasis on bifidobacterial species abundance.ResultsOn average, bifidobacteria were established earlier and more often in infants fed by secretor mothers than in infants fed by non-secretor mothers. In secretor-fed infants, the relative abundance of the Bifidobacterium longum group was most strongly correlated with high percentages of the order Bifidobacteriales. Conversely, in non-secretor-fed infants, Bifidobacterium breve was positively correlated with Bifidobacteriales, while the B. longum group was negatively correlated. A higher percentage of bifidobacteria isolated from secretor-fed infants consumed 2'-fucosyllactose. Infant feces with high levels of bifidobacteria had lower milk oligosaccharide levels in the feces and higher amounts of lactate. Furthermore, feces containing different bifidobacterial species possessed differing amounts of oligosaccharides, suggesting differential consumption in situ.ConclusionsInfants fed by non-secretor mothers are delayed in the establishment of a bifidobacteria-laden microbiota. This delay may be due to difficulties in the infant acquiring a species of bifidobacteria able to consume the specific milk oligosaccharides delivered by the mother. This work provides mechanistic insight into how milk glycans enrich specific beneficial bacterial populations in infants and reveals clues for enhancing enrichment of bifidobacterial populations in at risk populations - such as premature infants

The Relationship of Moral Distress, Ethical Environment and Nurse Job Satisfaction

Nurses are fundamental to the delivery of quality, safe and competent health care in multilevel complex systems. Faced with challenging, dynamic, and evolving patient care and workforce issues, nurses must create ethical environments, which foster a respectful climate in which decisions are made and supported. The current study examined the relationship between ethical climate, frequency of moral distress, intensity of moral distress, and overall job satisfaction among registered nurses at two hospitals located in the Southeastern United States as measured by the Moral Distress Scale and the Hospital Ethical Climate Survey. The results of the correlational study suggest a weak relationship between ethical climate and moral distress, but a moderate relationship exists between ethical climate and job satisfaction. Findings from this study highlight the importance of creating an ethical environment to improve job satisfaction which can ultimately result in improved patient care