Signal of harm in morphine use in adults with acute pulmonary oedema: A rapid systematic review

Background. Heart failure affects nearly 65 million people globally, resulting in recurrent hospital admissions and substantial healthcare expenditure. The use of morphine in the management of acute pulmonary oedema remains controversial, with conflicting guidance and significant variation in practice. Synthesised evidence is needed to inform standard treatment guidelines and clinical practice. Objective. To determine whether morphine should be used in the treatment of acute pulmonary oedema (APE) in adults. Methods. A rapid review of systematic reviews of randomised controlled trials or observational studies, and then randomised controlled trials, was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on 12 February 2022. We used a prespecified protocol following Cochrane rapid review methods and aligned to the National Standard Treatment Guidelines and Essential Medicines List methodology. We first considered relevant high-quality systematic reviews of randomised controlled trials or observational studies, then (if required) randomised controlled trials to inform time-sensitive or urgent evidence requests, clinical practice, policy, or standard treatment guidelines. Results. We identified four systematic reviews of observational studies. The two most relevant, up-to-date, and highest-quality reviews were used to inform evidence for critical outcomes. Morphine may increase in-hospital mortality (odds ratio (OR) 1.78; 95% confidence interval (CI) 1.01 - 3.13; low certainty of evidence; six observational studies, n=151 735 participants), resulting in 15 more per 1 000 hospital deaths, ranging from 0 to 40 more hospital deaths. Morphine may result in a large increase in invasive mechanical ventilation (OR 2.72; 95% CI 1.09 - 6.80; low certainty of evidence; four observational studies, n=167 847 participants), resulting in 45 more per 1 000 ventilations, ranging from 2 more to 136 more. Adverse events and hospital length of stay were not measured across reviews or trials. Conclusion. Based on the most recent, relevant and best-available quality evidence, morphine use in adults with APE may increase in-hospital and all-cause mortality and may result in a large increase in the need for invasive mechanical ventilation compared to not using morphine. Recommending against the use of morphine in pulmonary oedema may improve patient outcomes. Disinvesting in morphine for this indication may result in cost savings, noting the possible accrued benefits of fewer patients requiring invasive ventilation and management of morphine-related side-effects

Heavy Alcohol Use Is Associated With Worse Retention in HIV Care

Poor retention in HIV care is associated with worse clinical outcomes and increased HIV transmission. We examined the relationship between self-reported alcohol use, a potentially modifiable behavior, and retention

HIV primary care providers—Screening, knowledge, attitudes and behaviors related to alcohol interventions

Alcohol has particularly harmful health effects in HIV-infected patients; therefore, HIV clinics are an important setting for integration of brief alcohol intervention and alcohol pharmacotherapy to improve patient outcomes. Current practices of alcohol screening, counseling, and prescription of pharmacotherapy by HIV providers are unknown

Patterns of Tobacco-Use Behavior Among Chinese Smokers with Medical Conditions

Understanding the characteristics of Chinese American smokers with medical conditions and factors associated with their tobacco-use behaviors will guide effective cessation programs. In 2008, the authors described socio-demographic profiles of Chinese smokers with medical conditions treated during the period 2002–2006, documented their tobacco-use behaviors (i.e., average daily cigarette use, nicotine dependence, and number of past-year quit attempts), and drew comparisons between subjects recruited from hospitals (IP) and ambulatory settings (OP). Compared to OP, IP were significantly older, less educated, less acculturated, and more likely to be retired. Of the two groups, IP had poorer disease profiles, smoked less (4.4 vs. 11.9 cigarettes per day), and had lower nicotine-addiction scores (5.5 vs. 6.7). There was no difference between groups in past-year quit attempts. After adjustments, the data revealed that being employed and OP was associated with higher average daily cigarette use; IP were less nicotine dependent than OP; and for both groups, years of smoking was negatively associated with past-year quit attempts. Our study suggests that, more than acculturation level, health status influences the Chinese smoker’s level of cigarette use and nicotine addiction. Given the severity of their disease profiles, IP should be aggressively targeted for intervention, as they are more likely to be light smokers and to be less nicotine dependent than OP. Future tobacco treatment studies should pay attention to health status among smokers in health-care settings in order to provide a more accurate assessment of treatment needs and of barriers to successful smoking cessation

Protocols for the field testing

The COMMON SENSE project has been designed and planned in order to meet the general and specific scientific and technical objectives mentioned in its Description of Work (page 77). In an overall strategy of the work plan, work packages (11) can be grouped into 3 key phases: (1) RD basis for cost-effective sensor development, (2) Sensor development, sensor web platform and integration, and (3) Field testing. In the first two phases WP1 and WP2 partners have provided a general understanding and integrated basis for a cost effective sensors development. Within the following WPs 4 to 8 the new sensors are created and integrated into different identified platforms. During the third phase 3, characterized by WP9, partners will deploy precompetitive prototypes at chosen platforms (e.g. research vessels, oil platforms, buoys and submerged moorings, ocean racing yachts, drifting buoys). Starting from August 2015 (month 22; task 9.2), these platforms will allow the partnership to test the adaptability and performance of the in-situ sensors and verify if the transmission of data is properly made, correcting deviations. In task 9.1 all stakeholders identified in WP2, and other relevant agents, have been contacted in order to close a coordinated agenda for the field testing phase for each of the platforms. Field testing procedures (WP2) and deployment specificities, defined during sensor development in WPs 4 to 8, are closely studied by all stakeholders involved in field testing activities in order for everyone to know their role, how to proceed and to provide themselves with the necessary material and equipment (e.g. transport of instruments). All this information will provide the basis for designing and coordinating field testing activities. Type and characteristics of the system (vessel or mooring, surface or deep, open sea or coastal area, duration, etc.), used for the field testing activities, are planned comprising the indicators included in the above-mentioned descriptors, taking into account that they must of interest for eutrophication, concentration of contaminants, marine litter and underwater noise. In order to obtain the necessary information, two tables were realized starting from the information acquired for D2.2 delivered in June 2014. One table was created for sensor developers and one for those partners that will test the sensors at sea. The six developers in COMMON SENSE have provided information on the seven sensors: CEFAS and IOPAN for underwater noise; IDRONAUT and LEITAT for microplastics; CSIC for an innovative piro and piezo resistive polymeric temperature and pressure and for heavy metal; DCU for the eutrophication sensor. This information is anyway incomplete because in most cases the novel sensors are still far to be ready and will be developed over the course of COMMON SENSE. So the sensors cannot be clearly designed yet and, consequently, technical characteristics cannot still be perfectly defined. This produces some lag in the acquired information and, consequently, in the planning of their testing on specific platforms that will be solved in the near future. In the table for Testers, partners have provided information on fifteen available platforms. Specific answers have been given on number and type of sensors on each platforms, their availability and technical characteristics, compatibility issues and, very important when new sensors are tested, comparative measurements to be implemented to verify them. Finally IOPAN has described two more platforms, a motorboat not listed in the DoW, but already introduced in D2.2, and their oceanographic buoy in the Gdansk Bay that was previously unavailable. The same availability now is present for the OBSEA Underwater observatory from CSIC, while their Aqualog undulating mooring is still not ready for use. In the following months, new information on sensors and platforms will be provided and the planning of testing activities will improve. Further updates of this report will be therefore necessary in order to individuate the most suitable platforms to test each kind of sensor. Objectives and rationale The objective of deliverable 9.1 is the definition of field testing procedures (WP2), the study of deployment specificities during sensor development work packages (from WP4 to WP8) and the preparation of protocols. This with the participation of all stakeholders involved in field testing activities in order for everyone to know their role, how to proceed and to provide themselves with the necessary material and equipment

Field testing, validation and optimization report

The COMMON SENSE project has been designed and planned in order to meet the general and specific scientific and technical objectives mentioned in its Description of Work (page 77). As the overall strategy, the 11 work packages (WPs) of the work plan were grouped into 3 key phases: (1) RD basis for cost-effective sensor development , (2) Sensor development, sensor web platform and integration, and (3) Field testing. In the first two phases, partners involved in WP1 and WP2 have provided a general understanding and integrated basis for a cost effective sensors development. Within the following WPs 4 to 8 the new sensors were created and integrated into different identified platforms. During the third phase of field testing (WP9), partners have deployed precompetitive prototypes at chosen platforms (e.g. research vessels, oil platforms, buoys and submerged moorings, ocean racing yachts, drifting buoys). Starting from August 2015 (month 22; task 9.2), these platforms have allowed the partnership to test the adaptability and performance of the in-situ sensors and verify if the transmission of data is properly made, correcting deviations. In task 9.1 all stakeholders identified in WP2 have been contacted in order to agree upon a coordinated agenda for the field testing phase for each of the platforms. Field testing procedures (WP2) and deployment specificities, defined during sensor development in WPs 4 to 8, have been closely studied by all stakeholders involved in field testing activities in order for everyone to know their role, how to proceed and to provide themselves with the necessary material and equipment (e.g. transport of instruments). All this information have provided the basis for designing and coordinating field testing activities. Subsequently, the available new sensors have been tested since August 2015 till mid-October of the current year (2016) as part of task 9.2, following the indications defined in D9.1, such as the intercomparison of the new sensors with commercial ones, when possible. The availability of new sensors was quite different in time starting with the first tests in September and October 2015 on noise, nutrient and heavy metals sensors and closing with pCO2 in late September 2016. Sensors are technically fully described in the deliverables of WPs 3 to 8 and are here just mentioned where necessary. For further details, please consider those reports. Objectives and rationale The protocols prepared in D9.1 have been verified during the field testing activities of the innovative sensors on platforms. These can be summarized into 3 categories: (1) Research vessels (regular cruises); (2) Fixed platforms; (3) Ocean racing yachts. An exhaustive analysis of the different data obtained during field testing activities has been carried on in order to set possible optimization actions for prototypes design and performances. The data from each platform have been analyzed to verify limits and optimal installations or possible improvements. Finally a set of possible optimization actions has been defined. Data and observations collected during the course of field testing have been used to iteratively optimize the design and performance of the precompetitive prototypes

Analysis of relevant technical issues and deficiencies of the existing sensors and related initiatives currently set and working in marine environment. New generation technologies for cost-effective sensors

The last decade has seen significant growth in the field of sensor networks, which are currently collecting large amounts of environmental data. This data needs to be collected, processed, stored and made available for analysis and interpretation in a manner which is meaningful and accessible to end users and stakeholders with a range of requirements, including government agencies, environmental agencies, the research community, industry users and the public. The COMMONSENSE project aims to develop and provide cost-effective, multi-functional innovative sensors to perform reliable in-situ measurements in the marine environment. The sensors will be easily usable across several platforms, and will focus on key parameters including eutrophication, heavy metal contaminants, marine litter (microplastics) and underwater noise descriptors of the MSFD. The aims of Tasks 2.1 and 2.2 which comprise the work of this deliverable are: • To obtain a comprehensive understanding and an up-to-date state of the art of existing sensors. • To provide a working basis on “new generation” technologies in order to develop cost-effective sensors suitable for large-scale production. This deliverable will consist of an analysis of state-of-the-art solutions for the different sensors and data platforms related with COMMONSENSE project. An analysis of relevant technical issues and deficiencies of existing sensors and related initiatives currently set and working in marine environment will be performed. Existing solutions will be studied to determine the main limitations to be considered during novel sensor developments in further WP’s. Objectives & Rationale The objectives of deliverable 2.1 are: • To create a solid and robust basis for finding cheaper and innovative ways of gathering data. This is preparatory for the activities in other WPs: for WP4 (Transversal Sensor development and Sensor Integration), for WP(5-8) (Novel Sensors) to develop cost-effective sensors suitable for large-scale production, reducing costs of data collection (compared to commercially available sensors), increasing data access availability for WP9 (Field testing) when the deployment of new sensors will be drawn and then realized

Clinical features and presentation of cervicofacial infection : a maxillofacial trainee research collaborative (MTReC) study

Introduction Cervicofacial infection (CFI) is a common presentation to the Oral and Maxillofacial (OMFS) department and accounts for significant emergency activity. The current study aims to understand the aetiology, management and clinical features of patients hospitalised with CFI. Methods Our study included all patients admitted for management of CFI from May to October 2017 at 25 OMFS units across 17 UK regions. Data were collected prospectively and included age, comorbidities, prior treatment received, markers of sepsis and presenting clinical features. Results One thousand and two (1002) admissions were recorded; 546 (54.5%) were male. Median age was 34 years (1-94 years). The most common presenting complaints were trismus (46%) and dysphagia (27%). Airway compromise was present in 1.7% of cases. Odontogenic infection accounted for 822/1002 (82%) admissions. Of those with an infection of odontogenic origin, 453/822 (55.1%) had received previous treatment. Two-thirds of those who had received treatment were managed by antibiotics alone (300/453, 66.2%) Patients met criteria for sepsis in 437/1002 (43.6%) of CFI, and in 374/822 (45.5%) of odontogenic infections. Conclusion This is the largest study worldwide of patients requiring inpatient management for CFI. Infection due to odontogenic origin is the most frequent reason for admission and nearly half do not seek treatment before presentation. Patients with CFI often present late in their disease and frequently meet criteria for sepsis, requiring timely and aggressive treatment to ensure optimum outcomes. Trismus is an emerging dominant feature with all the implications related to the anaesthetic management of these patients. Knowledge of these factors has implications for the referrer, triage, the emergency department, the anaesthetic team and members of the OMFS team

Oral health status of adults in Southern Vietnam - a cross-sectional epidemiological study

Contains fulltext : 89929.pdf (publisher's version ) (Open Access)BACKGROUND: Before strategies or protocols for oral health care can be advised at population level, epidemiological information on tooth decay patterns and its effects on oral function are indispensable. The aim of this study was to investigate influences of socio-demographic variables on the prevalence of decayed, missing, filled (DMF) and sound teeth (St) and to determine the relative risk of teeth in different dental regions for D, M, and F, of adults living in urban and rural areas in Southern Vietnam. METHODS: Cross-sectional DMF and St data of 2965 dentate subjects aged 20 to 95 living in urban and rural areas in three provinces were collected by means of a self-administered questionnaire and an oral examination. The sample was stratified by age, gender, residence and province. RESULTS: The percentage of subjects having missing teeth was high for all ages while it was low for subjects with decayed and filled teeth. The mean number of missing teeth increased gradually by age from approximately 1 in each jaw at the age of 20 to 8 at the age of 80. The number of decayed teeth was relative low at all ages, being highest in molars at young ages. The mean number of filled teeth was extremely low at all ages in all dental regions. Every additional year of age gives a significantly lower chance for decay, a higher chance for missing, and a lower chance for filled teeth. Molars had a significantly higher risk for decay, missing and filled than premolars and anterior teeth. Females had significantly higher risk for decayed and filled teeth, and less chance for missing teeth than males. Urban subjects presented lower risk for decay, but approximately 4 times greater chance for having fillings than rural subjects. Low socio-economic status (SES) significantly increased the chance for missing anterior and molar teeth; subjects with high SES had more often fillings. CONCLUSIONS: The majority of adults of Southern Vietnam presented a reduced dentition. The combination of low numbers of filled teeth and relative high numbers of decayed and missing teeth indicates that the main treatment for decay is extraction. Molars are more at risk for being decayed or missing than premolars and anterior teeth

The GOES-R Geostationary Lightning Mapper (GLM) and the Global Observing System for Total Lightning

for the existing GOES system currently operating over the Western Hemisphere. New and improved instrument technology will support expanded detection of environmental phenomena, resulting in more timely and accurate forecasts and warnings. Advancements over current GOES include a new capability for total lightning detection (cloud and cloud-to-ground flashes) from the Geostationary Lightning Mapper (GLM), and improved temporal, spatial, and spectral resolution for the next generation Advanced Baseline Imager (ABI). The GLM will map total lightning continuously day and night with near-uniform spatial resolution of 8 km with a product latency of less than 20 sec over the Americas and adjacent oceanic regions. This will aid in forecasting severe storms and tornado activity, and convective weather impacts on aviation safety and efficiency among a number of potential applications. The GLM will help address the National Weather Service requirement for total lightning observations globally to support warning decision-making and forecast services. Science and application development along with pre-operational product demonstrations and evaluations at NWS national centers, forecast offices, and NOAA testbeds will prepare the forecasters to use GLM as soon as possible after the planned launch and check-out of GOES-R in 2016. New applications will use GLM alone, in combination with the ABI, or integrated (fused) with other available tools (weather radar and ground strike networks, nowcasting systems, mesoscale analysis, and numerical weather prediction models) in the hands of the forecaster responsible for issuing more timely and accurate forecasts and warnings