Evaluation of the impact of universal testing for gestational diabetes mellitus on maternal and neonatal health outcomes: a retrospective analysis

Background: Gestational diabetes (GDM) affects a substantial proportion of women in pregnancy and is associated with increased risk of adverse perinatal and long term outcomes. Treatment seems to improve perinatal outcomes, the relative effectiveness of different strategies for identifying women with GDM however is less clear. This paper describes an evaluation of the impact of a change in policy from selective risk factor based offering, to universal offering of an oral glucose tolerance test (OGTT) to identify women with GDM on maternal and neonatal outcomes. Methods: Retrospective six year analysis of 35,674 births at the Women’s and Newborn unit, Bradford Royal Infirmary, United Kingdom. Results: The proportion of the whole obstetric population diagnosed with GDM increased almost fourfold following universal offering of an OGTT compared to selective offering of an OGTT; Rate Ratio (RR) 3.75 (95% CI 3.28 to 4.29), the proportion identified with severe hyperglycaemia doubled following the policy change; 1.96 (1.50 to 2.58). The case detection rate however, for GDM in the whole population and severe hyperglycaemia in those with GDM reduced by 50-60%; 0.40 (0.35 to 0.46) and 0.51 (0.39 to 0.67) respectively. Universally offering an OGTT was associated with an increased induction of labour rate in the whole obstetric population and in women with GDM; 1.43 (1.35 to 1.50) and 1.21 (1.00 to1.49) respectively. Caesarean section, macrosomia and perinatal mortality rates in the whole population were similar. For women with GDM, rate of caesarean section; 0.70 (0.57 to 0.87), macrosomia; 0.22 (0.15 to 0.34) and perinatal mortality 0.12 (0.03 to 0.46) decreased following the policy change. Conclusions: Universally offering an OGTT was associated with increased identification of women with GDM and severe hyperglycaemia and with neonatal benefits for those with GDM. There was no evidence of benefit or adverse effects in neonatal outcomes in the whole obstetric population

Características limnológicas da coluna d'água e dos efluentes de viveiros de criação de camarões-da-amazônia

Os objetivos neste trabalho foram caracterizar os efluentes de viveiros de Macrobrachium amazonicum criados em diferentes densidades de cultivo e analisar a variação nictemeral (24 horas) do perfil vertical da temperatura e da saturação de oxigênio da coluna d'água dos viveiros. O experimento foi realizado durante um período de três meses utilizando-se 12 viveiros retangulares de 100 m² povoados com camarões-da-amazônia em quatro densidades de cultivo (40, 60, 80 e 100 indivíduos/m²), cada uma avaliada com três repetições. Mensalmente, foi realizado nos viveiros (superfície até o fundo) o acompanhamento da variação nictemeral da temperatura e da saturação de oxigênio dissolvido. Nos efluentes gerados pela criação de camarões foram determinados os valores de N-total, N-amoniacal, N-nitrito, N-nitrato, P-total, P-ortofosfato e turbidez. Foram constatadas estratificações e desestratificações diárias de temperatura e da saturação de oxigênio, independentemente da densidade de cultivo, caracterizando os viveiros como um sistema de circulação polimítico. Quanto maior a densidade de cultivo de camarões-da-amazônia, maiores os valores de P-total, N-total, P-ortofostato, N-amoniacal e turbidez nos efluentes.The objective of this research was to characterize the effluents of fish ponds of Macrobrachium amazonicum cultured in different densities of farming and to analyze the daily variation (24 hours) of the vertical temperature and oxygen saturation profile of the water column of the ponds. The study was conducted during a period of three months using 12 rectangular 100 m² earthen ponds supplied with M. amazonicum individuals in four densities of farming (40, 60, 80 and 100 individuals/m²), each one evaluated with three replicates. Follow-up of the daily variation of the temperature and of the saturation of the dissolved oxygen was monthly carried out in the fish ponds (from the surface to the bottom). It was determined, in the effluent caused by the prawn farming, the values of total-N, ammoniacal-N, nitrite-N, nitrate-N, total-P, orthophosphate-P and turbidity. Daily stratifications and desestratifications of temperature and of the saturation oxygen were recorded, irrespective of farming density, characterizing the ponds as a polimitic system of circulation. The higher the density of cultivation of M. amazonicum, the higher the values of total-P, total-N, orthophosphate-P, N-ammoniacal and turbidity

Dexmedetomidine- or Clonidine-Based Sedation Compared With Propofol in Critically Ill Patients

Importance Whether α2-adrenergic receptor agonist–based sedation, compared with propofol-based sedation, reduces time to extubation in patients receiving mechanical ventilation in the intensive care unit (ICU) is uncertain. Objective To evaluate whether dexmedetomidine- or clonidine-based sedation reduces duration of mechanical ventilation compared with propofol-based sedation (usual care). Design, Setting, and Participants Pragmatic, open-label randomized clinical trial conducted at 41 ICUs in the UK including adults who were within 48 hours of starting mechanical ventilation, were receiving propofol plus an opioid for sedation and analgesia, and were expected to require mechanical ventilation for 48 hours or longer. The median time from intubation to randomization was 21.0 (IQR, 13.2-31.3) hours. Recruitment occurred from December 2018 to October 2023; the last follow-up occurred on December 10, 2023. Interventions The bedside algorithms used targeted a Richmond Agitation-Sedation Scale score of −2 to 1 (unless clinicians requested deeper sedation). The algorithms supported uptitration in the dexmedetomidine- and clonidine-based sedation intervention groups and supported downtitration for propofol-based sedation followed by sedation primarily with the allocated sedation (dexmedetomidine or clonidine). If required, supplemental use of propofol was permitted. Main Outcomes and Measures The primary outcome was time from randomization to successful extubation. The secondary outcomes included mortality, sedation quality, rates of delirium, and cardiovascular adverse events. Results Among the 1404 patients in the analysis population (mean age, 59.2 [SD, 14.9] years; 901 [64%] were male; and the mean APACHE II score was 20.3 [SD, 8.2]), the subdistribution hazard ratio (HR) for time to successful extubation was 1.09 (95% CI, 0.96-1.25; P = .20) for dexmedetomidine (n = 457) vs propofol (n = 471) and was 1.05 (95% CI, 0.95-1.17; P = .34) for clonidine (n = 476) vs propofol (n = 471). The median time from randomization to successful extubation was 136 (95% CI, 117-150) hours for dexmedetomidine, 146 (95% CI, 124-168) hours for clonidine, and 162 (95% CI, 136-170) hours for propofol. In the predefined subgroup analyses, there were no interactions with age, sepsis status, median Sequential Organ Failure Assessment score, or median delirium risk score. Among the secondary outcomes, agitation occurred at a higher rate with dexmedetomidine vs propofol (risk ratio [RR], 1.54 [95% CI, 1.21-1.97]) and with clonidine vs propofol (RR, 1.55 [95% CI, 1.22-1.97]). Compared with propofol, the rates of severe bradycardia (heart rate <50/min) were higher with dexmedetomidine (RR, 1.62 [95% CI, 1.36-1.93]) and clonidine (RR, 1.58 [95% CI, 1.33-1.88]). Compared with propofol, mortality was similar over 180 days for dexmedetomidine (HR, 0.98 [95% CI, 0.77-1.24]) and clonidine (HR, 1.04 [95% CI, 0.82-1.31]). Conclusions and Relevance In critically ill patients, neither dexmedetomidine nor clonidine was superior to propofol in reducing time to successful extubation. Trial Registration ClinicalTrials.gov Identifier: NCT0365383

Development of inland aquaculture in arid climates: water utilization strategies applied in Israel

Israel has a temperate climate with marked differences between the northern and southern regions. Rainfall ranges between 250 and 600 mm year±1 in the former and between only 25 and 200 mm year±1 in the latter. During the last 30 years, water consumption has increased markedly in all sectors. Although a water allocation for inland aquaculture is made, in most cases it is given the lowest priority, and aquaculturists have learned to contend with difficulties, and thrive on brackish water sources not fit for human consumption or agricultural crops. Since most water sources are already fully exploited, further development of all sectors will depend on their respective capacity to use recycled city water, desalinated brackish or sea water, or recycled pond water. In this respect, inland aquaculture is handicapped by public prejudices which will not allow the use of water from the first source and farms are still not able to cope with the cost of the second. Therefore, further development of inland aquaculture will depend on the capacity of farmers to use sea water, and to recycle pond water time and again to produce more fish with less (inland) water. Various strategies have already been developed in Israel and new ones are under study. These include water harvesting in dual-purpose reservoirs, recycling of pond water from one year to another, development of intensive flow-through systems based on recycled pond water and others based on biofiltration