Comment on â Utility of screening questionnaire, obesity, neck circumference, and sleep polysomnography to predict sleepâ disordered breathing in children and adolescents

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122436/1/pan12952.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122436/2/pan12952_am.pd

The STBUR questionnaire for predicting perioperative respiratory adverse events in children at risk for sleep‐disordered breathing

Background In the absence of formal polysomnography ( PSG ), many children with symptoms of sleep‐disordered breathing ( SDB ) go unrecognized and thus may be at risk for perioperative respiratory adverse events ( PRAE ). Objectives To develop a simple practical tool to identify children with symptoms consistent with SDB who may be at risk for PRAE . Methods Three‐hundred and thirty‐seven parents of children scheduled for surgery completed the Sleep‐Related Breathing Disorder ( SRBD ) questionnaire. Data regarding the incidence and severity of PRAE including airway obstruction and laryngospasm, were collected prospectively. Results Thirty‐two (9.5%) children had a confirmed diagnosis of SDB by PSG and 90 (26.7%) had symptoms consistent with SDB based on the SRBD questionnaire. Principal component analysis identified five symptoms from the SRBD questionnaire that were strongly predictive of PRAE and which were incorporated into the STBUR tool (Snoring, Trouble Breathing, Un‐Refreshed). The likelihood of PRAE was increased by threefold (positive likelihood ratio 3.06 [1.64–5.96] in the presence of any 3 STBUR symptoms and by tenfold when all five symptoms were present (9.74 [1.35–201.8]). In comparison, the likelihood of PRAE based on a PSG ‐confirmed diagnosis of SDB was 2.63 (1.17–6.23). Conclusions Children presenting for surgery with symptoms consistent with SDB may be at risk for PRAE . It is important therefore that anesthesia providers identify these individuals prior to surgery to avoid potential complications. The STBUR questionnaire appears promising as a simple, clinically useful tool for identifying children at risk for PRAE . Further studies to validate the STBUR questionnaire as a diagnostic tool may be warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98131/1/pan12155.pd

Altering fatty acid availability does not impair prolonged, continuous running to fatigue: evidence for carbohydrate dependence

We determined the effect of suppressing lipolysis via administration of nicotinic acid (NA) on fuel substrate selection and half-marathon running capacity. In a single-blinded, Latin square design, 12 competitive runners completed four trials involving treadmill running until volitional fatigue at a pace based on 95% of personal best half-marathon time. Trials were completed in a fed or overnight fasted state: 1) carbohydrate (CHO) ingestion before (2 g CHO·kg−1·body mass−1) and during (44 g/h) [CFED]; 2) CFED plus NA ingestion [CFED-NA]; 3) fasted with placebo ingestion during [FAST]; and 4) FAST plus NA ingestion [FAST-NA]. There was no difference in running distance (CFED, 21.53 ± 1.07; CFED-NA, 21.29 ± 1.69; FAST, 20.60 ± 2.09; FAST-NA, 20.11 ± 1.71 km) or time to fatigue between the four trials. Concentrations of plasma free fatty acids (FFA) and glycerol were suppressed following NA ingestion irrespective of preexercise nutritional intake but were higher throughout exercise in FAST compared with all other trials (P < 0.05). Rates of whole-body CHO oxidation were unaffected by NA ingestion in the CFED and FAST trials, but were lower in the FAST trial compared with the CFED-NA trial (P < 0.05). CHO was the primary substrate for exercise in all conditions, contributing 83-91% to total energy expenditure with only a small contribution from fat-based fuels. Blunting the exercise-induced increase in FFA via NA ingestion did not impair intense running capacity lasting ∼85 min, nor did it alter patterns of substrate oxidation in competitive athletes. Although there was a small but obligatory use of fat-based fuels, the oxidation of CHO-based fuels predominates during half-marathon running

Association of maternal sleep practices with pre‐eclampsia, low birth weight, and stillbirth among Ghanaian women

ObjectiveTo assess sleep practices, and investigate their relationship with maternal and fetal outcomes, among pregnant Ghanaian women.MethodsIn a cross‐sectional study conducted at Korle Bu Teaching Hospital, Accra, Ghana, between June and July 2011, postpartum women were interviewed within 48 hours of delivery about sleep quality and practices during pregnancy. Interviews were coupled with a systematic review of participants’ medical charts for key outcomes including maternal hypertension, pre‐eclampsia, premature delivery, low birth weight, and stillbirth.ResultsMost women reported poor sleep quality during pregnancy. Snoring during pregnancy was independently associated with pre‐eclampsia (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.4–8.5; P = 0.007). The newborns of women who reported supine sleep during pregnancy were at increased risk of low birth weight (OR, 5.0; 95% CI, 1.2–20.2; P = 0.025) and stillbirth (OR, 8.0; 95% CI, 1.5–43.2; P = 0.016). Low birth weight was found to mediate the relationship between supine sleep and stillbirth.ConclusionThe present findings in an African population demonstrate that maternal sleep, a modifiable risk factor, has a significant role in pre‐eclampsia, low birth weight, and subsequently stillbirth.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135150/1/ijgo261.pd

Replication of “Experiencing physical warmth promotes interpersonal warmth” by Williams & Bargh (2008)

We report the results of three high-powered, independent replications of Study 2 from Williams and Bargh (2008). Participants evaluated hot or cold instant therapeutic packs before choosing a reward for participation that was framed as a prosocial (i.e., treat for a friend) or self-interested reward (i.e., treat for the self). Williams and Bargh predicted that evaluating the hot pack would lead to a higher probability of making a prosocial choice compared to evaluating the cold pack. We did not replicate the effect in any individual laboratory or when considering the results of the three replications together (total N = 861). We conclude that there is no evidence that brief exposure to warm therapeutic packs induces greater prosocial responding than exposure to cold therapeutic packs

Guidelines on the management of ascites in cirrhosis.

The British Society of Gastroenterology in collaboration with British Association for the Study of the Liver has prepared this document. The aim of this guideline is to review and summarise the evidence that guides clinical diagnosis and management of ascites in patients with cirrhosis. Substantial advances have been made in this area since the publication of the last guideline in 2007. These guidelines are based on a comprehensive literature search and comprise systematic reviews in the key areas, including the diagnostic tests, diuretic use, therapeutic paracentesis, use of albumin, transjugular intrahepatic portosystemic stent shunt, spontaneous bacterial peritonitis and beta-blockers in patients with ascites. Where recent systematic reviews and meta-analysis are available, these have been updated with additional studies. In addition, the results of prospective and retrospective studies, evidence obtained from expert committee reports and, in some instances, reports from case series have been included. Where possible, judgement has been made on the quality of information used to generate the guidelines and the specific recommendations have been made according to the 'Grading of Recommendations Assessment, Development and Evaluation (GRADE)' system. These guidelines are intended to inform practising clinicians, and it is expected that these guidelines will be revised in 3 years' time

Clinical prevalence of Lewy body dementia.

BACKGROUND: The prevalence of dementia with Lewy bodies (DLB) and dementia in Parkinson's disease (PDD) in routine clinical practice is unclear. Prevalence rates observed in clinical and population-based cohorts and neuropathological studies vary greatly. Small sample sizes and methodological factors in these studies limit generalisability to clinical practice. METHODS: We investigated prevalence in a case series across nine secondary care services over an 18-month period, to determine how commonly DLB and PDD cases are diagnosed and reviewed within two regions of the UK. RESULTS: Patients with DLB comprised 4.6% (95% CI 4.0-5.2%) of all dementia cases. DLB was represented in a significantly higher proportion of dementia cases in services in the North East (5.6%) than those in East Anglia (3.3%; χ2 = 13.6, p < 0.01). DLB prevalence in individual services ranged from 2.4 to 5.9%. PDD comprised 9.7% (95% CI 8.3-11.1%) of Parkinson's disease cases. No significant variation in PDD prevalence was observed between regions or between services. CONCLUSIONS: We found that the frequency of clinical diagnosis of DLB varied between geographical regions in the UK, and that the prevalence of both DLB and PDD was much lower than would be expected in this case series, suggesting considerable under-diagnosis of both disorders. The significant variation in DLB diagnostic rates between these two regions may reflect true differences in disease prevalence, but more likely differences in diagnostic practice. The systematic introduction of more standardised diagnostic practice could improve the rates of diagnosis of both conditions

Interaction Diversity Maintains Resiliency in a Frequently Disturbed Ecosystem

Frequently disturbed ecosystems are characterized by resilience to ecological disturbances. Longleaf pine ecosystems are not only resilient to frequent fire disturbance, but this feature sustains biodiversity. We examined how fire frequency maintains beta diversity of multi-trophic interactions in longleaf pine ecosystems, as this community property provides a measure of functional redundancy of an ecosystem. We found that beta interaction diversity at small local scales is highest in the most frequently burned stands, conferring immediate resiliency to disturbance by fire. Interactions become more specialized and less resilient as fire frequency decreases. Local scale patterns of interaction diversity contribute to broader scale patterns and confer long-term ecosystem resiliency. Such natural disturbances are likely to be important for maintaining regional diversity of interactions for a broad range of ecosystems

Increasing chlamydia screening tests in general practice: A modi fied Zelen prospective cluster randomised controlled trial evaluating a complex intervention based on the theory of planned behaviour

Objective: To determine if a structured complex intervention increases opportunistic chlamydia screening testing of patients aged 15-24 years attending English general practitioner (GP) practices. Methods: A prospective, Cluster Randomised Controlled Trial with a modified Zelen design involving 160 practices in South West England in 2010. The intervention was based on the Theory of Planned Behaviour (TPB). It comprised of practice-based education with up to two additional contacts to increase the importance of screening to GP staff and their confidence to offer tests through skill development (including videos). Practical resources (targets, posters, invitation cards, computer reminders, newsletters including feedback) aimed to actively influence social cognitions of staff, increasing their testing intention. Results: Data from 76 intervention and 81 control practices were analysed. In intervention practices, chlamydia screening test rates were 2.43/100 15-24-yearolds registered preintervention, 4.34 during intervention and 3.46 postintervention; controls testing rates were 2.61/ 100 registered patients prior intervention, 3.0 during intervention and 2.82 postintervention. During the intervention period, testing in intervention practices was 1.76 times as great (CI 1.24 to 2.48) as controls; this persisted for 9 months postintervention (1.57 times as great, CI 1.27 to 2.30). Chlamydia infections detected increased in intervention practices from 2.1/1000 registered 15-24-year-olds prior intervention to 2.5 during the intervention compared with 2.0 and 2.3/1000 in controls (Estimated Rate Ratio intervention versus controls 1.4 (CI 1.01 to 1.93). Conclusions: This complex intervention doubled chlamydia screening tests in fully engaged practices. The modified Zelen design gave realistic measures of practice full engagement (63) and efficacy of this educational intervention in general practice; it should be used more often. Trial registration: The trial was registered on the UK Clinical Research Network Study Portfolio database. UKCRN number 9722