Adjustment of apnea-hypopnea index with severity of obstruction events enhances detection of sleep apnea patients with the highest risk of severe health consequences

Introduction Presently, the severity of obstructive sleep apnea (OSA) is estimated based on the apnea-hypopnea index (AHI). Unfortunately, AHI does not provide information on the severity of individual obstruction events. Previously, the severity of individual obstruction events has been suggested to be related to the outcome of the disease. In this study, we incorporate this information into AHI and test whether this novel approach would aid in discriminating patients with the highest risk. We hypothesize that the introduced adjusted AHI parameter provides a valuable supplement to AHI in the diagnosis of the severity of OSA. Methods This hypothesis was tested by means of retrospective follow-up (mean ± sd follow-up time 198.2 ± 24.7 months) of 1,068 men originally referred to night polygraphy due to suspected OSA. After exclusion of the 264 patients using CPAP, the remaining 804 patients were divided into normal (AHI < 5) and OSA (AHI ≥ 5) categories based on conventional AHI and adjusted AHI. For a more detailed analysis, the patients were divided into normal, mild, moderate, and severe OSA categories based on conventional AHI and adjusted AHI. Subsequently, the mortality and cardiovascular morbidity in these groups were determined. Results Use of the severity of individual obstruction events for adjustment of AHI led to a significant rearrangement of patients between severity categories. Due to this rearrangement, the number of deceased patients diagnosed to have OSA was increased when adjusted AHI was used as the diagnostic index. Importantly, risk ratios of all-cause mortality and cardiovascular morbidity were higher in moderate and severe OSA groups formed based on the adjusted AHI parameter than in those formed based on conventional AHI. Conclusions The adjusted AHI parameter was found to give valuable supplementary information to AHI and to potentially improve the recognition of OSA patients with the highest risk of mortality or cardiovascular morbidity.

Nonlinear mechanical property of tracheal cartilage: A theoretical and experimental study

Background: Despite being the stiffest airway of the bronchial tree, the trachea undergoes significant deformation due to intrathoracic pressure during breathing. The mechanical properties of the trachea affect the flow in the airway and may contribute to the biological function of the lung. Method: A Fung-type strain energy density function was used to investigate the nonlinear mechanical behavior of tracheal cartilage. A bending test on pig tracheal cartilage was performed and a mathematical model for analyzing the deformation of tracheal cartilage was developed. The constants included in the strain energy density function were determined by fitting the experimental data. Result: The experimental data show that tracheal cartilage is a nonlinear material displaying higher strength in compression than in tension. When the compression forces varied from -0.02 to -0.03 N and from -0.03 to -0.04 N, the deformation ratios were 11.03±2.18% and 7.27±1.59%, respectively. Both were much smaller than the deformation ratios (20.01±4.49%) under tension forces of 0.02 to 0.01 N. The Fung-type strain energy density function can capture this nonlinear behavior very well, whilst the linear stress-strain relation cannot. It underestimates the stability of trachea by exaggerating the displacement in compression. This study may improve our understanding of the nonlinear behavior of tracheal cartilage and it may be useful for the future study on tracheal collapse behavior under physiological and pathological conditions.

Long-term ambient air pollution exposure and self-reported morbidity in the Australian Longitudinal Study on Women's Health: A cross-sectional study

- Objective We sought to assess the effect of long-term exposure to ambient air pollution on the prevalence of self-reported health outcomes in Australian women. - Design Cross-sectional study - Setting and participants The geocoded residential addresses of 26 991 women across 3 age cohorts in the Australian Longitudinal Study on Women's Health between 2006 and 2011 were linked to nitrogen dioxide (NO2) exposure estimates from a land-use regression model. Annual average NO2 concentrations and residential proximity to roads were used as proxies of exposure to ambient air pollution. - Outcome measures Self-reported disease presence for diabetes mellitus, heart disease, hypertension, stroke, asthma, chronic obstructive pulmonary disease and self-reported symptoms of allergies, breathing difficulties, chest pain and palpitations. - Methods Disease prevalence was modelled by population-averaged Poisson regression models estimated by generalised estimating equations. Associations between symptoms and ambient air pollution were modelled by multilevel mixed logistic regression. Spatial clustering was accounted for at the postcode level. - Results No associations were observed between any of the outcome and exposure variables considered at the 1% significance level after adjusting for known risk factors and confounders. - Conclusions Long-term exposure to ambient air pollution was not associated with self-reported disease prevalence in Australian women. The observed results may have been due to exposure and outcome misclassification, lack of power to detect weak associations or an actual absence of associations with self-reported outcomes at the relatively low annual average air pollution exposure levels across Australia.

Characterisation of humidity dependence of a metal oxide semiconductor (MOS) sensor array using Partial Least Squares (PLS)

Metal oxide semiconductor (MOS) sensors are a class of chemical sensor that have potential for being a practical core sensor module for an electronic nose system in various environmental monitoring applications. However, the responses of these sensors may be affected by changes in humidity and this must be taken into consideration when developing calibration models. This paper characterises the humidity dependence of a sensor array which consists of 12 MOS sensors. The results were used to develop calibration models using partial least squares. Effects of humidity on the response of the sensor array and predictive ability of partial least squares are discussed. It is shown that partial least squares can provide proper calibration models to compensate for effects caused by changes in humidity.

Characterisation of humidity dependence of a metal oxide semiconductor sensor array using partial least squares

Metal oxide semiconductor (MOS) sensors are a class of chemical sensors that have potential for being a practical core sensor module for an electronic nose system in various environmental monitoring applications. However, the responses of these sensors may be affected by changes in humidity and this must be taken into consideration when developing calibration models. This paper characterises the humidity dependence of a sensor array which consists of 12 MOS sensors. The results were used to develop calibration models using partial least squares (PLS). Effects of humidity on the response of the sensor array and predictive ability of partial least squares are discussed. It is shown that partial least squares can provide proper calibration models to compensate for effects caused by changes in humidity. Special Issue: Selected Paper from the 12th International Symposium on Olfaction and Electronic Noses - ISOEN 2007, International Symposium on Olfaction and Electronic Noses.

Process studies of odour emissions from effluent ponds using machine-based odour measurement

Replicable experimental studies using a novel experimental facility and a machine-based odour quantification technique were conducted to demonstrate the relationship between odour emission rates and pond loading rates. The odour quantification technique consisted of an electronic nose, AromaScan A32S, and an artificial neural network. Odour concentrations determined by olfactometry were used along with the AromaScan responses to train the artificial neural network. The trained network was able to predict the odour emission rates for the test data with a correlation coefficient of 0.98. Time averaged odour emission rates predicted by the machine-based odour quantification technique, were strongly correlated with volatile solids loading rate, demonstrating the increased magnitude of emissions from a heavily loaded effluent pond. However, it was not possible to obtain the same relationship between volatile solids loading rates and odour emission rates from the individual data. It is concluded that taking a limited number of odour samples over a short period is unlikely to provide a representative rate of odour emissions from an effluent pond. A continuous odour monitoring instrument will be required for that more demanding task.

Film cooling at hypersonic Mach numbers using forward facing array of micro-jets

Experimental investigations are carried out in the IISc hypersonic shock tunnel on film cooling effectiveness of a single jet (diameter 2 mm and 0.9 mm), and an array forward facing of micro-jets (diameter 300 mu m each) of same effective area (corresponding to the respective single jet). The single jet and the corresponding micro-jets are injected from the stagnation zone of a blunt cone model (58, apex angle and nose radius of 35 mm). Nitrogen and Helium are injected as coolant gases. Experiments are performed at freestream Mach number 5.9, at 0 degrees angle of attack, with a stagnation enthalpy of 1.84 MJ/kg, with and without injections. The ratios of the jet stagnation pressure to the freestream pitot pressure used in the present study are 1.2 and 1.45. Up to 50% reduction in surface heat transfer rate was observed with the array of micro-jets, compared to that of the respective single jet with nitrogen as the coolant, while the corresponding eduction was up to 37% for helium injection, with the schlieren flow visualizations showing no major change in the shock standoff distance, and thus no major changes in other aerodynamic aspects such as drag.

Clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector in wild dogs

Sodium cyanide poison is potentially a more humane method to control wild dogs than sodium fluoroacetate (1080) poison. This study quantified the clinical signs and duration of cyanide toxicosis delivered by the M-44 ejector. The device delivered a nominal 0.88 g of sodium cyanide, which caused the animal to loose the menace reflex in a mean of 43 s, and the animal was assumed to have undergone cerebral hypoxia after the last visible breath. The mean time to cerebral hypoxia was 156 s for a vertical pull and 434 s for a side pull. The difference was possibly because some cyanide may be lost in a side pull. There were three distinct phases of cyanide toxicosis: the initial phase was characterised by head shaking, panting and salivation; the immobilisation phase by incontinence, ataxia and loss of the righting reflex; and the cerebral hypoxia phase by a tetanic seizure. Clinical signs that were exhibited in more than one phase of cyanide toxicosis included retching, agonal breathing, vocalisation, vomiting, altered levels of ocular reflex, leg paddling, tonic muscular spasms, respiratory distress and muscle fasciculations of the muzzle.

Nursing physical assessment for patient safety in general wards: Reaching consensus on core skills

Aims and objectives To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Background Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. Design A modified Delphi study. Methods Focus group interviews with 150 acute care registered nurses (RNs) at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care RNs following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Results Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Conclusions Among a large and diverse group of experienced acute care RNs consensus was achieved on a structured core physical assessment to detect early changes in patient status. Relevance to clinical practice Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside.

Effect of sorghum ergot (Claviceps africana) on the performance of steers (Bos taurus) in a feedlot.

The effect of ergot (Claviceps africana) in naturally infected sorghum was assessed in feedlot rations. Thirty-two Hereford steers (Bos taurus) in individual pens with access to shade were adapted to feedlot conditions and then offered one of four rations containing 0, 4.4, 8.8 or 17.6 mg/kg of ergot alkaloids (84% dihydroergosine, 10% dihydroelymoclavine and 6% festuclavine), equivalent to ~0, 10, 20 or 40 g/kg ergot (sclerotia/sphacelia) in the rations. These rations were withdrawn at noon on the second day because of severe hyperthermia and almost complete feed refusal in ergot-fed steers. After recovery on ergot-free rations for 5 days, treatment groups were incrementally introduced, over a further 3–12 days, to rations containing 0, 1.1, 2.2 or 4.4 mg/kg of alkaloids (~0, 2.5, 5 or 10 g/kg ergot, respectively). Relative exposure to ergot was maintained, so that the zero- (control), low-, medium- and high-ergot groups remained so. Steers were individually fed ad libitum, and water was freely available. Steers in all ergot-fed groups had significantly elevated rectal temperatures at 0800–1000 hours, even when the temperature–humidity index was only moderate (~70), and displayed other signs of hyperthermia (increased respiration rate, mouth breathing, excessive salivation and urination), as the temperature–humidity index increased to 73–79 during the day. Plasma prolactin was significantly reduced in ergot-fed groups. Voluntary feed intakes (liveweight basis) of the ergot-fed groups were significantly reduced, averaging 94, 86 and 86%, respectively, of the feed intakes of the control group. Hair coats were rough. While the control steers grew from a mean initial liveweight of 275 kg to a suitable slaughter weight of 455 kg in 17 weeks (growth rate 1.45 kg/day), ergot-fed groups gained only 0.77–1.10 kg/day and took at least 5 weeks longer to reach the slaughter weight, despite removal of ergot at the same time as control steers were sent to slaughter. Sorghum ergot, even at low concentrations (1.1 mg alkaloids/kg feed) is severely detrimental to the performance of steers in the feedlot.

Effects of Isothermal and Adiabatic Thermal Loadings on Size and Strain Rate Dependence of Copper Nanowire

In the present paper, the size and strain rate effects on ultra-thin < 100 >/{100} Cu nanowires at an initial temperature of 10 K have been discussed. Extensive molecular dynamics (MD) simulations have been performed using Embedded atom method (EAM) to investigate the structural behaviours and properties under high strain rate. Velocity-Verlet algorithm has been used to solve the equation of motions. Two different thermal loading cases have been considered: (i) Isothermal loading, in which Nose-Hoover thermostat is used to maintain the constant system temperature, and (ii) Adiabatic loading, i.e., without any thermostat. Five different wire cross-sections were considered ranging from 0.723 x 0.723 nm(2) to 2.169 x 2.169 nm(2) The strain rates used in the present study were 1 x 10(9) s(-1), 1 x 10(8) s(-1), and 1 x 10(7) s(-1). The effect of strain rate on the mechanical properties of copper nanowires was analysed, which shows that elastic properties are independent of thermal loading for a given strain rate and cross-sectional dimension of nanowire. It showed a decreasing yield stress and yield strain with decreasing strain rate for a given cross- section. Also, a decreasing yield stress and increasing yield strain were observed for a given strain rate with increasing cross-sectional area. Elastic modulus was found to be similar to 100 GPa, which was independent of processing temperature, strain rate, and size for a given initial temperature. Reorientation of < 100 >/{100} square cross-sectional copper nanowire into a series of stable ultra-thin Pentagon copper nanobridge structures with dia of similar to 1 nm at 10 K was observed under high strain rate tensile loading. The effect of isothermal and adiabatic loading on the formation of such pentagonal nanobridge structure has been discussed.

Pharmacists' role in lung health

Breathing is important. In fact, most people take on average 23,000 breaths each day. However, most of us probably take this for granted and do not notice these breaths – unless of course maybe when we are exercising, or huffing and puffing because we are running late for the bus...

Methicillin Resistance In Staphylococci : Horizontal Transfer of Mobile Genetic Element (SCCmec) Between Staphylococcal Species

Regardless of the existence of antibiotics, infectious diseases are the leading causes of death in the world. Staphylococci cause many infections of varying severity, although they can also exist peacefully in many parts of the human body. Most often Staphylococcus aureus colonises the nose, and that colonisation is considered to be a risk factor for spread of this bacterium. S. aureus is considered to be the most important Staphylococcus species. It poses a challenge to the field of medicine, and one of the most problematic aspects is the drastic increase of the methicillin-resistant S. aureus (MRSA) strains in hospitals and community world-wide, including Finland. In addition, most of the clinical coagulase-negative staphylococcus (CNS) isolates express resistance to methicillin. Methicillin-resistance in S. aureus is caused by the mecA gene that encodes an extra penicillin-binding protein (PBP) 2a. The mecA gene is found in a mobile genomic island called staphylococcal chromosome cassette mec (SCCmec). The SCCmec consists of the mec gene and cassette chromosome recombinase (ccr)gene complexes. The areas of the SCCmec element outside the ccr and mec complex are known as the junkyard J regions. So far, eight types of SCCmec(SCCmec I- SCCmec VIII) and a number of variants have been described. The SCCmec island is an acquired element in S. aureus. Lately, it appears that CNS might be the storage place of the SCCmec that aid the S. aureus by providing it with the resistant elements. The SCCmec is known to exist only in the staphylococci. The aim of the present study was to investigate the horizontal transfer of SCCmec between the S. aureus and CNS. One specific aim was to study whether or not some methicillin-sensitive S. aureus (MSSA) strains are more inclined to receive the SCCmec than others. This was done by comparing the genetic background of clinical MSSA isolates in the health care facilities of the Helsinki and Uusimaa Hospital District in 2001 to the representatives of the epidemic MRSA (EMRSA) genotypes, which have been encountered in Finland during 1992-2004. Majority of the clinical MSSA strains were related to the EMRSA strains. This finding suggests that horizontal transfer of SCCmec from unknown donor(s) to several MSSA background genotypes has occurred in Finland. The molecular characteristics of representative clinical methicillin-resistant S. epidermidis (MRSE) isolates recovered in Finnish hospitals between 1990 and 1998 were also studied, examining their genetic relation to each other and to the internationally recognised MRSE clones as well, so as to ascertain the common traits between the SCCmec elements in MRSE and MRSA. The clinical MRSE strains were genetically related to each other; eleven PFGE types were associated with sequence type ST2 that has been identified world-wide. A single MRSE strain may possess two SCCmec types III and IV, which were recognised among the MRSA strains. Moreover, six months after the onset of an outbreak of MRSA possessing a SCCmec type V in a long-term care facility in Northern Finland (LTCF) in 2003, the SCCmec element of nasally carried methicillin-resistant staphylococci was studied. Among the residents of a LTCF, nasal carriage of MR-CNS was common with extreme diversity of SCCmec types. MRSE was the most prevalent CNS species. Horizontal transfer of SCCmec elements is speculated to be based on the sharing of SCCmec type V between MRSA and MRSE in the same person. Additionally, the SCCmec element of the clinical human S. sciuri isolates was studied. Some of the SCCmec regions were present in S. sciuri and the pls gene was common in it. This finding supports the hypothesis of genetic exchange happening between staphylococcal species. Evaluation of the epidemiology of methicillin-resistant staphylococcal colonisation is necessary in order to understand the apparent emergence of these strains and to develop appropriate control strategies. SCCmec typing is essential for understanding the emergence of MRSA strains from CNS, considering that the MR-CNS may represent the gene pool for the continuous creation of new SCCmec types from which MRSA might originate.

Experimental investigation of heat transfer reduction using forward facing cavity for missile shaped bodies flying at hypersonic speed

Forward facing circular nose cavity of 6 mm diameter in the nose portion of a generic missile shaped bodies is proposed to reduce the stagnation zone heat transfer. About 25% reduction in stagnation zone heat transfer is measured using platinum thin film sensors at Mach 8 in the IISc hypersonic shock tunnel. The presence of nose cavity does not alter the fundamental aerodynamic coefficients of the slender body. The experimental results along with the numerically predicted results is also discussed in this paper.

Chemical containment and eradication of screw− worm incursions in Australia

Screwworms are obligate, invasive parasites of warm-blooded animals. The female flies lay batches of eggs at the edge of wounds or other lesions. These eggs hatch to larvae or screw-worms which feed on affected animals for 6-7 days, burrowing deeply into subcutaneous tissues and causing severe trauma to animals, production loss and potentially death. Susceptible sites include wounds resulting from management practices such as castration, de-horning and ear tagging and lesions caused by the activities of other parasites such as buffalo flies and ticks. The navels of the new born and the vulval region of their mothers following parturition are highly susceptible and body orifices such as nose and ears are also frequent targets for ovipositing screwworm flies. The Old World screw-worm, Chrysomya bezziana (OWS) is considered one of the most serious exotic insect pest threatening Australia's livestock industries and is endemic in a number of our closest neighbouring countries. New World screwworm (NWS), Cochliomyia hominivorax, endemic to South America, has also entered Australia on at least 2 occasions. Many tropical and subtropical areas of Australia are suitable for the establishment of OWS and the potential range is expected to increase with climate change. The Australian screwworm preparedness strategy indicates a program of containment with chemical treatments followed by eradication of OWS using sterile male release and parasiticides. However, there is no longer an operational OWS sterile insect screw-worm facility anywhere in the world and establishing a large scale production facility would most optimistically take at least 2 years. In the interim, containment would be almost totally dependent on the availability of effective chemical controls. A review of chemical formulations available for potential use against OWS in Australia found that currently only one chemical, ivermectin administered by subcutaneous injection (s.c.) is registered for use against OWS and that many of the chemicals previously shown to be effective against OWS were no longer registered for animal use in Australia.18 From this review a number of Australian-registered chemicals were recommended as a priority for testing against OWS. The Australian Pesticides and Veterinary Medicines Authority (APVMA) can issue an emergency use permit for use of pesticides if they are registered in Australia for other animal uses and shown to be effective against OWS. This project tested the therapeutic and prophylactic efficacy of chemicals with potential for use in the treatment and control of OWS.