Background Obstructive apnea hypopnea index (OAHI) does not take into account the level of work of breathing when used to diagnose obstructive sleep apnea (OSA) in children. Aim 1) To measure quantitatively the surface EMG of the diaphragm (sEMGdia) and hence work of breathing in normal snorers, children with increased work of breathing (WOB) but no OSA, and children with OSA. 2) To determine the relationship between sEMGdia and OAHI. Methods Sleep studies were divided into 3 groups: 1. ‘Normal snorers’ who had an OAHI 1/hour. In each child, 2 excerpts consisting of 10 consecutive breaths during each stage of sleep (light sleep, deep sleep, and REM sleep) were exported from the Compumedics Profusion 3 system to the Spike2 data acquisition and analysis system for analysis of sEMGdia. Results The 3 ‘Normal snorers’ (age 0.92-8.6 years) had lower pooled sEMG dia 5.41uV (mean, SD 1.43) compared to the 4 children with OSA (age 2.9-6.6 years; sEMG dia 18.87uV, SD 10.91). The 4 children in WOB group (age 1.5-5.7 years) had increased respiratory effort compared to normal snorers, with sEMG dia 14.97uV, SD 13.51. OAHI did not correlate with sEMG dia . Conclusions sEMG dia hence work of breathing can be elevated in children with normal sleep study (OAHI dia appears to be a different measure to OAHI. Larger study is needed.
There is a need to develop ambulatory care components within medical schools and, accordingly, a need to recruit community faculty. To assist in recruiting and retaining community faculty, this study addresses factors influencing physicians' decisions to serve as preceptors. The study also examines the relative value of incentives as rated by physicians in different primary care specialties.We surveyed community physicians affiliated with a large, public teaching hospital. Physicians rated prior experiences training students in ambulatory settings, plans for serving as preceptors within the next year, and 7 incentives for serving as preceptors.A path analysis indicated that prior experiences and student influence on patient care affected future decisions to serve as preceptors. Analysis of the incentives for serving as preceptors indicated that physicians rated receiving continuing medical education (CME) credit the most favorably and financial compensation the least favorably. Overall, family physicians assigned the highest ratings to the incentives, and gynecologists gave the lowest ratings.This study produced a better understanding of the factors influencing physicians' decisions to serve as preceptors. Physicians are more concerned about students' influence on patient care than they are about students' influence on patient billings. In addition, preceptors preferred receiving nonmonetary compensation, such as CME credit, rather than receiving financial compensation. In addition, this study suggests better ways to reward community physicians for their service as preceptors. Community faculty should not be viewed as a homogenous group. The results of this study suggest that community physicians be provided with choices regarding the incentives for and rewards associated with serving as preceptors.
Standard of care recommend that patients with cystic fibrosis (CF) require screening investigations to assess for complications. Changing models of care due to the COVID19 pandemic may have impacted completion of recommended screening.To compare the frequency of screening investigations completed in people with CF before and after the onset of the COVID19 pandemic.Medical records were reviewed at 4 CF-specialist centers to identify screening investigations completed in the 12-months before and after pandemic onset.Records of 625 patients were reviewed. Prior to pandemic onset, there was between center variability in completion of screening investigations. There was greatest baseline variation between centers in performing oral glucose tolerance test (OGTT); range 38%-69%, exercise tests; 3%-51% and sputum screening for non-tuberculous mycobacteria; 53%-81%. Following pandemic onset, blood tests, and sputum cultures were maintained at the highest rates. Exercise testing, CXR and OGTT exhibited the greatest declines, with reductions at individual centers ranging between 10%-24%, 22%-43%, and 20%-26%, respectively. Return to in-person visits following pandemic onset was variable, ranging from 16% to 74% between centers.Completion of screening investigations varies between CF centers and changes in models of care, such as increased virtual care in response to COVID19 pandemic was associated with reduction in completion of investigations. Centers would benefit from auditing their adherence to standards of care, particularly considering recent changes in care delivery.
Introduction: Meconium ileus (MI) is a form of neonatal intestinal obstruction which affects approximately 15% of infants with cystic fibrosis (CF). The aetiology of MI appears unrelated to the severity of impairment of CFTR mediated chloride current or indeed to pancreatic sufficiency / insufficiency. Distal ileal obstruction syndrome in CF is associated with a transmural inflammation of the ileum. We hypothesized that MI is an antenatal inflammatory disorder of the intestine. Methods: Full thickness ileal tissues were available from 6 infants with CF and neonatal MI (complicated = 3; simple = 3) requiring surgical intervention. Control intestine was available from infants with intestinal atresia requiring neonatal surgery. No infant had been fed or received pancreatic enzyme supplements. All were homozygous or compound heterozygotes for the ƒ’F508 mutation. Specimens were examined using routine H&E staining and immunocytochemical staining (antibodies against CD45ro which reacts with primed or memory T cells, the anti-pan T-cell marker CD3 the anti helper / inducer T cell marker CD4 and CD8 a marker for suppressor / cytotoxic T cells). The integrity of the muscularis and characterisation of mesenchymal cell phenotype was assessed using monoclonal antibodies against ƒñ-smooth muscle actin, desmin and vimentin Results: Florid mucosal lymphocytic ileitis was present in 6/6 which was associated with a transmural lymphocytic inflammatory process in all cases. Myofibroblast (actin +ve, desmin +ve, vimentin??Vve) proliferation was prominent within the submucosa in 6/6 and collagen deposition apparent in 2/6. The findings were similar to those described in DIOS, although of a lesser severity Conclusion: Severe MI in children with CF is associated with transmural lymphocytic ileitis and leiomyositis and myofibroblastic transformation. These findings support the notion that CF is a proinflammatory and profibrotic condition which starts in utero.
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)