Measurements of ozone uptake efficiency in the human respiratory tract provide critical information toward understanding ozone dose-response characteristics. We measured ozone uptake efficiency by different regions of the respiratory tract between the mouth and bronchus intermedius in 10 healthy, resting, nonsmoking male and female subjects. The distal end of a bronchoscope was sequentially positioned at the bronchus intermedius (BI), main carina (CAR), upper trachea, and above the vocal cords. Ozone concentration was measured continuously at each sight using a rapid-responding ozone analyzer. During sampling subjects breathed through a mouthpiece connected to a pneumotachograph at a paced rate of 12 breaths/min. Integration of the product of the flow and ozone concentrations during inspiration and expiration provided the ozone mass passing each anatomic location during each phase of respiration. On inspiration the uptake efficiencies of ozone by structures between the mouth and each location j (Em-j) were 0.176 +/- 0.037 (SE), 0.271 +/- 0.024, 0.355 +/- 0.030, and 0.325 +/- 0.031 for above the vocal cords, upper trachea, CAR, and BI, respectively. A significant effect of location on Em-j was found by analysis of variance (P < 0.0002). Pairwise comparisons showed that Em-j increased as the lung penetration increased except between CAR and BI, which was not significantly different.
Background: Obesity and prescription opioid misuse are important public health concerns in the United States. A common intersection occurs when women with obesity undergo cesarean birth and receive narcotic medications for postpartum pain.
Objective: To examine the association between obesity and inpatient opioid use after cesarean birth.
Methods: A retrospective cohort study of patients that underwent cesarean birth in 2015-2018. Primary outcome was post-cesarean delivery opioid consumption starting 24 hours after delivery measured as morphine milliequivalents per hour (MME/hr). Secondary outcome was MME/hr consumption in the highest quartile of all subjects. Opioid consumption was compared between three BMI groups: non-obese BMI 18.5-29.9 kg/m2; obese BMI 30.0-39.9 kg/m2; and morbidly obese BMI ≥ 40.0 kg/m2 using univariable and multivariable analyses.
Results: Of 1,620 patients meeting inclusion criteria, 496 (30.6%) were in the non-obese group, 753 (46.5%) were in the obese group, and 371 (22.9%) were in the morbidly obese group. In the univariate analysis, patients with obesity and morbid obesity required higher MME/hr than patients in the non-obese group [1.3 MME/hr (IQR 0.1, 2.4) vs. 1.6 MME/hr (IQR 0.5, 2.8) vs. 1.8 MME/hr (IQR 0.8, 2.9), for non-obese, obese, and morbidly obese groups respectively, p<0.001]. In the multivariable analysis, this association did not persist. In contrast, subjects in the obese and morbidly obese groups were more likely to be in the highest quartile of MME/hr opioid consumption compared with those in the non-obese group (23.5% vs. 48.1% vs. 28.4%, p<0.001, respectively); with aOR 1.42 (95% CI 1.07-1.89, p-0.016) and aOR 1.60 (95% CI 1.16-2.22, p=0.005) for patients with obesity and morbid obesity, respectively.
Conclusion: Maternal obesity was not associated with higher hourly MME consumption during inpatient stay after cesarean birth. However, patients with obesity and morbid obesity were significantly more likely to be in the top quartile of MME hourly consumption.
INTRODUCTION:
5.0% of pregnant women use one or more addictive substances. Drug use during pregnancy significantly increases the risk of adverse maternal and fetal outcomes. The Prenatal Recovery Clinic (PRC) is a specialty clinic at Jackson Memorial Hospital that provides care for pregnant women with a history of addiction. The objective of our study is to gain a greater understanding of the patients, their drug habits, health care experiences, and health outcomes at the PRC.
METHODS:
Pregnant women 18-50 years old that used substance and were patients at the PRC between March 2016 and April 2017 were eligible to participate in the study. Surveys was administered at two different times; the first at a PRC prenatal visit and another postpartum. Birth outcome data was extracted from medical records manually.
RESULTS:
Twelve patients were enrolled in the study. Of these patients, 33% reported more than one drug as their drug of choice. Participants rated the PRC clinic experience overall more favorably than their experience at the hospital for delivery, although the two experiences were not found to be statistically significant. Averages of PRC patient birth outcomes, such as gestational age, birth weight, and APGAR scores fell within normal limits.
CONCLUSION:
Pregnant patients with addiction can benefit from specialized clinics like the PRC that provide specialized care and assistance for pregnant women with a history of substance use. The results from our study indicate a potential for establishing a model similar to the PRC, that can be replicated to other clinics to address addiction in pregnancy.
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