Pseudomonas aeruginosa was injected intranasally into four groups of chinchillas to determine if these bacteria can invade the middle ear by way of the eustachian tube. One group completed penicillin treatment of bilateral penumococcal otitis media (POM), and the second group started penicillin treatment of bilateral POM at the time of P. aeruginosa injection. A third group had no POM, but completed a course of penicillin treatment before P. aeruginosa injection, and a fourth group had no POM and received no penicillin. Middle ear susceptibility to nasally injected P. aeruginosa was significantly higher in animals with POM (61%) than in animals without POM (32%, p = 0.001). Forced eustachian tube opening pressures did not correlate with P. aeruginosa susceptibility. Thus, P. aeruginosa, the principle pathogen of chronic suppurative otitis media, can invade the middle ear by way of the eustachian tube, and acute otitis media predisposes to middle ear infection by P. aeurginosa.
The modified bubble CPAP system reliably provided alternating pressures similar to bi-level positive airway pressure modes of respiratory support in neonatal mannikins. The dual-pressure technology is a simple, single connection add-on that can readily be applied to existing bubble CPAP systems.
BACKGROUND: Infant respiratory distress remains a significant problem worldwide, leading to more than one million neonatal deaths each year. The cost, maintenance, energy, and personnel required to implement ventilators have proven to be a barrier in many resource-limited settings. To address these barriers, a nonelectric bubble noninvasive positive pressure ventilation (NIV) device was developed. This study aims to benchmark the performance of this bubble NIV device against commercially available ventilators. METHODS: The delivered pressure waveforms and tidal volumes of the bubble NIV device were compared with those of 2 conventional ventilators (ie, Dr€ ager Evita Infinity V500 and Hamilton G5) at the following pressure settings: 8/5, 12/5, and 15/5 cm H 2 O. To simulate the lung mechanics of an infant in respiratory distress, tests were conducted on the IngMar ASL 5000 Test Lung simulator. Resistance was set at 100 cm H 2 O/L/s, and compliance was tested at 0.5, 1.0, and 2.0 mL/cm H 2 O to simulate 3 different patients. RESULTS: The delivered pressure waveforms and compliance curves of the bubble NIV device are similar to those of the Hamilton and Dr€ ager ventilators. The mean 6 SD differences between delivered versus set pressure gradient (ie, the difference between the high delivered pressure and the low delivered pressure) for each treatment modality across the various values of compliance were 22 6 8% for the bubble NIV device, 3 6 4% for the Dr€ ager ventilator, and 7 6 10% for the Hamilton ventilator. CONCLUSIONS: The similarity of pressure waveforms and delivered tidal volumes in this simulated clinical scenario suggest that the bubble NIV device may provide comparable efficacy compared with traditional ventilator treatment for a range of patients. This may provide clinicians in resource-limited settings with an additional, simple, nonelectric treatment modality for the management of infant respiratory distress.
their needs and organizing strategies to meet those needs to a desired performance. There is inadequate evidence on interest, level of influence and effects of participation on facility performance. This study sought to explore the structures, intrests and level of influnce of collaborative level representatives in provision of primary care services in Uasin Gishu County Structure/Method/Design: Case Study Methodology. Five primary health care facilities were selected purposively, from the six different sub-Counties. Study population included health facility committee representatives and other stakeholders working to represent community members in health activities. Data collection was through observation, Key Informant interviews, informal group discussions and review of documents including minutes.. Data was captured using audio recording, pictures, notetaking and a reflective journal. Data was and transcribed cleaned coded and analyzed into emerging themes. Findings: A total of 26 respondents were interviewed, and minutes of 5 facilities for s reviewed of the past 2 years starting 2014. Attended 3 public health public participation activities, and sat in three meetings. Health Facility Committee is the main formal government structure for community members to participate. There was no formal schedule for meetings attendance except for one facility. Committee mainly meet when there is funds for facility or any project going on. The facility committee's members participated majorly in projects as opposed to day to day functioning of facility. The committee members generally attended all meetings funds. Committee members with bigger influence were former political leaders or retired government officials. They are also able to lobby with government for mainly infrastructure support Sometimes the committee members whistle blow on lack of drugs or shortage of facilities to political leaders like Governor. Outcome & Evaluation: Structures of collaborative representation should be strengthened. A coordinated and collaborative response is required to tackle the complexity collaborative participation. Collaborative participation is a delicte process and needs strentnening for representation of community inteests Going Forward: Community has some level of influce which utimately affects the service delivery. Source of Funding: Consortium for Advanced Research Training in Africa (CARTA). Future heath systems.
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