Objective
To assess the frequency of obstructive sleep apnoea among women with and without hypertensive disorders of pregnancy.
Design
Cohort study.
Setting
Obstetric clinics at an academic medical ...centre.
Population
Pregnant women with hypertensive disorders (chronic hypertension, gestational hypertension, or pre‐eclampsia) and women who were normotensive.
Methods
Women completed a questionnaire about habitual snoring and underwent overnight ambulatory polysomnography.
Main outcome measures
The presence and severity of obstructive sleep apnoea.
Results
Obstructive sleep apnoea was found among 21 of 51 women with hypertensive disorders (41%), but in only three of 16 women who were normotensive (19%, chi‐square test, P = 0.005). Author correction added on 16 June 2014, after first online publication: Results mentioned in the were amended. Non‐snoring women with hypertensive disorders typically had mild obstructive sleep apnoea, but >25% of snoring women with hypertensive disorders had moderate to severe obstructive sleep apnoea. Among women with hypertensive disorders, the mean apnoea/hypopnoea index was substantially higher in snorers than in non‐snorers (19.9 ± 34.1 versus 3.4 ± 3.1, P = 0.013), and the oxyhaemoglobin saturation nadir was significantly lower (86.4 ± 6.6 versus 90.2 ± 3.5, P = 0.021). Among women with hypertensive disorders, after stratification by obesity, the pooled relative risk for obstructive sleep apnoea in snoring women with hypertension compared with non‐snoring women with hypertension was 2.0 (95% CI 1.4–2.8).
Conclusions
Pregnant women with hypertension are at high risk for unrecognised obstructive sleep apnoea. Although longitudinal and intervention studies are urgently needed, given the known relationship between obstructive sleep apnoea and hypertension in the general population, it would seem pertinent that hypertensive pregnant women who snore should be tested for obstructive sleep apnoea, a condition believed to cause or promote hypertension.
Winner of the 2008 AERA Division B Outstanding Book Award Presenting the first complete history of the Progressive Education Association's Eight-Year Study, which took place during the 1930s and the ...1940s, this book corrects common misinterpretations of one of the most important educational experiments of the twentieth century and explores the study's value for reexamining secondary education in America today.
Before Stonewall Bullough, Vern L
2002, 20140204, 2014-02-04
eBook
Explore the early history of the gay rights movement!
In the words of editor Vern L. Bullough: "Although there was no single leader in the gay and lesbian community who achieved the fame and ...reputation of Martin Luther King, there were a large number of activists who put their careers and reputations on the line. It was a motley crew of radicals and reformers, drawn together by the cause in spite of personality and philosophical differences. Their stories are told in the following pages."
Before Stonewall: Activists for Gay and Lesbian Rights in Historical Context illuminates the lives of the courageous individuals involved in the early struggle for gay and lesbian civil rights in the United States. Authored by those who knew them (often activists themselves), the concise biographies in this volume examine the lives of pre-1969 barrier breakers like Harry Hay, Henry Gerber, Alfred Kinsey, Del Martin, Phyllis Lyon, Jim Kepner, Jack Nichols, Christine Jorgensen, Jose Sarria, Barbara Grier, Frank Kameny, and 40 more.
To anyone with an interest in the history of the gay/lesbian rights movements in the United States, these names will be familiar, but did you know that in addition to their groundbreaking activism:
Prescott Townsend was a Boston Brahman
Dorr Legg was a Log Cabin Republican
Harry Hay was at one time a member of the Communist party
Jim Kepner was a boy preacher
Troy Perry was removed from the ministry of his church for homosexuality--and then founded the gay-friendly Metropolitan Community Church
Reed Erickson--a transsexual millionaire who gave millions to the cause--kept a pet leopard called Henry
Barbara Gittings set up a kissing booth at the American Library Association convention and urged attendees to kiss a gay or lesbian!
Before Stonewall is a perfect ancillary text for any gay/lesbian studies course, but more to the point, no one interested in these heroic figures and
Summary We report a case of postpartum headache caused by internal carotid artery dissection in a 36-year-old woman following uneventful epidural analgesia for spontaneous labor and vaginal delivery. ...Cervicocerebral arterial dissection requires rapid diagnosis and anticoagulation to prevent thrombus formation and to avoid secondary cerebral thromboembolism. Fortunately, our patient suffered ischemic symptoms, but no permanent neurologic deficit. Anesthesiologists should consider carotid artery dissection in the differential diagnosis of postpartum headache.
A primiparous, full‐term, 28‐year‐old woman underwent an emergency lower segment Caesarean section under epidural anaesthesia for failure to progress in the first stage. Despite an uneventful ...pregnancy and delivery, she developed a hypertensive crisis in the postoperative period complicated by acute pulmonary oedema requiring ventilation for 48 h in the intensive care unit. Intravenous magnesium sulphate infusions and hydralazine boluses were used to control the blood pressure, which was associated with clonus, hyperreflexia, tachycardia and profuse sweating. The patient made a good recovery. Later measurement of urinary catecholamines in the recovery phase showed greatly elevated levels of norepinephrine, dopamine and vanillyl mandelic acid. Further investigations included a normal abdominal computed tomography scan and a I‐123 meta‐iodo‐benzyl‐guanidine scintigraphy scan which revealed a 3‐ to 4‐cm irregular tumour located at the level of the lower pole of the right kidney and further liver hot spots. Intravenous magnesium sulphate infusion proved successful in controlling hypertension caused by a phaeochromocytoma in the postpartum period.
This study was designed to measure anxiety levels in 91 partners of women undergoing elective Caesarean section under regional anaesthesia and to outline potential relieving factors. Twenty-eight ...percent of partners were pathologically anxious. There was a positive association between anxiety and prior attendance at the anaesthetic assessment clinic (p=0.008). There was no statistically significant association between anxiety and education, occupation, gender, relationship to the patient or previous attendance at Caesarean section. Concern about a safe outcome for the mother and child caused most anxiety, less being expressed regarding presence in the operating theatre or anaesthesia per se. Over 70% of partners expressed the view that attendance at the anaesthetic assessment clinic or provision of written information would reduce their anxiety.
The primary structural component of the bacterial cell wall is peptidoglycan, which is essential for viability and the synthesis of which is the target for crucial antibiotics
. Peptidoglycan is a ...single macromolecule made of glycan chains crosslinked by peptide side branches that surrounds the cell, acting as a constraint to internal turgor
. In Gram-positive bacteria, peptidoglycan is tens of nanometres thick, generally portrayed as a homogeneous structure that provides mechanical strength
. Here we applied atomic force microscopy
to interrogate the morphologically distinct Staphylococcus aureus and Bacillus subtilis species, using live cells and purified peptidoglycan. The mature surface of live cells is characterized by a landscape of large (up to 60 nm in diameter), deep (up to 23 nm) pores constituting a disordered gel of peptidoglycan. The inner peptidoglycan surface, consisting of more nascent material, is much denser, with glycan strand spacing typically less than 7 nm. The inner surface architecture is location dependent; the cylinder of B. subtilis has dense circumferential orientation, while in S. aureus and division septa for both species, peptidoglycan is dense but randomly oriented. Revealing the molecular architecture of the cell envelope frames our understanding of its mechanical properties and role as the environmental interface
, providing information complementary to traditional structural biology approaches.
As long as there have been teachers, there has been an expectation that they be of good character and model virtue. The author describes developments in the thought about teacher dispositions and ...identifies specific shortcomings in the effort to define and assess them as part of teacher education program accreditation. Virtue ethics as an alternative conceptual possibility is considered but found wanting. Seeking to identify a moral framework capable of supporting education, including teacher education program development, he suggests focus on the “manners” of democracy that arise from an analysis of democracy as a distinctive way of life, an essential social and civic practice. Five manners are suggested: hospitality, attuned listening, voice, reflectivity, and evidential discernment. Each manner is briefly described and discussed.
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