Search

This study is entitled, "Perception of Passengers on Safety Measure Practices of Motorized Banca in Naval, Biliran". The purpose of this study is to determine the level of perception of passengers on safety measure practices of motorized Banca in Naval, Biliran. With 100 respondents the study revealed that most of the respondents of the municipality of Naval, Biliran are ages 25 and below, male and single. Based on the perception of passengers, it indicates that not all of the crews of the Banca are in uniform and have proper hygiene also since only a few of them experience commotion or problems during their travel, Banca operators and crews are doing their job on maintaining safety and security sea travel for the public.

This paper presents the safety practices of hotel accommodation amidst the pandemic in Naval, Biliran. The aim is to evaluate the safety practices of hotel establishments during the Covi-19 pandemic. This paper used a descriptive approach to assess the demographic profile of the respondents such as age, sex; civil status, and work status of the employee, including the social measures they practice. The research design for this study is a quantitative research approach as it is the most appropriate approach to answer the research problem. The research study revealed that in the Safety practices of hotel establishment and Basic protective measures of Hotel establishment majority of the respondents are constantly practicing Reception & Check-in procedures, accommodation, employees, Physical distancing measures, hand cleaning, respiratory hygiene, Ventilation, Air conditioning. Therefore, the study limits the number of bookings and guests to ensure the spreading of COVID-19 in the area as the employee practices social distancing and applies social measures during working time.

• Background: Obstructive Sleep Apnoea (OSA) involves repeated breathing pauses during sleep due to upper airway obstruction. It causes excessive daytime sleepiness and has other health impacts. Continuous Positive Airway Pressure(CPAP) therapy is effective first line treatment for moderate to severe OSA. Unfortunately, many patients have difficulty tolerating CPAP and pressure intolerance is probably an important contributing factor. Mandibular Advancement Devices (MAD) are an alternative to CPAP. They are worn in the mouth during sleep to reduce airway obstruction. There is some evidence that, when used in combination with CPAP, MADs improve airway anatomy enough to reduce the CPAP pressure required to treat OSA; and that this combination therapy could improve CPAP adherence. • Methods: Consecutive patients starting on CPAP for moderate to severe OSA will be recruited at a regional NHS sleep service. Patients with high CPAP pressure requirements after initial titration, who satisfy all entry criteria and consent to participate, will undertake a 2-arm randomised crossover trial. The arms will be: i) standalone CPAP and ii) CPAP+MAD therapy. Each arm will last 12 weeks, including 2 weeks acclimatisation. CPAP machines will be auto-titrating and with facility for data download, so the impact of MAD on CPAP pressure requirements and CPAP adherence can be easily measured. The primary outcome will be CPAP adherence. Secondary outcomes will include measures of OSA severity, patient reported outcome measures including subjective daytime sleepiness, quality of life, and treatment preference at trial exit and health service use. Cost-effectiveness analyses will be undertaken. • Discussion: If the intervention is shown to be effective and cost-effective in improving adherence in this standard CPAP-eligible OSA patient population it would be of immediate benefit to all patients with OSA, within the wider NHS and globally. Both MAD and CPAP are already used by sleep services so their combination would require only minor adjustments to existing clinical pathways. It would be straightforward to disseminate the results of the study through regional, national and international respiratory meetings. The health economics analysis would provide cost effectiveness data to inform service planning and clinical guidelines through policy briefing papers, including to NICE and SIGN. • Trial registration: If your article reports the results of a health care intervention on human participants, it must be registered in an appropriate registry and the registration number and date of registration should be in stated in this section. If it was not registered prospectively (before enrollment of the first participant), you should include the words 'retrospectively registered'. See our editorial policies for more information on trial registration. • PAPMAT wasregistered with ISRCTN prior to recruitment beginning (1).: https://www.isrctn.com/ISRCTN33966032

Background Postpartum haemorrhage (PPH) is a major cause of maternal morbidity and mortality and its incidence is increasing in many countries despite management guidelines. A national quality improvement programme called the Obstetric Bleeding Strategy for Wales (OBS Cymru) was introduced in all obstetric units in Wales. The aim was to reduce moderate PPH (1000 mL) progressing to massive PPH (> 2500 mL) and the need for red cell transfusion. Methods A PPH care bundle was introduced into all 12 obstetric units in Wales included all women giving birth in 2017 and 2018 (n = 61,094). The care bundle prompted: universal risk assessment, quantitative measurement of blood loss after all deliveries (as opposed to visual estimation), structured escalation to senior clinicians and point-of-care viscoelastometric-guided early fibrinogen replacement. Data were submitted by each obstetric unit to a national database. Outcome measures were incidence of massive PPH (> 2500 mL) and red cell transfusion. Analysis was performed using linear regression of the all Wales monthly data. Results Uptake of the intervention was good: quantitative blood loss measurement and risk assessment increased to 98.1 and 64.5% of all PPH > 1000 mL, whilst ROTEM use for PPH > 1500 mL increased to 68.2%. Massive PPH decreased by 1.10 (95% CI 0.28 to 1.92) per 1000 maternities per year (P = 0.011). Fewer women progressed from moderate to massive PPH in the last 6 months, 74/1490 (5.0%), than in the first 6 months, 97/1386 (7.0%), (P = 0.021). Units of red cells transfused decreased by 7.4 (95% CI 1.6 to 13.2) per 1000 maternities per year (P = 0.015). Red cells were transfused to 350/15204 (2.3%) and 268/15150 (1.8%) (P = 0.001) in the first and last 6 months, respectively. There was no increase in the number of women with lowest haemoglobin below 80 g/L during this time period. Infusions of fresh frozen plasma fell and there was no increase in the number of women with haemostatic impairment. Conclusions The OBS Cymru care bundle was feasible to implement and associated with progressive, clinically significant improvements in outcomes for PPH across Wales. It is applicable across obstetric units of widely varying size, complexity and staff mixes.

Introduction: Previous studies have linked short sleep duration, poor sleep quality, and late sleep timing with lower health-related quality of life (HRQoL) in children. However, almost all studies relied solely on self-reported sleep information, and most studies were conducted in high-income countries. To address these gaps, we studied both device-measured and self-reported sleep characteristics in relation to HRQoL in a sample of children from 12 countries that vary widely in terms of economic and human development. Methods: The study sample included 6,626 children aged 9-11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Waist-worn actigraphy was used to measure total sleep time, bedtime, wake-up time, and sleep efficiency on both weekdays and weekends. Children also reported ratings of sleep quantity and quality. HRQoL was measured by the KIDSCREEN-10 survey. Multilevel regression models were used to determine the relationships between sleep characteristics and HRQoL. Results: Results showed considerable variation in sleep characteristics, particularly duration and timing, across study sites. Overall, we found no association between device-measured total sleep time, sleep timing or sleep efficiency, and HRQoL. In contrast, self-reported ratings of poor sleep quantity and quality were associated with HRQoL. Conclusions: Self-reported, rather than device-based, measures of sleep are related to HRQoL in children. The discrepancy related to sleep assessment methods highlights the importance of considering both device-measured and self-reported measures of sleep in understanding its health effects. (c) 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.

Background Existing research has documented inconsistent findings for the associations among breakfast frequency, physical activity (PA), and sedentary time in children. The primary aim of this study was to examine the associations among breakfast frequency and objectively-measured PA and sedentary time in a sample of children from 12 countries representing a wide range of human development, economic development and inequality. The secondary aim was to examine interactions of these associations between study sites. Methods This multinational, cross-sectional study included 6228 children aged 9–11 years from the 12 International Study of Childhood Obesity, Lifestyle and the Environment sites. Multilevel statistical models were used to examine associations between self-reported habitual breakfast frequency defined using three categories (breakfast consumed 0 to 2 days/week [rare], 3 to 5 days/week [occasional] or 6 to 7 days/week [frequent]) or two categories (breakfast consumed less than daily or daily) and accelerometry-derived PA and sedentary time during the morning (wake time to 1200 h) and afternoon (1200 h to bed time) with study site included as an interaction term. Model covariates included age, sex, highest parental education, body mass index z-score, and accelerometer waking wear time. Results Participants averaged 60 (s.d. 25) min/day in moderate-to-vigorous PA (MVPA), 315 (s.d. 53) min/day in light PA and 513 (s.d. 69) min/day sedentary. Controlling for covariates, breakfast frequency was not significantly associated with total daily or afternoon PA and sedentary time. For the morning, frequent breakfast consumption was associated with a higher proportion of time in MVPA (0.3%), higher proportion of time in light PA (1.0%) and lower min/day and proportion of time sedentary (3.4 min/day and 1.3%) than rare breakfast consumption (all p ≤ 0.05). No significant associations were found when comparing occasional with rare or frequent breakfast consumption, or daily with less than daily breakfast consumption. Very few significant interactions with study site were found. Conclusions In this multinational sample of children, frequent breakfast consumption was associated with higher MVPA and light PA time and lower sedentary time in the morning when compared with rare breakfast consumption, although the small magnitude of the associations may lack clinical relevance. Trial registration The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) is registered at (Identifier NCT01722500 ).

BackgroundPostpartum haemorrhage (PPH) contributes to substantial maternal morbidity. Research into PPH has led to improvements in care which have been incorporated into the Obstetric Bleeding Strategy for Wales.InterventionA national quality improvement team supported local teams in implementing multiple interventions including risk assessment, objective measurement of blood loss, multiprofessional assessment (at the bedside at 1000 mL blood loss) and point-of-care (POC) testing of coagulation to guide blood product resuscitation during PPH. The project was rolled out to all 12 obstetric units in 2017. The interventions were reinforced by an All Wales Guideline, PPH proforma and standardised training. A national database, biannual audits, and patient and staff surveys reported process and outcome measures.ResultsProcess measures: during 2017, there was an increase in the percentage of maternities with documented risk assessment (0%–76%), objective measurement of blood loss (52%–88%) and POC testing for coagulation for PPH ≥1500 mL (38%–59%). Maternity staff survey indicated that 94% were aware of the project and 87% stated that it had changed their unit’s management of PPH. Interim outcome measures: the incidence (95% CI) of PPH ≥2500 mL per 1000 maternities in 2017 was 6.03 (5.23–6.95). The annual number of women receiving any red blood cell transfusion, level 3 intensive care admission and hysterectomy for PPH was 19.7 (18.2 to 21.3), 0.702 (0.464 to 1.06) and 0.255 (0.129 to 0.504) per 1000 maternities, respectively.ConclusionsA high level of project awareness across Welsh maternity units has been achieved. Measurement of blood loss was reported to be the most important early change in practice, while PPH documentation and POC testing continue to be embedded. Combining qualitative and quantitative measures to inform implementation has improved project delivery and allowed teams to adapt to local contexts.

PURPOSE: Inspiratory muscle training (IMT) has been shown to improve dyspnoea, exercise tolerance and respiratory muscle strength in patients with chronic obstructive pulmonary disease (COPD), however the efficacy of expiratory muscle training (EMT) is equivocal. Respiratory muscle training (RMT) protocols are strenuous, therefore the purpose was to determine the effects of a modified IMT protocol or EMT protocol compared to standard IMT on respiratory health outcomes in patients with COPD. METHODS: 11 COPD patients enrolled in pulmonary rehabilitation completed a randomised controlled pilot trial involving either: eight breaths of IMT (IMT8), 30 breaths of IMT (IMT30) or 30 breaths of EMT (EMT30). RMT was performed twice daily, six days a week for six weeks, commencing at 25% of respiratory muscle strength and progressing by 5% per week up to 50% in the final week. Maximal inspiratory (PImax) and expiratory (PEmax) mouth pressures, Body mass index, airway Obstruction (FEV1), Dyspnoea (modified MRC scale) and Exercise capacity (6 minute walk test; 6MWD), for the calculation of BODE index, and anxiety and depression (hospital anxiety and depression scale; HADS) were recorded before and after the intervention. Data are presented as mean difference ± SD and percentage change while Cohen’s d were applied to determine small (≥0.2), moderate (≥0.5) and large (≥0.8) effect sizes. RESULTS: BODE index decreased in all groups (IMT8: 22% [d = -1.00], IMT30: 7% [d = -0.25] & EMT30: 36.5% [d = -1.08]), with IMT8 (-1.3 ± 1.3) and EMT30 (-1.3 ± 1.2) being the most meaningful. IMT8 & EMT30 were more effective in improving BODE index (d = 0.75 & d = 0.87, respectively) and reducing anxiety (d = -0.83 and d = -0.95, respectively) compared to IMT30. 6MWD increased in all groups: 17% in IMT8 (d = 0.85), 22% in IMT30 (d = 0.38) and 32% in EMT30 (d = 0.75). Both PImax (+15.4 ± 13.1 [d = 1.04] & 11.3 ± 21.4 cmH2O [d = 0.94] and PEmax (+4.0 ± 16.2 [d = 0.16] & 4.0 ± 13.5 cmH2O [d = 0.22]) increased following IMT8 and IMT30, respectively, whereas EMT30 had no positive effect on PImax/PEmax. Compliance was greater during IMT8 (98±2%) compared to IMT30 (85±14%; d = 1.33) and EMT30 (65±31%; d = 1.83). CONCLUSION: Both IMT protocols demonstrated similar improvements in respiratory muscle strength, however only IMT8 and EMT30 showed meaningful reductions in BODE index and HADS.