Body Mass Index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers

OBJECTIVES: Obstructive sleep apnea (OSA) is the main predisposing factor of excessive daytime sleepiness (EDS), and, therefore, increases the risk of road crashes. However, it is difficult to rely on medical intake for OSA or fatigue since drivers' symptoms reports are not reliable. On the other hand, direct measurement of EDS among large numbers of drivers carries serious practical drawbacks. Obstructive sleep apnea, in turn, is strongly related to obesity, and elevated body mass index (BMI) is considered one of the major risk factors for OSA. Thus, it could be postulated that BMI may carry predictive value for EDS proneness. METHODS: The present study examined the interrelation between BMI, degree of OSA, as measured with Respiratory Distress Index (RDI), and the degree of EDS, as measured with the mean sleep onset latency in the Multiple Sleep Latency Test (MSLT) among obese (BMI = 32) professional drivers. The drivers went through polysomnography followed by the five sessions of MSLT in the next day. RESULTS: In accordance with prior studies, we have found strong correlation between BMI and the degree of OSA on the one hand, and between the degree of OSA and EDS on the other hand. OSA was detected among 77.7% of the drivers, 47.1% were sleepy, 19% had severe sleepiness [mean sleep latency [MSL < or = 5 min.], 28.1% had moderate sleepiness [MSL < or = 10 min.]. None of the drivers complained about any sleep problem, including snoring, and all reported that they do not experience excessive daytime sleepiness. Thus, there was no correlation between their subjective report and objective findings. CONCLUSIONS: Obese drivers with BMI above 32 are highly prone to be sleepy during the day. Their subjective reports of OSA or fatigue symptoms are not reliable. Therefore it is highly recommended to screen them easily by weight and height measure for further sleep study and decision about their driving abilities.     

The normal fetus of an acardiac twin pregnancy: Perinatal management based on echocardiographic and sonographic evaluation

Experience with three prenatally diagnosed pregnancies complicated by an acardiac twin reveals that ultrasonography and echocardiography are helpful in detecting early signs of in-utero congestive heart failure in the normal twin. The use of Doppler blood flow analysis to determine direction of blood flow, post-mortem placental and fetal angiography, and umbilical cord blood gas determination provided proof that retrograde arterial perfusion occurs in the acardiac fetus. In a fourth pregnancy, an experimental approach to occlude the acardiac twin's umbilical cord was attempted, but was unsuccessful.     

Settlement behavior and metamorphosis of oyster larvae (Crassostrea gigas) in response to bacterial supernatants

Veliger larvae of the oysterCrassostrea gigas (Thunberg) responded to unknown dissolved chemical inducers found in supernatants of cultures of the bacteriaAlteromonas colwelliana andVibrio cholerae. The response, which was similar to that seen when larvae were exposed to the neurotransmitter precursor L-3,4-dihydroxyphenylalanine (L-DOPA), consisted of an initial settlement phase of swimming with the foot extended and crawling on the substrate. Subsequently larvae attached to the substrate and metamorphosed. The percentage of veligers metamorphosing following inducation of settlement behavior was higher in a group of older larvae, a response similar to that seen with L-DOPA, suggesting that competence to respond to bacterial supernatants is divided into two phases: behavioral competence followed by morphogenetic competence. Following size exclusion chromatography, the molecular weight of the peak containing the activity which induced settlement behavior was determined to be 300 daltons. Autoclaved Marine Broth, which induced low levels of settlement behavior also contained this low molecular weight active peak, suggesting that an oyster settlement inducer is also present in this medium.Contribution # 137 from the Center of Biotechnology, Marine Biotechnology Institute, University of Maryland, USA     

δ<Superscript>15</Superscript>N as a natural tracer of particulate nitrogen effluents released from marine aquaculture

The flow of particulate nitrogen from marine net pen fish farm effluents to the surrounding biofouling community was quantified by means of stable isotopes of nitrogen. Plastic mesh substrates were deployed at 8 m depth near a sea bream fish farm and at a nearby reference site in the northern Gulf of Aqaba (Red Sea) to assess whether natural fouling organisms could sequester substantial quantities of farm-derived particulate nitrogen waste. A mixing equation, incorporating differences in nitrogen stable isotope composition, δ¹⁵N, between particulate organic matter (“source”) and fouling organisms (“sink”) at the fish farm and reference site, was used to estimate the amount of farm-derived nitrogen that was incorporated by the fouling community. Among the conspicuous fouling organisms examined, sponges, tunicates and polychaetes showed greatest uptake of fish farm N, where the mean fractions of farm-derived N estimated over the 2-year period of observation were 19±7, 22±6 and 31±8% of total organisms’ N content, respectively, with maximal recorded seasonal values of 68, 85 and 57%, respectively. Mean N uptake by mixed fouling communities (conspicuous + cryptic organisms) was as much as fivefold higher than that calculated for the sum of conspicuous taxa, suggesting that the retention efficiency is greater in mixed than in mono-specific biofouling communities.     

Ultrasonic diagnosis of mediastinal cystic hygroma

The incidence of cystic hygroma, which represents dilated obstructed jugular lymph sacs, is 1 in 6000 pregnancies. Cystic hygromas can be located in the nuchal area or in any other location. The prenatal ultrasonic diagnosis of a cystic hygroma in the mediastinum is presented.     

Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi

Hazard vulnerability analysis (HVA) is used to risk‐stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi, utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical School. The secondary objective was to review each facility's disaster plan and make recommendations based on the HVA findings. Based on the review, this article makes eight observations, including on the need for more accurate data; better hazard assessment capabilities; enhanced decontamination capacities; and the development of hospital‐specific emergency management programmes, a hospital incident command system, and a centralised, dedicated regional disaster coordination centre. With this project, HVAs were conducted successfully for the first time in health care facilities in Abu Dhabi. This study thus serves as another successful example of multidisciplinary emergency preparedness processes.     

Discovery of copper chloride cancer in ancient Egyptian polychromic wall paintings and faience: A developing archaeological disaster

We are deeply indebted to the Stiftung Volkswagenwerk for the generous financial support to conduct a detailed research program on ancient Egyptian pigments in time and space. We are grateful to the Egyptian Antiquities Organization specifically to its former Presidents Dr. Ahmed Kadry and Dr. Abdel Halim Nour El Din for their support and for the permission to collect pigment samples from various archaeological sites. During the course of this study we enjoyed the continuous encouragement of Dr. Ahmed Kadry and Dr. Abdel Halim Nour el Din and their deep understanding for the importance of the link between scientific research and Egyptology in solving archaeological problems. We also enjoyed constructive discussions with Dr. Ali Radwan Dean of the Faculty of Archaeology, Cairo University. We are also grateful to the following Directors, officials, and inspectors of the Egyptian Antiquities Organization: Dr. M. Abdel Razeq, Dr. Ali Hassan, Mr. M. Balbush, Dr. M. El Sughair, Dr. M. Saleh, Mr. M. Nasr, Mr. Ismail El Masri and other colleagues at various sites in Egypt. We are also grateful to Dr. Shawki Nakhla, Director of the Conservation Center of the Egyptian Antiquities Organization. This work has benefited from discussions with Dr. E. Martin-Pardey, Mrs. I. Blom, and Dr. A. Eggebrecht. Specifically Dr. E. Martin-Pardey laid the sampling plan for and participated in the field campaign in March 1988 and we enjoyed her egyptological support.     

Prenatal diagnosis of gall bladder anomalies—report of 17 cases

We describe here 17 cases of fetal gall bladder anomalies, detected as early as the 14th week of gestation, out of 10 016 fetal systemic examinations performed by us in the last 6 years (015 per cent). In seven cases, agenesis of the fetal gall bladder was detected. The diagnosis was confirmed by post-abortal examination in five cases and in two post-partum. In six other cases, a left-sided gall bladder and in one case, a ‘floating’ gall bladder were detected at 15 weeks' gestation. In two cases, a septated or bilobed gall bladder was visualized. None of these 15 cases was dyskaryotic, but in five cases, two with agenesis and three left-sided gall bladders were associated with other fetal malformations. In two other cases, the gall bladder appeared dysmorphic on sonographic examination and in both of them intrauterine growth retardation and other anomalies were detected. Trisomy 18 was diagnosed by amniocentesis in one of them. According to our experience, failure to visualize the fetal gall bladder by the 15th gestational week is diagnostic of its absence and should raise the differential diagnosis between gall bladder atresia, which has a good prognosis, and external biliary atresia, which has a poor prognosis. Further experience is needed to characterize the various gall bladder malformations and their prognosis.